1908–1920: The formative years

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10s influenz epidemic
Policemen wear masks during the influenza epidemic of 1917.

The need for nurses grows

During the early part of the 20th century, health needs in the state of Washington were many and varied. Although the trend was for more hospitals, the bulk of hospital nursing service was provided by students — and the largest field for graduate nurses was private duty nursing in the hospital and the home. The hours were long, and wages were low. In the majority of cases, this meant 20 to 24-hour duty with an average wage of $3 to $5 per day. It was also in this period that the need for the visiting or public health nurse became apparent. The first industrial nurses were also employed in this era; indications were that this, too, would be a consistently growing field of nursing.

As the United States moved into World War I, the first experience with a serious shortage of trained nurses became a reality. The need for nurses was compounded by the national influenza epidemic of 1918 and the public demands for the development of public health. These factors placed a heavy burden on the nursing profession. In addition, the scope of nursing practice was expanding, with corresponding demands for nurses in laboratory work, anesthesia and hospital staff work.


In 1908, a group of 14 nurse leaders officially formed the Washington State Graduate Nurses Associ­a­tion (WSGNA). The WSGWA was renamed the​ “Washington State Nurses Associ­a­tion (WSNA)” in 1940.

It was concern for the public’s welfare that prompted these nurses to organize. They formed the WSGNA so that, working together, nurses could effec­tively achieve the following goals:

  • Bring into one compact organi­za­tion the nursing profes­sion of the state of Washington.
  • Extend, advance and elevate the standards of nursing practice (Nursing Practice and Education).
  • Secure enact­ment and enforce­ment of just nursing laws (Legis­la­tion and Public Policy).
  • Promote friend­ship among the nurses (Networking and Mentoring).
  • Guard and foster the material inter­ests of nurses (Economic and General Welfare and Profes­sional Devel­op­ment of Nurses).
  • Enlighten and direct public opinion.

In order to achieve their objec­tives, the founding nurses knew they must regulate the practice of nursing and raise the standards of nursing practice.

Following two years of intense work, the delegates of the third WSGNA Convention finalized and adopted the original Articles of Incorporation.


  • WSGNA lobbied the state legislature and achieved passage of the first Nurse Practice Act in Washington state. This was no small feat, as many legislators feared that the title “registered nurse” would make it possible for nurses to practice medicine, surgery or midwifery. Nurses, however, were determined not to fail in their first organized attempt to set standards and gain status. This was the beginning of the active, aggressive government relations program that remains an integral part of WSNA today.
  • On April 18, the first Board of Nurse Examiners was appointed by the governor. The Board consisted of five graduate nurses with at least three years of experience. In September, the first examination was held in Seattle for one applicant, George Smith, a graduate of the Annie Paddock School of Nursing (now Tacoma General Hospital School of Nursing). George became the first licensed nurse in Washington state.


As the nation struggled with a growing tuberculosis (TB) epidemic, WSGNA members contributed funds to build a TB cottage at Riverton for the care of nurses who contracted TB.

10s anna r moore red cross


WSGNA helped form the Washington State Organization for Public Health Nursing as part of the National Organization for Public Health Nursing.


A national influenza epidemic and World War I produced the first severe nursing shortage; nurses were urged to join the armed forces and nurses responded en masse. The first WSGNA president, May S. Loomis, was in charge of nurse recruitment for the state. As the nurse shortage and influenza epidemic peaked in local communities, public health nurses, inactive married nurses and non-nurse volunteers responded to the local call for nurses — serving with courage, determination and unbelievable stamina.


WSGNA supported a pay increase for private duty nurses to $5 per day because of the high cost of living.