Introduction

Nursing evolved from an informal and unregulated practice for centuries. Leaders such as England’s Florence Nightingale, considered to be the founder of modern nursing, saw a need to formalize education and set high standards for practice. In America, nursing leaders saw not only a need to formalize education and set high standards for nursing practice, but to seek regulation through government and hold individuals accountable for their practice.

Professional nursing had its beginning in Alabama in 1888 when three trained nurses arrived in Birmingham from the old Blockley Hospital in Philadelphia to take charge of the Almshouse. Soon other nurses followed in large numbers and physicians offices and hospitals in the state established training schools. The supply of nurses grew rapidly. The quality of nurses entering the state was of concern to resident nurses and the training schools were often questionable. A group of concerned nurses in Birmingham organized in 1913 and took measures to seek state government regulations for nurses and to protect the public against imposters. The legislature of Alabama responded to their efforts and passed the first Nurse Practice Act in 1915 thereby establishing an Alabama Board of Nurse Examination and Registration. Governor Charles Henderson signed the bill into law on August 6^th, 1915.

The Early Years

The state’s legislature and subsequent Governors have continued to support the efforts of the board to promote the public safety and welfare. Today’s Board of Nursing takes seriously the challenge and responsibility of regulating nursing practice and education. From its humble beginnings of meeting in four different locations around the state with no specific headquarters, the Alabama Board of Nursing is now centrally located in the state complex near the Capitol.

Earliest minutes show that the first official meeting of the Board was held at the Tutweiler Hotel in Birmingham on November 23, 1915. The Governor appointed the first members, two physicians and three registered nurses on October 28, 1915. One of these was from the Alabama State Association of Graduate Nurses. The first item of business was to decide on the rules governing the Board. The first president of the Board was Mrs. Lamoyn Phares and the first authorized secretary of the Board was Miss Helen McLean. Miss McLean was paid $75.00 for the year for her services. The Fidelity Deposit Company of Maryland bonded Miss McLean for $1000.00.

The 1915 law focused heavily on entry into practice of nursing, specifically the regulation of nursing education. At the first meeting in 1916, 14 schools were approved; the first of which was Saint Vincent’s Hospital Training School in Birmingham. The first board was forward thinking, Dr. J.N Baker moved at the fifth meeting in 1917 for Alabama to make an agreement with all states desiring to have reciprocity whose standards is equal or higher. The same board set the standards for curriculum requirement for training schools. They planned the first examinations.

In 1921, Miss Linna Denny, now recognized as the first executive officer of the Board, actually started as the secretary of the Board. Her career as described in the 1929 American Journal of Nursing as epitomizing the history of nursing in Alabama.

Miss Denny was recognized at the state and national levels for her business abilities and leadership. At one time she held three offices, two of which were executive secretary of the State Association of Graduate Nurses and the executive officer of the Board. Her dedication was such that she contributed a room in her home as the first office of the Board. In 1923 her salary was set at $250.00. Under her leadership the Board’s activities assumed structure in matters of licensure and regulation of education. Operations became more formalized. The nurses themselves once licensed were active in practice and responsive to national interest.

The Twenties and Thirties

As the Board entered the 20s and 30s collaborative relations with physicians continued. Concerns about curriculum were considerable. In 1931 a group of physicians asked for a conference with the Board and made a plea for education for all nurses. Matters of discipline began to emerge in this era. The Board employed a lawyer, Mr. Phares Coleman prior to 1922. Records show that discussions were held with him regarding matters of discipline and legislation required to amend the laws. Disciplinary cases were few. Although it had been presumed that the secretary managed earlier cases, the first case mentioned in the minutes occurred in 1928 and referenced a drug addict in which the individuals certificate of registration was returned. In 1932 a letter of complaint of immoral conduct was presented and the license of that nurse was revoked. Two other cases were mentioned in the same year. Due process was followed. Today, matters of discipline are extensive.

The Forties and Fifties

In 1939 two events occurred that began a reshaping of the first board. Miss MacLean died and Miss Denny retired. At this time one of the physicians was replaced by a nurse on the board. In 1942 the title of the board was altered to be the State Board of Nurse Examiners. The war years were in full swing. The state licensure examination, previously handwritten in essay form and written by the physicians now was contracted by a national board under the National League for Nursing Education. There was also a new challenge on the educational scene. The war years had taken its toll on the numbers of nurses available. A study indicated the need for a second level of practitioner. What had previously been a board of nursing for registered nurses became one for RNs and LPNs. Licensed practical nurses entered the scene in 1946. The first were accepted by waiver.

At the same time a curriculum was being developed for LPN programs. The first LPN programs were at Birmingham, Gadsden and Dothan Technical schools.

Up through the 1950s hospital schools of nursing conducted most of the education for registered nurses. Tuskegee University offered the first baccalaureate degree program in nursing in 1948. In the late 1940s plans materialized to implement the first state supported nursing education program that offered a baccalaureate degree. The University of Alabama School of Nursing opened in 1950 under the leadership of Dean Florence Hixson.

The Sixties and Seventies

Societal changes were occurring that impacted the laws governing nurses. Antiquated laws were examined and changed through the efforts of concerned nurses. Physicians were no longer appointed to the board by 1965 and matters of segregation were addressed. Meanwhile licensed practical nurse education grew in promise and popularity. Graduate LPNs organized and in 1965 the first LPN was appointed to the Board. Mrs. Mildred Westmoreland attended her first meeting in January of 1966. At first they did not have a vote on the board. Then as time progressed a vote was allowed on matters that affected LPNs. Today LPNs have assumed a full participatory role on the Board.

In the 1960s focus of the board was on the egalitarian movement in education. Associate degree programs in nursing began in community colleges after the enactment of the 1965 Nurse Practice Act.

While education was a major focus for board decision making the board also confronted with an increase in disciplinary matters. Although the board had from the beginning interacted with the legislature prior to the 60s to insure the requirements of the law were met and necessary changes were made to meet societal demands the board became more politically conscious to achieve its functions. Dr. Katherine Crossland, president of the Board from 1973-1979 and dean of the second state supported baccalaureate program broke ground for the school at the University of Alabama in Huntsville. In the 1970s a critical legislative move that involved the board was made to assure that schools of nursing help prepare qualified teachers. Special legislation was initiated to provide scholarships for selected and qualified applicants. Today the Board of Nursing administers 15 post-baccalaureate scholarships for qualified nurses seeking advanced degrees in schools of nursing.

The Eighties and Nineties

In the 1980s practice emerged as the major focus of the board. Special focus was placed on continuing competence of nurses. Greater emphasis was also placed on interactions at the national level and the Board became more astute to political obligations and public accountability. Discipline issues continued to increase. The enactment of the Administrative Procedures Act in 1982 led to a formalized structure for rulemaking. Due process was assured to licensees. Staff of the Board was increased to handle an increasing number of complaints and investigations.

The 90s showed a proactive thrust of all board members, with an inclusive membership of representatives from licensed practical nurses, registered nurses, advanced practice nurses, consumers, men and women, issues are addressed in public meetings. The legislature required mandatory continuing education for license renewal and the Board began implementing and enforcing the mandatory law in 1991.

In response to growing concerns about public protection and consumer rights the first consumer board member was appointed to the board in 1998. Dr. Anne Permaloff, a political science professor at Auburn University-Montgomery, served as the first consumer member of the Board.

Issues of scope of practice expanded practice roles of nurses through advance practice led to the addition of two advanced practice nurse positions on the Board in 1998. Three practice/nursing administration positions were also added in 1998. The Board is now comprised of 13 members.

Conclusion