Cadet Nurse Corps

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The United States Cadet Nurse Corps was established by the U.S. Congress on June 15, 1943, and signed into law by president Franklin D. Roosevelt on July 1, 1943. Its purpose was to ensure the country had enough nurses to care for its citizens at home and abroad during World War II. It was a non-discriminatory program that allowed Native Americans, African Americans, and relocated Japanese Americans to participate. The Corps was supervised by the United States Public Health Service (USPHS), whose duty it was to train young women as nurses during the war.

The program was open to all women between the ages of 17 and 35, in good health, who had graduated from an accredited high school. Successful applicants were eligible for a government subsidy, paying for tuition, books, uniforms, and a stipend. In exchange, they were required to pledge to actively serve in essential civilian or federal government services for the duration of World War II. All state nursing schools were eligible to participate in the program. However, they needed to be accredited by the accrediting agency in their state, and connected with a hospital that had been approved by the American College of Surgeons.

Cadet nurses came from across the nation and from all backgrounds. Some joined because they wanted to become nurses, others for the free education, and others joined because their country needed them. Attrition rates for cadets were comparable to those reported for other nursing schools in the same period. The corps was the largest of the federal nurse-training programs, and allowed young women to serve their country in uniform and without discrimination. The American Hospital Association credited the cadet student nurses with helping to prevent the collapse of civilian nursing during the war.

The unique feature of the program was its accelerated training curricula. The nursing schools were required to compress the traditional nursing program of 36 months to 30 months. Of the 1,300 schools of nursing in the country, 1,125 participated in the program. The Corps operated from 1943 until 1948, and during this period 179,294 student nurses enrolled in the program and 124,065 of them graduated from participating nursing schools. The enrollment included over 3,000 African Americans, 40 Native Americans, and 400 Japanese Americans. The federal government spent $160,326,237 on the nursing program.

The Cadet Nurse Corps alleviated the critical shortage of nurses during World War II and thus fulfilled its congressional mandate. In the process, it positively influenced the way future nurses would be educated and trained in the United States.

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History

Background

Nurses were in short supply before the United States entered World War II. In July 1940, a meeting was organized by the American Nurses Association to discuss the role nursing might play in wartime. Those in attendance included representatives from six nursing organizations, the American Red Cross, and federal agencies involved with nursing. The gathering resulted in the formation of the Nursing Council for National Defense. One of the council's first acts was to survey nursing resources and schools throughout the country. They determined that 100,000 nurses were eligible for military service and found most nursing schools were ill-equipped to expand their instructional or housing capabilities. In response, the Council urged the federal government to appropriate public funds to support nursing education.

In the subsequent fiscal years 1941 and 1942, the federal government partially funded the education of 12,000 students at 309 nursing schools. Through that initiative, 3,800 inactive nurses received refresher courses and 4,800 graduated nurses received postgraduate training. By the end of 1942, 47,500 students were enrolled in nursing schools but that did not meet the country's need. At this point, it was clear that nurses could not be trained quickly enough to keep abreast of both civilian and military needs. The need for additional federal aid for the recruitment of nurses became apparent when the U.S. Army and Navy called for 2,500 new nurses each month during the fiscal year 1943.

Meanwhile, supporters of nurse training programs recommended the doubling of federal aid for basic nursing education in the fiscal year 1943. Representative Frances P. Bolton of Ohio, an advocate of nursing, supported the proposed increase in federal aid. She told Congress further expansion of nursing schools might be needed the following year.

Creation of the program

On March 29, 1943, Bolton introduced H.R. 2326, a bill that would "provide 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". The act also stated that the nurses trained by its funding would be a uniformed body. An amendment by the Senate prohibited discrimination against race, creed, or color. The Nurse Training Act, also called the Bolton Act, was passed unanimously by Congress on June 15, 1943, and became Public Law No. 74 on July 1, 1943. The Division of Nurse Education of the USPHS was established to supervise the program and was answerable to the U.S. Surgeon General, Thomas Parran, Jr. He appointed Lucile Petry, a registered nurse (RN), as director of the corps; she was the first woman to head a division in the USPHS.

Shortly after the Nurse Training Act was passed, the Surgeon General sent a lengthy telegram outlining 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. Hawaii's two nursing schools were not eligible for the program because they were in the war zone; Alaska did not have any nursing schools at the time.

Regulations required interested nursing schools to: (1) be state accredited; (2) be connected with a hospital approved by the American College of Surgeons or a hospital of equal standards; (3) maintain adequate instructional facilities and personnel; (4) provide adequate clinical experience in four basic services--medicine, surgery, pediatrics and obstetrics; (5) provide maintenance and a stipend of $30.00 for all Senior Cadet Nurses, or arrange for their requested transfer to federal or other hospitals; (6) provide satisfactory living facilities and an adequate health service for students; (7) provide for an accelerated program; and (8) restrict its hours of practice. The standards of the National League of Nursing Education were adopted to evaluate the participating schools. 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 ..."

The Federal Security Administrator was required by law to appoint an advisory committee for federal nurse training programs. The committee, which was appointed for the Nurse Training Act, consisted of people in nursing and related fields drawn from various parts of the country. Once in place, the committee met with designated federal officials and formulated the regulations necessary to carry out the act. The agreed-upon rules were then approved by the Surgeon General and published in the Federal Register. The 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.

By the time the Nurse Training Act was passed by congress in 1943, the U.S. had been involved in World War II for nearly two years, and a serious shortage of nurses already existed at home and abroad. The Cadet Nurse Corps was open to all women between the ages of 17 and 35, in good health, who had graduated from an accredited high school. Marriage was permissible subject to guidelines. Successful applicants were eligible for a government subsidy, which paid for tuition, books, uniforms, and a living stipend. In exchange, student cadets were required to pledge to actively serve in essential civilian or federal government services for the duration of World War II. All state accredited schools of nursing were eligible to participate in the program; however, each school was required to apply individually. Of the 1,300 nursing schools in the country, 1,125 participated. For the purposes of the program, the traditional 36-month nurse training program was accelerated to a 30-month program. Senior nursing students were required to work for a six-month period in a federal or non-federal hospital, or in other health agency. In return, the federal government would pay the schools for the related tuition and fees of the students.

Recruitment

The USPHS and cooperating groups created the plan for the recruitment of cadet nursing students. It was broad in scope to attract the maximum number of potential applicants in the shortest time. The primary target was the high school graduate but college girls were also recruited. The selling point of the program was that the cadets would obtain a free education in a proud profession and provide an essential service to their country. Appeals to join the Corps reached more than 7,000,000 newspaper and magazine readers, millions of radio listeners, and movie patrons around the country. Pleas were made in a thousand speeches, through 2,800,000 car-boards and billboards, and in several million leaflets. U.S. corporations donated $13,000,000 worth of advertising space and technical services to the program in one year. Few media sources lacked advertising for the Corps.

For example, Eastman Kodak sponsored a full-page advertisement in Life magazine (January 24, 1944) touting the U.S. Cadet Nurse Corps as a way to serve the country in the war job with a future. The ad proposed that young women who could qualify as a Cadet Nurse were lucky girls, lucky in so many different ways. Ads promised free training with pay, room and board, and gray uniforms with gray berets. The uniforms were sold with the slogan "There's one for summer and one for winter, and it's hard to say which is the smarter, which you'll wear with more pride". Applicants were assured they could wear something "frilly and feminine" for dances and they would have time for dating.

In 1944, David O. Selznick's Vanguard Films produced a short film, Reward Unlimited, to promote the Cadet Nurse Corps. Starring Dorothy McGuire in one of her first films, and directed by Jacques Tourneur, the 10-minute film was exhibited in theaters and at Cadet Nurse Corps recruitment events in 1944 and 1945. The story, by Mary C. McCall, Jr., dramatizes the choice that young Peggy Adams makes to become a nurse, her training, and her volunteering for military nursing service. The cast includes Aline MacMahon, James Brown, Spring Byington and Tom Tully.

Recruitment centers were established by the American Hospital Association in all 1,125 participating nursing schools. Using recruiting booths, volunteers disseminated information about the opportunities offered by the Corps to potential candidates. State and local nursing councils, and many other organizations, associations, and volunteers aided the recruitment effort. 65,521 nursing students--521 more than projected--registered for the program in the fiscal year 1943, the first year of enrollment. In the 1944 enrollment period, 61,471 registered, exceeding the estimate by 1,471. In the 1945 enrollment period, 3,000 students were admitted to what would be the final class of the program. As a result of the non-discriminatory provision, by 1945, over 3,000 African Americans, 40 Native Americans, and 400 Japanese Americans had enrolled in the Corps.

Uniforms

The official outdoor uniforms of the Cadet Nurse Corps were distinctive; there was one for summer and another for winter. The summer uniform consisted of a two-piece, gray-and-white-striped cotton suit and a gray twill raincoat. The winter uniform was a gray, woollen, single-breasted jacket suit, a gored skirt and a gray velour overcoat. A gray Montgomery beret was worn with both uniforms. The winter uniform was one of three designs created by professional designers and introduced at a fashion show in New York City on August 16, 1943. Thirty-two fashion editors judged this uniform and the Montgomery beret--resembling the one worn by the British general--as the winners. The uniform was "... heralded as the most attractive for all women who served during World War II, provided a strong incentive for young women to join the corps".

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 items. Indoor uniforms varied from school to school, and were purchased by the school from federal grants. Models recruiting for the corps wore the first available cadet uniforms, which were first issued to cadets in May 1944.

The insignia of the Cadet Nurse Corps was the Maltese Cross. The patch was worn on the left shoulder of the uniforms and on the student nurse uniform of the official school of nursing. The USPHS official insignia was worn on 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.

Training

A key feature of the Cadet Nurse Corps program was its accelerated training curricula. Participating schools of nursing were required to compress the traditional nursing program of 36 months to 30 months. They were also bound to provide the students with the four clinical experiences of medical, surgical, obstetrics, and pediatrics. The students became senior cadets in the last six months before graduation, requiring them to serve in a federal or civilian hospital. They rendered full-time service equivalent to that of a graduate nurse. During their first nine months of service, the cadets were protected by regulation from working on the 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.

The quality and standards of the educational systems in which the 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 at least conform to minimum standards. With his rule-making powers, the Surgeon General issued regulations; schools had to:

be accredited by the appropriate accrediting agency for schools of nursing in the state or territory;
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 rural schools of nursing, the major hospital clinical unit had to meet these standards;
require for admission not less than graduation from an accredited high school;
maintain an educational staff adequate to provide satisfactory instruction and supervision;
provide adequate clinical experience in the four basic services - medicine, surgery, pediatrics, and obstetrics;
provide well-balanced schedules of organized instruction, experience and study;
provide adequate and well equipped class rooms, laboratories, libraries, and other necessary facilities for the program;
provide satisfactory living facilities and health service for students.

Institutions offering degrees in nursing had to be accredited by the appropriate nursing agency for universities and colleges. The curriculum had to include all units of instruction necessary to conform with accepted practices in basic nursing education. It had to be arranged so the entire program of combined study and practice would be completed in 24 to 30 months. The standards of the National League of Nursing Education were to be used as a guide for evaluating the adequacy of school facilities to meet the requirements specified.

Congressional hearings on appropriations emphasized that all schools--regardless of location or size--should be allowed to participate in the cadet nurse program. However, when the educational consultants Division of Nurse Education tested the standards against actual conditions, they did not seem possible for some schools to achieve. Adjustments were made for certain schools, setting lower standards for them. They would be judged by criteria included the qualifications and number of instructional personnel, their clinical facilities, the curricula, the weekly schedule of hours, and the health and guidance programs. Borderline schools produced a small percentage of the total cadet force. The educational consultants traveled thousands of miles, wrote thousands of letters, and provided support services while monitoring the standards of the 1,125 approved schools of nursing.

Cadet nurses

Cadet nurses came from across the U.S. and from all economic backgrounds. Some joined because they wished to become nurses, others for the education, and others joined for the temporary World War II service. Cadets shared accepted the pledge to serve and contributed nursing services to the nation when it was needed. The Cadet Pledge was:

At this moment of my induction into the United States Cadet Nurse Corps of the United States Public Health Service, I am solemnly aware of the obligations I assume toward my country and toward my chosen profession; I will follow faithfully the teachings of my instructors and the guidance of the physicians with whom I work; I will hold in trust the finest traditions of nursing and the spirit of the Corps; I will keep my body strong, my mind alert, and my heart steadfast; I will be kind, tolerant, and understanding; Above all, I will dedicate myself now and forever to the triumph of life over death; As a Cadet nurse, I pledge to my county my service in essential nursing for the duration of the war.

The cadet pledge was considered a statement of intention rather than a binding contract. The attrition rate for cadets was comparable to that reported for other schools of nursing in the same period. The main cause of 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 realities of a nursing career.

The Cadet Nurses Corps was the largest of the federal nurse-training programs; it allowed young women to serve their country in uniform and without discrimination. It also influenced the way in which nurses would be educated and trained in the United States. The American Hospital Association credited the 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.

End of the Corps

Following the surrender of Japan in August 1945, President Harry Truman set October 5, 1945, as the final date for new student admissions, allowing for an "orderly transition of an important wartime activity". At the time, 116,498 students were still in training and 3,000 more were admitted for the fall and final term. Student nurses were providing 80% of the country's nursing care in more than 1,000 civilian hospitals. Of the 1,300 nursing schools contacted by the Surgeon General, 1,125 participated in the Cadet Nurse Corps. The program was operational from 1943 to 1948, which included three enrollment periods, or fall terms: the first term was 1943, the second was 1944, and the third and final term was 1945. During this time, 179,294 student nurses enrolled in the program and 124,065 of them graduated from participating nursing schools.

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 by up to 32 field auditors, who were assigned to each (USPHS) district office and covered the schools in that area. The work of the field auditors resulted in the recovery of $2,200,000 of prepaid funds.

In January 1945, the Surgeon General, Thomas Parran, Jr., appeared before the House Committee on Military Affairs and said, "In my opinion, the country has received and increasingly will receive substantial returns on this investment. We can not measure what the loss to the country would have been if civilian nursing service had collapsed, any more than we could measure the cost of failure at the Normandy beachheads."

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References

Citations

Bibliography

Perry, Paulie M.; Robinson, Thelma M. (2001). Cadet Nurse Stories. Indianapolis, IN: Center Nursing Publishing. ISBN 1-930538-03-0.
Robinson, Thelma M, (2009). Your Country Needs You. Blomington, IN: Xilbris. ISBN 978-1-4415-5378-2. CS1 maint: Multiple names: authors list (link)
U.S. Public Health Service (1950). PUB. NO. 38, ed. United States Cadet Nurse Corps [1943-1948] and other Federal nursing programs.

Cadet Nurse Corps

Wednesday, December 13, 2017