Susan Rimby Leighow. Nurses' Questions/Women's Questions: The Impact of the Demographic Revolution and Feminism on United States Working Women, 1946-1986. New York and Bern: Peter Lang, 1996. vi + 208 pp. $39.95 (cloth), ISBN 978-0-8204-2755-3.
Reviewed by Gwen Kay (University of Tennessee at Chattanooga)
Published on H-Women (January, 1998)
The central question of Nurses' Questions/Women's Questions is how did nurses appropriate feminism into a traditionally female job. Nurses worked outside the home before it was widely accepted, faced pressures to unionize, and wanted to be treated equitably within the medical profession. Leighow sees feminism as providing a framework, if not an answer to this and other questions about nurses in the mid to late twentieth-century.
The book is structured chronologically, and several threads run through the work. In the first chapter, Leighow provides a cursory history of nursing before 1946, so that the action of her players can be viewed in historical context. In focusing primarily on the hospital, however, other loci for professional nurses were obscured. Hospital nursing was, before 1946, accorded lower status than private-duty nursing, or public health nursing. Little mention is made of at-home nursing, community health care, or private practice. A reader might assume that all nursing was done in the hospital setting, and while this was increasingly true, such an assumption ignores other nurses, many of whom did not benefit from unionization, litigation, and other processes more effectively conducted with a large number of participants.
The second and third chapters examine educational systems and participation in the work force. These two chapters work well together and raise some interesting questions. Following trends in female employment after the war, many nurses left their paid posts and returned to the home. The drop in the number of nurses in the labor pool coincided with an increased need for nurses: more children meant more pediatricians, which in turn increased the demand for private-practice nurses; the Hill-Burton Act meant more money for more hospitals, which in turn increased the demand for hospital nurses. The American Nurses Association (ANA) encouraged women at home to return to active nursing, and provided workshops to update them on advancements in medical knowledge, and train them to use new technology. In encouraging these "older" women, though, I wonder if the ANA neglected the new nurses. The increased number of students attending college meant that educational standards of nursing also could be changed. The hospital-based educational system for nursing gave way to years of college and additional education to become a registered nurse. The movement to encourage "retired" nurses to return to the field, and the emphasis hospitals and the professional associations placed on the advantages of these women, left a vacuum: why would an administrator choose to hire young nurses when more mature and experienced women are available? The older women seemed to offer a more stable workforce, because they would not leave the profession to have children. Arguments might also have been made against hiring older women, although these are not mentioned. As physicians gained more authority and the patriarchal system became more firmly entrenched, might older nurses be less willing to accept things than younger nurses, fresh from indoctrination about hospital hierarchy?
The fourth, fifth, and sixth chapters consider nursing and feminism, where feminism is seen as the "women's question" and professionalism is seen as the "nursing question." These chapters seek to connect registered nurses and how the viewed feminism. While the larger organizations ignored feminism--in fact, the ANA did not endorse the Equal Rights Amendment until 1982--small groups of feminist nurses formed and questioned their pay, the structure of hospital organization, and issues such as child care. Much of the sixth chapter examines litigation in which nurses fought state laws that limited their actions in the health-care field. "Feminism," a critical issue to this book, and oft-used word, is never defined. A footnote acknowledges Nancy Cott's definition, but just as every person has her own nuances, Leighow's take on Cott's definition would have been useful. While this might seem a pedantic point, the link between feminism and a willingness to adopt union tactics is never clearly drawn. I am not entirely convinced that "work place feminism" means litigation as a way to resolve problems.
The history section was useful, and perhaps too brief. Scant attention is paid to the shift in the structure of the hospital itself. Just as nursing became more respectable as the century advanced, so, too, did hospitals, as they increasingly became an integral part of medical education and technology became more important in diagnosis. Women of color rarely appear in this narrative. The self-help health care movement, in which women were active participants, does not merit much attention, nor do related issues of nurses "usurping" doctor control in health clinics.
This book is very instructive in how politics shaped and were shaped by women in the nursing profession. Leighow nicely juxtaposes radical feminist nursing groups against feminist organizations, and those same nurses against the larger nursing (non-feminist) community. Missing, though, was motivation: because it was never clear why women chose to enter nursing, or re-enter the profession after time devoted to hearth and home, I had no sense of why women would react in certain ways. Women who became nurses in the 1940s and 1950s knew, or learned, that their profession was a hierarchical, if not patriarchal, system. Understanding the motivations of these women might explain why some women were more willing to accommodate that system, and others more willing to rebel.
One of the most interesting, and also frustrating, components of this book were the oral histories. A copy of the questionnaire is included in the appendix, but several questions about the study itself are unanswered, including to whom the author sent questionnaires, how these women were selected, how many received questionnaires and how many answered, how many respondents are active nurses and how many retired. The respondents seem to be a cohort of Pennsylvania nurses, yet their answers are used to offer context or comment upon national rather than local events that affected their profession.
This book offers a snapshot of nursing over a forty-year period in which nursing became more acceptable as a profession, employees in a wide range of jobs unionized, larger numbers of women worked outside the home, feminism became a political option, and litigation became a popular method for resolving unfair practices. While readers might not come away with a sense of why individual women chose to become nurses, and chose to become politically active, readers will appreciate the struggles of nurses, a traditionally female profession, to empower themselves using a variety of political, organizational, and litigation techniques. Students of women's labor issues will find themselves richly rewarded. The next time someone asks why nurses are still mostly female, and still underpaid, yet in such high demand, I will recommend this book.
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Gwen Kay. Review of Leighow, Susan Rimby, Nurses' Questions/Women's Questions: The Impact of the Demographic Revolution and Feminism on United States Working Women, 1946-1986.
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