American nurses have changed in the last generation. This transformation is manifested in their education, clinical responsibility, and in the huge increase in their numbers relative to the population. During recent decades the scope of nurses' practice expanded to include many new responsibilities, including work formerly in the province of physicians, as well as entirely new functions. Today the term nurse encompasses a wider and more complex spectrum of individual academic attainment and practice than was true in 1950. In the 1980s nurses began to be much better paid relative to previous decades and to other workers. Taken together, all these factors add up to new and different life-style and career prospects associated with nursing.

As health care systems organize to emphasize care in the community, the home, and other alternative settings, the centrality of the hospital to the system and to nursing will probably be diminished.
Until the publication of this book, no single secondary source reported on this highly eventful era in nursing. A rapidly growing professional literature and a barrage of commissioned studies of nursing, however, provided ample material for reconsideration and analysis of the linkages between nursing and hospitals.

This book, based on voluminous government and professional studies of the hospital nursing problem commissioned during the last fifty years, explores these criticisms, highlights persisting themes, and shows how today's concerns relate to those of the recent past.