Nursing America

The Baltimore Directory and the Mother of American Nursing Schools

Jul 12, 2024

Release Date: July 12, 2024

Networking for Private Duty Nurses

When Aimee Henry enrolled in the University Hospital Training School for Nurses in 1911, her expectation was likely that she would follow in the footsteps of Amelia Wright, who had been Mary Martha Parker’s private live-in nurse for nearly two decades.

That was the norm. Most nurses of the day were private duty nurses, employed by individuals or families to provide around-the-clock, in-home care for someone who was ill or injured. If the patient required hospital care, the private duty nurse went along and continued to care for the patient there. And when the patient recovered or died, the nurse moved on to another job.

If she were lucky.

If not, she likely spent some time doing what we’d refer to today as networking, reaching out to doctors and hospitals to let them know she were available, tacking notices onto community billboards, looking over help wanted ads in local papers.

Marketing herself like the independent businesswoman she was.

(And yes, there were male nurses, but their numbers were dwarfed when compared to female nurses. Of the nearly 79,000 people who self-identified as nurses in the Federal Census of 1910, just over 4,000 of them were male. A decade later, that number had only grown from 4,210 to 4,440.) ¹

Starting in the early 1900s, women who’d graduated from a formal training program like the one at University Hospital had another option – a private duty registry.

One such registry was Baltimore’s Central Directory of Registered Nurses. Incorporated under the sponsorship of the Maryland State Association of Graduate Nurses in 1909, the Directory’s office had opened their doors on February 1, 1910.²

By January of the next year, the Directory of Registered Nurses included 54 graduate nurses registered in Maryland, 30 graduate nurses registered in other states and 24 graduate nurses who were not registered, and received 307 calls for care. In addition, a second directory, this one for caretakers and male nurses, included 52 caretakers, and two male nurses. In 1911, it had received 237 calls for service. ³

The difference between graduate nurses and caretakers was explained this way by Clara Query, register and secretary of Baltimore’s Directory in a 1911 article published in the Baltimore Sun:

“We register caretakers here as well as nurses. The former are women who have had some training in the work, but who are not graduates. Often they have a great deal of real nursing instinct and can be of immense service and aid in the home. They are paid less than the graduate nurses, of course, and so are in demand in families which cannot afford the $25 a week demanded by the latter. They are paid from $8 to $12 a week. Very occasionally they are permitted to ask $15, when they are particularly capable, or have some very hard work to do.”⁴

In addition to connecting nurses and caretakers with those in need of their services, the Registry also vetted graduate nurses, checking their training credentials, but also their standing in the communities from which they came.

But, perhaps the most important role of the Registry was to help protect the reputation and safety of the nurses they served. Again, Clara Query provided insight into this aspect of her work:

“Not long ago I had a call from a certain hotel in the city for a nurse to come and take care of a gentleman who was ill. The call came at 4 o’clock in the morning, The voice which talked to me over the telephone sounded suspiciously like that of an inebriated man. I hesitated for some time before deciding to send a nurse on this case. Finally I remembered a particularly level-headed girl who was disengaged and telephoned her.

‘Take a taxicab and go to the _____Hotel to report on the case. The patient is in Room ___. Before you go to it, ask the clerk at the desk whether or not it is a fit place for you to go, and, if he says it isn’t, take your taxi and go back home,’ I told her.

“She followed these injunctions (sic) to the letter. The clerk said he would advise her strongly not to go to the room in question, and she went home in her taxi at once.” ⁵

Although private duty nursing largely fell out of favor in America in the 1940s, Baltimore’s Central Directory of Registered Nurses remained active until 1974. Of the nearly 5.2 million registered nurses today, just over 17,000 of those are thought to work in the private duty sector. ⁶

In the 1930 Federal census, Aimee Henry listed her occupation as trained nurse for private families. She, like Amelia, was a private duty nurse.

Dr. Zakrzewska and the Elevation of Womanhood

Florence Nightingale gets a lot of credit as the founder of modern nursing, as she should. I remember reading Jeanette Covert Nolan’s book on her when I was in elementary school and understanding, maybe for the first time, that women could make history, too.

But there’s another woman who should also get credit, especially in America, and her name was Marie Zakrzewska. A midwife by age 20, Maria left Prussia in 1853 and came to New York with hopes of becoming a doctor, something she wasn’t allowed to do in her homeland. Maria realized that ambition three years later, and in 1857, cofounded the New York Infirmary for Women and Children, the first hospital in America run exclusively by women for women. She was just 28.

Talk about making history!

In 1859, Dr. Zak, as Maria was called, relocated to Boston, and in 1862 opened the New England Hospital for Women and Children with the goal of providing women with care delivered by female doctors and staff, assisting female doctors in their careers and training nurses. A decade later, her dream of establishing America’s first school of nursing was achieved, and the next year, 1873, Linda Richards became the school’s first graduate.

" I am in reality as family-proud as any aristocrat can possibly be, but I prefer to be remembered only as a woman who was willing to work for the elevation of Woman. " Marie Zakrzewska

By the time Maria died in 1902, her vision of training professional nurses in hospital settings had spread across the U.S., including to Baltimore, MD where The University Hospital Training School for Nurses opened in 1889.

And, at which, in a perfect full circle moment, a 34-year-old protégée of Florence Nightingale named Emma Amelia Louisa Parsons became the first superintendent of nursing.

If you want to learn more about Dr. Maria Zakrzewska, The New England Hospital for Women and Child posthumously published a memoir of her in 1903. Titled “Marie Elizabeth Zakrzewska”, the book is available to read on Google Books. ⁷

What qualities define a hero in the context of your community? Let’s share stories of local folks who may not fit the conventional hero mold but have made a substantial difference in their own unique ways.

Endnotes

¹ D'Antonio P, Whelan JC. “Counting nurses: the power of historical census data”. J Clin Nurs. 2009 Oct;18(19):2717-24. doi: 10.1111/j.1365-2702.2009.02892.x. PMID: 19744023; PMCID: PMC2756047.

² “Dolly and I Visit the Central Directory of Registered Nurses”, The Baltimore Sun, December 9, 1911, Pg 6.

³ “To Continue Work of Nurses: Stockholders of Central Directory Please with Year’s Report”, The Baltimore Sun, January 12, 199, Pg. 8.

⁴ “Dolly and I Visit the Central Directory of Registered Nurses”, The Baltimore Sun, December 9, 1911, Pg 6.

⁵ “Dolly and I Visit the Central Directory of Registered Nurses”, The Baltimore Sun, December 9, 1911, Pg 6.

⁶ The 2022 National Nursing Workforce Survey, The Journal of Nursing Regulation, National Council of State Boards of Nursing. Published by Elsevier Inc.

⁷ Elizabeth Blackwell, “Marie Elizabeth Zakrzewska”, New England Hospital for Women and Children, New England Hospital for Women and Children, 1903.