This article, first presented as the Kate Hurd-Mead Lecture, is one aspect of my exploration of twentieth-century transformations in American nursing practice and education. At times I am tempted to argue that there are two distinct eras in the history of nursing; a ninety-year history from about 1860 to 1950, followed by a fifty-year history from 1950 to the turn of the present century. Of course, I won't pursue that, because it is a kind of nonsense. But I am fascinated by the busy decades after World War II. Indeed, the period between 1950 and 1980 was a time of erratic but fundamental change in every arena of nursing. What we see by 1950 is a public and professional consensus about two things related to the nursing profession in the United States. Most nurses were not well enough educated for the demands of their work. And, in any case, nurses were too scarce to meet the rising health care expectations of Americans. These complaints about nursing were not new. What was new was both the political energy and an emerging set of public/private coalitions willing to do something about it. I will return to this later. First, though, I want to look briefly at two influences inside nursing that I think helped channel reform; we can see these influences at work beginning in the 1930s.
