"The Relation of the Nurse to the Working World": Professionalization, Citizenship, and Class in Germany, Great Britain, and the United States before World War I

By Soine, Aeleah | Nursing History Review, January 1, 2010 | Go to article overview

"The Relation of the Nurse to the Working World": Professionalization, Citizenship, and Class in Germany, Great Britain, and the United States before World War I


Soine, Aeleah, Nursing History Review


Abstract. Campaigns for state nursing registration in the United States and Great Britain have a prominent place in the historical scholarship on nursing professionalization; the closely related German campaign has received less scholarly attention. Applying a transnational perspective to these three national movements highlights the collaborative and interrelated nature of nursing reform prior to World War I and recognizes the important contribution of German nurses to this dialogue and agenda. Focusing particularly on the years 1909-12, this article depicts a generation of German, American, and British nurses who organized national and international nursing associations to realize state registration as a stepping stone to other markers of professional recognition, such as collegiate education, full political citizenship, social welfare, and labor legislation. However, the consequent reliance of these strategies on nation-states as arbiters of citizenship and professional status undermined the shared ideological foundation of international and national nursing leaders. This article contributes to a more multinational understanding of how these international nursing leaders transcended and were confined by the limits of their nation-states in the years leading up to World War I.

On June 26, 1913, Lavinia Dock gave her final address to the American Nurses' Association. Her paper, "The Status of the Nurse in the Working World," challenged the middle-class nature of professional identity that had set nurses of respectable means apart from-and in fact above-the working class. 1 Dock called on nurses to jettison this nineteenth-century legacy and instead to recognize the tripartite demands of the worker-"education, hours of work, wages"-as issues of shared relevance between professional nurses and the world of workers. She supported her radical assessment of protective labor legislation with the claim of manipulation inherent in "the sentiment too often skillfully suggested by hospital directors personally interested, that a 'profession' must not become tainted with 'trade unionism' . . . [which would] destroy professional ethics. All solemn pharisaism! And hospital directors know it is." 2

The suggestion that nurses were being exploited by hospital administrators makes palatable the formerly inconceivable idea that nurses would embrace working-class alliances over professional solidarity with physicians and administrators. Though remaining devoted to education and female enfranchisement as the primary vehicles toward professionalization, Dock was also integrating tenets of protective labor legislation into the foundations of nursing professionalization. The significance of this message was not its foresight or effectiveness but rather its unique ability to convey the essential combination of professional aspirations and complications of gender, class, and nation-state formation that characterized the transnational nursing professionalization movement in the early twentieth century, as it prepared to embark on a new path.

In the decade before World War I, the International Council of Nurses (ICN) and the transnational professionalization movement it represented reached the height of their collaborative success in pursuit of state registration for nursing. Registration was a logical strategy for nurses to follow based on the precedents of physicians, lawyers, and professors in Europe and the contemporary professionalization efforts of the female-dominated occupations such as social work, elementary education, and midwifery. 3 In the quarter-century prior to World War I, nursing registers were developed in twenty-two of the twenty-six German states, 4 thirty-two of the forty-eight American states, and various other nation-states belonging to the ICN. 5 Great Britain, however, still had no such system of nursing registration at this time. 6 This uneven attainment of nursing registration between 1909 and 1912 challenged the ideological unity among nursing leaders in Great Britain, the United States, and Germany. …

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