Following Doctors' Orders

It's the largest profession in healthcare. It's the largest female profession in America. But despite its tremendous importance and impact, most people know very little about contemporary nursing. Public ignorance of the present-day profession, however, pales in comparison with ignorance of nursing's history. How many of us know that the development of nursing as the first secular profession for respectable women was a major feminist achievement? Or that Florence Nightingale was not, in fact, the "founder" of modern nursing? Or that nurses played a key role in developing the American hospital system, as nursing historian Sioban Nelson has documented in her recent book Say Little, Do Much? How many of us know about the role of nursing in the development of public health and care of the chronically ill and poor? Most important, how many of us recognize that society's persistent devaluation of nursing--reflected today in the prejudices of many newly liberated female physicians, health policy experts and journalists--is a legacy of longstanding, socially enforced subordination to medicine?

Katrin Schultheiss, an assistant professor of history and women's studies at the University of Illinois, Chicago, is one of a handful of non-nurses who understand what the profession has to teach us about the complex process of female emancipation, as well as about the development of modern healthcare systems. She recounts the tortuous history of how the "professionalization" of nursing in France coincided with anticlericalism and the secularization of the field. Although her story focuses on the forty-year period from 1880 to 1922 and takes place in one country, the gender dilemmas Schultheiss explores have hampered nurses' ability to care for patients in healthcare systems around the globe, including in the United States.

Her tale begins with the advent of France's Third Republic and follows political reformers who attacked clerical authority as they tried to modernize the healthcare system. Until that time, nursing outside the home was typically provided by convent-trained nuns. Modern hospital reformers recognized that nursing required more nurses with more systematic education, but therein lay the problem. Since knowledge is power, the acquisition of knowledge was inevitably a challenge to authority.

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