Thursday 16 April 2015

Nurses - Training and Registration

     At the time of the Great War there was still no national registration of nurses in the United Kingdom nor any official registers of who they were and where they were trained. Family historians trying to trace pre-war nurse ancestors still have to rely on information, letters and photos passed down over the generations. Census returns might yield up some information if caught at just the right moment, but even then only give a snapshot of where a nurse was working on one single day. Although nurses trained between 1860 and 1890 were likely to have completed just one year in hospital, by the turn of the twentieth century a three year training had become the standard required in hospitals throughout the country. As there were no national standards for nurses, those with a lesser training, or even no training at all could continue to nurse as long as they worked within the law and proved themselves safe - trained on the hedgerows of life.

Nurses in the classroom in 1900

     Nurses trained in hospitals received a certificate at the end of their one or three year period which was precious as it provided proof for future employers of their training and experience. Some hospitals insisted that nurses stayed on for a further year at the end of their training before receiving their certificate. Hospitals considered they'd spent a lot of time and effort on the training and the fourth year ensured they would retain a good supply of newly-trained nurses on their staff, at least in the short term.  Women were not compelled to stay for a fourth year but to leave without their certificate could have serious implications for their future careers.

     The fight for the national registration of nurses continued over more than three decades and was not universally supported by hospitals, doctors or nurses themselves. Ideas and suggestions as to the need for highly-educated nurses at that time throw up alarmingly similar parallels to the current debate on whether nursing has been improved by making it an all-degree profession. In 'The Lamp and the Book' Gerald Bowman writes of nurse reformer Ethel Bedford Fenwick:

'She was a crusader of almost fanatical spirit, a close friend of Mrs. Pankhurst who was leading the campaign for the women's vote.  She believed that only educated women could have a chance of winning freedom for womankind who were debarred from almost all professions and who, until 1882, five years beforehand, had no legal right to their own money after marriage.  She wanted her own profession of nursing to be brought into the same category, if not on a level with, the profession of medicine. That was the object of her first proposed state register to be exclusive to those who were fully trained and could pass an examination demanding a high educational standard. Only those women were to bear the honoured title of Nurse.  For the rest, her original proposal was that those who could not or would not train and sit for the examination, no matter how efficient they had been in practice, should drop the work.' **

     By the time the Nurses' Registration Act passed into law on the 23rd December 1919 the conditions for inclusion in the register were far broader than Mrs. Bedford Fenwick had desired. In addition to those nurses who held hospital certificates it was also possible for both women and men to be included if they had been in practice for a minimum of three years prior to November 1919 and had adequate knowledge and experience of nursing the sick.  The Act contained various clauses with regard to training, but it was Rule 9(1)g which set out the conditions by which a nurse without a hospital training or certificate could be registered:

'In the case of a nurse who was at 1st November 1916, engaged in actual practice and who produces the following evidences of knowledge and experience:
(a)  a certificate of good character;
(b)  a certificate signed by the matron of a general hospital or an infirmary or by two medical men setting out that the applicant has been in attendance upon the sick in the capacity of a nurse for a period of not less than three years prior to the 1st November, 1919; and
(c)  a certificate signed by a registered nurse and by two medical men, one of whom shall be on the staff of a general hospital, setting out that the applicant has adequate knowledge and experience of medical and surgical nursing and is competent to attend upon the sick in the capacity of a nurse.

     Registers of the General Nursing Council for England and Wales were published yearly from 1921 and from then all newly qualified nurses could apply to be included.  After 1923 it was a requirement that all women and men undertaking nurse training must pass a written and practical examination at the end of their course and from 1927 the GNC Register shows nurses qualified 'by certificate,' 'by examination' or by one of the other avenues, usually Rule 9(1)g.

A page from the General Nursing Council Register for 1928 showing nurses trained in the three ways mentioned above (click to enlarge)

     Almost one hundred years later medical care has advanced and nursing care has had to keep pace. However, the parallels in nurse training are still present; there are nurses working in hospitals today with various levels of educational achievement and training according to the regulations in place at the time. There are men and women with degrees, diplomas and still some qualified by examination at the end of their course. The latter group are fading fast as they work their way toward retirement. With nursing currently an all degree profession for new entrants in the United Kingdom, one hundred years on Ethel Bedford Fenwick finally seems to have come into her own. Of course, as might be expected, not everybody agrees with her, neither then nor now.


** The Lamp and the Book, the story of the RCN, 1916-1966; Gerald Bowman; The Queen Anne Press Ltd., 1967