The Guardians of Childhood: Nurses at St. Louis Children’s Hospital

“…Lily was admitted to 7East. The nurses assigned to Lily’s care were very special. What was so amazing to us was their ability to see each child with a fresh new set of eyes. It is incredible to think that despite their work load during their 12-hour shifts that they could convey care, nurturing, and professionalism with each contact…Just being in a hospital with so many caring employees is most assuredly a factor in the healing process.”

-Excerpt from a letter of thanks published in Children’s: The Magazine of St. Louis Children’s Hospital, October 1997

This year St. Louis Children’s Hospital is celebrating 140 years of dedication and service to children and their families. To join in the celebration of this anniversary, Becker Library will premiere a new Glaser Gallery exhibit and present the 70th Historia Medica lecture exploring the history of St. Louis Children’s Hospital on Jan. 31. Throughout my research and preparation for the upcoming exhibit, I have been struck by the many groundbreaking changes that have taken place since the hospital’s inception, from surgical techniques to the treatment of malnourishment to neonatal intensive care. I have also realized that undergirding these sweeping changes to the way disease is understood and medicine is practiced, the foundation of St. Louis Children’s Hospital has always been the pediatric nurses who stand on the front lines of patient care.

In 2005, the American Nurses Credentialing Center designated St. Louis Children’s Hospital with Magnet status. Developed in 1994, the award is the highest honor in the United States for excellence in nursing, an achievement that only 3% of U.S. hospitals can claim. As of 2016, the hospital had over 1,300 nurses on staff working in 45 pediatric specialties. Although the level of compassion and care that Children’s Hospital nurses convey has always been extraordinary, the nursing profession has changed dramatically since the hospital first opened in 1879.

St. Louis Children’s Hospital initially employed only a single matron at a salary of $20 per month and had no nurses on staff at all. Nurses were soon hired, but their training was informal and unstandardized, and their employment status was considered at the same level as housekeeping staff. By 1885 the board of managers took a step toward formalizing nurses’ status by requiring that nurses wear uniforms, and in 1907, the board made a giant leap toward professionalization by establishing their own nurses’ training school. The St. Louis Children’s Hospital training school was soon absorbed into the Washington University School of Nursing, established in 1905 and formally closed in 1969 after affiliating with Barnes Hospital School of Nursing (now the Goldfarb School of Nursing).

No sooner was the crucial importance of a professionally trained nursing staff recognized by the board than the hospital endured a prolonged nursing shortage. When the United States entered World War I, a group of nurses from Children’s Hospital traveled overseas to serve with Base Hospital 21, one of the first six military hospital units sent to France ahead of the U.S. military. Due to the war, an already-depleted nursing staff was stretched even further as they cared for critically ill and contagious children during the 1918 influenza epidemic. Physician-in-Chief Williams McKim Marriott described the difficulty of this period in St. Louis Children’s Hospital’s 1918 annual report:

During the fifteen months covered by this report our country passed through the most critical period of the world war. The emergency called for every available man and woman and it may be truthfully said that every member of the Staff responded to the call. More than half entered the National Service; the others undertook willingly and enthusiastically the duties of absent members… With the appearance of the epidemic of influenza, in the fall of 1918, the Hospital was confronted with a serious problem. The nursing staff, never adequate in numbers, was further reduced; in addition applications for admission of children to the Hospital increased very considerably… Voluntary nurses’ aides came into the Hospital and rendered valuable assistance. In this way it was possible for the Hospital to care for almost a hundred influenza sufferers.

The hospital’s struggle to keep adequately staffed with nurses remained a constant through World War II when once again many nurses left for overseas assignments with Washington University’s 21st General Hospital.

Despite the constant stresses of being understaffed, the nurses at St. Louis Children’s Hospital brought about notable improvements in patient care. They spend an enormous amount of time advocating for their patients and families. Elizabeth O’Connell, a 1943 graduate of Washington University School of Nursing, served as the nursing superintendent at St. Louis Children’s Hospital from 1948 to 1957. She developed a coloring book with drawings by a student nurse for prospective patients to better understand what a typical hospital stay would entail. In a June 1954 St. Louis Post-Dispatch article describing the book, titled “Margie Goes to St. Louis Children’s Hospital,” Elizabeth O’Connell is also credited with relaxing the hospital’s visiting regulations, and putting the emotional needs of children and their parents into sharper focus.

When O’Connell wrote her book in the early 1950s, the St. Louis Children’s Hospital building was located at 500 South Kingshighway Blvd. Although an additional floor had been added to the original building in the 1930s, and an additional six-story wing was under construction, the hospital’s critical lack of space was in part the reason for restricted visiting hours for families (2- 4 p.m. and 6- 8 p.m.). Some doctors were also reluctant to have parents around because they thought the intensity of a parent’s anxiety would be noticeable to their child, potentially causing negative outcomes. O’Connell believed “[t]he best situation would be for parents to come and go at will,” but recognized that there was not enough space to accommodate so many people. She determined that for the first two days of a patient’s stay, parents could visit all day until bedtime, and after that, they’d have to stick to visiting hours unless their child was critically ill. It would be almost 20 more years before another nurse, Doris England, succeeded in instituting open visiting hours at the hospital.

Doris England was offered the position of director of nursing at St. Louis Children’s Hospital straight out of graduate school in 1965, when she was only 26 years old. She later became the vice president of patient care, a position she held until 1987. England became keenly interested in the relationships between hospitalized children and their parents when she was earning her Master of Science in Nursing at Washington University. She found an ally in Philip R. Dodge, chief of pediatrics from 1966-1984, who was also interested in reorganizing patient groups from an age-based system to groups based on diagnostic categories. Each of these changes was initially unpopular, as Dodge and England were altering policies that were nearly 100 years old, but they soon became recognized as providing benefits to staff and their patients in ways that far outweighed the initial inconveniences. When the new hospital building at 400 S. Kingshighway Blvd. opened in 1984, space was finally sufficient in patient rooms for parents to sleep near their children, including cushioned window seats and reclining chairs that opened into beds.

Over its 140-year history, St. Louis Children’s Hospital has remained steadfast in its mission to do what is right for children. That mission is a non-starter without a highly skilled and dedicated nursing staff. A nurse’s job at the hospital has changed in ways large and small since 1879, but a commitment to patients is the constant. Elizabeth O’Connell summed it up best as reminisced over her years as the superintendent of nursing, “Children’s Hospital was like a family, and a family will make sure every child gets the best of care. If the hospital had had a mantra, that would have been it. It was – and still is – a family of professionals and non-professionals, devoted to the care of children.”



O’Conner, Candace. Hope and Healing. St. Louis Children’s Hospital: The First 125 Years. St. Louis Children’s Hospital, 2006.

Start, Clarissa. “Book Explaining Hospital to Children.” St. Louis Post-Dispatch, Thursday, June 10, 1954.