According to Susan Reverby's Ordered to Care, the most salient fact about the occupation of nursing has been its traditional conceptualization by both the public and medical professionals as women's work, a judgment that has had a dramatic impact both on the nature of the tasks nurses perform and on the status of the profession. Reverby demonstrates how this ideology of nursing grew, not out of a belief in women's rights but from eighteenth- and nineteenth-century understandings of womanly character and duty.
Before 1870, nursing took place either in the home, where women nursed their loved ones as part of their familial obligations or in hospitals, which were custodial institutions for the poor. Despite the differences in the settings, women in each of these roles were assumed to be 'naturals' for the job, so hospital nurses were paid wages whose meagerness suggested money's irrelevance to the true character of nursing.
Even after 1870, when scientific and medical advances hastened the development of nursing as skilled paid labor, the ideology concerning nursing changed very little. True, leaders in nursing education advocated professionalism: being a woman was necessary, but not sufficient, for nursing. They envisioned the establishment of strict training schools, controlled by women, to teach the elements of health care that were no longer attended to by the rapidly specializing physician. They were pleased to be aided in their efforts by hospital administrators and doctors, who understood that the movement to upgrade and standardize nursing education would support their own plans for reforming medicine.
But the goals of the three groups, Reverby argues, were radically divergent. Hospital administrators realized that training schools attached to their own institutions could become sources of cheap and malleable labor. Doctors saw nursing education as a way of improving care in the hospital, but they opposed any move to bolster nurses' control of their own labor or to improve their scientific skills, arguing that nurses should remain submissive and nurturing. As hospital exigencies quickly came to dominate the decision-making process in the training schools, nursing educators lost control over admission standards, the quality of education, and the labor of students on the wards.
