Handling the Sick: The Women of St. Luke's and the Nature of Nursing, 1892-1937 (review)

In Handling the Sick, Tom Olson and Eileen Walsh examine how nursing was conceptualized by 838 rank-and-file nurses from St. Luke's Hospital Training School for Nurses in St. Paul, Minnesota, from 1892 to its closing in 1937. Using extensive primary sources such as student application materials, instructor evaluations, monthly time records, reports to accrediting agencies, and alumnae records, the authors challenge nursing's long-held assumptions about the advancement of nursing through a process of professionalization. They inform the reader about the importance of the study by arguing for the school's "ordinariness" (p. 7): its typicality in length, schedule, size, and focus on patients' medical and surgical problems is what makes it particularly valuable. Issues of science, gender, labor, and social class frame the book and highlight its broader significance as a means to understand the nature of nursing. More specifically, is nursing a craft, or is it a profession? Or might it be both?

The authors situate their research within existing historiography of nursing.¹ Similar to Barbara Melosh ("The Physician's Hand," 1982), they are interested in nursing's craft tradition. In their unconventional interpretations, Olson and Walsh are sure to stir up controversy. First, they argue that a greater demand for nurses that began in the early twentieth century did not mean lowered entrance requirements. Second, a common theme in accepted histories is that a strong religious influence led to problems in achieving professional status; yet, evidence shows that the St. Luke's training program did not emphasize religious ideas of "saintly" nursing. Third, St. Luke's valued strong-willed and motivated women; its sources do not portray the nurses as weak and submissive, exploited by hospital administration and physicians. Finally, the authors challenge the caring tradition of nursing, arguing that caring alone cannot explain the nature of nursing. Rather, the picture that emerges is that St. Luke's nurses valued experience, skill, occupational loyalty, and strength that was needed for arduous physical labor. These women focused on practical, apprenticeship training rather than academic concerns. They understood the nature of nursing as a demanding occupation that required pragmatic skills in handling, managing, and controlling patients and situations, with the aim of presenting a neat, finished product. In this sense, accepted stereotypes that attributed strength and skill only to men were challenged.

What is most compelling about this book is the use of insights from history to present a new model that can remake nursing in the future, one that incorporates both occupational and professional traditions. How this can be done involves recognizing nursing as an intensely physical activity that still demands emotional and physical strength. A contentious aspect of the model, perhaps, is its advocacy of the reinstitution of apprenticeship learning. Some readers may have difficulty accepting this reaffirmation of nursing's "craft" legacy that appears to oppose other intellectual endeavors. However, the authors broaden the definition of apprenticeship learning to include the validation of knowledge gained in academic courses through practical experience at the bedside. They call for not only skillful nursing based on experience but also "practice generated and driven knowledge" (p. 149). In advocating research that focuses on "needs of patients as identified by the practicing nurses" (p. 152), are they not really promoting evidence-based research? Today's nursing leaders surely support this concept.

In conclusion, while care should be taken in making generalizations based on one school of nursing, the results from this study can be added to those by Melosh, Patricia D'Antonio, and others who study rank-and-file nurses.² In my own research with retired nurses today, I have found that they maintained a high commitment to their craft and did not see themselves as victims of...