Rethinking the Rewriting of Nursing History

by Patricia D'Antonio">

by Patricia D'Antonio,RN, PhD

At first glance, the cross-disciplinary reciprocity between nursing and social history seems profound. Understanding the work of nurses has reshaped historians' sense of the hospital, the treatment of disease, the birth of babies, and the role of women in their families and communities. And there are now few stories told about nurses by nurses without some reference, however fleeting, to the issues of gender, class, race, and the politics of professionalism.

The problem, however, is that the "two way street" that lies at the heart of this reciprocity has seen much of its meaningful intellectual traffic slow to a crawl. The publication of Barbara Melosh's The Physician's Hand in 1982, Susan Reverby's Ordered to Care in 1987, and Darlen Clark Hine's Black Women in White in 1989, essentially established the still dominant interpretive paradigm within the health care system at the center of nursing women's lives, and then use the tools of economic, class, and racial analysis to dissect its socially structured contradictions. Reverby's hard-hitting analysis, for example, superbly illustrates nursing history's historical quest for an independent role in the home and hospital. But her analysis works only if we continue to position nurses solely as labor market participants.

The dominant paradigm may not fully capture the historical experience of nursing. Most women lived much of their lives outside the nexus of wage-based activities and most nursing women, in particular, left the workforce within ten years of their graduation from training school. Even so, we are beginning to understand that the idea of work, if not work itself, still held significant salience for them. That is, non-wage earning women looked both to their own experiences and to those of their neighbors and kin to construct an enduring identity for themselves as past or potential workers.

There are works that are beginning to break the "traffic jam" and suggest new ways of thinking about nursing history. They suggest, on a very concrete level, that the contradictions faced by nurses were neither unnegotiable nor insurmountable. More important, however, they offer a different way of thinking about thc interconnectedness between the evidence and its implications-- especially at a point when the debates about the role of gender, class, race, and mobility in nursing's past still veers uneasily between positions celebrating the e discipline's transcendence and those chiding its rigidity. They suggest that rather than being passively defined by socially constructed stereotypes, women actively embrace the gendered meaning on nursing for the ease with which it allowed then to create work identities that remained connected to their personal identities, despite their formal relationship to the world of productive work. Nurses created the boundaries that were, often simultaneously, both a source of their strength and a dam around their ambition. Still, women's commitment to the idea, if not always the reality, of nursing, stirred within them the possibility of using a particularly constructed gendered identity to step out of or, perhaps more importantly, step up from the traditional conventions of their particular stating place.

Thus, the challenge ahead, I would argue, lies in thinking about nursing's history in such a way as to reposition identity rather than work at the center of our analyses. Identity is, and has been, a critical, albeit ambiguous, variable in nursing. Still, this notion does have historical grounding. In early twentieth century America, for example, we can catch a glimpse of its quite pragmatic role. The ironic humor of women "fresh from the farm," for example, suggests they fully understood the social and economic price of a nursing diploma. And, in early twentieth century Britain, we can see its more affective workings. There, the experiences shared by volunteer nurses during World War I gave new meaning and satisfaction to their live then, and for many, for decades afterwards. These studies do begin to disentangle the relationship between work and identity. More importantly, they suggest the direction in which we might proceed. If, in fact, nursing women drew as much of their identity from their social place in a particular community-- be it farm, training school, or the Red Cross-- as they did from their structural place in an occupational labor market, then we must wonder about the worth of their nonmaterial as well as their material rewards. That is, we must wonder if women bartered transient workplace exploitation and devaluation for the enduring status and prestige their identity as nurses gave them in their communities.

For nursing's work, Hine reminds us in Back Women in White, took on different meanings to different nurses at different times with different p[laces in their own communities of family, friends, and colleagues. Still, this work, as both Christine Stansell and Emily Abel argue in their respective studies of urban and rural working-class women, was as much linked to the enduring traditions of class, ethnic, and racial neighborliness as it was to their ability to sell their skill in the wage-labor market. Thus, we have no reason to continue to assume it was work that ended with their marriages. We might assume that marriage, and, later, children, changed the structure of their work: their own domestic responsibilities quite likely precluded the possibility of their spending the sustained days, weeks, and even months with sick patients they did as private duty nurses. But the well-documented demand that women maintain their nursing role within the socially gendered division of labor suggests the work itself continued even if its form became more episodic.

We do need to bring to light the meaning of this work to those who did it. Here, new studies of the history of nursing in the South prove particularly instructive. For there, during the nineteenth and early twentieth centuries, the nursing of neighboring strangers lay within the domain of elite white men and, to a far greater extent, slave and, late, disenfranchised black women. World War I marked the first time the actual work of nursing-- that is, the actual care of the sick, not just organizing other to do that work-- became acceptable to the South's elite, white women. They took on nursing as their patriotic contribution to the War effort and, as in the North in an earlier time, other white women of other classes followed rather quickly in their wake.

The incorporation of the heroic and the prestigious into this now complete gendering of nursing's work with strangers as well as with kin suggests the role that a formal nursing identity played in support of women's sense of agency. Touchstones of valor, status, and recognition outside those traditionally available in their families and communities gave women who, in marriage, returned to the conventions surrounding the socially gendered division of domestic labor, a new base of socially legitimated authority. Now their socially valued place did not have to be earned. it could be assumed-- both by them, by their communities, and by the wider world.

In the end, then, this reconsideration of nursing's history suggests the value nursing women placed on their work resonated more with their identity as women and less with that as labor market participants. They thus recast work as a gender-affirming strategy to be honed within but to be deployed outside the nexus of wage-base relations. we can see the poser inherent in this reconsideration. A formal nursing identity-- that is, a gendered identity built around the social salience of a particular kind of work-- enabled women to create a more coherent, a more generalizable, and, ultimately, a more sustained independent place for themselves within their chosen sphere. It gave them, now as a group rather than as individuals, the authority to renegotiate the terms of some of the inequities they experience and to shape their own sense of the value of work in their lives.

Patricia D'Antonio, RN, PhD, is the Associate Editor of Nursing History Review. She is also and Adjunct Assistant Professor of the University of Pennsylvania School of Nursing.