This book compares the histories of psychiatric and voluntary hospital nurses’ health from the rise of the professional nurse in 1880 to the advent of the National Health Service in 1948. In the process it reveals the ways national ideas about the organisation of nursing impacted on the lives of ordinary nurses. It explains why the management of nurses’ health changed over time and between places and sets these changes within a wider context of social, political and economic history. High rates of sickness absence in the nursing profession attract increasing criticism. Nurses took more days of sick in 2011 than private sector employees and most other groups of public sector workers. This book argues that the roots of today’s problems are embedded in the ways nurses were managed in the late nineteenth and early twentieth centuries. It documents the nature of nurses’ health problems, the ways in which these problems were perceived and how government, nurse organisations, trade unions and hospitals responded. It offers insights not only into the history of women’s work but also the history of disease and the ways changing scientific knowledge shaped the management of nurses’ health. Its inclusion of male nurses and asylum nursing alongside female voluntary hospital nurses sheds new light on the key themes to preoccupy nurse historians today, particularly social class, gender and the issue of professionalisation.
This chapter establishes why the question of nurses’ health is important and sets out the analytical themes that underpin its discussion. The management of nurses’ sickness has recently been targeted as a crucial way National Health Service trusts can save money. This new financial focus on the care of nurses’ health emphasises the need for managers to understand the links between health and organisational performance and, as a result, to remodel their provision of occupational welfare to include a much stronger preventative emphasis than in the past.
The impact of the campaign for professional status on nurses’ health, 1890–1914
Chapter one examines the impact of the late nineteenth-century debate about nurse registration on ideas about the health of nurses. Between 1888-90, the mortality and morbidity rate among The London Hospital nurses dramatically increased and critics alleged that its cause was linked to matron Eva Luckes’ increasing power and political opposition to nurse registration. Using evidence from the inquiry called to investigate the problem, this chapter contrasts Luckes’ ideology about the organisation of nursing and the care of sick nurses with that of Harriet Hopkins, matron of the South Devon and East Cornwall Hospital and a staunch supporter of nurse registration. The disparity between these women’s ideas is then contrasted with those of the Cornwall Lunatic Asylum matrons who expressed no interest in the politics of nursing and enjoyed little power.
Chapter two explains why Cornwall Lunatic Asylum (CLA) nurses chose to join a trade union and take strike action in 1918, at the end of the First World War, by relating it to the terrible deterioration in their health and working conditions. Indeed, seven CLA nurses died from infectious diseases between 1917-18, all under the age of thirty. The chapter compares the impact of the war on nurses’ health at the South Devon and East Cornwall Hospital (SDEC) and examines whether these voluntary hospital nurses’ lack of interest in any form of occupational representation can be explained by the fact that they experienced little day-to-day change between 1914-18. Brian Abel-Smith and Christopher Hart cite the reason for voluntary hospital nurses’ choice of the College of Nursing and asylum nurses’ decision to join trade unions within a framework of gender and class. This chapter will assess how influential these factors were at the SDEC and CLA and suggest that further analysis must include nurses’ occupational health issues.
This chapter examines the Nurses’ Registration Act of 1919. This is an important episode in the history of the health of nurses because it was an opportunity for state legislation to regulate nurses’ work conditions. Early twentieth-century nurse leaders predicted that they would be able to stipulate conditions once professional status had been achieved. They reasoned that if nurses were better educated and more highly trained then improvements to economic conditions would follow. Yet their prediction failed to materialise, and although asylum nurses achieved standardised work conditions by 1919, voluntary hospital nurses’ work remained unregulated despite the award of professional status. This chapter questions why nurse organisations failed to achieve improvements revealing their attitudes towards the regulation of work conditions and the treatment of nurses’ health.
The problem of tuberculosis and its threat to nurses’ health, 1880–1950
This chapter examines the rising incidence of tuberculosis (TB) among nurses in the 1930s and 1940s. Such was the attention given to the problem by nursing and medical journals that TB was presented as the only occupational health problem nurses faced in the interwar period. Why, this chapter asks, did TB emerge as a health problem for nurses at this point in time and not before? Furthermore, it also investigates how the changing conception of TB as a disease, between 1890-1948, impacted on ideas about nurses’ susceptibility. Despite Koch’s discovery in 1882 that TB was an infectious disease, explanations of risk continued to suggest a range of social factors particularly social class and gender. This chapter questions whether the different class backgrounds of nurses at the case study institutions shaped the incidence of TB. It also identifies why nurses’ experience of TB varied between place and across time.
Psychological ideas, chapter five argues, became increasingly influential as recruitment problems intensified during the Second World War. This chapter assesses industrial psychology’s influence on three important nursing inquiries, stimulated by the shortage of nurses and preparations for a national health service: the Lancet Commission (1932), the Interdepartmental Committee on Nursing Services (Athlone report, 1937) and the Working Party on Nurse Recruitment and Training (Wood report, 1946). It explores why nurses’ mental health gained importance at a national level and whether the reports’ ideas and recommendations impacted on the ways nurses were managed in the case study institutions.
The conclusion argues that the health care of nurses was comparable to other workers, which, on the whole, had also been neglected. The risks of nursing had been widely discussed from the late nineteenth century onwards but the state had failed to regulate any provision of care. The health of nurses was always taken seriously but the professionalisation of nursing failed to address nurses’ health problems. Nurse leaders downplayed the occupational risks of nursing long after the Registration Act of 1919 and struggled to escape vocational ideology. Debates about nurses’ health obscured the issue by focussing on power, discipline, gender and class rather than identifying what it was about the work that produced a risk of illness.
This chapter compares nurses' work in two very different hospitals situated thirty-two miles apart in the south-west of England. It reveals the significant differences and similarities between asylum and voluntary hospital nurses' work at a time of duress. It also compares levels of nurses' sickness as a barometer of the impact of war. The Cornwall Lunatic Asylum (CLA), known locally as St Lawrence's Hospital, opened in 1820 in Bodmin, the county town of Cornwall. The South Devon and East Cornwall Hospital (SDEC), a provincial voluntary hospital in Plymouth, Devon, opened in 1840 and at the start of the war employed 50 female nurses to care for 124 patients. The First World War had a much greater impact on asylum nurses' work in Cornwall than their voluntary hospital counterparts in Devon. There were strong similarities between asylum and voluntary hospital nurses' work.