Rationale and significance: In the early 20^th Century, most registered nurses worked as private duty nurses. The expense of private nursing limited the number of patients able to hire nurses. Professional nurse groups expended a significant amount of energy attempting to set fees at levels that would allow the largest number of patients to hire nurses yet maintain satisfactory nurse incomes. Many of the strategies used proved unpopular with nurses. The lack of a lasting solution pitted working nurses against their own leadership. Fee setting problems exerted long lasting implications affecting the supply and demand for nurse services.

Description of Methods: This study was carried out using the methods of social history research and the approaches and methods of case study analysis.

Primary and Secondary Sources: Primary sources used for this study include the records of national and local professional nurse associations, early 20^th century private duty registries, and records pertaining to studies carried out on the nurse labor market. Secondary sources included articles found in nursing and health related professional journals, newspaper reports and commentary on the status of nurses.

 Findings and Conclusions: Nurses’ fees and fee setting arrangements failed to either expand the market for nurse services or insure fair income for nurses. Contemporary studies identified low income levels of nurses as a major problem. Health care experts urged nurses to adopt measures that would expand their services to a larger population. Nurse leaders voiced consistent concern over the situation but were unable to resolve the issue in an adequate manner. Private duty nurses and patients remained frustrated by a dysfunctional system of nurse distribution.