Reviewed by Alannah Tomkins
This is the first book-length examination of the General Nursing Council in Ireland. It contains a wealth of information, and charts the uneasy relationship between statutes passed by Westminster, the emergence of the Irish Free State and the management of nursing regulation across all of the counties of the island.
The book is written both chronologically and thematically. Chapters one and two chart the backdrop to nursing reform in Ireland, and the contribution of Irish reformers to legislative change across the United Kingdom. Activists were Irish by birth or adoption: prominent amongst them was Margaret Huxley (1854-1940), born in Surrey, who lived out her professional life in Dublin and became central to the campaign raising standards in nursing across Ireland.
Chapter three gets to the heart of the work conducted in the early years of the Council. The first, interim Council had to devise rules for admission to its nascent Register of trained nurses, at the same time that similar bodies were codifying rules for Scotland, England and Wales. Everyone had to grapple with the tricky problem of recognising earlier forms of training and experience among women who had already started their careers, while simultaneously drawing lines between them and the untrained handy-women. It was agreed that there should be separate schedules in the Register for fever, children’s and mental nursing, plus a discrete list for qualified male nurses. Despite these complications, the Irish Register opened in 1921, and by early 1922, 895 nurses had been registered. The first body was replaced by an elected Council in 1923, which was re-elected every five years.
Chapter four turns to the regulation of training, the centrality of hospital experience, and the role of smaller institutions that had fewer beds and/or a reduced variety among cases. The history of integrating hospitals into recognised training centres runs in parallel to an account of the prominence of untrained Catholic nursing sisters across multiple locations. Nuns whose nursing derived from vocation and experience might find themselves managing nurses who had been trained to a syllabus and examined in scientific competences. Chapter five focusses on the smaller hospitals that could only offer adequate training facilities when working in concert with other similar establishments. These were known as ‘affiliated’ (rather than ‘complete’) training schools and from the 1930s onwards they raised significant problems for the Council. Were they offering a satisfactory form of training?
The book then turns to thematic treatments of, respectively, mental-health nursing, the biographies of two prominent personalities (of whom Huxley is one), tuberculosis nursing, and ‘special’ cases (public health, orthopaedic, and male nurses). Regulation of mental nurses entailed negotiation and even conflict with the Medico-Psychological Association, which was the representative body for the medical superintendents of asylums. There was some jockeying for position over which body should have the final jurisdiction over training, certification and regulation of nursing appointments. Sanatoria existed for nursing tubercular patients, and the disease remained a prominent public-health issue throughout the period covered by this book. The training of specialist TB nurses occupied the Council in the 1940s, but the first registrations only took place in 1950 (at the very end of the Council’s existence). Each section of chapter nine is understandably brief, given that the main developments in district and orthopaedic nursing emerged after 1950, and the recruitment of significant numbers of men into general nursing only took place in Ireland in the 1970s.
Chapters ten and eleven cover the dissolution of the Council in 1951, to be succeeded by the An Bord Altranais (The Nursing Board), and Fealy’s conclusions. He categorises the legacy of the Council under tangible developments in leadership, health services, the nursing role/identity, and the increased sophistication of professional nurse regulation. The Catholic Church acquired further prominence in the new republic as the country sought ‘a distinctly Gaelic cultural identity’ (page 139), which influenced the trajectory of the Council’s work and achievements. At the level of individual nurses’ experience, registration conferred professionalism at the same time that it embedded women in a subordinate position within the gendered medical hierarchy.
This is a well-written and scholarly book, based on a wealth of original research in Dublin’s archives and across relevant publications. It is also quite pithy, with the main content running to just 148 pages. Readers will only wish they could have settled down with this volume for longer perusal!