Cadet Nurse Corps

The U.S. experienced a shortage of nurses long before its entry into World War II; this shortage worsened with the prewar buildup of the military and industrial upturn that this caused.[1] Professional nursing groups were unprepared to deal with the problem. On 10 July 1940, however, the situation changed when Isabel M. Stewart, professor of nursing at Columbia University and a member of the National League for Nursing, wrote to its president: "I believe we should have a committee or board that is representative of the nursing profession as a whole and it should be at work now ...".[2] Within three weeks, on 29 July 1940, representatives of the national nursing community gathered in New York City under the umbrella of the American Nurses Association, where they formed the Nursing Council on National Defense.[3] In its first order of business, the council concentrated on surveying nursing resources and securing federal funding to expand nursing educational opportunities.[4]

The survey results indicated 100,000 nurses were eligible for military service, and that most nursing schools were ill-equipped to enlarge their instructional or housing facilities.[5] The council submitted its federal aid request for fiscal year 1 July 1941 to 30 June 1942 to the U.S. commissioner of education, who approved it and moved it on to the Bureau of the Budget.[6] The Congress enacted and funded the Nurse Training Program, which assisted in the education of 12,000 students at 309 nursing schools. Through the program, 3,800 inactive nurses received refresher courses and 4,800 graduate nurses received postgraduate training. By the end of the fiscal year, 47,500 students were enrolled in nursing schools but this did not meet the country's demands. Nurses could not be trained quickly enough to keep pace with the country's civilian and military needs. [7]

During 1942 the Office of War Information tried to mobilize interest in the nursing profession, using prime-time radio advertisements to focus their broadcasts on interviews, dramatic sketches, and spot announcements urging young women to join the nursing profession. While these efforts were helpful, they did not meet expectations.[8] The supporters of the nurse training programs recommended doubling federal aid for basic nursing education in the fiscal year ending 30 June 1943. Representative Frances P. Bolton of Ohio, a longtime advocate of nursing, supported the proposed increase in federal aid, and informed the Congress that further aid requests for nurse training programs were likely.[9]

Lucile Petry (RN) was the director of the Cadet Nurse Corps from 1943 to 1948

Bolton took the initiative and introduced H.R. 2326, a bill to create and fund a training program for nurses, on 29 March 1943. The Senate added an amendment that prohibited discrimination based upon race, color, or creed. At the bill's legislative hearings, hospital groups explained how distressed nursing care in civilian hospitals had become. Support for the bill also came in the form of letters and telegrams. The bill passed both houses of the Congress by unanimous vote on 15 June 1943 and became Public Law 74 on 1 July 1943; with the title of Nurse Training Act of 1943 but commonly referred to as the Bolton act. It provided for the training of nurses for the armed forces, government and civilian hospitals, health agencies, and war industries through grants to the institutions providing the training.[10][Note 1] It also contained a provision requiring that those trained under the act would comprise a uniformed body but without military status.[12]

The Division of Nurse Education was established in the USPHS to supervise the program; it was answerable to the surgeon general of the United States, Thomas Parran Jr. He appointed Lucile Petry, a registered nurse (RN), as the director.[13] The federal security administrator was required to appoint an advisory committee to assist in guiding the nurse-training programs. The committee consisted of people in the nursing and related fields, who were drawn from various parts of the country.[Note 2] [15] On 25 June 1943, the committee met for the first time with government officials to establish the rules and regulations to carry out the act. As required, they were approved by the surgeon general and published in the Federal Register.[16]

The surgeon general then sent telegrams that outlined the program to 1,300 nursing schools in the United States and Puerto Rico. This was followed up with applications and instructions sent by mail. Territory of Hawaii's two nursing schools were not eligible for the program because they were in a war zone and Territory of Alaska had no nursing schools at the time.[17] The regulations required interested nursing schools to:

• be state accredited;
• be connected with a hospital approved by the American College of Surgeons or a hospital of equal standards;
• maintain adequate instructional facilities and personnel;
• provide adequate clinical experience in four basic services—medicine, surgery, pediatrics, and obstetrics;
• provide maintenance and a stipend of $30.00 for all senior cadet nurses, or arrange for their requested transfer to federal or other hospitals (a student nurse became a senior cadet in the last six months before graduation);
• provide satisfactory living facilities and an adequate health service for students;
• provide for an accelerated program; and
• restrict its hours of practice.[18]

The standards of the National League for Nursing were adopted to evaluate the participating schools.[19] After issuing these regulations, the surgeon general said:

The schools of nursing are free to select students, to plan curricula, and to formulate policies consistent with the Act and the traditions of the institution concerned. This is a partnership job between the USPHS, the institutions, and the students ... .[13]

The CNC was open to all women between the ages of 17 and 35 who were in good health and had graduated from an accredited high-school. Marriage was permissible subject to individual nursing school guidelines. Successful applicants were eligible for a government subsidy that paid for tuition, books, uniforms, and a stipend. In exchange, student cadets were required to pledge[Note 3] to actively serve in essential civilian or federal government services for the duration of World War II.[22] All state-accredited schools of nursing were eligible to participate in the program; each school, however, was required to apply individually. Of the 1,300 nursing schools in the country, 1,125 participated. For this program, the traditional 36-month nurse training was accelerated to 30 months. Senior nursing students were required to work for a six-month period in a hospital or in another health agency. In return, the federal government would pay the schools for the related tuition and fees of the students.[23]

The advisory committee was also responsible for naming the new program. The Victory Nurse Corps and the Student War Nursing Reserve were considered, but both were rejected in favor of the United States Cadet Nurse Corps (CNC).[24]

In its 1940 survey, the Nursing Council on National Defense reported that most of the nursing schools in the U.S. were ill-equipped to enlarge their housing and classroom facilities.[4] In the following two fiscal years, federal aid was provided to nursing schools for nurse training but it did not provide any aid for housing facilities.[25] Even with the passage of the Nurse Training Act of 1943, the problem remained. Some schools were able to rent or purchase additional buildings; those that could not requested assistance from the federal government. Without funds for physical facilities, the USPHS arranged with the Federal Works Agency to allow nursing schools to share in some of the construction funds provided under the National Defense Act of 1940. The two federal agencies agreed the need for housing and other facilities in nursing schools would be based on school participation in the CNC program. The Federal Works Agency would decide where, how, and to whom the aid would be granted.[26]

Under the agreement, the schools of nursing that could not otherwise accommodate classes would receive a share of the federal aid for housing. It would include aid for living quarters, library space, classrooms, and demonstration rooms. The amount allocated for construction projects was $25,657.785. The Federal Works Agency projects started in September 1943 and ended in November 1944; during this period, about 400 applications consisting of 160 for training facilities, 172 for construction, and 68 for the purchase, lease, or renovation of existing buildings, were cleared. Nursing schools in all but nine states were helped by the federal aid; the arrangement called for the nursing schools to share in the cost of the projects. Of the $25,657.785 spent on the nursing school projects, federal aid paid $17,397.002 (about 67.8 percent) and the nursing schools paid $8,260.783 (about 32.2 percent).[27]

The outdoor or winter uniform of the Cadet Nurse Corps

The outdoor uniforms of the CNC were designed to be distinctive and to identify each cadet as a member of the corps. There was one uniform for winter and another for summer. The winter uniform was a gray, woolen, single-breasted jacket suit, a gored skirt, and a gray, velour overcoat. A gray Montgomery beret, similar to the one worn by the British officer, General Bernard Montgomery, was worn with both of the uniforms. The summer uniform consisted of a two-piece, gray-and-white-striped, cotton suit and a gray twill raincoat.[55] The winter uniform was one of three designs created by professional designers and introduced at a fashion show in New York City on 16 August 1943. Thirty-two fashion editors judged this uniform and the Montgomery beret as the winners.[56] The selected uniform style was said to be attractive enough to have provided an incentive for young women to join the CNC.[57]

The official outdoor uniforms—with the exception of blouse, gloves, shoes, and stockings—were supplied to the cadets by the institution in which they were enrolled. The students paid for the excluded items.[58] The indoor or work uniforms varied from school to school; these were purchased by the school from federal grants.[30] Work uniforms were worn by the cadets while on duty in hospitals; the CNC patch on the sleeve of the uniform identified the wearer as a cadet.[59]

The insignia of the CNC was a Maltese Cross. A patch with the insignia was worn on the left shoulder of the uniforms and on the student nurse uniform of the official school of nursing.[57] The USPHS official insignia was worn on the jacket lapels and was also present on the silver buttons. On the Montgomery beret, the USPHS insignia was worn beneath the spread eagle and the American Shield.[55] Wearing the CNC outdoor uniforms was optional for all cadets, except when instructed to do otherwise.[58]

Cadet Nurse Peggy Adams (Dorothy McGuire) studies in the bacteriology laboratory in Reward Unlimited (1944), a promotional short film produced for the Public Health Service

The participating schools of nursing were required to compress the traditional nursing program to 30 instead of 36 months and to provide students with the four clinical experiences of medicine, surgery, pediatrics, and obstetrics. The students became senior cadets in their last six months before graduation, requiring them to serve in a federal or civilian hospital, where they provided the equivalent services to those of a graduate nurse. During their first nine months of training, cadets were protected by regulation from working on the hospital wards for more than 24 hours each week. Junior cadets typically worked between 40 and 48 hours each week, including classes; senior cadets were free of classes. All state boards of nursing modified their regulations to agree with the accelerated program.[60]

The quality and standards of the educational systems in which cadets would be trained varied considerably. In 1943, nursing schools, hospital administrators, and government officials assured the U.S. Congress the federally subsidized training of nurses would conform to the minimum standards.[61] With his rule-making powers, the surgeon general issued these regulations:

• The school had to be accredited by the appropriate accrediting agency for schools of nursing in the state or territory;
• An institution offering a degree in nursing had to be accredited by the appropriate accrediting agency for universities and colleges.
• The school had to be connected with a hospital that had been approved by the American College of Surgeons, or that maintained standards of nursing equivalent to those required by the college. In a central school of nursing, the major hospital clinical unit had to meet these standards.
• The school had to require for admission not less than graduation from an accredited high-school;
• The school had to maintain an educational staff adequate to provide satisfactory instruction and supervision;
• Its curriculum had to include all those units of instruction necessary to conform with accepted practices in basic nursing education.
• The school had to provide adequate clinical experience in the four basic services – medicine, surgery, pediatrics, and obstetrics;
• The school had to provide well-balanced weekly schedules of organized instruction, experience and study;
• The school had to provide adequate and well-equipped class rooms, laboratories, libraries, and other necessary facilities for carrying out the program, and satisfactory living facilities and health service for students.
• In evaluating the adequacy of the school facilities to meet the various requirements specified, the standards of the National League of Nursing Education were to be used as a guide.[62]

Congressional hearings on appropriations stressed all schools should be allowed to take part in the program.[63] When the standards were applied against the existing conditions, they did not seem practical for some schools to achieve. Some accommodations were made for smaller schools by lowering the standards for them. They would be judged by criteria that included the qualifications and number of instructional personnel, their clinical facilities, the curricula, the weekly schedule of hours, and the health and guidance programs. Such schools produced a small percentage of the cadet force.[64] While monitoring the standards of the 1,125 approved schools of nursing, the consultants of the Division of Nurse Education traveled thousands of miles, wrote countless letters, and provided direct and specific support services. The consultants were assigned to an area and each school was well known to them.[65]

The CNC program began on 1 July 1943 and ended with the last group of graduating students on 31 December 1948[66]and included three enrollment periods; the first term was in 1943, the second in 1944, and the third and final term was in 1945. During this time, 179,294 students enrolled in the program[67] and 124,065 of them graduated from the participating nursing schools[68] and became registered nurses.[69] The main cause of student withdrawals was homesickness; some married students withdrew to be with their husbands when they were released from the military; others when the hostilities ceased; some failed in their studies; others left for health reasons; and some left because of the stress of a nursing career.[21]

The CNC was the largest of the federal nurse training programs.[70] The federal government spent $160,326,237 on the Nurse Training Act of 1943 for administration, uniforms, maintenance, tuition, fees, and stipends. By the end of the program, the records of all participating schools of nursing had been audited. The work of the field auditors resulted in the recovery of $2,200,000 of prepaid funds.[71]

Cadet nurses from around the United States

Cadet nurses came from every state in the U.S.; they were the daughters of farmers and mechanics, of teachers, lawyers, clerks and businessmen. Some joined because they wished to become nurses and others for the free education. In the course of their training, cadet nurses served in Army and Navy hospitals, with the Indian Health Service, with the Veterans' Administration, and in Public Health hospitals.[72] During and after World War II, student nurses restored the diminished capacity of civilian nurses; making a major contribution to the nation's civilian and military healthcare systems. [73][74]

The American Hospital Association credited cadet student nurses with helping to prevent the collapse of civilian nursing care and commended them for replacing graduate nurses who enlisted in the armed forces during World War II.[72] In Cadet Nurse Stories, the authors noted the CNC program influenced the way in which future nurses would be educated and trained in the United States.[70]

By the time October 1945 rolled around, 10,000 CNC graduates had applied for service with the U.S. Army. It is, however, unknown how many of these applicants were accepted.[75]