Florence Nightingale’s Opposition to State Registration of Nurses

It is well known that Florence Nightingale strongly opposed state registration for nurses. Her opposition is usually treated in the standard literature as reactionary and dismissed in a few paragraphs. For example, Dock and Stewart wrote in 1931 that, when state registration was first publicly broached in 1887, Nightingale had reached the point where the old cannot go on with the young, adding that no doubt her years of seclusion made it difficult for her to realize the newer conditions.1 Nightingale was actually sixty-seven years old in 1887. In this article, I argue that although Nightingale did adhere to an older ideal of nursing as a religious vocation, a view that was becoming less acceptable to young women in the 1890s, she was a lady of extraordinary perspicacity and had many reasons for opposing state registration that were realistic, well informed, and intelligent. First and foremost, Nightingale understood that nurses in the late 1880s and 1890s were simply not educated well enough to be registered as a profession. second, the proponents of state registration wanted to exclude working-class nurses and make nursing a profession for ladies only. Nightingale believed many of the most competent nurses were working-class women. Third, she believed the campaign leaders did not distinguish adequately between medicine and nursing and were placing nursing under the control of medical men. Fourth, she found the state registration proposal for credentialing inadequate. Finally, she was distressed by the dishonesty and lack of professional ethic on the part of the campaign's leaders. Throughout the whole debate, Nightingale's focus would be on clinical competence and expertise, while the state registration party would focus on improving the social status of nurses. The Campaign for State Registration The British Nurses Association Ethel Bedford Fenwick, former matron of St. Bartholomew s Hospital, led the lobby that was pushing for state registration. Bedford Fenwick was a flamboyant, ambitious, and competent person who had been a great success as matron and would later become the primary founder of the International Council of Nurses. Full of spirit and with a will of steel, she was rich, well educated, and beautiful,2 but Dr. Norman Moore, who taught the course on medical nursing at St. Bartholomew's, believed her to be unscrupulous and wanting in honor. One of the City of London companies had given the hospital a prize to be awarded to the probationer who achieved the highest score on her final exams. By the late 1880s, these companies, descendants of the medieval guilds, were largely charitable organizations that supported community activities. Bedford Fenwick waited until she had seen the marks the doctors gave each nurse, and then added marks for good conduct to those of her favorite nurse so as to give her the top score. The case was so flagrant, Moore said, that the doctors asked the company for another equal prize. Nightingale was not certain that Bedford Fenwick's addition of points for conduct was wrong. Perhaps a matron would be right, she commented. A St. Bartholomew's nurse had told her that if any nurse did something wrong, Bedford Fenwick was sure to know about it before the next morning. All satisfactory evidence is that Mrs. Fenwick was unscrupulous but generally right, Nightingale concluded.3 In 1887, Bedford Fenwick and a group of matrons, including Catherine J. Wood, former matron of the Hospital for Sick Children in Great Ormond Street, founded the British Nurses Association (BNA), the organization that would lobby for state registration. Wood would become Bedford Fenwick's second-in-command in the early years of the campaign. Wood, Mr. William Scovell Savory, one of the consulting surgeons at St. Bartholomew's, and Dr. Bedford Fenwick, Ediel's husband, began furiously canvassing Nightingale to join. Wood also told Lucille Pringle, matron of St. Thomas's, that she was bound in honor to become a member. …

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