Daring to Care: American Nursing and Second-Wave Feminism (review)

Images of nurses from the second half of the twentieth century show considerable changes from the distinctive white-uniformed and white-capped nurse of the 1950s to the scrub-clad and often unrecognizable nurse of today. Susan Gelfand Malka argues that the changes in uniform reflect deeper transformations in the nursing profession, transformations that struck at the basis of modern nursing in Victorian gendered ideals. In short, second-wave feminism provided the language, rationale, and strategy with which nursing could end its historic ties to feminine deference and subordination, even if all nurses did not identify as feminists.

Malka begins her study after World War II, when nursing moved from private homes to hospitals. This move marked a decline in nurses' autonomy, as their work became even more defined and regulated by gender norms that demanded feminine (nurse) subservience to male (physician) dominance. But even as hospital and gendered hierarchies shaped nurses' work, nurses began to challenge these ideals, particularly in nursing education. Most nurses throughout the 1950s and 1960s trained in three-year hospital-run diploma programs laden with gendered rituals, dress, and behavior. Increasingly, however, as second-wave feminists began to question hierarchical gender roles, some nurses questioned such traditions as white caps, aprons, and pins. Challenges emerged gradually, but as baccalaureate programs in universities and associate degree programs in community colleges shifted nursing education from hospitals to higher education, gendered rituals declined in importance.

The move of nursing education to universities boosted nurses' autonomy by allowing them more control over education and curriculum. As more nurses pursued higher degrees and developed a nursing theory that defined nursing's intellectual foundation and basis as an academic discipline, nurses wrested control of education from physicians. The American Nurses Association began advocating for a broader educational foundation, the addition of courses on women's history and electives in nursing specializations, and a thorough purging of all stereotypically feminine indoctrination. Nursing education began to emphasize empowerment and equality with other professions, and some nurses joined unions and organized politically for progressive change. Although the effects of these changes on nurses without higher degrees or specialized training is hard to ascertain, the information on the development of nursing specializations—particularly the nurse practitioner program—is most convincing. Specializations enabled nurses to claim more independence from physicians in their daily work, more authority in the hospital, and greater recognition in the public eye.

The nursing profession's relationship with organized feminism was anything but simple. While feminism opened doors for women, nursing became less appealing to many women—feminists in particular—because of its historically gendered nature. It is not clear, though, what nurses thought of organized feminism. Malka effectively shows how nursing organizations and politically organized nurses adopted feminist standpoints on a number of issues, but the text could benefit from more description of average nurses' opinions about feminism. As the profession became more racially and sexually diverse, a more detailed picture of nurses' responses to feminism would help to underscore the book's thesis. What did the men whom the feminist movement helped usher into nursing in greater numbers think of the increasing influence of feminism? Did black and white nurses hold similar opinions about feminism and its effects on nursing? As increasing numbers of women became physicians, did feminism unite these women, or did their professions and the gendered connotations of their work divide them?

A more thorough treatment might have allowed for a deeper mining of the sources to answer these questions. Instead of simply presenting the findings of contemporary studies of nurses as conclusive evidence of particular behaviors or beliefs, for example, Malka's thesis would be strengthened by a discussion of the gendered and racial assumptions of the studies themselves. Still, Malka convincingly demonstrates the overarching...