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State Registration of Nurses
- Wilfrid Laurier University Press
- Chapter
- Additional Information
State Registration of Nurses T he British Nursing Association (B.N.A.) was founded in 1887 by Ethel Bedford-Fenwick,1 Catherine J. Wood, Isla Stewart and some prominent men doctors, including Dr Bedford-Fenwick. The royal patron was Princess Christian, daughter of Queen Victoria.2 The association became the Royal British Nursing Association (R.B.N.A.) in 1891 and received its royal charter in 1893. Their object, a centralized , national, register of nurses, or state registration, would seem to be a normal step in the development of the profession. Nightingale opposed it fiercely, however, and with important allies succeeded both in watering it down and in delaying it. Nightingale had her reasons for opposing a centralized register,3 which was shared with a substantial number of experienced matrons and sympathetic doctors. The first, and perhaps foremost, reason was that she considered the most important qualities a nurse had to have to be moral ones, which could not be tested by an examination. People who could easily pass a written test might not be good nurses, while poorly educated women—and virtually all working-class women then had little schooling—who were otherwise effective, good nurses, would fail. As she recalled late in life, ‘‘Some of our best could not pass an examination with credit, while some of our worst could gain the most 1 Ethel Gordon Bedford-Fenwick, née Manson (1857-1947), matron at St Bartholomew’s 1881-87. She resigned in 1887 on her marriage to Dr Bedford -Fenwick (1855-1939). 2 Helena Augusta Victoria (1846-1925), wife of Prince Christian of SchleswigHolstein . 3 On the registration movement, see Susan McGann, The Battle of the Nurses: A Study of Eight Women Who Influenced the Development of Professional Nursing 1880-1930. For a good analysis of Nightingale’s position on registration, see Carol Helmstadter, ‘‘Florence Nightingale’s Opposition to State Registration of Nurses,’’ Nursing History Review 15 (2007):155-66. / 515 creditable place’’ (see p 574 below). The examination would have served to screen more for social origins than merit on the job. The B.N.A. wanted to exclude women of working-class origin in order to raise the social status of the profession. Nightingale wanted, rather, to raise the quality of the work of nurses through better training . While high social status was a definite advantage for administrative positions, she felt it should not be required for regular nursing. She wanted the working-class nurses in. Another major objection was that the register would be out-of-date almost immediately, retaining the names of nurses who had been dismissed or otherwise were not to be recommended for posts. Nightingale asked how a bad nurse would ever be removed from the register, short of a criminal conviction, as it was difficult enough to dismiss a nurse from a hospital for serious failings, such as drunkenness and immorality on the job. She never did get a good answer as to how names would be removed. Another ramification of a permanent, centralized register that offended Nightingale was that it would lump nurses from all training schools together, despite their differences in training and experience. In this wise, the register would largely fail to distinguish the good from the bad, both individually and institutionally. She was also appalled at the amount of control the B.N.A.’s scheme would give to doctors. Nightingale’s mission was to make nursing to be an independent profession, with its own hierarchy. Nurses would take their medical orders from doctors, but doctors were never to have the power to hire, promote, discipline or dismiss nurses. The B.N.A. proposal gave doctors half the seats on the governing body. Finally, the leaders of the B.N.A. had shown a hearty disregard for the truth, as Nightingale saw it. In their flagrant exaggerations of the number of supporters they had, they even claimed nurses known to be opposed as supporters. Nightingale was not opposed in principle to a register, and had argued in 1861 for a register over giving probationers a certificate on completion of their training. I quite agree with you, though I was not aware that Mr Clough had come to that conclusion, that to register the nurses (and not to give them at first a certificate to carry about) is the better and safer plan.4 4 Letter to R.G. Whitfield 23 May 1861, Columbia University, Presbyterian Hospital School of Nursing C-64. 516 / Florence Nightingale: The Nightingale...