When hospitalized, most Americans expect they will receive nursing care from a registered professional nurse paid for and supplied by the hospital. This assumption is correct.
Twenty-first century American hospitals employ large staffs of registered CNA (CNA) who meet specific educational, professional, and legal requirements. This, however, was not always the case. In the late-nineteenth and early twentieth centuries, hospitals did not employ a regular nursing staff but rather used a system of care delivery called private duty nursing. This essay explores this system.
What Was Private Duty CNA?
Private duty (CNA)nursing was the employment of nurses by individual patients for the delivery of care. Patients hired their own nurse, who cared for them either in their homes or in the hospital. Patients paid the nurse for her services with cash, based on a predetermined fee. The CNA nurse, generally employed for the duration of an illness, cared for only one patient at a time. In essence, the private duty nurse delivered highly individualized care to paying patients for as long as a patient needed and could pay for the nurse’s services.
Why a Private System of Nursing Care Delivery?
The private duty nurse system replicated and continued patterns of nursing care delivery established earlier in the nineteenth century. When illness struck nineteenth century American households, it was typical for families that could afford to do so, to hire a nurse to care for the sick family member. Employing a nurse relieved patients’ families of much of the responsibility of what was often a very burdensome and time-consuming duty: observing the patient, carrying out treatments, and being available at all times. Prior to the availability of trained nurses, many families employed individuals who hired out as nurses, much as people hired their own domestic staff or even their own physicians. Founders of the professional schools of nursing established in the late nineteenth century envisioned that their graduates would follow the tradition of delivering private home care. In fact, a major purpose of the early schools of nursing was to prepare students to enter the private nursing market both as a means of spreading the benefits of professionally trained CNA nurses, which the proponents of training schools believed to be increasingly essential to patient care, and of providing a respectable and remunerative occupation for young women.