the late 1800s, the quality of nursing in the United States was
extremely variable and in disarray. There were no standards for entry
into practice: Persons who were educated and received diplomas from hospital schools of nursing could "nurse for hire” as ”trained nurses," while other "nurse for hire" persons who had either not attended or not graduated from any type of formal program were so-called "practical or domestic nurses." By the 1890s, there were approximately 3,000 trained
nurse graduates of 432 schools and an estimated 42,500 “domestic”
nurses. Even the “trained” nurses were from programs that were widely
diverse in their length of study and content, and physicians often
dictated nursing duties and methods of training. In short, nurses
themselves held little or no control at all over the development and
standards of their rapidly growing profession.
Nationally, early pioneer leaders such as Adelaide Nutting proposed the formation of a national nursing organization to elevate the standards of nursing education, establish a code of ethics and promote the interests of nursing. These first efforts to organize were through the existing alumnae associations of the training schools; in 1896, the Nurses Associated Alumnae of the United States and Canada was successfully formed as a national association of professional nurses. It was later renamed the American Nurses Association (ANA) in 1912.
The story of the Washington State Nurses Association (WSNA) is very similar.
As early as 1898, nurse leaders began attempting to start local nurses associations; in October of that year, the first county nurses association in Washington state was organized in Spokane. In the next few years, local associations in Seattle, Tacoma, Walla Walla and Whatcom County rapidly followed. In 1908, a group of 14 of these courageous, far-sighted nurse leaders officially formed the Washington State Graduate Nurses Association (WSGNA) — which would later be renamed the "Washington State Nurses Association (WSNA)" in 1940.