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Introduction Women's dominance in nursing nearly equals our monopoly on motherhood: nursing has always been a woman's job. In the mid-nineteenth century, most nursing care was done at home as part of women's domestic duties. Florence Nightingale's 1860 manual, Notes on Nursing, was addressed to women in families and opened with the assertion, "Every woman is a nurse."1 As medical care became more complex and more tied to hospitals, nursing gradually separated from the sphere ofwomen's domestic work and became established as paid work that required special training. Arguments ofwomen's special fitness for nursing connected traditional domestic roles to female participation in this new category ofpaid labor. As one doctor wrote in 1925, "A hospital is a home for the sick, and there can be no home unless there is a woman at the head ofit. "2 While these sentimental images of nursing as womanly service lingered, the actual content and practice of nursing grew increasingly specialized. In the esoteric technological setting of modern hospitals, no one would proclaim that "every woman is a nurse." But the cultural ideology ofwoman's place still informs medical division of labor: nearly every nurse is a woman. Unlike most women's jobs, nursing has been characterized by the presence ofan articulate and self-conscious elite. Identified with Nightingale's English hospital reforms, these leaders sought to move American nursing in the same direction . Beginning in 1873, they opened hospital schools and argued that nursing was a special skill that required such training. They struggled to establish nursing as respectable 4 INTRODUCTION work for middle-class women, recrUItmg among them to replace the socially marginal women who had traditionally done most ofthe hospital's work. They formed associations to share their problems and to promote the cause ofthe "trained nurse" to a wider audience. They sought the public legitimacy of legal licensure to affirm and defend the nurse's skills. In their efforts to establish educational credentials, licensure, and employment standards, they worked to assert the control over training and practice that is the mark of established profesSlOns . These leaders have shaped our views and understanding ofnursing history. Highly visible and vocal, they promoted a certain ideal of the "professional" nurse in journals, surveys, reports, manuals, even in novels. Leaders also left a number of histories, interpreting the development oftheir occupation in the image of their own hopes and aspirations. Like their medical colleagues, these nurses celebrated a history ofprogress , from "the twilight and the darkness" before Nightingale to the triumphs ofmodern nursing. The heroes in these narratives are nurses' leaders, shown as dedicated reformers; the aim and end of reform is professionalization.3 But sifting back through nurses' written literature and listening to oral memoirs, we hear voices that trace the shadowy outlines of another history of nursing. This evidence reveals that leaders faced considerable opposition in their own ranks: the ideals and goals they set forth were hotly contested by nurses themselves. Such conflict emerged as a consistent and pervasive theme in nursing history. Bitter struggles accompanied each proposal for new educational standards and licensure, indicating deep divisions among nurses. In letters to the editors of the American Journal of Nursing, many nurses protested leaders' strategies and criticized their professional ideology. Two other journals spoke for those nurses who disagreed with their official organs. Trained Nurse and Hospital Review, first published in 1888, often took a critical stance toward the professional associations, and attracted dissenting nurses as authors, readers, and letter-writers. The first issue of INTRODUCTION 5 RN: A Journal for Nurses, published in 1937, promised to follow''the expressed will ofthe rank and file ofnurses, " and noted (in 1938), "Because RNis independent, it is able to serve its readers freely and without prejudice. There are no axgrinding 'groups to dictate its editorial policy."4 Oral and written memoirs offer further evidence ofnurses' mixed feelings about their professional leaders. Finally, in mute testimony to their alienation from official leaders, nurses stayed away from their professional associations in droves. Resistance to professionalization was one expression of an occupational culture that developed quite outside the professional associations. Most nurses interpreted their work from a different and sometimes sharply divergent perspective. Leaders looked outward, beyond the work experience to its social context and implications. Aspiring professionals, they oriented themselves to nursing's place in the larger structure of work and sought to improve nurses' positions within the medical division oflabor. Nurses on the job were sometimes...


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