The Rockefeller Foundation’s (RF) program in nursing education extended to 53 schools across the globe. The program succeeded despite the fact that it never became a top priority of the Foundation. The growth and success of the RF's program in public health nursing and nursing education can, in fact, be attributed to the tenacity and passion of a few women who exerted their influence both inside and outside the RF to raise the prestige and the standards of an entire profession.
Three formidable women championed the reform of nursing education. Mary Beard, Elizabeth Crowell and Mary Tennant advocated for the female-dominated field of nursing, and they worked tirelessly to convince the male-dominated RF of the value of an investment in the field. Mary Beard, Associate Director of the International Health Division (IHD), advocated for the presence of a regular nursing representative at the RF administrative offices. Beard wrote to Raymond Fosdick, “Medical education cannot advance far without nursing education. Public health programs cannot be carried far without the public health nurse. Public health and medical education must lose an essential element for making wise programs unless the nursing aspect is regularly presented and considered.”
Surveying the Field
While the official program in nursing education began in 1924, comprehensive consideration of the issue of nursing education began in 1918. That year an RF-sponsored conference focused specifically on the issue of public health nursing education in the United States. This meeting resulted in the formation of the Committee for Study of Public Health Nursing to survey the state of the field. The scope of the study was later expanded to include hospital nursing as well. The resulting Goldmark Report, named for the committee’s Executive Secretary, Josephine Goldmark, advocated university education for nurses and argued that public health nursing must include training in basic hospital nursing.
The recommendations of the Goldmark Report proved crucial in subsequent RF funding decisions. In the United States, the Yale School of Nursing became the first American school to receive funding to improve the education of public health nurses, while in Canada the influential nursing program at the University of Toronto became a model program and an important center of training. In 1921 Elizabeth Crowell was charged with conducting an extensive study of nursing in Europe. As a result of her findings, the RF funded the creation of a number of modern nursing schools during the interwar period. Following World War II many of these European schools fell under Communist rule, and the RF was forced to sever its ties with them. In South America the IHD-funded Anna Nery School of Nursing in Rio de Janeiro opened in 1923, signaling an increase in spending on that continent.
The increased funding of nursing education helped to raise the standards of the profession by formalizing educational requirements and combining training in the wards with classroom instruction. Nursing schools were also able to attract a growing number of women from the middle class, which helped to solidify the status of nursing as a respectable profession.
RF appropriations for nursing focused on several activities, including:
- Surveys to assess the state of nursing and nursing education globally
- Senior staff to direct new projects
- Support for the development of curriculum and teaching standards
- Aid for buildings, equipment and endowment
- Fellowships for promising individuals in the field
Of these expenses, the fellowship program had the largest global impact. Almost 800 nursing fellows from 70 countries studied in Canada and the United States. These fellows were selected for their skills, as well as their future potential as leaders. Nurses who accepted fellowships were expected to return to their home countries and apply their new knowledge of the fields of nursing, public health and administration. A high percentage of RF fellows fulfilled these expectations, becoming nursing leaders in their own countries, and in some instances even starting their own nursing schools or public health programs.
Control of the RF nursing program changed hands several times during its existence. The initial program, designed in part by Crowell, was administered by the Division of Studies, which Crowell joined in 1923. Two years later the program was transferred to the Division of Medical Education and the IHD. In 1928 the Division of Medical Education took the program over entirely, but four years later it was transferred back to the IHD. Mary Tennant administered the nursing program in both of these divisions during her 27-year career with the RF.
RF support for nursing continued because nurses, especially public health nurses, proved vitally important to RF activities. A review of RF nursing activities explained:
She [a public health nurse] is the link between the other workers and the home and family. She carries the message of health to the ultimate unit, the individual. She must know the preventative and social aspects of medicine and nursing as well as the curative side. Her chief role is that of teacher. Standards of qualifications for a nurse must be of the same high order as for other professions. In many countries nurses are looked upon as full partners of doctors.”
Financial support from the RF trained better nurses, who proved vitally important to RF health initiatives. This investment in nursing education also led to an increased amount of respect for the profession. Once considered a career only for underprivileged women, nursing gained real status as a respectable profession for all women due in large part to RF involvement.