The modern nurse emerged from the church and the military. Religious sisters served in almshouses, caring for the poor and sick as part of their religious service. Military nurses came from two classes, patriotic women who wanted to serve their country, and servants and camp followers who knew how to provide hands on care. Florence Nightingale was very clear about the two classes of nurses. The patriotic women were the managers and Florence required them to have little direct contact with patients; their job was to direct the work of the floor nurses. The direct care nurses came from the large service class who understood how to be of service in any way necessary.
In the modern hospital, the head nurse or matron had similar authority over nurses as the medical superintendent had over the entire hospital. She was in charge of training and supervising a nursing staff that was made up largely of trainees who usually lived in the nursing school and served for long hours in the hospital. The nurses were being trained in the ways of the modern hospital and their schools were modelled after the medical schools in many ways. As trainees, student nurses were given many of the more menial tasks in the teaching environment that had been the responsibility of apprentice doctors before medical schools became professionalized. The political friction that characterizes the relationship between doctors and nurses was present as far back as 1914.
In The Modern Hospital, we read:
There seems to be something radically wrong with the trained nurse of today – the medical profession says there is something wrong; the thinking women at the head of training-schools say there is something wrong; and the lay public finds something radically wrong. Not all these elements agree as to just what the trouble is, in fact, they all seem to differ. The doctors say the nurses who are being graduated from the training-schools are not efficient, and a great many thinking members of the medical profession say that the nurses are being trained to too fine a point, but not in the right direction . The heads of training-schools think the nurses are not being sufficiently trained. The public does not seem to care to analyze the situation, but merely finds fault with the nurse as an individual (pg. 34).
The author goes on to present the medical side of the argument – doctors, now scientifically trained, have begun to assume the clinical authority that nurses used to have, and nurses have been left behind and resent their supportive role. One can see that the hospital has already become the battleground between doctors and nurses over the division of clinical labour. Today, nurses continue to struggle to work to “their full scope of practice.” Since early on nurse have been trained to assume far more clinical responsibility than they are actually given. For many years they were considered to be the aides and supporting staff for doctors: their role was to carry out orders of the doctors with no independent practice. From the beginning of nursing some nurses went on to become doctors in order to expand their role and authority. Some have accepted that their role is a ‘pink collar’ occupation, and see themselves as the health care equivalent of police and firemen. And yet others have taken on the political burden of making nursing a health profession fully on a par with medicine and with its own knowledge and philosophy of practice.
An excellent history of the development of nursing and its politics is presented in An introduction to the Social History of Nursing by Robert Dingwall, Anne Marie Rafferty, and Charles Webster. There are many good biographies of Florence Nightingale.