REFRAMING DISORDER: GENDER, CLASS, AND THE HISTORY OF THE RESURFACING DEBATE IN NURSING by April D. Matthias July, 2011 Director of Dissertation: Sylvia T. Brown Major Department: Nursing The nursing profession has sustained a state of disorder. The debate within the disorder historically exists in relationship to multiple educational pathways for entry into RN practice. Diploma, BSN, and ADN pathways still exist today as a means to enter into nursing practice through RN licensure. Historical research of the three pathway developments is significant and timely in that the evidence from the study helps to shed light on professional issues resurfacing in the “BSN in 10” proposals. The purpose of this research is to understand the socio-cultural-political context surrounding the decisions to develop the diploma, BSN, and ADN educational pathways; the historical debate concerning the role and functions, educational pathway, and professional identity of the entry-level RN; and the relationship between the educational pathway developments and the resurfacing historical debate. Historical case study research focused on three historical decision points for the educational pathway developments: Diploma-Bellevue Training School for Nurses in New York, 1873; BSN-University of Cincinnati School for Nursing and Health in Ohio, 1916; and ADN-Orange County Community College nursing program in Middletown, New York, 1952. Archival retrieval of primary documents for each case study was completed. Each educational pathway development revealed divisions of gender and paternalistic control over nursing, divisions of class within nursing, and an undefined division of nursing labor. Prolonged paternalistic control rooted in divisions of gender, coupled with the divisions of class and unstructured divisions of labor within nursing, prevented full realization of a professional, collegiate education for entry into RN practice. The historical debate continues as a distinct professional identity and role does not exist for the entry-level RN. Lack of clear differentiation of role and functions within nursing practice for each pathway nurse creates an education-practice disorder, sustains division within the profession of nursing, and permits continued paternalistic control over nursing. Facing the “BSN in 10” proposals, nursing must reach a decision regarding the needed division of labor within nursing for today’s health care system. Nursing can resolve the historical debate by reframing Montag’s practice model and delineating an educational preparation for each practice role. REFRAMING DISORDER: GENDER, CLASS, AND THE HISTORY OF THE RESURFACING DEBATE IN NURSING A Dissertation Presented to the Faculty of the College of Nursing East Carolina University In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Degree in Nursing by April D. Matthias July, 2011 Copyright by APRIL D. MATTHIAS 2011 All Rights Reserved REFRAMING DISORDER: GENDER, CLASS, AND THE HISTORY OF THE RESURFACING DEBATE IN NURSING BY APRIL D. MATTHIAS APPROVED BY: DIRECTOR OF DISSERTATION: Sylvia T. Brown, EdD, RN, CNE COMMITTEE MEMBER: Marie E. Pokorny, PhD, RN COMMITTEE MEMBER: Ann Schreier, PhD, RN COMMITTEE MEMBER: Karin L. Zipf, PhD DEAN OF THE COLLEGE OF NURSING: Sylvia T. Brown, EdD, RN, CNE DEAN OF THE GRADUATE SCHOOL: Paul J. Gemperline, PhD DEDICATION To my brother, Jason Irey, and grandfather, Kenneth Lee Hill, PhD Your spiritual presence within my heart provides me strength. I love you and miss you both. ACKNOWLEDGMENTS Many individuals touched my work both personally and professionally throughout the process of this research study. My acknowledgments may seem lengthy but so many people helped me through this journey and they deserve recognition. I wish to first acknowledge the intimate connections with individuals who contributed to my work personally separate from the professional relations and contributions. First and foremost, I praise God for the guidance provided to me in my weakest and most vulnerable, as well as my strongest and most successful, moments. Every challenge, decision, obstacle, accomplishment, “aha” moment, and reward provided to me by my God shaped my work into what it has become. I cannot express enough my love and gratitude toward my husband, Bill, and my daughters, Jacelyn and Noelle. Without their unending and tenacious support, encouragement, patience, and tolerance, I may not have completed this research study. I am grateful to my father, Roy Irey, and my mother, Nina McCauley, for the love and lessons they have provided me. My father has taught me how to be analytical and objective yet, remain compassionate. My mother has taught me through positive role modeling that I can achieve anything I set out to accomplish. Although for many, my parents’ lessons may seem unrelated to my research, their lessons greatly facilitated the completion of this study. I would like to extend my love and appreciation to my and my children’s Godparents, Aunt Linda and Uncle Gary Parker, for their consistent prayer and endless faith in me. To my stepson and daughter-in-law, Billy and Beth Matthias, thank you for listening and encouraging me and your father, Bill, as we journeyed through this research as a family. Thank you to Emily and Chuck Egerton, who provided for me a very productive week by allowing me to escape to their beach house to write uninterrupted for several days. To all my church friends and “Supergirls,” thank you for your unending encouragement and prayers. And now, I wish to acknowledge the many individuals who provided professional and academic contributions to my research. I appreciate Dr. Martha Alligood for her suggestion to learn the “real story” about associate degree nursing—an independent summer inquiry that blossomed into this research study. Dr. Martha Libster recognized the originality and research potential of my questions. She shared with me her love of nursing history and guided the development of my historical research questions and the process of my first two archival visits. Her passion and shared expertise will remain with me forever. Dr. Sylvia Brown, who began as my faculty advisor and now serves as my dissertation chair, has been with me throughout my entire PhD experience. She has supported, pushed, questioned, listened, and encouraged me at all the right moments. Dr. Marie Pokorny, a professor of my qualitative research method course and historical research elective course, now serves as a valuable dissertation committee member. Her enthusiasm and love of nursing history and research penetrates everyone around her and positively influences her students. Dr. Ann Schreier, the quiet but profound presence on my committee, provides me with strength and encouragement. Her knowledge and expertise—from my days working as her teacher’s assistant to the days she served on my committee—has proved invaluable. The knowledge and expertise of Dr. Karin Zipf, whom I sat with numerous mornings at the Starlight Café discussing women’s history, gender methodology, and feminist perspectives, has enlightened my work and moved my writing to the active voice. Many individuals have assisted me in my archival retrieval of documents. I would like to thank Melissa Nasea of the East Carolina University, William E. Laupus Health Sciences Library for helping me find the first document for my preliminary literature review. I am truly grateful to Gertrude Hutchison and Cathryne Welch of the Foundation of the New York State Nurses Association, Bellevue Alumnae Center for Nursing History in Guilderland, New York for their warm hospitality during my archival visit and the pristine archive index of the Bellevue Alumnae Center. Suzanne Maggard and Janice Schulz were extremely helpful to me during my visits to the Archives and Rare Books Library/Blegen Library at the University of Cincinnati in Ohio. Special thanks go to Rebecca Bogart, the financial administrator of the University of Cincinnati, College of Nursing, for assisting me during my first visit to the Wedbush Centre but more importantly for introducing me to Betty Michaels, a 1946 University of Cincinnati BSN graduate. I extend heartfelt gratitude to Betty for opening her home to me during my second archival visit and helping me find needed documents within the Wedbush Centre. Meeting Betty was an unexpected joy I experienced through my research. Last but not least, I extend my thanks to Jennifer Govan of the Gottesman Libraries Archives at Teachers College, Columbia University in New York, a woman I have never met, for her dedication and many hours locating and sending documents to me for my research. I wish to express my gratitude to each and every person who has taken the time to listen. Every educator, nurse, student, and friend who engaged in dialogue with me throughout the entire process of this research study has influenced my work. The passage of time and every detour, contact, emotion, and thought that occurred were all necessary to produce this research study and analysis before you now. May God bless each and every one of you! TABLE OF CONTENTS CHAPTER 1 – Introduction.................................................................................................1 The Disorder ...............................................................................................................2 Significance of the Research ......................................................................................2 Attempts to Resolve the Disorder ..............................................................................3