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The Politics of Nursing Knowledge

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The Politics of Nursing Knowledge The Politics of Nursing Knowledge The entry of nursing into higher education has raised a number of questions about its academic identity and future. The Politics of Nursing Knowledge puts into context the historical factors which have shaped the development of nurse education and lays the foundations for an historical sociology of nursing knowledge. Based on substantial new research and drawing on government and professional records, The Politics of Nursing Knowledge looks at how nurse education has been shaped by wider social attitudes towards gender and class. In a critical reappraisal of Florence Nightingale’s vision of nursing, Anne Marie Rafferty explores the implications of Nightingale’s belief that nursing training should be regarded as an education of character rather than an intellectual discipline. Analysing the relationship between nursing and associated professions, the author traces the evolution of training and policy-making from the origins of hospital reform in the 1860s to the start of the National Health Service (NHS) in 1948. Examining the contemporary issues affecting nursing, The Politics of Nursing Knowledge questions the extent to which the notion of a ‘profession’ is compatible with the career patterns and lifestyle opportunities of the majority of nurses, who are women. Looking to the future of nursing as an academic discipline, the final chapter asks whether an intellectually self-confident culture can emerge or whether the contradictions of professionalism and the health care system will prevent nursing from achieving its full potential. Anne Marie Rafferty is Director of the Centre for Policy in Nursing Research, London School of Hygiene and Tropical Medicine, and Research Associate at the Wellcome Unit for the History of Medicine, University of Oxford. The Politics of Nursing Knowledge Anne Marie Rafferty London and New York For my mother, Bridget Rafferty and the memory of my father, Michael Smith Rafferty First published 1996 by Routledge 11 New Fetter Lane, London EC4P 4EE This edition published in the Taylor & Francis e-Library, 2002. Simultaneously published in the USA and Canada by Routledge 29 West 35th Street, New York, NY 10001 © 1996 Anne Marie Rafferty All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloguing in Publication Data Rafferty, Anne Marie. The politics of nursing knowledge/Anne Marie Rafferty. Includes bibliographical references and index. 1. Nursing—Study and teaching—Government policy—Great Britain. 2. Nurses—Education—Political aspects—Great Britain. 3. Professional socialization—Great Britain. 4. Occupational prestige—Great Britain. 5. Nurses—Social conditions—Great Britain. I. Title. [DNLM: 1. Education, Nursing—organization & administra- tion—Great Britain. 2. Education, Nursing—history—Great Britain. 3. Nursing—trends—Great Britain. 4. Social Conditions —Great Britain. WY 18 R137p 1996] RT81.G7R34 1996 610.73’071’141–dc20 ISBN 0-203-42896-X Master e-book ISBN ISBN 0-203-73720-2 (Adobe eReader Format) ISBN 0-415-11491-8 (hbk) ISBN 0-415-11492-6 (pbk) Contents Acknowledgements vii List of abbreviations ix Introduction 1 1 Reformatory rhetoric 9 2 The character of training and training of character 23 3 Registration revisited 42 4 The Nurses’ Registration Act 68 5 Crisis and conflict in the Caretaker Council (1919–23) 96 6 The education policy of the General Nursing Council (1919–32) 113 7 Commission and committee in nurse education policy (1930–9) 139 8 Nationalising nursing education (1939–48) 157 Conclusion 182 Notes 193 Bibliography 256 Index 287 Acknowledgements I have accumulated many debts in the course of producing this book. Many friends and colleagues have contributed to it in visible and invisible ways; my heartfelt thanks to all of them. Dr Charles Webster was an inspiring supervisor who launched me into the research upon which the book is based and who has been a most generous and unfailing source of advice, encouragement, expertise and humour. Professor Pamela Gillies has been a tower of strength and fellow traveller along the path taken by this book, and I am deeply in her debt forever. Colleagues at the Wellcome Unit for the History of Medicine in Oxford provided a haven of friendship, facilities and a model community of scholarship. Josephine Guy was a friend and critic of style and substance. I am especially grateful to Richard Smith, Elizabeth Peretz, Anne Summers and Professor Michael Dols, who sadly died before I could thank him. Professor Robert Dingwall shared his insights and interest in nursing so generously with me. Elizabeth Rafferty provided immeasurable support when all seemed bleak and beyond. The research upon which this thesis is based could not have been begun without a Department of Health nursing research studentship. The Wellcome Trust generously continued the support of the research and I am deeply grateful to them. No historical research can be completed without the thoughtful consideration of librarians and archivists. I am deeply grateful to librarians of the Bodleian and Radcliffe Science Libraries, Radcliffe Infirmary, Oxford, the Royal College of Nursing, London, and the University of Nottingham. Susan McGann, archivist at the Royal College of Nursing, has been unstinting in her support and friendship. The staff of the Public Record Office were efficient and very helpful in their retrieval of files consulted at Kew. Many thanks to Edwina Welham and Alison Poyner at Routledge for their patience and perseverance. viii Acknowledgements Colleagues from Oxcept, John Radcliffe Hospital, the Department of Nursing Studies Department, University of Nottingham, and the University of Pennsylvania, where I spent an academic year as a Harkness Fellow, have given me more than collegial support. In particular I should like to thank Wendy Green and Jill Buckledee from Oxcept, and Professor Jane Robinson and Mark Avis from Nottingham. Professors Linda Aiken and Joan Lynaugh from the University of Pennsylvania were exemplary role models and mentors for me in the USA. Joan Lynaugh’s enthusiasm for this work and her leadership of the International Council of Nurses (ICN) Centennial Project, in which I have had the privilege of participating, have been inspirational. Throughout the period of writing this book I have also benefited from the scholarly and social support of the ICN History Collective, which I have found a model of collaborative exchange and research. Latterly I have been privileged to work with excellent colleagues at the London School of Hygiene and Tropical Medicine. Jenny Stanley has helped to prepare this manuscript with her usual skill and efficiency. Lara Marks, Jo-Ann Crawford and Aylish Wood have provided shelter and sustenance during my research trips. My family have spurred me on, especially my mother, Bridget Rafferty, with her ‘faith’. The stories of her own nursing experiences have kindled my imagination and form part of the written and unwritten history of this study. Special thanks also go to Katie McCaughey and Danny and Peter Rafferty for their support and sustenance. Last but not least, a great debt of gratitude is due to my father, Michael Rafferty, for his constant confidence and encouragement throughout our adventures and misadventures. We miss his sense of values, humour and humanity immeasurably. Abbreviations AHM Association of Hospital Matrons BHA British Hospitals Association BMA British Medical Association BNA British Nurses’ Association CAB Cabinet Committee CMB Central Midwives Board COHSE Confederation of Health Services Employees ED Board of Education EMS Emergency Medical Service GMC General Medical Council GNC General Nursing Council GPDST Girls’ Public Day Schools Trust ICN International Council of Nurses ICW International Council of Women LAB Ministry of Labour and National Service LCC London County Council MH Ministry of Health NALGO National Association of Local Government Officers NAPSS National Association for the Promotion of Social Science NAWU National Asylum Workers Union NHS National Health Service NPFN National Pension Fund for Nurses NUCO National Union of County Officers PRO Public Record Office PUTN Professional Union of Trained Nurses RBNA Royal British Nurses’ Association RCN Royal College of Nursing RMN Registered Mental Nurse x Abbreviations RMPA Royal Medico-Psychological Association RRC Royal Red Cross SMA Socialist Medical Association SRN State Registered Nurse SSRN Society for the State Registration of Nurses T Treasury TB Tuberculosis TUC Trades Union Congress VAD Voluntary Aid Detachment WSPU Women’s Social and Political Union Introduction Education lies at the centre of professional work and expertise and therefore occupies a pivotal position in the shaping of occupational culture and the politics of nursing. Far from being a value-neutral and disinterested activity, education represents a powerful vehicle for socialisation and the transmission of culture. But nursing education has been characterised by the inculcation of moral values and virtues rather than intellectual prowess. Indeed ‘virtue’ has been at the ‘heart’ of nursing education since it began to be codified
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