Professionalization of Nursing in Minnesota, 1898–1920

For most of its history, nursing was an unregulated profession. To raise both their reputation and their standard of care, Minnesota nurses during the Progressive Era founded local and statewide nursing associations. Using these to create community among members, influence training schools, and engage in legislative advocacy, these nurses transformed what had been a mixture of skilled and unskilled work into a full, licensed profession.

In St. Paul in August 1898, Theresa Ericksen and eight of her fellow nurses founded the United States’ first centralized nurse registry. “Realizing that in union is strength,” these nurses called themselves the Ramsey County Graduate Nurses’ Association (RCGNA). By their “mutual help and protection,” they aspired “to advance the standing and best interests of graduates [...] and to place the profession of nursing on the highest plane obtainable.”

Because hospitals were too small to accommodate full-time nursing staff, nurses represented themselves and advertised their services through the few means available. These included word of mouth, newspaper ads, and free drug store registries with the nurses’ contact information and areas of expertise. While some hospital training schools had their own registries for alumnae, private duty nurses relied upon these free registries.

This decentralized approach to connecting nurses to patients was problematic. Not only did each school have its own practices and standards, but the free registries were open to anyone. Nurses of all skill levels were mixed together, placing side-by-side the field’s capable Theresa Ericksens and less responsible practitioners. In contrast, the RCGNA’s centralized registry was selective in its membership and thus served as a kind of credentialing service.

In its infancy, the association grew slowly as younger nurses relied on their school registries. Despite its small numbers, members shared best practices at their meetings and presented papers on an array of topical subjects. They also served as mentors to one another, creating a familial atmosphere they hoped would transfer to the workplace. Additionally, members had access to a private library of major nursing journals, which the association supplemented with its own publications. Such publications were also distributed to training schools and in time became part of the curriculum. Within five years, the association’s dues-paying membership reached 120.

By 1903, having successfully maintained a centralized registry, the RCGNA set its sights higher. Because the association was only one of many around the state, its members realized that uniformly raising the profession’s standards required collective action. A statewide association would “develop a sense of unity and solidarity among nurses” and could lobby for a state registration system.

Two years later this culminated in the Minnesota State Graduate Nurses’ Association (MSGNA). The association aimed for “the advancement of the nurses’ profession […] including the furtherance of the efficient care of the sick.” Membership applications arrived from every corner of the state, and groups from Seattle and Chicago wrote asking for advice on how to form their own statewide association. As one nurse put it, “the public awoke to the fact that the nurses of Minnesota were organized.”

Small hospitals worried about the costs that came with an organized work force and pushed back against the MSGNA. By 1905 only a handful of states had state registration systems, which were often opposed by physicians and others as “giv[ing] the profession the nature of a Trade Union.” The MSGNA publicly denied this characterization, insisting it was not a matter of trade unionism but instead about raising standards of care—and that to do this, government oversight was necessary. With this as their cause, the association turned to the legislature.

In 1906 the MSGNA hired a lawyer to draft a state registration bill, which it hoped would accomplish what centralized registries could not. The licensing system the group proposed did not ban anyone from practicing nursing but instead set standards for who could use the title of “registered nurse” (RN). These standards would be established and overseen by a State Examiners Board made of those invested and trained in the profession. Such a system granted nurses professional standing and reassured patients that the RN serving them could perform her duties. Additionally, beginning January 1, 1910, only nurses who received board-approved training were eligible for registration.

Given women’s disenfranchisement and the sexist attitudes of the time, to pass its bill the MSGNA “carried on a quiet, but effective campaign.” They wrote letters and met with legislators, explaining why registration was necessary. Surprisingly, they were met “with much less opposition than anticipated.” In fact, the reception was such that—despite the protests of some (including their own lawyer)—MSGNA members “filled the gallery” to watch the final vote on April 9, 1907.

After the bill passed and Governor John A. Johnson signed it into law, he appointed the State Examiners Board from a list of nominees provided by the MSGNA. The association’s president later wrote of this: “The time has nearly passed when a hospital can be a law unto itself in the kind of pupils it receives, the character of the training given and the general treatment of the nurses.” In less than a decade, the movement had evolved from nine nurses maintaining a centralized registry to a statewide organization successfully lobbying for uniform standards.

Despite its victory at the legislature, the MSGNA knew its work was not yet done. Just as the board oversaw the profession, so too the profession needed to oversee the operations of the board. To this end, the MSGNA committed itself to vetting board nominees and protesting the appointments of those deemed “injurious” to the profession.

As there was strength in numbers, the MSGNA continued to maintain its community of nurses through its journal and annual meetings. But because it was only a coalition of organizations, the local work of nursing remained in the hands of county associations like the RCGNA. Nurses’ accomplishments during this first decade of the twentieth-century provided the infrastructure necessary to address what awaited them.

With the outbreak of World War I, nurses mobilized both financial and personal support of the nation’s war efforts (at least ninety RCGNA members served overseas). Even more, they helped nurses better withstand the horrors of the 1918 influenza epidemic. But despite its successes, these pressures revealed the difficulties of a decentralized network. From 1919–1920, this led many associations—including the RCGNA—to consolidate into the Minnesota State Registered Nurses Association.

Despite its evolution, the former nurses of the RCGNA—now part of the state association’s Fourth District—echoed in their charter the vision Theresa Ericksen had described two decades earlier. No matter the name of the organization, their cause was the same. Their purpose remained “[t]o establish and maintain ethical standards among nurses, and to promote the educational and social standing of the nursing profession.”