American Nursing: A History of Knowledge, Authority, and the Meaning of Work (review)

In this provocative study, Patricia D’Antonio focuses on knowledge, authority, and the meaning of work as she examines the evolution of American nursing as a profession. She employs a sophisticated analytical framework and relies on an impressive array of archival sources, statistical data, and recent scholarship to assemble an insightful series of case studies and profiles of individual women nurses. The result makes for a fascinating and significant contribution to the history of women, labor history, and nursing history.

Central to D’Antonio’s study is the conviction that nursing is a profession characterized by expert knowledge and authority. Nursing knowledge and practice was every bit as essential to successful patient healing as was the expertise of medical doctors. D’Antonio convincingly demonstrates that “modern nursing was born in the mutually constitutive process of women seeking medical knowledge and physicians seeking knowledgeable women” (p. 3). As the nineteenth-century hospital became a site for the generation of new scientific knowledge, it demanded the creation of new nurses, “trained” and “thinking” nurses (p. 19). “[S]pecialized medical knowledge, taught by powerful physicians and learned in a context dedicated to science and scientific healing, would allow women invited to train as nurses to invest themselves with an authority that might effectively compete with maternal claims at the bedsides of sick patients at home” (p. 25). As nurses became “assistants to men, not mothers,” they “embodied a specific form of socially legitimate authority and identity” (p. 26).

Both nineteenth-century sick nursing and twentieth-century professional “hired” nursing navigated the “the uneasy intersection” (p. 7) of class interests, race, gender, religion, region, and knowledge. In chapter 2, D’Antonio explores the ways in which the traits of discipline, loyalty, and obedience joined those of “competence, coolness, courage, and control of clinical spaces” (p. 30) to create “a strong nursing identity” (p. 53). This nursing identity transcended social and racial backgrounds. All women, despite their racial, ethnic, and class origins, could identify with “the same history that made their role possible, could survive the formative processes that turned women into nurses, and could appropriate and refashion the nursing identity for the particular performances they played on their particular stages” (p. 51). This complex and multilayered identity would serve nursing well during the World War II and cold war eras as leaders, both black and white, across regions, intensified struggles to desegregate the profession.

An especially illuminating case study is D’Antonio’s investigation of the training and experiences of nurses in Western states and in religious communities, specifically the nineteen white Mormon women graduates of the Latter-day Saints Hospital Training School for Nurses in Salt Lake City in the class of 1919. D’Antonio probes their collective experiences as a way to unravel the complex of “meanings” in nursing. For Mormon nurses, she argues, nursing enabled them to “remain active and empowered participants in constructing meaningful lives” (p. 82) as they simultaneously supported their families’ domestic economy and participated in their communities’ social world. This case study underscores the importance of using religion and region as analytical categories when discussing diversity in nursing.

A dramatic change in the modern era of nursing training occurred as a consequence of massive governmental appropriations of the Hill-Burton Act that situated the hospital at the center of the U.S. health care system. By 1968 the Hill-Burton Act had financed the construction of over nine thousand new hospitals containing over four hundred thousand new beds “for patients needing nurses” (pp. 167–68). The explosion in hospital construction ignited the demolition of hospital-based nursing training programs. Intriguingly, D’Antonio declares that “it was the community college movement that eventually spelled their death knell” (p. 168). D’Antonio...