Bachelor of Science in Nursing degree (BSN)

Advancing by Degrees

Tuesday, September 17, 1929

For much of its first one hundred years, nursing education at the University of Kansas has followed a path that might be characterized as evolutionary rather than revolutionary. This series of slow but steady steps – similar to what was happening at other university-based nursing programs across the country during this time period – saw nursing gradually transformed from a trained vocation to an academically-based profession.



One milestone along this journey was marked on September 17, 1929 when KU began offering students the opportunity to earn a Bachelor of Science in Nursing degree (BSN) through a newly-reconfigured Department of Nursing Education at the KU School of Medicine.



The ability to grant a bona fide baccalaureate degree in nursing at KU was a long time in coming. The Med School’s dean George Hoxie had first proposed the idea more than 20 years earlier, shortly after KU established what was then called the Training School for Nurses in 1906 at the University’s original Eleanor Taylor Bell Memorial Hospital in Rosedale.



But Hoxie was unable to achieve this goal. His successors in the 1910s and early 1920s were distracted by more pressing matters relating to the Medical School’s very survival. Just as significantly, early nursing leadership at KU was heavily influenced by the then-prevalent approach to nurse training pioneered by Florence Nightingale in Great Britain following the Crimean War. This methodology saw nursing as a “calling” best taught via an apprentice-style regimen that minimized classroom time in favor of grueling 60-hour work weeks on the hospital floor.



As such, for the first two decades-plus of its existence, students at KU’s Training School for Nurses learned while on the job in clinical classes taught by the hospital’s head of nursing throughout the 10-12 hour work day. In the process of their learning, they rendered valuable service to the patients and the hospital, and received compensation in the form of a small stipend of eight to fifteen dollars per month along with room and board. Occasional clinical lectures from doctors in their specialty areas took up another six hours a week.



But perhaps the most important lesson of all from this regimen – at least from the Nightingale perspective – was the development of “a caring heart.” This meant the pupil nurses learned to put the patients’ needs, as well as those of the attending physicians, ahead of their own hopes and wishes. (To be sure, in one significant particular, the KU program differed from the Nightingale model. As Shirley Veith observed in her 1988 doctoral dissertation on the early history of KU nursing, Florence Nightingale had “established an independent training school” that was “financed separately from the hospital” with which it was associated, whereas the KU Training School for Nurses was directly controlled by a university medical school and its physicians.)



Under this framework, the first 20 graduating classes of KU nurses (1909-1929) did not receive academic degrees. Instead, upon completing three years of work in the hospital plus the smattering of classroom lectures, the women who finished the program satisfactorily were awarded diplomas that signified them as “graduate nurses.” In 1913, following passage of the Kansas Nurse Practice Act, this KU diploma qualified its holders to become licensed registered nurses (RNs).



By the late 1920s, however, the situation at the Medical School had stabilized. The School and its third Bell Memorial Hospital had moved to the present-day location at 39th Street and Rainbow Boulevard in Kansas City, Kansas. Harry R. Wahl had assumed firm command as dean. And Henrietta Froehlke had taken over KU’s nursing portfolio, which at that time included superintending the nursing function in the hospital plus heading the nursing education program.



Froehlke was decidedly in favor of enhancing the academic component of KU’s nursing program. She herself had earned a degree from St. Luke’s Hospital School of Nursing in Chicago, and a BA from Columbia University’s Teachers College in New York, where she had majored in school of nursing administration. (She would later complete an MA at Columbia as well, becoming the first KU nursing director to hold an advanced degree.)



Froehlke began pressing for implementation of a full-fledged baccalaureate degree in nursing soon after her arrival at KU in fall 1927. Two years later, with Dean Wahl’s concurrence and the backing of other influential Med School faculty members, the baccalaureate program was approved. It became available for the first time beginning with the 1929-30 school year. Unfortunately, this achievement was marred by two factors.



In the first place, it appears that some members of the faculty of the College of Arts and Sciences on KU’s main campus in Lawrence – which would technically award the BSN degree – were unconvinced that nursing was an academic profession. In the second place, the new BSN was merely an option. The original three-year diploma program with its apprenticeship model remained intact, and for many years thereafter continued to attract the lion’s share of KU nursing students.



Nonetheless, a handful of women did begin to gravitate to the BSN degree and its rigorous curriculum. It required students to complete ninety-four hours of liberal arts and sciences instruction at the Lawrence campus as well as two calendar years of clinical instruction at Bell Memorial Hospital in KCK. Essentially, this meant that young women pursuing the BSN had to complete three-fourths of a normal four-year bachelor’s degree program and then add the additional years of instruction and clinical work, for a total of five years in all.



Not surprisingly, throughout the 1930s, the majority of aspiring nurses preferred the old three-year diploma track. Entrance requirements into this program remained nominal – primarily a completed high school education and evidence of good moral character – and the heavily clinical form of instruction at Bell Memorial Hospital meant that students who were not academically inclined could still become nurses and obtain jobs without having to take six semesters of arts and sciences courses in Lawrence.



Meanwhile, even under the stressful circumstances of the Great Depression, nursing education at KU continued to make modest progress toward developing a fully academic program. In 1932, for example, Froehlke and several other Bell Memorial Hospital nurses gained faculty status with academic rank.



Also in the 1930s, the monthly stipends to student nurses were discontinued and tuition began to be charged. While these changes undoubtedly had a negative impact on the finances of nursing students, the overall effects were to decrease the sense that these young women were merely underpaid employees of the hospital and increase the perception that they were students. (Much to Froehlke’s dismay, the funds saved or earned from these changes were not used to increase her full-time nursing staff in the hospital but instead were allocated to other uses within the Medical School.)



Another positive development began in 1936 when the KU nursing education program inked an agreement with the Kansas State College Division of Home Economics in Manhattan (an early predecessor of the present-day College of Human Ecology at Kansas State University). The arrangement enabled students who had completed 94 semester hours at Kansas State in general education and home economics to be admitted to KU’s BSN program. At the completion of their clinical work in Kansas City, these students received a BS in Home Economics and Nursing awarded by K-State.



By 1940, a little more than a decade after the BSN track had been established, the academic option had essentially achieved enrollment parity with the older vocational track. There were 48 degree-seeking students in KU’s nursing education program and 52 pursuing the diploma route. After World War II, the BSN attained permanent supremacy in terms of enrollees, and in 1951, KU announced that the diploma track would be discontinued. At the 1953 commencement ceremonies, the University awarded its last-ever diplomas in nursing.



William S. Worley

Adjunct Professor of History

University of Missouri-Kansas City

 

[Source Notes: The documents and materials consulted for this article can be found in the University of Kansas Medical Center Archives. They include the following: Shirley Veith, “The Development of the Nursing Profession at the University of Kansas, 1906-1941,” (PhD dissertation, University of Kansas, 1988); Hester I. Thurston, RN, “The Kansas University School of Nursing: An Historical Perspective” (paper presented at the Nursing Perspectives Workshop, May 15, 1982); “University of Kansas School of Nursing: 1906-1990” by Hester I Thurston, Mary A. Eisenbise and Rita Clifford, submitted to the Kansas State Board of Nursing, Topeka, Kansas, November 1, 1990. The history of apprenticeship nursing, especially as practiced in Great Britain, is well-documented in Ann Bradshaw, The Nurse Apprentice, 1860-1977 (Aldershot, GB: Ashgate, 2001. This source includes an excellent chapter on “British nursing tradition and the North American influence, 1948-1960” which, despite its later dating, gives a helpful summary of U. S. evolution of nursing away from the apprenticeship model and towards the academic pattern in the first half of the 20th century.]