North Carolina Nursing History

Despite the recitation of the Florence Nightingale Pledge by nursing graduates for over a century, personal and organizational racism prevented the Pledge from being fulfilled for many decades.
The first 50 years of professional nursing in North Carolina were marred by racial exclusion, prejudice and segregation. From education to employment to membership in professional associations, African-American nurses in North Carolina, indeed in all the states of the old Confederacy and in much of the nation, faced legal, social and professional discrimination.

Despite these obstacles, though, many African-American nurses survived and thrived. Many brought the rudiments of nursing to poor, uneducated, and sick people. In addition, they sought to fulfill the obligations of the Florence Nightingale Pledge by maintaining and elevation he standards of profession.

Because the exclusively white North Carolina State Nurses Association (NCSNA) provided the primary arena for professional discussion, legislative activity and continuing education programs for nurses in North Carolina. African-American Nurses established a parallel organization, the North Carolina Association of Colored Graduate Nurses.

When the NCSNA formed in 1902, membership privileges were extended only to white nurses. Although North Carolina was then home to several high caliber nursing schools for African Americans, such as Good Samaritan in Charlotte, St. Agnes in Raleigh and Lincoln in Durham, their graduates were barred from participating the only professional nursing organization in the state. Membership in the American Nurses Association (ANA) was granted only to members of state affiliates until 1948; therefore, membership in the predominant national professional association was also closed to all southern African-American nurses.

Seeking the benefits of a professional organization denied them by the ANA, a group of African-American nurses, led by Martha Franklin of Philadelphia, met in New York in 1908 to form the National Association of Colored Graduate Nurses (NACGN). The purposes of the new organization were enumerated in its Certificate of Incorporation. A portion of it reads: “…to promote the professional and educational advancement of nurses in every proper way; to elevate the standards of nursing education: to establish and maintain a code of ethics among nurses…”

Charlotte Rhone, the first African American Registered Nurse from New Bern, was the only registered nurse from North Carolina to attend the initial meeting of the NACGN. She became a charter member of the organization. All nurses were welcome to participate in the NACGN. Annual meetings were held to provide opportunities for continuing education, networking and discussion and action on legal, legislative and professional issues affecting their practice, their race and the nursing profession.

Five North Carolina nurses attended the 1921 NACGN annual convention in Washington, D.C. They were Carrie Early Broadfoot, Mrs. Faison,),Miss Anna Sanders, MIss M.L. Taylor and Miss Miller. Carrie Early Broadfoot, of Fayetteville, called the North Carolina nurses together during the conference and suggested they establish a state chapter of the NACGN. Upon their return to North Carolina, they wrote and spoke to as many nurses as possible about the benefits of having an organization. Their hard work paid off. The first meeting of the North Carolina Colored Graduate Nurses Association (NCCGNA, changed in 1931 to North Carolina State Association of Negro Registered Nurses, Inc. –NCSANRI) was held on January 18, 1923 in Winston-Salem, with 16 nurses in attendance. Broadfoot was elected president, a post she held for the next eight years. A second meeting was held in Raleigh on May 3, 1923 with 35 nurses participating. By 1938, there were 150 active members of the group and by 1949, 269 African-American nurses were involved in the organization.

African American nurses in the larger towns and cities had their own chapters of the state organization. The Charlotte group named themselves the Florence Nightingale Club and had 15 members. The Raleigh group had 10 active members and was known as the Edith Cavell Club and the Durham group numbered 9. Greensboro, Wilson, Wilmington and High Point also had chapters at one time or another of the groups existence.

Members had to be Registered Nurses or retired Registered Nurses. As early as 1924 the group was approached by the all white NC State Nurses Assocaition to discuss merger, but this did not come to fruition until 1949.

The NCCGNA offered opportunities for professional growth. Members rotated leadership positions, attended and coordinated state and national conferences, lobbied politicians about health and nursing concerns and took turns representing North Carolina on the NACGN Executive Board. In addition, NCCGNA members participated in events sponsored by groups such as National Negro Health Week, the American Red Cross and the Anti - Tubercular Society.

Educational and employment discrimination deeply concerned members of the NCGNA. In 1937, there were only 11 hospitals in North Carolina employing African-American nurses. In addition, African-American nurses wanting to work in community health could only find jobs in a few cities. Tthere were only 11 schools of nursing in North Carolina open to African-American students between 1896 and 1965, and some of those only existed for a few years.

By the 1940s, the nation was experiencing a zeitgeist of social, political, moral and economic forces that were changing the accepted patterns of behavior. Racial injustice was being questioned by more people than ever before in American history.

Leaders of the NCSANRN and the NCSNA met throughout the 1940s to create a plan to merge, thus ending discrimination in the largest professional nursing organization in the state. This planning paid off in 1949 when the NCCGNA voted itself out of existence and the NCSNA voted to open its membership to all registered nurses in the state of North Carolina. Maria B. Noell, executive secretary of the NCSNA, praised the actions of the NCCGNA by saying:

“Since all citizens of North Carolina need adequate nursing care and since the professional nursing organizations are to a great degree responsible for such care. I believe the action taken this morning by the N.C. Association of Negro Registered Nurses, Inc. to dissolve its organization of 27 years standing and to associate itself wholly with the NC State Nurses’ Association will be a great asset in promoting nursing service for all North Carolinians.’’

Elizabeth M. Thompson, President of NCSANRN in 1949 closed the last meeting of the NCCGNA with these words: The final chapter has been written by the North Carolina Association of Negro Registered Nurses, Inc., but the activities of nurses and nursing must go on. As professional women, we all have a great part to play in furthering the progress and elevating the standards of this work. The integrating of the associations gives opportunity for great service, and by so doing, humanity will be better served.

It took over a decade after the merger of the professional organizations for white schools of nursing in North Carolina to accept African-American students. It took the Simkins v. Moses Cone court case in 1963 and the passage of the federal Civil Rights Act of 1964 to begin to end employment discrimination against African-American nurses in North Carolina.

Most North Carolina nurses, regardless of race, are unaware of the hard work and professionalism exhibited by a small group of Tarheel African-American nurses in the first half of this century. These individuals worked under very difficult circumstances to promote professional nursing in our state. Their determination to elevate the standards of nursing for themselves and their patients can inspire use today.

 

Overview

The first 50 years of organized professional nursing the United States were marred by racial exclusion, prejudice and segregation. From education to employment to membership in professional associations, African American nurses in North Carolina, indeed in all the states of the old Confederacy and in much of the nation, faced legal, social and professional discrimination. When the North Carolina State Nurses Association (NCSNA) was formed in 1902, membership privileges were extended only to white nurses. Although North Carolina was then home to several high-caliber nursing schools for African Americans, including Good Samaritan in Charlotte, St. Agnes in Raleigh and Lincoln in Durham, their graduates were barred from participating in the only professional nursing organization in the state. Membership in the American Nurses Association (ANA) was granted primarily through membership in its state affiliates until 1948; therefore, membership in the predominant national professional association was also closed to most southern African American nurses.

Despite these obstacles, African American nurses survived and thrived. From tumble-down rural sharecroppers’ shacks to chrome-trimmed surgical suites, these nurses provided skilled care and warm hearts to many who were strangers to the health care system. In addition, these early African American Registered Nurses sought to fulfill the obligations of the Florence Nightingale Pledge by maintaining and elevating the standards of the nursing profession. Because the exclusively white NCSNA provided the primary arena for professional discussion, legislative activity and continuing education programs for nurses in North Carolina, a small group of African American nurses established a parallel organization in 1921, the North Carolina Association of Colored Graduate Nurses.

Background: The American Nurses Association

The Associated Alumnae of the United States and Canada (AAUSC, the antecedent to the American Nurse Association) was founded in 1896 as an organization of the alumnae societies of select nursing schools to exchange ideas and work to standardize and upgrade the new nursing profession.  Only four African American schools of nursing were founding members of the AAUSC, Provident in Chicago, Lincoln in New York City, Freedman’s in Washington, D.C. and Mercy in Philadelphia. Therefore, while membership in the AAUSC was limited, it did include a few African American nurses.  In 1911, the association renamed itself the American Nurses Association (ANA) and replaced membership criteria from alumna associations to membership in state nurse associations. Unfortunately, sixteen state associations in the old Confederacy as well as the nurse association in Washington DC refused to admit black members. Therefore, most African American nurses were barred from membership in the ANA until 1951 individual nurses could join even if they were not state association members. Until 1942, the National League of Nursing Education (NLNE) also required membership in the ANA for membership in the NLNE, therefore most African Nurse educators were barred from participation in the NLNE before WWII.  Only the National Organization of Public Health Nursing, founded in 1912, was founded as open to all nurses regardless of race.

The National Association of Colored Graduate Nurses 1908-1951

In 1906, Connecticut nurse Martha Minerva Franklin surveyed African American nurses to see what challenges they faced. One of the biggest obstacles was their inability to join the largest professional nursing organization in the country, the American Nurse Association (ANA). Two years later, in 1908, fifty-two African American nurses led by Martha Minerva Franklin and Adah Belle Samuels Thoms, met in New York City and formed the National Association of Colored Graduate Nurses. Franklin was elected president at the first meeting.  The new organization had three main goals: “to advance the standards and best interests of trained nurses, to break down discrimination in the nursing profession, and to develop leadership within the ranks of African American nurses.” 

The goals of the new organization were enumerated in its Certificate of Incorporation and included promotion of the professional and educational advancement of nurses in every proper way, the elevation of the standards of nursing education and the establishment and maintenance of a code of ethics among nurses.  All RNs and retired RNs were welcome to join the NACGN. Annual meetings provided opportunities for leadership, continuing education, networking, discussion and action on legal, legislative and professional issues affecting their practice, their race and the nursing profession. Through hard work, bravery and dedication, the NACGN was successful in many of its endeavors. It finally merged with the ANA in 1951. 

North Carolina Nurses Were Active in the National Association of Colored Graduate Nurses

Throughout its history, North Carolina nurses were active in the NACGN. Charlotte Rhone of New Bern, a 1903 Freedman's Hospital graduate and probably the first African American Registered Nurse in the United States, was the only North Carolina nurse to attend the founding meeting of the NACGN. She was elected national secretary. Several other North Carolina nurses participated in the NACGN in its first decade. At the 4th annual meeting in 1912 in Washington, DC, Miss Sarah Leonora Hargrave of Wilmington gave a paper on “Feeding the sick” and Durham nurse Julia Latta spoke on “How can the Association be made beneficial to its members” as well as another talk on “Nursing ethics” (Of interest to nurses" JNMA 3(4), 399). The national organization held its 8th annual 3-day meeting in Raleigh on August 17-19, 1915, in the Chapel of Shaw University. The nurses toured St. Agnes Hospital. were given a trolley ride around Raleigh, and enjoyed a reception hosted by Mrs. Lottie Jackson, RN, Matron of St. Agnes Hospital. Nurse Hargrave of Wilmington was elected Corresponding Secretary. (Raleigh News and Observer 8-19-1915, p. 8) (Of interest to nurses". JNM 7(4) p.326)

At the 1916 meeting in New York City, Mrs. Lottie Jackson, of Leonard Hospital and later St. Agnes Hospital in Raleigh spoke in the “Welcoming” session and Durham public health nurse Julia Latta “presented a very spicy paper" on “Public health nursing and sanitation in the south”. Nurse Lula G. Warlick, born and raised near Charlotte but then serving as the Assistant Superintendent of Provident Hospital in Chicago “enthused the entire audience with a well prepared and well delivered paper entitled Use what is in thy hand. At that meeting, Hargrave was re-elected as the Corresponding Secretary. (Clark, M.F. (1916) "Of interest to nurses" JNMA 8(4) 203

North Carolina nurses participating in the 13th Annual Convention in Tuskegee, Alabama in 1920 included Carrie Early Broadfoot of Fayetteville, who gave the invocation and was elected as the Assistant Corresponding Secretary, Elizabeth Miller of Charlotte and Lottie Jackson of Raleigh both served on the nomination committee.

On August 19, 1921, Broadfoot convened a meeting with the four other North Carolina nurses attending the 14th Annual Convention of the NACGN in Washington, D.C. At that time, Broadfoot was the treasurer of the NACGN and the Superintendent of Nurses at the Negro Division of the North Carolina Sanitarium in Sanitarium, NC, a state-funded tuberculosis hospital. These five founding nurses: Carrie Early Broadfoot, Charlotte Hall McQueen Faison, Miss Anna Saunders, M. L. Taylor (secretary of the new group) and Elizabeth Miller formed the North Carolina Association of Colored Graduate Nurses. Upon returning to North Carolina, these nurses contacted as many nurses as possible about the benefits of having a professional African American nursing organization. At that time in North Carolina, each county’s Clerk of Court maintained a Registry of Nurses in their office. There was no statewide registry (the county registries were consolidated in Raleigh in the 1930s – thus creating a state wide data base of nurses), so trying to contact every African American nurse in the state was a somewhat haphazard effort. They did their best before the days of consolidated registration records, telephones or the internet.

Their hard work paid off. Twenty-one nurses attended the first in-state meeting of the NCACGN on January 18, 1923, in Winston-Salem. Broadfoot was elected president, a post she held for the next eight years. The meeting opened with the singing of the first verse of “All hail the power of Jesus’s name” followed by a recitation of the 23rd Psalm and then the Lord's Prayer. Dues were set at $1 to join and $1 a year. Eight nurses gave podium presentations on the advantages and disadvantages of different practice settings.

The group voted that membership be restricted to RNs – retired nurses who were not registered could join as honorary members. The first nurse registration law in the country passed the North Carolina General Assembly on March 3, 1903. Nursing school graduates who finished before 1904 could register at their county’s Clerk of Court office by presenting their diploma and two letters of reference from physicians. Charlotte Rhone and Annie Lowe Rutherford, both graduates of Freedman’s Hospital School of Nursing, an African American school in Washington, D.C., registered in North Carolina in 1903. Beginning in 1904, nurses were required to pass the State Board of Nursing Examination to earn the title Registered Nurse. The North Carolina Board of Nursing refused to allow African American nursing school graduates to take the exam until Public Law 284 passed the North Carolina Legislature in 1915. This forced their hand, as the law in full stated:

CHAPTER 284. AN ACT TO REGULATE THE EMPLOYMENT OF COLORED NURSES IN HOSPITALS. The General Assembly of North Carolina do enact: Section 1. That in every public and private hospital, sanatorium, and institution in North Carolina where colored patients are admitted for treatment and where nurses are employed it shall be mandatory upon the management of every such hospital, sanatorium and institution to employ colored nurses to care for and wait upon said colored patients. Sec. 2. That every person, firm or corporation violating the Misdemeanor, provisions of this act shall be guilty of a misdemeanor and upon Punishment, conviction thereof shall be fined the sum of fifty dollars for each and every offense. Sec. 3. That all laws and clauses of laws in conflict with the provisions of this act are hereby repealed. Sec. 4. That this act shall be in force from and after its ratification. In the General Assembly read three times and ratified this the 9th day of March, 1915.

Many hospital administrators wanted to hire Registered Nurses to both improve their reputations and to meet emerging hospital accreditation requirements. Beginning in 1916 this meant they had to hire African American RNs if they maintained segregated “Negro” wings or wards in their hospitals. Five brave African American nursing school graduates sat for and passed the exam in 1916, 17 did so in 1917 and 30 in 1918. By 1923, when the first session of the NACGN was held, approximately 110 African American nurses held the title Registered Nurse in North Carolina.

The second annual session of the NACGN was held in Charlotte on May 1, 1924. By then, African American nurses in the larger cities had organized chapters of the state association. The minutes of the second annual session report that the Winston-Salem chapter had 10 active members, held regular monthly meetings and developed “a deep interest in helping the unfortunate.” The 15 members of the Charlotte chapter, also known as the Florence Nightingale Club, held monthly meetings and contributed to charity, especially “the unfortunate, underweight school children.” They also took bed sheets to the county-managed old folks’ home. The Raleigh chapter reported ten members. “Their attention is turned towards helping the hospital” (St Agnes Hospital in Raleigh). The Durham Chapter was organized in 1923 with nine active members. The chapter furnished a room in the new Lincoln Hospital. Nurses in Greensboro, Wilson, Wilmington, Henderson, Kinston, Gastonia and High Point also formed chapters in the 1920s.

Membership in the NACGN offered opportunities for professional growth. Members rotated leadership positions, attended and coordinated local, state and national conferences, lobbied elected officials about health and nursing concerns and took turns representing North Carolina on the NACGN Executive Board. In addition, members co-sponsored numerous events with groups such as National Negro Health Week committees, the National Health Circle, the American Red Cross and the Anti-Tubercular Society.

Talk of Affiliation Between the White NCSNA and the African American NCACGN in the 1920s

In 1925, both the white NCSNA and the African American NCACGN discussed affiliation at their separate annual meetings. According to the minutes of the white NCSNA:

Miss Ross told about the nurses attending the meeting of the Colored Nurses Association and coming back very enthusiastic. It was suggested every aid possible should be extended to the colored nurses.

Minutes of the NACGN state:

A letter from Mary P. Laxton (President of the NCSNA) was read which discussed affiliation between the NCSNA and the NCACGN. Miss Blanche Hays (Vice President of the NCACGN) made a motion that was seconded by Mrs. Robinson to write to Nurse Laxton approving affiliation between the 2 organizations.

On March 19, 1926, NCSNA President Laxton wrote to Jane VandeVrede, President of the ANA, saying:

We feel that affiliation with our state organization [the NACGN] would be wiser than accepting that organization as a section, that however is only the opinion of a few. You may also be interested to know that at our last annual meeting an advisory committee for the Colored Nurse Association, consisting of the State President, President of the Board of Examiners and the Education Director was appointed after some correspondence with the President of the Colored Nurse Association. As yet, we have not been called upon but signified our willingness to help them in any way we could.

As far as can be determined, nothing happened after these early discussions of affiliation. A merger finally occurred in 1949.

1930s

During the 1930s, despite the Great Depression with unemployment at records numbers  the NCACGN continued to grow. The group legally changed its name to the North Carolina Association of Negro Registered Nurses, Inc. (NCANRN) in 1931. In 1934 there were active chapters in Winston-Salem, Wilmington, High Point, Durham, Fayetteville, Greensboro, Raleigh, Charlotte, Weldon, Clinton, Rocky Mount, Goldsboro, Jamestown and Tarboro. By 1938, the membership numbered 150. Racial discrimination deeply concerned members. In 1937, there were only 11 hospitals in North Carolina employing African American nurses. In addition, African American nurses wanting to work in community health could only find jobs in a few cities. The seven African American nursing education programs open in 1930 were joined by Kate B. Reynolds Hospital School of Nursing in 1938.

These schools, like the segregated white schools in North Carolina, ranged from substandard to excellent. However, the disproportionate lack of funds for libraries and equipment, limited clinical facilities and less educated faculty in the African American schools were reflected in the 1936 State Board of Nursing examination results: 70% of white students passed, but only 36% of African American graduates passed that year. Some African American schools of nursing were successful in securing funds for nursing education from the Rosenwald and Duke Foundations and other sources in the 1930s. By 1940 the passing rates remained at 70% for white exam takers but rose to 50% for African Americans.  African Americans hospital schools of nursing in North Carolina that operated in the 1930s were St. Agnes in Raleigh, Lincoln in Durham, Good Samaritan in Charlotte, Community in Wilmington, Jubilee in Henderson, L. Richardson in Greensboro, The Negro Division of the State Sanitorium in Sanitorium, McCauley Private Hospital in Raleigh, and Kate B. Reynolds in Winston-Salem opened in 1938.  Blue Ridge Hospital School of Nursing in Asheville closed in 1930.

1940s

Attitudes and laws were slowly changing for the better in the 1940s. African American troops and nurses served in World War II in record numbers. In 1948, President Truman signed Executive Orders 9980 and 9981, integrating the armed forces and the federal work force. In line with these changes, in 1948 the American Nurse Association opened membership to individual RNs – no longer requiring membership in state affiliates in order to join the national organization. This opened the doors for all nurses of color in every state to join the ANA. After World War II, nurses—particularly those working in VA hospitals and other federal facilities—began organizing unions and entered into collective bargaining agreements. The NCSNA was the union representative for nurses at several VA hospitals in North Carolina. The federal government would only bargain with racially integrated unions. This provided a further incentive to integrate the NCSNA. Given these circumstances, leadership of the NCSNA and the NCANRN began talks to merge the two organizations in the mid-1940s. Despite some members’ misgivings in each organization, and concern about where an integrated group could meet and eat together under the segregation laws of North Carolina, majorities in each organization voted to merge.

The delegates to the 1947 NCSNA Convention voted to delete the sentence in their by-laws that read: “only white nurses can belong to this organization,” and in 1948, NCSNA delegates, by a vote of 52 to 22, voted to merge with the NCANRN. Elizabeth M. Thompson, President of NCANRN, closed the last meeting of the organization in 1949 with these words:

The final chapter has been written by the North Carolina Association of Negro Registered Nurses, Inc., but the activities of nurses and nursing must go on. As professional women, we all have a great part to play in furthering the progress and elevating the standards of this work. The integrating of the associations gives opportunity for great service, and by so doing, humanity will be better served.

Maria B. Noell, executive secretary of the NCSNA in 1949, reacted to the actions of the NCANRN by saying:

Since all citizens of North Carolina need adequate nursing care and since the professional nursing organizations are to a great degree responsible for such care, I believe the action taken this morning by the N.C. Association of Negro Registered Nurses, Inc. to dissolve its organization of 27 years standing and to associate itself wholly with the NC State Nurses’ Association will be a great asset in promoting nursing service for all North Carolinians.

1950s-1960s

While the desegregation of the NCSNA was a huge step forward, it took over a decade after the merger of the professional nursing organizations for white schools of nursing in North Carolina to accept African American students. It took the Simkins v. Moses Cone court case in 1963 and the passage of the federal Civil Rights Act of 1964 to begin to end employment discrimination against African American nurses in North Carolina. In 1962, Dean Helen Miller, RN, MSN, CNM, of the North Carolina Central University School of Nursing became the first African American nurse to be elected the president of a district nursing association in North Carolina (District 11). In 1966 she was the first African American nurse appointed to a three-year term on the North Carolina Board of Nursing. In 1967, Ollie Mae Massey Carroll, RN, became the first African American to graduate from the UNC Chapel Hill BSN program, and Donna Harris became the first African American BSN Duke University School of Nursing graduate. Twenty years later Dr. Ernestine Small became the first African American president of the NCSNA.

Most nurses today are unaware of the hard work and professionalism exhibited by a small group of African American Tarheel nurses in the first half of the twentieth century. These nurses worked under very difficult circumstances to promote professional nursing. Their determination to elevate the standards of nursing for themselves and their patients can inspire us today to address the issue of health disparities still plaguing our country.

 

Source

Pollitt, P. (2022). A Sourcebook of the North Carolina Association Of Colored Nurses. NC Docks permission granted by author. Available at: https://www.scribd.com/document/500638308/Sourcebookpart1. Article includes biographies of the six association presidents (pp.40-61), as well as several newspaper clippings related to early African American RNs.

 

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Presidents of the NCACGN/NCANRN

 

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Timeline of Selected Events After Merger of NCSNA and NCANRN

Note: The North Carolina State Nurses Association (NCSNA) changed its name to the North Carolina Nurse Association (NCNA) in the 1960s.

• By 1949 African American nurses served in key positions in the American Nurses Association committees.
• 1950 – Mrs. Rosa Mai Godley, former VP of the NCANRN was one of the North Carolina representatives to the national ANA convention in San Francisco.
• 1951 – On January 26, 1951 the NACGN dissolved and merged with the ANA.
• 1962 – Dean Helen Sullivan Miller of North Carolina Central University is elected the first district president (District 11) in the North Carolina State Nurse Association.
• 1966 - Dean Helen Sullivan Miller of North Carolina Central University is appointed by Governor Dan Moore to a three-year term on the North Carolina State Board of Nursing.
• 1967 – Olla Mae Massey Carroll is the first BSN graduate from UNC-Chapel Hill School of Nursing and Donna Harris is the first Duke University School of Nursing graduate.
• 1987- Dr. Ernestine Small is elected the first African American president of the North Carolina Nurse Association.
• 2017 – Dr. Ernest Grant, RN, PhD of Black Mountain became the fist African American male President of the NCNA.
• 2019 - North Carolinian Dr. Ernest Grant was elected the first African American male president of the ANA.
  
  

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