Background
Today's Red Cross nurses continue a proud tradition of service that stretches back to the earliest days of the International Red Cross Movement and the founding of the American Red Cross. Nursing was at the core of the International Red Cross Movement at its beginning. When the Swiss businessman Henri Dunant saw the 40,000 casualties of one day's battle in 1859 between French and Austrian forces outside the Italian town of Solferino, he rushed to the aid of the wounded, assisted by local residents. He took as his model the famous Englishwoman, Florence Nightingale, who is credited with introducing nursing to the battlefield in 1854 during the Crimean War. Later Dunant wrote the book Memory of Solferino recounting his experiences and calling for an international body to aid the wounded in battle. His plea was answered in 1863 with the founding in Switzerland of the International Committee of the Red Cross. The following year 12 European states adopted the first Geneva Convention calling for the protection of the war injured.

Clara Barton, founder of the American Red Cross, first came to widespread public attention as an amateur nurse who provided aid to soldiers during the Civil War. Later she traveled to Europe where she learned about the International Red Cross and served as a Red Cross volunteer in the Franco-Prussian War (1870-71). Several years after her return to the United States, Barton formed the American Red Cross (1881) and campaigned vigorously for American acceptance of the Geneva Convention which finally occurred in 1882.

Formative Years
From the start, nursing played an important role in American Red Cross history. At first nurses served on an "as needed" basis, performing functions consistent with the organization's purpose, as stated in its articles of incorporation, to provide "a system of national relief and apply the same in mitigating the sufferings caused by war, pestilence, famine and other calamities." Among examples of their early work:

• Clara Barton led a team of volunteers, including nurses, who operated field hospitals during annual U.S. army maneuvers in Washington, D.C., beginning in 1887.
• The Red Cross recruited nurses in 1888 to combat a severe yellow fever outbreak around Jacksonville, Fla. Some of these nurses became famous for jumping off a moving train to reach one small town so badly afflicted by the disease that the railroad would not stop there.
• Philadelphia nurses joined the Red Cross team helping survivors of the monstrous 1889 Johnstown, Pa., flood that killed 2,000 and left another 25,000 homeless.
• In 1898 the Red Cross provided its first assistance to the military under wartime conditions. It recruited 700 nurses to provide medical assistance to the U.S. Army and civilian casualties in Cuba and the Philippines during the intense but brief Spanish-American War. At first U.S. commanders resisted women near the battlefields but the nurses proved their worth and eventually earned acceptance from the military. The U.S. Congress recognized their value in 1901 when it created the Army Nursing Corps to assure the availability of nurses in the event of war.

Institutionalization
Red Cross nurses were involved mainly in disaster relief and support to the military during the early years, although the organization made attempts to broaden its mission. In the 1890s, the Red Cross briefly operated some nursing schools. At about the same time, the Brooklyn, N.Y., Red Cross Society experimented with training nurses to provide home health care to the poor and later the Washington, D.C. branch offered lectures on home nursing. In 1900 and, again, in 1905, Congress issued charters to the American Red Cross that assigned specific responsibilities to the organization, some of which involved nursing. Both charters required the Red Cross to provide "volunteer aid to the sick and wounded of armies in time of war" and to "carry on a system of national and international relief in time of peace and apply the same in mitigating the sufferings caused by pestilence, famine, fire, floods, and other great national calamities."

The organization took a major step in expanding its nursing services to meet its charter obligations in 1909 when it created a nursing division, called the "Red Cross Nursing Service," and appointed a strong-willed visionary, Jane Delano, as its director. Delano had experience as a nurse during the Florida yellow fever epidemic and had recruited nurses for the Red Cross during the Spanish-American War. At the time of her appointment to the Red Cross Nursing Service she was already director of the Army Nursing Corps, a post she continued to hold until 1912 when she turned her attention full-time to Red Cross nursing.

Delano's first major step was to create a Red Cross nurses' reserve in preparation for service with the military in the case of warfare. She also moved quickly to expand nursing into areas of domestic life. She initiated educational programs in home nursing and first aid for homemakers and created a Rural Nursing Service for medically underserved populations in remote areas. This service was later expanded to include city dwellers and became known in 1913 as the "Town and Country Nursing Program." In 1918 the name was changed to the "Bureau of Public Health Nursing," indicative of the leadership role Jane Delano and the Red Cross played in establishing public health care in this country.

World War I
Within weeks of the outbreak of World War I in 1914, the Red Cross dispatched a "Mercy Ship" to Europe with medical supplies, doctors, and 125 nurses to provide aid to military and civilian victims on both sides in the conflict. When the Red Cross recalled its medical personnel a year later because of funding problems, more than 250 American Red Cross nurses had served in Europe. This number was dwarfed, however, when the United States entered the war in 1917. During the 20 months of U.S. participation, the Red Cross recruited over 29,000 nurses to serve within its own ranks and with the U.S. military at home and overseas. This time Red Cross nurses supplied aid only to U.S. armed forces and to the military and civilians of its allies. They served at emergency stations near the front, field hospitals behind the lines, evacuation hospitals where rail or motor transportation was available, and at base hospitals and convalescent homes far from the battle lines and back in the United States.

To help overworked nurses at home provide medical attention to a growing number of returning veterans and to sustain ongoing, domestic nursing programs, the Red Cross introduced the Volunteer Nurses' Aide Service in 1918. Volunteers were trained to relieve nurses of many mundane and repetitive tasks. The Red Cross also established a Hospital and Recreation Corps in 1918 to provide comfort and recreational services, especially to veterans. The volunteers serving in this Corps soon became known as "the Gray Ladies" because of the color of their uniforms. During the war and following the 1918 armistice, Red Cross nurses also provided aid to those afflicted by diseases that accompanied the hostilities. The most devastating of these was the Spanish influenza epidemic of 1918-19 that began in Europe and quickly spread worldwide causing an estimated total of 22,000,000 deaths. More than 15,000 American nurses responded to this emergency at home that caused widespread suffering and more than 500,000 deaths in the United States.

Between the Wars

Service to civilian war victims in Europe continued for several years after hostilities ended. The American Red Cross set up hundreds of health centers and child welfare stations staffed by Red Cross doctors, social workers, and nurses. The organization also assisted some countries in establishing their own schools of nursing.

At home, nurses continued to provide service to convalescing veterans. At the same time, the Red Cross increased its civilian services. It offered new courses in first aid and nutrition to homemakers and expanded its rural nursing programs. In honor of Jane Delano, who died in 1919 while in Europe on a tour of military hospitals, the Red Cross established a special fund to train public health service nurses. Nurses responded, along with members of other branches of the Red Cross, to natural disasters during the 1920s and 1930s, such as periodic floods on the Mississippi and Ohio rivers and the Midwest drought that caused the Dust Bowl, as well as to social problems caused by the Great Depression. The Red Cross continued to serve exclusively as the nurse enrollment agency for the U.S. military until the end of the 1920s when the military began to accept nurses from other sources.

Two other changes occurred during this period to affect the status of Red Cross nursing. In 1930, the government established the Veterans Administration that took over responsibility for the health care of veterans. Consequently the Red Cross withdrew its nursing staff from veterans' hospitals although it continued to provide social and recreational services to veterans. When the federal government introduced Social Security in 1935, the Red Cross reduced its public health nursing activities because the new system provided local jurisdictions with their own public health funds.

World War II
During World War I, Red Cross nurses served side-by-side with military nurses. In World War II, the military role of Red Cross nursing was limited to the recruitment of nurses for the Army and Navy Nursing Corps. During the war, approximately 153,000 nurses held "active" status on Red Cross rolls and 71,000 of them served with the military at home and overseas. When the Red Cross launched a blood supply program for the armed services in February 1941, the organization faced a critical need for nurses trained in blood collection and met this challenge through vigorous nurse recruitment. Blood procurement reached its peak in June 1944 when nearly 1,000 nurses served in Red Cross blood centers across the country. At the same time, Red Cross nurses continued to present first-aid and nutrition programs to the public, incorporate civil defense instruction in their courses, and train large numbers of nurses' aides. By 1944-45, there were over 110,000 nurses' aides in service.

Since World War II
After the war, the U.S. government created a permanent Army and Navy Nurse Corps and relieved the American Red Cross of its nurse recruitment responsibilities. Continued expansion of government into the public health field eventually caused the Red Cross to cease its own public health nursing service. Organized into a new Office of Health Services, American Red Cross nurses concentrated on other areas of community service in the post-war era. As in the past, they provided relief in disasters and designed and taught courses in home nursing and nutrition. They became increasingly involved in the Red Cross civilian blood program following its inception in 1948. They responded to national health emergencies such as the severe polio epidemic that swept the country in the late 1940s and early 1950s and periodic outbreaks of influenza that continue to the present day. Under the shadow of the Cold War and especially during the Korea War (1950-53), the American Red Cross expanded civil defense training in its home care courses and greatly enlarged its blood program to meet the demands of warfare after its appointment during the Korean conflict as the official blood collection agency for the U.S. military. In 1961, under the influence of President John F. Kennedy's campaign for physical fitness, Health Services introduced a new course, "Fitness for the Future," designed to help senior citizens maintain good physical, mental, and social health. Responding to another wave of health consciousness in the late 1970s, the Red Cross issued the reference guide, "Family Health and Home Nursing." Following the near disaster at the Three Mile Island nuclear plant in 1979, Red Cross nursing added a radiation safety course to its curriculum.

While nurses were in the forefront of American Red Cross activities for many decades, their prominence diminished as government agencies took over many of their functions. Nursing, however, remains a vital part of the American Red Cross, especially in disaster services, the blood program, and the more recently introduced human tissue donor program. Nursing's importance was acknowledged in 1992 when the Red Cross re-established the Office of Chief Nurse which had been vacant since the early 1980s when the Office of Health Services had been disbanded in a period of organizational restructuring and downsizing. In late 1999, Red Cross President Bernadine P. Healy, M.D. called for a renewed emphasis on the nursing program when announcing a structural realignment of the national headquarters.

Today the Office of Chief Nurse is responsible for supporting and strengthening paid and volunteer nurse involvement throughout the Red Cross and for maintaining liaison with other Red Cross services. The Office manages a program that promotes the enrollment of nurses in Red Cross activities and develops infrastructure for Red Cross nursing programs in the field. It also represents Red Cross nursing outside the organization, in professional organizations, at educational institutions, and before regulatory groups.

For more information about Red Cross nursing, including the nurse enrollment program, see the American Red Cross Nursing web page.

Bibliography

- American Journal of Nursing, 1900-

- Mary Jo Clark, Nursing in the Community. 2nd edition. Stamford, CT: Appleton & Lange, 1996.

- Lavinia L. Dock and Isabel M. Stewart, A Short History of Nursing. New York: G.P. Putnam & Sons, 1920.

- Lavinia L. Dock, Sarah E. Pickett, et al., History of American Red Cross Nursing. New York: MacMillan Co., 1922.

- Foster Rhea Dulles, The American Red Cross. New York: Harper and Brothers, 1950.

- Patrick F. Gilbo, The American Red Cross: The First Century. New York: Harper and Row, 1981.

- Portia B. Kernodle, The Red Cross Nurse in Action: 1882-1948. New York: Harper & Brothers, 1949.

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