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CHAPTER 2 "A Charge to Keep": Hospital Schools of Nursing, 1920-1950 Nurses' distinctive training set them aside from other working women and formed the core of their occupational culture. Until the 1950s, virtually every school required that the student nurse live in the hospital's nursing residence, so the hospital was school, workplace, and home combined. Separated from her family and community, the young woman took her place in a world of female authority, where she underwent a rigorous apprenticeship into nursing, learning her craft in classrooms and on the ward. Within a few months-sometimes within hours-the new student would venture into the ward, first arranging flowers or scrubbing utensils, then gradually advancing to tasks that demanded more skill and knowledge. Superintendents drilled and disciplined her, constantly reminding her of her special mission and grave responsibilities. Hard work, strict discipline, and the shocks ofhospital life bonded students together and initiated them into a common occupational identity. Nursing histories often portray the hospital school as an unfortunate historical accident, a product ofthe imperatives of hospital expansion, rather than of nurses' own needs and goals. Certainly the schools had close economic ties with the hospitals; they drew funding from the hospital budget, and students provided most of the nursing services. Through the 1920s, most hospitals with schools depended entirely on student nurses, hiring graduate nurses only for a few supervisory positions. While hospitals began to hire some graduates for ward duty in the 1930s, student nurses continued to work in both staffand supervisory positions into the 1950s. But nurses 38 CHAPTER 2 were not merely the hapless victims of this system. Indeed, some nurses actively perpetuated it as hospital superintendents and administrators, and many more affirmed its methods and values. The schools represented a coherent ideology of their own that offered a powerful alternative, and sometimes a direct challenge, to the values of professional ideology. The schools stood at the center of the conflict between professional leaders and other nurses. While the content and conduct of nurses' training changed between 1920 and 1950, the debate remained remarkably consistent in that period, reflecting the persistent ideologies and traditions of each group. For those committed to professionalization, educational reform represented a key strategy. Beginning with a 1912 survey, prominent nurses railed against apprenticeship training. Critical of the wide variation in the schools' programs , they pressed for uniform requirements for admission, standard curriculums, and a program weighted toward academic education rather than ward experience. In the professional associations, leaders struggled to establish and control accrediting of the schools. Committed to professional autonomy, they also sought to separate nursing education from hospital ward service. Leaders called for graduate hospital staffs to release students from the responsibility ofrunning the nursing service, and they argued that students should pay tuition rather than receive stipends. Throughout, they stressed the value of a "professional" education-that is, a program oriented to theoretical knowledge, based in colleges and universities rather than in hospitals. As the reformers often pointed out, many ofthe superintendents and graduates who defended the hospital schools had a strong material interest in the existing system. Hospital administrators, many ofwhom were nurses, were reluctant to pay graduates for services that students would perform in exchange for room, board, training, and a small stipend. Superintendents exercised considerable autonomy under the apprenticeship system, running their schools and their wards "A CHARGE TO KEEP" 39 according to their own notions of proper training and discipline . "Professional" education, removed from the hospital, would drastically reduce their control. Many graduates resisted standardization of education and practice, defending themselves against an upgrading that would devalue their own skills and their hospital school diplomas. Nurses' resistance to professionalization also drew on deep ideological differences. Skeptical of the claims ofeducational reformers, they upheld apprenticeship training as a part ofnursing's craft tradition. In this conception, education meant more than acquiring skills and knowledge: it was a process ofinitiation that transformed the student from a laywoman into a nurse. This chapter inverts the familiar history of progress in nursing education, told from the viewpoint of professional leaders, to reconsider the claims and experience ofthe losers, thosenurses steeped in the apprenticeship tradition. The ideology and culture of the schools stood at the center of nursing history: the hospital programs provided a common experience shared by generations of practitioners. Until 1971, the diploma schools graduated more new nurses than associate and baccalaureate programs combined; even as late as 1974, 76 percent of all active nurses held diplomas...

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Additional Information

ISBN
9781439904602
Related ISBN
9780877222903
MARC Record
OCLC
639014043
Launched on MUSE
2012-01-01
Language
English
Open Access
No
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