While nursing as a profession began with Florence Nightingale, known as “The Lady with the Lamp” for her efforts in the Crimean War, it wasn’t until the Great War that the field of nursing expanded and evolved. Prior to World War I, most nurses (all of whom were women at that time) worked in private duty in homes, not in hospitals.
In the Great War, the volume of casualties from trench warfare drastically changed the role of nurses on the health care team. Much of the time, the doctors were in surgery, dealing with horrific injuries to soldiers’ extremities, heads and faces. The nurses performed triage as patients came in on ambulance trains, directed corpsmen who had little medical training, managed entire wards of patients and performed a variety of procedures, including irrigating wounds and managing infection.
“The nurses had never seen injuries like this, and they had to care for the soldiers, sometimes large numbers of soldiers at once, on the fly,” said Peterson who served on the planning committee for the symposium and has written extensively about the history of nursing in war time. “Up to this point in the nursing field, nurses were not in a position to make decisions on their own. They operated only at the direction of a doctor. Now, with 10, 20 or even 80 patients in their care at once, they made decisions they wouldn’t have before.”
“Those nurses did what needed to be done,” Peterson said. “And they did an incredible job with few resources.”
Base Hospital No. 28 in Limoges, France, which was staffed with physicians, corpsmen and nurses from the Kansas City area, was intended to serve 500 patients, then expanded to 1.500, and at peak times 3,000. It was not uncommon for the numbers of patients in hospital facilities to fluctuate widely as efficient ambulance trains arrived, bringing hundreds of patients from the battle front at once.
The battlefield conditions presented extreme challenges for nurses. Patients had massive wounds to the face and head incurred as they poked their heads out of trenches, massive wounds to extremities that would require amputations, and also burns from poisonous gases. Injuries from battles on French farm fields featured both shards of shrapnel and imbedded soil and manure. Antibiotics were not available, and rubber gloves and wound irrigation solutions were recent innovations. Nurses managed infections with great success under these trying circumstances, especially considering there was no electrical power and bandages from wounds had to be washed by hand and re-used.
“Nurses were intended to work in the rear and not face dangerous conditions near the battlefield, but the plans had to be discarded when new medical groups were organized,” said Sanders Marble, Ph.D., a symposium presenter and senior historian in the U.S. Army’s Office of Medical History. Marble noted that American nurses worked on base hospitals, hospital trains, hospital ships, field hospitals, camp hospitals and even evacuation hospitals and mobile units. Their contributions were appreciated, and there was a recognition that their care had not only comforted patients but prevented infection and saved lives.
As the role of nurses expanded, so did the numbers of nurses involved. Six months after the United States entered the war, around 1,100 nurses were serving overseas. By the end of the war, there were more than 21,000 nurses serving in the U.S. Army Nurse Corps, with more than 10,000 having served overseas. The nursing profession was growing, and nurses were seen as a critical part of the health care team.
“The U.S. nurses who served in WWI proved they could save lives and make a difference in patient care close to the battlefield,” Marble said.
When those same nurses came home from war, they had an expanded view of themselves and their contributions to care.
”They came back with a sense of themselves as team members,” Peterson said. “They had earned the respect of those they served with, and they were decision-makers. That was very different for them, not just as nurses but as women.”