1. Training at work: the pupil nurse as hospital machine How we generally think of nursing school in the 19th and early 20th century What nursing school was generally like in the 19th and 20th century

2. Nursing training vs. labor“Nursing education was called training; in reality it was work.” • Women’s suffrage and formal collegiate education for women is increasing, but little formal endowments for nursing education. • Nursing is attempting to define itself as an independent discipline but is challenged by: • Rapid increase in demand d/t rapid urban expansion • Public’s image of hospitals as charity institutions…wealthy are suburbanites who prefer home care • Power struggle between hospital trustees and physicians who don’t want to further divide their power

3. Hospitals needed cheap labor to survive • Earned $8-$12/month plus room and board-about 1/3 of what was offered to untrained women for the same work. • Hospitals would assign students as private duty nurses and keep the payment • When graduated, most left hospital work in private duty to escape the drudgery, lack of sanitation and poor pay

4. The Process of Educating Nurses • Fill out application for admittance-no criteria, selections often made by hospital trustees. • Nursing Superintendents had little real authority, work came before education. • Nursing organizers complained hospitals exchanged labor for diplomas with little regard to education or standards of care • The title “nurse” was used before training was completed

5. The Hospital Machine • Hard physical work required of pupils • Cleaning, washing laundry • Little time for actual lectures • Students usually worn out from long days, making it hard to learn in lecture • Illnesses frequent from unsanitary conditions and exhaustion • Nursing theories focused training on discipline, leading to “justifiable” student abuse • No standards for how long students could be forced to work or how heavy their workloads could be

6. Appearance is Everything • Appearance more important that care • Smiles were always expected • “…devote my energies to perfecting myself in the art of letting patients wait…but I here confess that I sometimes think there is just a little too much stress tied upon the things that count only for appearance and not quite enough upon other things that tend more directly to make the patients comfortable and happy” • Anonymous, 1908

7. Rebellion-1910 the “strike decade” • Strikes, instigated by students were common due to poor conditions, overwork, bad food, and abuse of power • Most students did not rebel due to the dilemma of leaving patients and fear of challenging authority

8. More Tension • The power struggle between hospital trustees and physicians for ultimate institutional authority leaves little room for the Nursing Superintendent to retain control over nursing • Superintendents often aligned with administration d/t the nursing theories that espoused discipline, order and morality . • Physician power grew with advances in science and medicine • “Nursing was continually at loggerheads with the hospital, physicians…and itself.”