"A necessity in the nursing world": the Chicago Nurses Professional Registry, 1913-1950.

In 1923, Lucy Van Frank, Head Registrar of the Chicago-based Nurses Professional Registry, addressed the annual meeting of the Illinois State Nurses Association (ISNA).1 The main topic of her talk centered on the problems encountered in administering a private duty registry. However, Van Frank seized the opportunity to emphasize the importance of the establishment of nurse-owned and-operated central registries. Central registries were agencies that placed private duty nurses with patients and provided a source of jobs for nurses in a particular locality. Van Frank's remarks focused specifically on central registries owned and operated either by or in close affiliation with a professional association of nurses, the formation of which was a growing movement among nurses in the early twentieth century.2 Van Frank's comments left no doubt in the audience's mind of the value she placed on central registries. She declared: "They are now considered as much a necessity in the nursing world as are commercial bureaus in the business world, and as essential a part of the great plan of caring for the sick, as is the system of Training Schools in the hospitals."3 Van Frank's position as head of one of the largest and fastest growing central registries in the United States most likely influenced her view of central registries. But many in the professional nursing world of the 1920s agreed absolutely with her assessment.4 Private duty registries offered early 20th century nurses a convenient means of obtaining work, and professional registries, run specifically by and for nurses, were a vehicle through which nurses could achieve a degree of independent practice and autonomy. Contemporary nursing leaders urged nurses to align with professional registries and forecast the future of nursing as centering around these organizations. Yet by the mid-twentieth century the vision Van Frank and other nurse leaders held for private duty registries owned and operated by nurses remained unfulfilled. The radical changes in the ways nurses were employed, created by the demands of an acute care-centered modern hospital system, would render professional private duty registries obsolete. This article records the rise and demise of professional private duty registries as demonstrated by the experience of the Chicago Nurses Professional Registry during the years 1913-1950. I examine the origins of the private duty system, describe how private nurses were distributed to patients, and analyze patterns of supply and demand for nursing services. My perspective differs from previous interpretations, which generally attribute the demise of private duty to the circumstances surrounding the Great Depression.5 I argue that the private duty nurse market remained viable and very important until sometime after World War II. Private duty nursing declined, not as a direct result of changes taking place in the 1930s, but rather several years later as a consequence of the inability of the labor market to supply sufficient numbers of nurses to meet heightened demand for their services. This examination recognizes the significance of changes during the 1930s, but stresses the importance of fluctuating patterns of supply and demand as a major factor in nurse employment arrangements and how they affected the nurse labor market and created vast changes in the ways nurses were employed. Highlighting the importance of how supply and demand functions in the nurse labor market refines our understanding of the transformation of nurses from independent private practitioners to hospital employees. Examining this intriguing nurse job market offers a unique view of nurses' work and illuminates the foundations on which the contemporary labor market for nurses was formed. Beginnings: Businesses Owned and Operated by Nurses The genesis of private duty nursing lies in the peculiar system of hospital-based nursing education that began in the nineteenth century and combined education with employment in the same body of workers. …