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A profession shaped by adversity

Adaptability, innovation, and political savvy have endured throughout our nursing history. By Pamela Wood.

The past has great potential. It is a rich source of ideas, insights and lessons to be learnt. It shows us our strengths and failings. It offers alternative ways of seeing an issue and sometimes shows us possible responses to current problems, which we might not have considered.

Knowing the past can help us determine future directions in nursing. What we need is historical imagination.

In introducing the idea of historical imagination in nursing, I defined it broadly as the creative capacity to envisage possibilities of engaging with the past. In this case, more specifically it’s the capacity to identify why, and how, nurses have successfully responded to a changing healthcare environment in the past, so we can harness this in determining nursing’s future.

Even if we look at just a few early decades in the history of professional nursing in Australia, we can see several successful attributes that have endured through time. Key ones are adaptability, innovation, a willingness to seek and share information, and political savvy.

From the early 1900s Australian nurses were beginning to claim professional status and recognition as an essential part of the healthcare system. The drive toward professionalism can perhaps first be seen in the establishment of nursing organisations – the Victoria Trained Nurses Association (VTNA), and the Sydney-based Australasian Trained Nurses Association (ATNA), which served all other states.

A third measure, nursing registration, was achieved in each state at different times from the 1920s. The value of a professional workforce that had received the kind of training established by Florence Nightingale in Britain in the 1860s was quickly recognised. Its potential was also soon demonstrated beyond the hospital system.

Nurses’ adaptability meant the emerging profession could take up the expanded roles needed if the country was to have the kind of healthcare it needed. Building on the profession’s experience in establishing district nursing in the 1890s, nurses quickly developed expanded roles in school, bush, insurance and public health nursing.

No training was available for these expanded roles – nurses pioneered them, developing each form of practice “on the job”. The capacity to be innovative was essential. As they developed their new roles, nurses eagerly shared ideas, practical suggestions and ways to avoid pitfalls.

The new nursing journals made it easier to share information. UNA was the VTNA journal, while the ATNA produced the Australasian Nurses’ Journal with a readership across Australia. Nurses and doctors contributed a range of articles. The editors followed international editorial practice by reprinting significant articles from overseas journals.

Australian nurses also made sure they were internationally active by sending delegates to overseas conferences, such as the International Women’s Congress in London in 1899 where nurses decided to found the International Council of Nurses. In all these ways, Australian nurses were abreast of international advances in nursing practice and professional issues occurring around the world. Their willingness to seek and share information at a local and international level is clear.

Nurses also knew how to create political alliances and manage professional challenges in demonstrating the value of nursing’s expanded roles and critical place in the healthcare system. In setting up their professional organisations, they deliberately included powerful medical allies on their boards. They also enlisted them to set examinations for nurses who had completed their hospital training and were seeking recognition as qualified nurses.

Successful candidates had their names recorded on the associations’ registers. This meant that standards for training and formal admission to the profession were set and maintained. All these actions strengthened nursing’s position within the healthcare system. Involving medical colleagues in this process was not a case of nurses being passive, oppressed handmaidens of doctors, it was a case of nurses using their political savvy to ensure their value as a profession was recognised.

Early bush nursing gives us an example of the way these characteristics of adaptability, innovation, information-sharing and political savvy merged. The first bush nurses were appointed in 1911. They created their roles to meet the health needs of people living in remote rural areas, a demanding role requiring resourcefulness, determination, stamina and confidence.

Enduring the hardships of difficult travel, isolation, and lack of privacy within a small community meant that bush nurses needed exceptional qualities. As they developed their new practice, nurses shared information by writing to each other and sending articles to the journals explaining how to make do with scarce resources and adapt hospital procedures to suit the bush environment.

Their political savvy was crucial for maintaining good relationships with the community, their association’s committee and with doctors in the area who often resented their arrival as it could threaten their income. It was also needed in negotiating the conflicting expectations that they would stringently follow doctors’ instructions, when available, but use their own knowledge and expertise to decide on appropriate treatments when they had to work independently.

These attributes and challenges are still identified by rural and remote nurses today. Bush nursing’s past therefore demonstrates enduring nursing qualities and strategies that nurses can draw on in shaping its future direction.

The past also yields cautionary tales. Setting up separate associations, one to address professional issues in Victoria and the other to cover the rest of the country, perhaps created an acceptance of separateness within the profession that has emerged in different forms, combinations and circumstances through ensuing decades. Recent mergers, not only in our registration system, have highlighted persistent challenges but also the willingness to review and create new entities and partnerships.

We can’t predict the future by looking back into the past. What we can do, however, is identify the things of value in the past that are worth bringing with us into the future. To achieve this, we need quality historical research on all areas of our professional past and inclusion of nursing history in our curricula. Then we can be confident that the profession is able to use the power of historical imagination in determining its future directions.

Associate Professor Pamela Wood is from the School of Nursing and Midwifery at Monash University. She is a nurse and an historian. Her recent research has focused on how nurses developed new areas of practice in the marginal settings of rural areas, urban slums and war.

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