Women’s dominance in nursing nearly equals our monopoly on motherhood: nursing has always been a woman’s job. In the mid-nineteenth century, most nursing care was done at home as part of women’s domestic duties. Florence Nightingale’s 1860 manual,Notes on Nursing, was addressed to women in families and opened with the assertion, “Every woman is a nurse.”¹ As medical care became more complex and more tied to hospitals, nursing gradually separated from the sphere of women’s domestic work and became established as paid work that required special training. Arguments of women’s special fitness for nursing connected traditional domestic roles to...

Writers on the professions have set forth conflicting definitions and interpretations, but all acknowledge the special place that professions occupy in the world of work. Common usages reveal the near-mystique associated with the concepts of professions and professionals. When we comment that someone is “a real professional,” we bestow high praise: we mean an expert, someone fully qualified to perform the task at hand, one who can be trusted to assess and act on important problems. Professionals are their own bosses, not subject to the same close discipline as most workers. They occupy a special place in their communities: they...

Nurses’ distinctive training set them aside from other working women and formed the core of their occupational culture. Until the 1950s, virtually every school required that the student nurse live in the hospital’s nursing residence, so the hospital was school, workplace, and home combined. Separated from her family and community, the young woman took her place in a world of female authority, where she underwent a rigorous apprenticeship into nursing, learning her craft in classrooms and on the ward. Within a few months—sometimes within hours—the new student would venture into the ward, first arranging flowers or scrubbing utensils,...

In the 1920s and 1930s, most nurses graduated from the bustling wards of hospital training schools to work in private duty, caring for a single patient at home or in the hospital. Unlike salaried public-health or hospital nurses, private-duty nurses operated as freelancers: their patients hired them and paid them by the shift or by the day. Nurses found their cases through hospital or private registries, which acted as employment bureaus. Doctors, nursing superintendents, and patients applied to the registries, which matched these requests with their lists of nurses on call. Informal and often highly personal, the hiring networks and...

As private-duty nurses faced the steady decline of their market, public-health nurses were building a place for themselves in the setting of the expanding lay public-health reform movement. Trudging down city streets or jolting over country roads in their Fords, public-health nurses brought bedside nursing services to people who could not afford private duty, and solicited patients for the new services of preventive medicine. Like private-duty nurses, they often traveled to their patients, and most worked alone. But the organization of public-health services and their relative independence from mainstream medicine gave public-health nurses an unprecedented autonomy at work. Even as...

In the 1930s, graduate nurses began to move from freelance private duty to hospital staff jobs. Nursing practice took its modern form as hospitals hired increasing numbers of graduates for general ward duty. Once run by students or attendants supervised by a single graduate nurse, hospital wards rapidly became the province of graduates. The transition took place within the space of fifteen years. In 1927, nearly three-quarters of hospitals with training schools relied exclusively on students for ward nursing services; a decade later, most reported that they had begun to employ some graduate staff nurses. By 1940, nearly half of...

The tension between nursing’s two cultures still underlies and informs nurses’ efforts to define and control their work. Leaders have gradually won much of their program; yet as more and more nurses earn degrees, they are discovering the limits of credentials as a means to gain the prerogatives of professionals. On the job, the culture of apprenticeship continued to reproduce itself and, in somewhat altered forms, the values of apprenticeship still flourish. The divisions introduced by the transition to baccalaureate requirements are not yet mended, and nurses confront the persistent limits of their work under the handicap of internal conflict...