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Thursday, May 9, 2013

Guest Post by Michelle Smail

Nursing Professionalization: Good, Bad, or Just Ugly?
Professionalizing nursing would “standardize and raise” [Susan M. Reverby, Ordered to Care: the Dilemma of American Nursing, 1850-1945. Cambridge: Cambridge University Press, 1987,121-207] the educational requirements as well as creating a greater amount of power and professional recognition for those nurses who would also be part of a smaller pool of nurses thus increasing job availability. However, there were many consequences for these advancements . Many women who had become nurses, particularly working nurses, would find themselves excluded [Reverby, 121]. This professionalization, which came with demands for higher wages and greater respect in the work force, also created a dilemma of how to maintain their status as ladies while still pushing for these changes. Such professionalization also threatened the men of the hospitals who worked as doctors, surgeons, and administrators because they feared that such professionalization would create competition for them and would decrease their relatively cheap work force of student nurses [Reverby 121].
A graduate nurse’s place in the medical community was already unique and isolated before these pushes were made. Professionalization seemed only to further alienate her from the largely male members of the medical community as well as working nurses whose goals and desires in regards to their nursing careers were vastly different from that of the upper class graduate nurses who were organizing and directing these professionalization attempts. This can be seen particularly in the educational standards that were put forth by the upper class graduate nurses. They pushed for requirements of high school diplomas and tighter restrictions on the issuing of licenses. Yet they ignored reform issues such as wages and forbade unionization because these actions seemed unprofessional and shallow in contrast with the ideals that the upper class graduates valued.
 Because smaller schools often did not meet these educational standards, graduates of those schools often found themselves fighting the professionalization of nursing because they feared “to have their status and standing lowered” [Reverby, 127] when the standards held strong legal backing. Along with opposition from the small school graduates, there was opposition from many of the state-nursing board members in regards to the requirement of a high school diploma to be a registered nurse. This is not altogether shocking when one considers that many of those members “were not themselves high school graduates” [Reverby, 127].  In an ironic twist, as the nursing community was trying to create an educational line to who was and was not a professional nurse, they were fighting against physicians who didn’t want nursing to be professionalized for the simple reason that they believed that “nurses are helpers and agents of physicians; not co-workers or colleagues” [Reverby, 131].
The essential split in these two groups of nurses seeking reform was that, “those eager for registration and higher standards focused on entry requirements and nursing education, whereas nurses already in the field were occupied with the conditions they faced at work” [Reverby, 134]. So rather than a united community of nurses taking on the medical community and gaining better pay, increased avenues of employment, and greater respect in the workforce, these two factions spent a great deal of time fighting against each other instead. Furthermore, the working nurses felt alienated from the upper class nurses because “they refused to accept the judgment that only those with pure noneconomic motives could be true nurse” [Reverby, 131]. This was one of the largest points of contention between the often upper class nurses from large schools that held the positions of leadership within the nursing organizations. These working nurses actually needed the funds from their work to support themselves and often a family. Therein lies the difference, their motivations and backgrounds were so very different that seeing eye to eye became nearly impossible.