1. Ordered to Care Chapter 7 Professionalism and its Discontents Angela Bridges Wendy DuBose BEF 644 Fall 2012

2. 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

3. 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

4. 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

5. 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

6. Hostility and Indifference in the Public Realm Environment changing o Nursing education/training more accepted in medicine o Growing hostility from administrators and physicians Dr. Catlin o Endowed home for nurses o Training by physicians o Fees determined by physicians

7. 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 )

8. Traditionalists versus Rationalizers Annette 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.

9. References : Reverby, S. M. (1987). Ordered to care: The dilemma of American nursing, 1850-1945. Cambridge, United Kingdom: Cambridge University Press