Ordered to Care Chapter 7

Professionalism and its Discontents

Angela BridgesWendy DuBose

BEF 644Fall 2012

Introduction

• Trained Nurse and Hospital Review (1889)– Discussed need for national

organization for nursing– Intent was to:

a. Limit number of nurses

b. Standardize education requirements

c. Increase education requirements

Obstacles for Reform

• Womanly character vs “unladylike” conduct

• Service oriented work ethic vs self-interest

• Wages vs commercialism• Female vs Male gender

• Admission standards• Exploitation of nursing

students• Criterion for education• Lack of public buy-in for

educating nurses• Alienation from working

nurses

Professional Reformation

1893 Isabel Hampton Robb

• Instrumental in founding the American Society of Superintendents of Training Schools (ASSTS)-known today as the National League of Nursing Education (NLNE)

• ASSTS drafted and approved bylaws that set standards for admission into nursing schools

History of Nursing Reformation

• 1897- Funds collected for official nursing journal

(American Journal of Nursing)

• 1889-proposition for organization called the American Nurses Association (ANA)

• State Board examinations

On left from top, clockwise:

Lillian Wald, Lavinia Dock, & Adelaide Nutting

Hostility and Indifferencein the Public Realm

• Environment changingo Nursing education/training

more accepted in medicineo Growing hostility from

administrators and physicians

• Dr. Catlino Endowed home for nurseso Training by physicianso Fees determined by

physicians

Nursing: Ununited

Worker-Nurse Perspective•Concern with wages, working conditions, practical skills, independence •Resisted professionalization through registration and educational reform•Selection of nurses through character•Some adept in skills, modifying hospital techniques•Some inadequate based on training.

“Where there is one nurse with a missionary spirit,….there are forty-nine others who are obliged to make the humiliating confession: I am a nurse because I must earn a living for myself and those dependent on me, because my nursing is well paid, honorable and to me is interesting.” Trained Nurse (1888)

Traditionalists versus RationalizersAnnette Fiske-private duty nurse and educator

• Character/service; not education• Private duty most important• Attacked elitism of leadership• Objected to routinization• Recognized problems-no

solutions

Charlotte Aikens-nurse and hospital superintendent

• Character/service; not education• Raise nursing standards through

organizational power• Provide hospitals with cheap

labor• Proposed grading/classification of

nurses.

References:Reverby, S. M. (1987). Ordered to care: The dilemma of American nursing, 1850-1945.

Cambridge, United Kingdom: Cambridge University Press