Making Nursing a Profession

By the early 20th century, hospital administrators discovered that running a nursing school gave a hospital ready access to cheap labor, so hospitals across the nation began opening such schools. Within these hospital-based schools, education was secondary to patient care, and many schools had neither paid instructors nor libraries. Students worked on the wards for 10–12 hours a day, with work assignments based on hospital needs rather than on educational goals. Formal lectures or training, if any, occurred only after other work was done.

This exploitative training system stemmed directly if unintentionally from the Nightingale model and its emphasis on caring and duty. As historian Susan Reverby notes, “Since nursing theory emphasized training in discipline, order, and practical skills, the ideological justification explained the abuse of stu- dent labor. And because the nursing work force was made up almost entirely of women, altruism, sacrifice, and submission were expected and encouraged.”

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Those women who, by the beginning of the 20th century, sought to make nursing a profession by raising educational standards, establishing standards for licensure or registration, and improving the field’s status found their hands tied by the nature of the field. According to Reverby, to raise its status, nursing reformers had to exalt the womanly character and service ethic of nursing while insisting on the right of nurses to act in their own self-interest, yet not be “unladylike.” They had to demand higher wages commensurate with their skills and position, but not appear “commercial.” Denouncing the exploitation of nursing students as workers, they had to forge political alliances with hospital physicians and administrators who perpetrated this system of training. While lauding character and sacrifice, they had to measure it with educational criteria in order to formulate registration laws and set admission standards. In doing so, they attacked the background, training, and ideology of the majority of working nurses. Such a series of contradictions were impossible to reconcile.

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