From Self-Sacrifice to Self-Interest: The De-Christianization of Nursing from 1926-1940
Micah Rojo, Duke University, and Jackson McNeece, Baylor
In 1926, the American Nurses Association (ANA) defined the nursing profession as a vocation of self-sacrificing service to those in need. Nursing leaders of the time argued that a nurse participates in the spirit of Christ, making no account of oneself but doing good. But in 1940, however, the notion of self-sacrifice had largely disappeared from nursing literature. Nursing leaders redefined the nursing profession as the development of skills, science, and social standing. Between 1926 and 1940, the nursing profession thus underwent a paradigm shift— from self-sacrifice to self-interest.
This paper describes how nursing leaders used both ideals: self-sacrifice and self-interest, to motivate and maintain a compliant labor force, before turning to the cultural, economic, and religious factors involved in this revolution of self-understanding. It concludes by considering how nurses might today navigate the ongoing tension between self-sacrifice and self-interest by turning to John Paull II and Sarah Coakley.
Nursing leaders, particularly nurse superintendents who managed nursing schools and staff within hospitals, upheld Christ-like self-sacrifice and self-immolation as the spirit of nursing in order to maintain a system that financially exploiting student nurses. The conditions student nurses operated in were abysmal. National surveys 7such as the 1923 Goldmark Report, found them over-worked, underpaid, poorly fed and inadequately housed. The goal of student of nursing training was unquestioning obedience, both to etiquette and mechanical routine. “Why” was not a word in the student nurse’s vocabulary. This was achieved not only through disciplinary techniques, but also rhetorical ones.
Student-nurses were told that, in their obedience they were emulating Christ, who thought little of himself, and gave up his life for others. “Think also of the saints!” nursing leaders urged, how they devoted their whole life to the care of the sick. Did these saints ever once think of themselves, of their financial gain? In this way, the exploitation of student nurses was justified with a theological veneer. Hospitals positioned themselves as places for moral training, super-intendents as the enactors of this moral training.
Self-sacrifice as the spirit of nursing lost its rhetorical force in 1930s following a series of nursing crises. First, several nationally recognized reports exposed the poor conditions and education standards of American nursing schools. Second, because nursing education was so inadequate, many graduate nurses were tasked with caring for patients they simply did not know how to care for. Finally, the Great Depression left 60 percent of nurses unemployed in 1932.
Because nursing care in hospitals was primarily performed by student nurses, graduate nurses typically worked in the entrepreneurial private duty. The Depression, however, left these private nurses without work. Nursing superintendents took this as an opportunity to bring them back in the hospital— reducing student labor demands and allowing for improved education. Yet graduate nurses were reluctant to return, fully aware of the poor wages and harsh conditions awaiting them.
If nurses were no longer motivated by ideals of self-sacrifice, how would hospital labor be maintained? Nursing leaders began to appeal to self-interest. The profession was reimagined as a specialized field of scientific expertise. Whereas respect for the nurse in 1926 rested on moral character and dedication to service, by 1940 it rested on technical competence and professional knowledge. As a result, nursing emphasized technological prowess, shifted bed baths and toileting to Nurse Assistants, and grounded their knowledge in Randomized Control Trials. While this shift earned nurses greater academic and professional prestige, it also led them farther away from the patient.
How then are nurses today to think about their practice? While the turn toward self-interest can be seen as the ANA’s attempt to improve the nurse’s struggle, it simultaneously draws nursing into capitalistic logics that value productivity or presence. Yet an unqualified turn to self-sacrifice, though resonant with the Christian tradition, reopens the nurse to great exploitation by capitalistic medicine. Turning to the works of Sarah Coakley’s Powers and Submissions, and John Paul II Laborem Exercens, we end by proposing a theology of nursing grounded in an account of self-giving love that eschews passivity and rather dignifies the relational and co-creational act nursing participates in. The nurse’s care for others becomes inseparable from the care owed to herself as a worker made in the image of God.
This paper describes how nursing leaders used both ideals: self-sacrifice and self-interest, to motivate and maintain a compliant labor force, before turning to the cultural, economic, and religious factors involved in this revolution of self-understanding. It concludes by considering how nurses might today navigate the ongoing tension between self-sacrifice and self-interest by turning to John Paull II and Sarah Coakley.
Nursing leaders, particularly nurse superintendents who managed nursing schools and staff within hospitals, upheld Christ-like self-sacrifice and self-immolation as the spirit of nursing in order to maintain a system that financially exploiting student nurses. The conditions student nurses operated in were abysmal. National surveys 7such as the 1923 Goldmark Report, found them over-worked, underpaid, poorly fed and inadequately housed. The goal of student of nursing training was unquestioning obedience, both to etiquette and mechanical routine. “Why” was not a word in the student nurse’s vocabulary. This was achieved not only through disciplinary techniques, but also rhetorical ones.
Student-nurses were told that, in their obedience they were emulating Christ, who thought little of himself, and gave up his life for others. “Think also of the saints!” nursing leaders urged, how they devoted their whole life to the care of the sick. Did these saints ever once think of themselves, of their financial gain? In this way, the exploitation of student nurses was justified with a theological veneer. Hospitals positioned themselves as places for moral training, super-intendents as the enactors of this moral training.
Self-sacrifice as the spirit of nursing lost its rhetorical force in 1930s following a series of nursing crises. First, several nationally recognized reports exposed the poor conditions and education standards of American nursing schools. Second, because nursing education was so inadequate, many graduate nurses were tasked with caring for patients they simply did not know how to care for. Finally, the Great Depression left 60 percent of nurses unemployed in 1932.
Because nursing care in hospitals was primarily performed by student nurses, graduate nurses typically worked in the entrepreneurial private duty. The Depression, however, left these private nurses without work. Nursing superintendents took this as an opportunity to bring them back in the hospital— reducing student labor demands and allowing for improved education. Yet graduate nurses were reluctant to return, fully aware of the poor wages and harsh conditions awaiting them.
If nurses were no longer motivated by ideals of self-sacrifice, how would hospital labor be maintained? Nursing leaders began to appeal to self-interest. The profession was reimagined as a specialized field of scientific expertise. Whereas respect for the nurse in 1926 rested on moral character and dedication to service, by 1940 it rested on technical competence and professional knowledge. As a result, nursing emphasized technological prowess, shifted bed baths and toileting to Nurse Assistants, and grounded their knowledge in Randomized Control Trials. While this shift earned nurses greater academic and professional prestige, it also led them farther away from the patient.
How then are nurses today to think about their practice? While the turn toward self-interest can be seen as the ANA’s attempt to improve the nurse’s struggle, it simultaneously draws nursing into capitalistic logics that value productivity or presence. Yet an unqualified turn to self-sacrifice, though resonant with the Christian tradition, reopens the nurse to great exploitation by capitalistic medicine. Turning to the works of Sarah Coakley’s Powers and Submissions, and John Paul II Laborem Exercens, we end by proposing a theology of nursing grounded in an account of self-giving love that eschews passivity and rather dignifies the relational and co-creational act nursing participates in. The nurse’s care for others becomes inseparable from the care owed to herself as a worker made in the image of God.