Men in Nursing paper (part2)

[Thunderwolf, MSN, RN]

Oral History

The oral history of nursing has been the subject of a growing interest in the 1990s (26). In this paper, we shall explore the accounts of men who worked as nurses between World War II and the 1970s which can still be heard at first hand, within which the residues of Nightingale's teachings can still be detected. This study takes its place among a number of similar efforts in the history of nursing, which often partake of a 'bottom up' historiography, where researchers try to suspend their desire to impose values on the material, rather in the manner of early participant observers (27). Whatever concept of history the researchers have, in nursing scholarship there is considerable excitement at life histories (28) and their ability to enliven history in a most compelling way.

The strength of oral history lies in the access it affords to people's accounts of their lived experiences, in a way which allows them to be recorded and preserved. Not only this, but within nursing the people involved in providing the histories are often themselves aware of the contribution their activities have made to the changing history of the profession. Nursing's ongoing concern for its history has been linked with the profession's search for an identity (29). Therefore nurses are often to be found collaborating to record one another's histories, where nurse-historians interview their older colleagues.

Oral history has gained increasing respect for the opportunity it provides to locate the feelings, attitudes and ways of life - which have been hidden from traditional written histories - within the broader framework of legislative, professional and social changes. Indeed, the accounts of 'ordinary people' who worked in the Health Service are richer than the formal accounts from officials, who often promulgate an 'official' version of events. In any case, through oral history we can show how these everyday reminiscences are intelligible through their being intertwined with the warp and weft of social change. The experience of a man becoming a nurse is nowadays relatively mundane. But in an era when this was unusual, these experiences, however mundane, would be uniquely significant.

Because of its focus on reminiscences of the fine detail of social life, oral history is perhaps the post-modern discipline par excellence. It resolutely avoids grand theory and enables, via participants' everyday narratives, 'to explore the gaps, ambiguities and implicit power relations in the social and health contexts' (30).

In order to examine the experiences of men in nursing during the middle part of this century, this paper focuses on the personal ac****s of two nurses who were interviewed about their careers between the 1940s and 1970s. One had spent most of his working life in a General Hospital while the other had worked mainly in a psychiatric hospital. These two informants were interviewed as part of a larger project on the history of nursing in the Midlands and have been selected because their accounts appeared to be emblematic of the changing spirit of the times in post war nursing.

The interviews were semi-structured but the respondents were free to recall whatever events they chose and to describe them as they saw fit. The interviews were organised around a number of themes which were of interest to the researchers including the reasons why they entered nursing, their expereience as students and the social relationships which they remembered exisiting between them and their colleagues at work in their early careers. In addition, as researhcers we were interrsted in what had made the job worthwhile to them and why they had maintained their commitment to the career over several decades and how it changed as they gained in experience, seniority and influence. At the same time, it was emphasised to them that it was their experiences in nursing that were of interest and that they were free to develop their own agenda in the discussion. In general nursing at the time they trained, men were very much a novelty, so in the interviews and the subsequent interpretation we were especially attentive to what it felt like to be a man in a predominantly female occupation.

In presenting the 'data', in addition to their historical narratives, we will be particularly attentive to the recollections of social organisation, the training, the wards' organisation, even the way they wore their uniforms. Partly, this is because these elements featured prominently in the reminiscences, but also because it is in these ceremonies that the residua of nineteenth century can be detected. In addition, we shall attempt to discern how the transformation of their roles over time reflects a broader change in nursing from a system which was hierarchical, regimented and which embodied military lines of organisation to one which has become increasingly patient-centred.

A Male Nurse in a General Hospital

'I was the only man in a group of a thirty who commenced their PTS [Preliminary Training School] in 1942 in a very prestigious hospital in the West Midlands'. This vignette is based on experience at a time when there were very few male nurses in training in the West Midlands although untrained male orderlies were being employed in some hospitals to fulfil a variety of roles from that of porter to nursing auxiliary. The Matron at the respondent's hospital was one of the few in the country who accepted male students and exercised no discrimination. She had also shown a progressive attitude towards nurse education, considering it essential if nurses were to be valued for their unique contribution to patient care rather than merely for being servants to the medical profession and to the routines of the hospital. The Sister Tutor had, on the other hand, been clearly uneasy in the respondent's presence; she addressed him as 'Mr.', a title usually reserved for surgeons. Matron addressed everyone, regardless of gender as 'Nurse'.

The fact that the respondent was one man amongst thirty female students did not bother him; he came from a large family which included four sisters and his brothers had girl friends whom he knew well. He had spent two years with the Red Cross prior to entering nursing and had considerable experience of dealing with casualties and of the emergency treatment of serious injuries. He was about two years older than the rest of the students and had no difficulty in getting on with them. Most of the lectures, he recalled, were given by doctors who were treated with extreme deference. The Sister Tutor would always introduce the Doctor in the same way - explaining that he was a very busy man and that the students should, therefore, be very grateful to him for coming to talk to them. She would then sit at the back of room during his lecture, taking notes and requesting him not to erase anything he wrote on the blackboard. 'I never recall a female doctor coming to talk to us, although there were female doctors working in the hospital at the time', commented the respondent. The respondent found the lectures to be generally very good. As the doctor left the room, all the students would stand. 'We had no idea that doctors were being paid to lecture to us,' he remarked. 'We all thought they were doing it free in order to improve the collaboration between nursing and medical staff!' After the lecture, the Sister Tutor would go through the words written on the board to make sure the students had understood them and would ask questions based on the notes she had herself taken during the lecture.

This vignette encapsulates several important themes. Nightingale's nurse education emphasised medical lectures, but training also focused on high moral character, duties and responsibilities rather than skills (31). Notice how the trainees were formalising the appropriate deferential demeanour of nurses (women) towards doctors (men). Notice also how the teaching is organised as if they would be barely able to understand the technical aspects of the talk, which required reinforcement and elaboration later. The ceremonies with which their education is delivered, in other words, consolidate their status. This also recollects the separation between nurses sphere of nurturance and moral character in relation to the medical knowledge which originated in male dominated contexts. In this way also we can see how the generic form of nurse education recollected Nightingale's programme. This parallels Bakhtin's writings about the way the form of social systems contains sclerotic deposits of what has gone before (32).

The most important event of the first week in Preliminary Training School was the day the uniforms arrived. A seamstress came to ensure that they fitted correctly. 'There were about six full-length mirrors for the female students to view themselves. However, I was given a white coat several sizes too big and was told that it would shrink after three or four washes!' It was frequently impressed upon the female nurses that they had the smartest uniforms in the country and that they should be proud of them.

The centrality of uniforms to nurses has been noted by other writers (33) who have examined how nurses police one another's uniform wearing and ensure that it is up to scratch. Street sees this regulation of one another's uniforms as an oppressive practice which is in part self-inflicted by the nursing profession. However, here we can see a rather different angle. The uniform makes new forms of identity possible - in this case pride. The informant here is almost left out as there is little for him in this ceremonial form. The tendency of uniform-wearing to facilitate new identities has also been noted by scholars of military matters (34). There were other aspects of life as a trainee nurse which sidelined our informant. The Sister in charge of the Nurses' Home informed all the female nurses about the rules and regulations, the procedures for requesting leave and late passes, the times of meals and the importance of rest. 'I got the impression,' commented the respondent, 'that the welfare of the female nurses was the prime concern of the senior nursing staff and that males were thought to be able to fend for themselves.' Thus, rather than simply being restrictive, the rules also contributed to the identity and well-being of nurses.

On the wards, the new student accustomed himself to the rigid hierarchy, with the Ward Sister at the top. Reprimands came solely from her; praise solely from the junior staff nurses. Routines ordered the day: the 'back' round, the TPR round, the BP round, the teeth collection round at night and the medicine round. This informant knew why he was welcomed on the wards: 'I was popular to work with when it came to doing 'back rounds' and blanket baths because I was good at lifting patients.' He had three allocations to orthopaedic wards during his training, not because of any special interest he had in orthopaedics, but because he was strong and could lift immobile patients on his own. However, he had not found his position as a male nurse difficult. 'The patients accepted me and I never once experienced any discrimination'. Yet took far longer to achieve the rank of Charge Nurse than his fellow-students had to become Sisters.

In the mid 1950s, he and a nurse who had started training in the same set as himself decided to get married. To do so, the respondent had to request permission from Matron: 'She showed little interest in me but was very concerned about my wife to be. Had I enough money to keep her? Was there somewhere for her to live? Were we thinking of starting a family?' After the wedding, they lived outside the hospital and their strong attachment to the institution weakened. This reflects a broader historical process too. In the late twentieth century nurses are less likely to live 'over the shop' where their trade is practised. This loosening institutional attachment reflects also a lessening interest within nursing in routine and hierarchy and a greater interest in the nature of nursing practice.

[happthearts]

Very interesting alot of things I had not heard before.

Thanks

Happthearts