1. SARA TRESLER MARY HANKS ORDERED TO CARE CHAPTER 10: GREAT TRANSFORMATION, SMALL CHANGE

2. EVERYTHING OLD IS NEW AGAIN Great Depression 1929-1940 Hospitals Patients Nurses Private duty Hospital staff

3. THE HOSPITAL IN TRANSITION Big Business in American Economy 6,719 hospitals 955,869 beds 3 billion dollar investment in plants, equipment Medical specialization/specialty clinics Extended lengths of stay (1-3 months) Increased technical medical procedures “too busy”

4. CHANGING TIMES Costs, Costs, Costs, Hospital closings common Lower costs, increase income Encourage occupancy Regularizing income source Public relation consultants Third-party payments (Blue Cross) “old days of not worrying about costs because of availability of charitable gifts had gone” (p. 183)

5. TINKERING WITH CHANGE Re-examining nursing practice Student nurses Graduate nurses Private-duty specialty nurses “Specials” 24 or 12 or 8 hour days, which is better? 54 hour work weeks common until post World War II

6. THE RELUCTANT STAFF NURSE Sixty percent of all hospitals contain nursing schools Of these, 73 % no graduate staff Of these only 15% had 4 or more graduates So many graduate nurses Not enough work Task- versus patient- oriented Hospitals to the rescue: minimal wages; room and board

7. EMPLOYMENT AND CONTROL AT A COST Graduate Staff nurses Cheapness, hard work, loyalty Work split shifts, long hours Heavy patient loads Move between wards Eat within walls of hospital Increasing absenteeism; high turnover Better working conditions, more control over pt care

8. SALARY AND PRICE COMPARISON 1946 Nurse’s Salary $0.75 to $0.87 cents Annual Salary: $1,810 Comparable Salaries and Prices in 1946 Typist $0.97 Bookkeeper $1.11 Gasoline: 21 cents/gal House: $12,500 Bread: 10 cents/loaf Milk: 70 cents/gal Avg Annual Salary: $3,150 Minimum Wage: 40 cents per hour

9. US VERSUS THEM Graduate and Student Nurses Versus Nursing Aides

10. BEDSIDE OR BARGAINING Moving from the bedside New technical skills Supervisory Role Unionization versus Professional Organizations The right to care