“The Most Important Problem”: Group Nursing and Hospital Staffing, 1920–1949

Abstract This article aims to explain an early twentieth-century staffing method known as group nursing and its relationship to nurse shortages. In the 1920s hospital wards in the United States were generally staffed with student nurses. Hospitalized patients who wanted more personalized care or needed more care because of serious illness often hired a self-employed, private-duty registered nurse for one-on-one care. Under group nursing, a hospital dedicated certain clusters of private rooms where two or three patients were cared for by one registered nurse. Group nurses were employed, paid, and supervised by the hospital, and hospitals charged patients extra to offset the cost. High-quality personalized care increased nurse satisfaction and decreased nurse shortages. Many hospitals experimented with group nursing in the 1920s, but when they transitioned to registered nurse service in the 1930s, the hospitals’ options for having a fully qualified staff were group nursing and general duty nursing. Under general duty nursing, registered nurses replaced some students on the wards. General duty nursing was easier for a hospital to implement and eventually became the standard for hospital staffing. Nevertheless, group nursing mitigated nursing shortages, promoted nurse satisfaction, and decreased the need for outside nursing staff.