Prior to World War II, hospitals were staffed by physicians, nurses, specialists such as laboratory technicians, and a few support personnel such as cooks and janitors. World War II brought about massive changes in the staffing of health facilities. These changes were first felt in England in the late 1930s as the immense number of casualties put an intolerable strain on physicians and nurses. First, the nurses took over some of the physicians’ “duties,” such as taking blood pressures and starting intravenous therapy. This meant that the nurse needed someone to take over some of her duties. (The vast majority of nurses at that time were women.)
It had always been noted by nurses that “desk” duties such as answering the telephone or going on errands frequently interrupted the giving of nursing care. So an individual was added to the staff to do these duties. This person was designated a “floor clerk.” As the war went on, more and more responsibilities, such as copying diet lists and condition reports, were assigned to the “floor clerk” position description.
The first recorded unit coordinating history was found in an article, “In Favor of Floor Secretaries,” published in 1940 in a journal, The Modern Hospital, written by a hospital administrator. In the article, the author, Abraham Oseroff, outlined the implementation of unit coordinating at Montifiore Hospital in Pittsburgh, Pennsylvania. He described how “a new helper was introduced to the nursing unit to take care of the many details of a secretarial nature that formerly made demands on the limited time of the nurse.” The new helper was called a “floor secretary.” Mr. Oseroff further said,” that the idea of a floor secretary was first met with skepticism, but it proved to be worthwhile from the beginning.”
Following World War II, new hospitals were being built and old ones were being enlarged. The shortage of nurses continued and more responsibilities were being placed on the “ward clerk”, the name of the 1950s. These new duties, usually head nurse tasks, were ordering supplies, keeping up with time sheets and preparing certain reports. During the 1950s, hospitals began to train their ward clerks to transcribe physicians’ orders. About this time, some hospital administrators recognized that these individuals were performing tasks which were not strictly clerical, so more name changing took place and ward clerks also became know as unit clerks or unit secretaries.
By the 1960s, recognition of the need for educational programs took place. An article in Nursing Outlook, August 1966, by Ruth Stryker described the findings from a small hospital study on the functions of the head nurse, ward secretary, and ward manager. The findings resulted in the implementation of a hospital station secretary program in the Minnesota vocational education system. Miss Stryker had suggested the name “station coordinator,” because the ward secretary did a great deal of managing in the form of coordination of activities.
In 1977 a national survey was done by Myrna LaFleur (NAHUC founding president and instructor from Phoenix) to determine the number and kind of unit coordinating programs in existence in the United States. Fifty-two programs were located in adult educational centers, community colleges and vocation-technical schools. Not every state had a program. A part of the survey asked if the recipient was interested in the formation of a national association for unit coordinators.
In the spring of 1980, Myrna was asked to speak at the Upper Midwest Hospital Conference in Minneapolis, Minnesota to a group of unit coordinators and unit managers. A state association for unit coordinators had just been formed in Arizona, and realizing the need for a national association, Myrna included the possibility of forming such an association in her talk. Upon Myrna’s return home, feeling highly motivated by her trip she dug out the responses from the 1977 survey. She contacted those respondents who said they were highly interested in forming an association and invited them to meet in Phoenix in August 1980. Those people who came and became the founding members of NAHUC included Velma Kerschner from Texas, Kay Cox from California, Jane Pedersen from Wisconsin, Carolyn Hinken from New Mexico, and Helga Hegge from Minnesota. They were joined by Winnie Starr and the officers from AMSCA (Arizona association for unit coordinators). They spent a weekend hammering out the constitution, selecting a title, and declaring NAHUC the National Association of Health Unit Clerks/Coordinators, Inc.
In June of 1982, the first NAHUC annual national convention was held in San Antonio, Texas. At this convention, the Code of Ethics and Standards of Practice for unit coordinating were adopted. Education and recognition as a health profession were two of the main concerns of the founders of NAHUC. Accordingly, a subsidiary Certification Board was established and the first National Certification Examination was given in May 1983. By the end of 1991, approximately 15,000 health unit coordinators had become certified. Two other subsidiary boards, the Education Board and the Accreditation Board, were formed to work toward accreditation of programs and to establish an official listing of unit coordinator competencies.
Today Health Unit Coordinating is a health profession. According to Wilson and Neuhauser in their book, Health Services in the U.S., for a group to become a profession, they must meet the following criteria:
1. Have a national association.
2. Have a formal education.
3. Have certification.
4. Have a code of ethics.
5. Have an identified body of systematic knowledge and technical skill.
6. Have members that function with a degree of autonomy and authority under the assumption that they alone have the expertise to make decisions in their area of competence.