The proletarianization of nursing in the United States, 1932--1946

There have been many studies of the development of an industrial work force with all its attendant hardships as newly proletarianized peasants were thrown off the land and into factory labor. The author postulates that a similar process occurred in the creation of at least one modern "profession"--nursing--as the traditional autonomy of private practive nursing was displaced by institutional nursing in hospitals and nursing homes. Prior to the Depression, most nurses worked in private duty--as independent entrepreneurs--without the regimentation, rigid division of labor, and intense supervision characteristic of modern hospitals. The collapse of the U.S. economy made it impossible for most nurses to continue to earn a living privately at the same time that hospitals required cheap labor power in order to develop as viable businesses. Despite the promise of job security in hospital work, most nurses resisted the change by criticism, sabotage, walking away from job, and attempts at unionization. Hospitals sought in response to inculcate loyalty by a variety of methods, including screening of applicants, in-service training, and professional ideology. In some instances, hospitals coerced private nurses into "staff" jobs by threatening their ability to secure business on their own. By the end of World War II, the majority of nurses were employed, for the first time, as wage earners for institutions. The entire period was marked by such discord and revolt on the part of nurses, however, that the American Nurses' Association was transformed as an organization in order to avoid massive unionization. The study points out that this unwritten history of nursing has been obscured by professional nursing leaders who are still suppressing revolts of rank-and-file nurses against the conditions of hospital work.