|Author: Karen Flynn, University of Illinois, Urbana-Champaign
||The UKAHN Bulletin|
|Volume 9 (1) 2021|
In response to Indigenous and racialized scholars who insist that gender is not the only category of analysis and by extension, that sexism is not the only form of oppression nurses face, nursing scholars have made efforts to acknowledge race, gender, class, sexuality, and other vectors of difference in historical research. At the time of writing, there is no question that nursing as a discipline has been enriched by the proliferation and wide-ranging areas of historical inquiry. Despite attempts to expand and complicate nursing’s collective past, there remain notable gaps in the historical scholarship. Outside of a few exceptions, racialized nurses and their distinctive experiences are given cursory attention in the occupation’s historical archive.
Calls to critically engage with the occupation’s historical and ongoing association with whiteness and in some instances exclusionary practices demand attention. Simply put, nursing historians must be attentive to the structural inequalities embedded in nursing in ways that reaffirm a normative and often exclusive identity. This disavowal has implications not just for the writing of nursing history but also impacts the material lives of racialized nurses. White nurses, at least in the US and most likely in Britain, Canada, and other white settler societies dominate in leadership roles in hospitals and nursing schools. Nursing conferences, academic associations, and journals whether unconsciously or not generally center white subjects and whiteness as the norm. Even in attempts to present a global history of nursing, the Global North continues to maintain its hegemonic sway, while the “others” in the Global South are often added in a way which gives the appearance of an afterthought. How and why this is so will be addressed throughout this Introduction.
Global protests following the murder of George Floyd by a police officer in Minneapolis, Minnesota, and the rallying cry that Black Lives Matter have led to a racial reckoning of sorts. A peek into the Twitterverse suggests that millennials, in particular, are advocating for nurses to attend to and interrogate their racist past and present, especially in the context of a global pandemic. Instead of producing statements that can be viewed as performative, some institutions are exploring ways to address and dismantle structural and institutional forms of oppression. Thus, in response to the urgency of this political moment, the compilation of articles assembled here for the special issue of the UKAHN Bulletin is an attempt to decolonize nursing by centering the experiences of subaltern subjects. Moreover, as an intellectual and political undertaking, we shift the lens from a US- and British-dominated nursing histories. This special issue with a focus on Indigenous, Black, African, Indian, and Caribbean nurses across time and space makes visible subjugated knowledge. This collection is unique in that the majority of authors identify as Indigenous, Black, African, and Indian women from several continents mostly within the academy and at different stages in their careers. Eight of the articles have been reproduced publications produced in the early years of this century, while three are new scholarship or works in progress. The purpose of this introductory essay is to identify key themes that the articles share and the possibilities they engender in terms of thinking about nursing history globally. This collection is a modest attempt to contribute to a discipline that continues to privilege the voices and activities of white nurses, and to stimulate new work in the field of race and nursing. Significantly, some of the articles show us how histories can be written that involve and empower aggrieved communities.
A note on language use and identifiers:
The politics of naming is ongoing, contested, and depends on the historical moment and the various actors involved. While recognizing that racialized groups are not always in agreement about how they name and identify themselves, instead of the oft repeated, “what are they calling themselves now,” researchers must consider the histories and contexts that lead to these various forms of identification. Indigenous people, according to Taiaiake Alfred and Jeff Corntassel, are ‘the communities, clans, nations and tribes…Indigenous to the lands they inhabit, in contrast to and in contention with the colonial societies and states that have spread out from Europe and other centres of empire.’ Indigenousness, Alfred and Corntassel continue is ‘as an identity constructed, shaped and lived in the politicized context of contemporary colonialism,’ an analysis applicable to the groups discussed in this collection. The ability to name oneself is an active form of resistance especially in light of the state’s propensity to name its others. Alfred and Corntassel point out how the purpose of the identifier Aboriginal, was created by the state with the intention to ‘gradually subsume Indigenous existences into its own constitutional system and body politic…’ Similarly, visible minority, also a state-sanctioned terminology was used in the 1980s as an umbrella term to refer to Native, Black, and Southeast Asian women in Canada. It too was not without critique. Of course, these naming controversies and debates are not specific to Canada.
In the 1960s and 1970s, for example, the term Black, while contentious was used as a political term by people of African-Caribbean and South Asian descent in response to their structural location and concomitant treatment by the state. According to Avtar Brah, African-Caribbean and South Asian organizations, and activists ‘borrowed the term from the Black Power Movement to foster a rejection of chromaticism amongst those defined as “colored people” in Britain’.While eschewing essentialism and recognizing the heterogeneity in experiences, the use of Black as an identifier is an example of what post-colonial theorist, Gayatri Chakravorty Spivak, describes as strategic essentialism. Both groups employed Black as a political identity, as a strategy to call attention to their shared experience of racial discrimination in areas such as immigration, housing and the labor market. Solidarity and the struggles for equality were prioritized over cultural, racial and other forms of differences.
Today, the umbrella term BAME in the UK is used to refer to Black, Asian, and Minority Ethnic people in Britain and it too is criticized for failing to capture the complexities of the group(s) it encompasses. Unlike its predecessor Black, which at the historical moment appeared more “acceptable” and more commonly used by the masses, BAME does not have the same currency. Based on a poll conducted by the thinktank British Future of 2000 ethnic minority and 1500 white British respondents, ‘less than half of ethnic minority Britons (47%) feel confident that they know what ‘BAME’ means…. three in ten (29%) saying that they don’t recognize the term at all’. These statistics suggest that the BAME might be a state-imposed term. According to the poll, ‘ethnic minority Britons slightly prefer ‘ethnic minority’ as an umbrella term, with two-thirds (68%) saying they either support or accept the term, and 13% opposed to it’. None of the authors writing about Britain in this collection used BAME; they used Black, people of African or Caribbean descent, or Black British. In any one article, two or three of these terminologies might be used interchangeably.
For the same reasons relating to the identifiers discussed above, other problematic designations are women/people of color. Again, the charge is the homogenization without recognition of differences within those who comprise the category. In the context of the United States, colored is viewed as a pejorative term, but not so in South Africa. Colored is used to describe Africans of mixed heritage. ‘Racialized people’ is also another contested term raising similar concerns such as those in relation to women/people of color.
Clearly, there will never be a consensus on the correct terminology especially since identities are socially constructed, malleable, and subject to change depending on the context. That some mixed-race people even if they “look” white might choose to identify otherwise also speaks to the dynamics of identification. To that end, the authors’ terminology will be employed in the discussion of their submissions. While recognizing the limits of Black, and the problematic usage of people of color, they will be used as an umbrella term to refer to people of African descent where appropriate. Racialized will be used to denote ascribing meaning to peoples’ identity.
Recovering nursing’s past: how do we do it?
Prior to the institutionalization of modern nursing and the establishment of nursing schools and hospitals, women were primarily responsible for health care. Indigenous women in that geographic area that came to be known as Canada shared their medical knowledge and expertise with white women. On plantations in the Caribbean, South America, and the southern United States, enslaved African women cared for the sick on plantations as doctoresses and medicine women. Drawing on traditional medical knowledge and healing practices that has been passed down from generations, these healers knew how to treat a variety of ailments, and in the case of midwives, deliver babies. Textual records detailing the experiences of these caregivers are rare. The institutionalization of modern nursing and the establishment of nursing schools meant that nurses in some geographical locations now kept written records. These archival resources include but are not limited to annual nursing reports, yearbooks, and student records yielding rich insights into nursing education and practice as well the professionalization of the occupation.
Documenting nursing’s past has been uneven, selective, and exclusive. In white settler-colonial societies, the term nurse was embodied by white middle-class women, who emerged as key actors in the late nineteenth century, particularly those leaders’ instrumental in the professionalization of the occupation. Rank and file, Black, Indigenous women, men, and various “others” were excluded or portrayed as ancillary in nursing’s historical script. It is this knowledge regarding the absence of Indigenous, Black, Caribbean, African and Filipino nurses from the historical record that motivated many of the authors in this volume.
In reference to the Caribbean, Jocelyn Hezekiah noted, in her article ‘Dame Nita Barrow and the development of black nursing leadership in the West Indies’, that ‘the contributions and accomplishments of Caribbean nurses were neither recognized nor documented’. Thus, she felt compelled to document ‘the achievements and lived experiences of three Caribbean nursing leaders’. Likewise in India, where some attention has been paid to western medicine and the development of hospitals ‘as the symbol of modern medicine’, this institution, Sanyal pointed out in her article, ‘Institutionalisation of Nursing as a Profession in early 20th Century Bengal’, ‘…cannot be understood without considering the role of … nurses both as professionals and working women’ from a colonial perspective. While this is less the case for Sanyal, the lacuna in nursing scholarship is further compounded by access to, availability of, or lack of sources. Several scholars besides Hezekiah address the challenges of writing Indigenous, Black, and African nursing histories.
Best and Bunda, in their article, ‘Disrupting Dominant Discourse: Indigenous Women as Trained Nurses and Midwives, 1900-1950s’, pointed out that many of the historical records used to validate previously unidentified Indigenous women who trained as nurses and midwives ‘were difficult to source and, when sourced were incomplete’. For other groups of nurses, their experiences will remain partial or incomplete due to what Nicholson and Brown characterize, in their article, ‘Huddersfield and the NHS: the Caribbean Connection’ as ‘the unevenness of historical record-making’. The authors discuss migrant nurses’ multiple diasporic mobilities, that is, those who ‘worked with the NHS and later left the UK’. For the authors, the issue of linking migrant nurses’ ‘career journeys through hospital archives and other record-keeping systems’, is a real concern. In their attempts to access overseas documents, Nicholson and Brown discovered that some ‘materials [were] lost during the administrative upheaval of later 20th-century decolonisation’. No doubt, Nicholson and Brown’s findings are also applicable to Hezekiah who found the task of obtaining primary documents relating to the islands of the Caribbean daunting. How do we address what Omise’eke Natasha Tinsley refers to as ‘the impossibility of knowing’ due to the premeditated act of destroying records?
In their article, ‘Oral History from Within: African Women and the National Health Service’, Douglas-Bailey and Small cited the destruction of the Windrush landing cards by the Home Office of immigrants of Caribbean descent and Operation Legacy as an egregious illustration of state power and historical erasure. The Young Historians Project (YHP) is a group of young people who are interested in preserving Black history and stimulating interest in it, especially among the Black community in the UK. Operation Legacy was a program where the British Foreign Office deliberately destroyed, doctored, or hid documents that would embarrass or taint its image as a violent colonial power. An example of epistemic violence, Operation Legacy in particular raises questions about the archive as a reliable repository of the past, whose records are worthy of preserving, and how history is written. Scholarship rooted in critical race and settler colonial studies shows us that many of the narratives that get produced through the so-called formal archival record ‘mak[e] some stories eligible for historical rehearsal and others not’. As an institution, the archives, as the YHP authors illustrate, reflect the dynamics of power in British society, whereby, only the actions and standpoints of the dominant group are deemed worthy of preservation. As the example of Operation Legacy proves, if the records fail to venerate the British empire they will be expunged. This erasure impacts how colonial and post-colonial histories are written.
In addition to archival sources being destroyed, non-existent, inaccessible, or incomplete, the YHP authors identify the ‘accidental or deliberate miscataloging of archival materials’ as an extension of the epistemic violence carried out in the colonial process. Nicholson and Brown referring to ex-colonies argue that archival creation is a crucial element of nation-building following independence and is ‘often long-delayed and under-funded’. Funding of archives and the expense of digitization of materials is not only unequal it is also a costly endeavour. For Douglas-Bailey and Small, accessibility also includes where archives are physically located, the cost of travelling to the archives, and how archives are organized and structured. Are archives user-friendly and safe spaces? Are they only accessible to seasoned researchers who ‘know’ the rules? Are the collections/documents contained within the archives the rightful property of that archive? How might the selection and interpretation of archival materials be different for those who share a similar location to the subjects they are researching? Researchers, too, are accountable for how they utilize archival sources. Knowledge of how historically marginalized peoples have been virtually excluded from the archives is critical. A reflexive approach to the archives is necessary even when nurses are the authors. Saidiya Hartman insists that ‘Every historian of the multitude, the dispossessed, the subaltern, and the enslaved must grapple with the power and authority of the archives and [the] limit it sets on what can be known, whose perspective matters, and who is endowed with the gravity and authority of historical actor.’
While decolonizing and democratizing the archives is critical to unearthing and writing nursing histories, that the archive is far from a neutral space has to be acknowledged. Archivists make choices about which records they choose to preserve thus contributing to how and whose histories matter.
The dearth of historical materials does not necessarily mean the sources are unavailable but are sometimes obscured beneath larger or seemingly unrelated search terms. It might mean drawing from the fragments of archival materials, such as hospital and administrative records and supplementing these findings with complementary sources found outside the archives. Nicholson and Brown found that ‘surviving diaries, notebooks, memoirs, and letters, news cuttings and mentions in other people’s writings [offered] important clues to [nurses] subjectivities and agency that flesh out entries in administrative records’. Stephen Bourne, in compiling his biography of a late 19th century Black nurse in London, ‘Annie Catherine Brewster’, relied on a variety of sources, such as newspapers, the London Hospital Official Ward Book, and census returns. Charissa Threat (‘The Negro Nurse: a Citizen Fighting for Democracy’) drew on a range of institutional, organizational, and personal sources in order to painstakingly map out the complicated Civil Rights story of the role of nurses and their allies in integrating the US Army Nurse Corps (ANC). Recruitment advertisements were used by Catherine Choy (‘To the Point of No Return: from Exchange Visitor to Permanent Resident’) alongside various forms of mass media to examine the transnational mobility of Filipino nurses to the United States. For some authors, these sources were complemented by oral narratives.
To augment the limits of the archives, fragmented and partial sources, five of the authors in this collection (Hezekiah, Flynn, Best and Bunda, Douglas-Bailey and Small, Nicholson and Brown) conducted oral interviews as a way to fill in omissions, and legitimize and recover subjugated knowledges. While oral interviews are important in incorporating neglected voices for the historical record, as a source, they cannot be used uncritically especially in terms of memory and the passage of time. Similar to the critical eye that is brought to bear on the archival sources, the same sentiment applies to oral interviews. Unpacking how and what people remember ought to be considered as part of recuperating the subaltern voice. Despite these critiques, the value of oral interviews cannot be underestimated. While recognizing the shortcoming of oral history, Franca Iacovettta points out that it ‘hardly justifies dismissing [it], any more than the fragmented and biased character of preserved written records should prompt us to abandon the archives’. Moreover, Gretchen Lemke-Santangelo recommends that we think about the benefits as opposed to the limitations of oral interviews in a manner that is particularly constructive. For Lemke-Santangelo, oral interviews ‘provide a different way of examining history, one that shifts the focus from ‘what really happened’ to how people use the past to produce individual or collective meaning and identity’. An example that speaks directly to Lemke-Santangelo’s point is an interview conducted by the YHP project with the daughter of a deceased nurse, Lyatunde Williams, from Sierra Leone. Through her daughter Margaret, the YHP interviewers learned about her mother’s experience as an African migrant nurse in Britain including resistance strategies Williams employed in response to racism. In addition to memorializing William’s contribution to the National Health Service (NHS), the YHP interviewers, are able to draw parallels with other African migrant nurses regarding an ethos rooted in ‘[good] intention, commitment and care’ producing a collective African migrant nurse identity.
Despite methodological challenges, the authors in this volume have drawn on a range of methods, sources, and theoretical lenses to investigate Indigenous, African, Black, Indian and Filipino nurses’ histories temporally and spatially. While some of the themes are reflective of nursing history more broadly, the authors capture the nuances and the specificity of nursing, medicine, and healthcare in diverse historical settings. In response to the epistemological silence in nursing and medical history, the authors presented in this volume shed light on the inner workings of settler colonialism and imperialism, provide insights into the evolution of nursing, and introduce new actors into the nursing lexicon. Indeed, the authors all demonstrate the possibilities and practice of nursing when the margin moves to the center.
Theoretical frameworks and approaches
Influenced by or drawing on Indigenous perspectives, settler colonialism, intersectionality, transnationalism and feminist approaches and methods, individual contributors to this volume explored nursing and nurses in relation to specific histories, contexts, and cultures. The authors demonstrate how serious engagement with the legacy of colonialism, imperialism, racism, and white supremacy shaped nursing and nurses’ experience, which outside of a few notable exceptions are often ignored, downplayed, or glossed over in nursing histories. Critically important is how perceptions of the “other” structured relations of dominance in colonial societies. How the various countries under discussion are implicated in the colonial and imperial project must be considered.
At different historical moments, the Caribbean, India, South Africa, Australia, Canada, and the United States were once British colonies. To be sure, colonialism and imperialism were far from monolithic processes, thus there is no master narrative regarding their impact and legacy. Australia and Canada are characterized as white settler colonies because they structured their nations by attempting to naturalize their occupation of Indigenous territories, mimic their former owner’s white supremacist values, and the colonization of Indigenous peoples remains ongoing and violent. The same is true of the United States; even as it fought for independence from Britain, the United States was also steeped in maintaining white superiority reflected in its treatment of Native Americans and enslaved Africans.
In South Africa, Afrikaners viewed themselves as victims of British colonialism, which was used to justify apartheid, a system similar to Jim Crow in the United States. It should be noted that South Africa used Canada and its treatment of Indigenous peoples as an exemplar to establish its apartheid system. In these countries, legislation was put in place to disenfranchise Black and Indigenous populations. Legislation such as the 1876 Indian Act, the Aboriginal Protection and Restriction of the Sale of Opium Act 1897 and other assimilatory policies circumscribed the lives of Indigenous nurses and midwives. It is the context of these various socio-legal structures that Best and Bunda situated their discussion of Indigenous nurses and midwives.
To rationalize the forcible removal of ‘many Indigenous people to missions and reserves across Australia’, Best and Bunda pointed out how a ‘eugenic attitude justified the mass relocation of Indigenous people’. Discourses of Indigenousness, the authors argued were ‘tied to blood quantum’. White authorities determined whether Indigenous people were ‘full blood, half-caste, or quarter caste’. This system was tied to employment and a clear indication of how race was a constitutive element in the labor market. The fiction of blood quantum sounds disconcertingly similar to the one-drop rule in the United States, whereby a person was said to be of Black ancestry if they had a drop of Negro blood, to use the vernacular at the time. Regardless of geographical location, one can argue that this race-based legislation, while a social construct, was used to buttress white supremacy.
The period of segregation and protectionism had devastating consequences for Indigenous peoples. Best and Bunda focused on four nurses and midwives: May Yarrowick, Muriel Stanley, and two unnamed nurses. Because Yarrowick was considered “half-caste,” during her training, separate accommodations were made available to her. The two unnamed nurses trained with the Native Nurses Scheme, a nursing program developed for young Indigenous women interested in nursing. Stanley wanted to train as a nurse because she wanted to be of service to her people but discovered that ‘no hospital in Queensland would accept her’. Stanley ultimately ‘decided to move interstate and was eventually accepted by the South Sydney Women’s Hospital’. Similar to Australia, nursing education in other geographical locations did not develop in a vacuum and was clearly influenced by race-based legislation. India (specifically West Bengal), Swaziland (now present-day Eswatini), and the United States are further illustrations of the nexus of race, caste, gender, class, and colonialism. The professionalization of nursing brings these cleavages into sharp relief.
Professionalization of Nursing
Nursing leaders in Britain, Canada, and the United States and have fought for the development of nursing as a legitimate, respectable, and autonomous occupation vis-a-vis- medicine. During the 19th and mid-twentieth centuries, white nurses from Britain, Canada and the United States travelled to the Caribbean, India and elsewhere to assist with the development of nursing education and the establishment of formal nursing organizations. Although these nurses were instrumental to the professionalization of nursing in the various regions, some appeared uncritical of, oblivious to, or reinforced the asymmetrical relationships that exist between their countries and the ones they visited. In her fascinating article on the institutionalization of the nursing profession in early 20th century Bengal, Sanyal identified a number of factors and multiple players involved in shaping colonial policies about nursing as well as the development of nurse training institutes and nursing organizations. While nurses were recognized as an integral element of Western medical modernity, the path to institutionalization was complicated by a number of forces including, but not limited to, lack of state support and restrictions to certain women.
While Britain profited from its colonies, it was slow to implement recommendations that would improve the health of colonial citizens. In the case of West Bengal, Sanyal pointed out that the British government was reluctant to provide support either financially or towards the creation of institutional facilities. When the subject of the professionalization of nursing emerged in the administrative system of British India, it was not locals that dominated the conversation. It was, as Sanyal asserts, the ‘European domiciled in India’. Despite the growing demand for nurses, preference was given to training European, and to lesser extent Eurasian, rather than Indigenous women.
Indian nurses, especially midwives, encountered obstacles with respect to training reminiscent of professionalization pursuits in Western countries. In addition to obtaining registration, licensure and regulating nursing education, the development of nursing organizations is a tangible example of professionalization efforts. Even as some of the European nurses who came later recognized, ‘the importance of cooperative rather than individual action and the need for professional solidarity’, the nursing organizations they founded were ‘overwhelmingly Anglo-American’ Citing the Trained Nurses Association of India (TNAI) founded in 1908, with a mandate of inclusivity, similar to the International Council of Nurses (ICN), Sanyal noted that, while ‘there was no racial bar to membership, Indian nurses were rarely represented in the TNAI’. As a result of the TNAI’s eligibility requirements, Indian probationers were judged insufficiently qualified. Thus, Sanyal argues, ‘many Indian nurses may have had no desire to join an organization so transparently Eurocentric in nature’. Nursing organizations such as the TNAI need not make explicit the fact that the organization was exclusive; it did so through eligibility requirements that on the surface appeared neutral. Moreover, other factors such as the stigmatization and suspicion of hospital nursing in particular by the Indian population meant at independence the nursing profession remained underdeveloped. 
A key element of colonialism is the dispossession of land and resources and the resultant restructuring of these societies that have denigratory implications for health care provision. Such was the case with Swaziland (present-day Eswatini). In her article, ‘Colonialism and Race in Nursing Education’, Dlamini exposes the domino effect of land redistribution to white businesses and settlers on local populations. Left with very little land, ‘local communities ended up in overcrowded conditions in so-called labour reserves’, resulting in mass labor migration. Together these factors, in conjunction with the ‘introduction of capitalist relations of agricultural production’, had a disastrous effect on the local population and their economy, resulting in large numbers of Swazi moving to South Africa to provide much-needed labor for their neighbours. Corralled in close quarters near their jobs, ‘sexually transmitted diseases and tuberculosis were commonplace’. The high incidence of communicable and non-communicable diseases coupled with other health concerns became the impetus for nursing education. Like West Bengal, there was a racial hierarchy in Swaziland; health care provision was initially intended for the white colonial occupiers underscored by an agreement between the Church of the Nazarene and the Swaziland colonial government which required their ‘medical missionaries not to heal the Swazi bodies, but only to save their souls’. Thus, the health of the local population was hardly a concern. Further Dlamini notes, that ‘where people of colour were provided with medical care, it was simply to prevent their diseases from affecting the whites’. In this way, racism, Dlamini argues, ‘became an impetus to nurse training’.
It bears repeating that colonialism is not a monolithic process, yet parallels can be drawn between various geographical locations. While the South African Trained Nurses Association recognized the urgent need for African nurses on the reserves, one member stressed that ‘such training should not compromise the standards of the certificates granted by the South African Medical Council’. To address the dire health needs on the reserves the solution was to introduce a ‘qualification of [a] lower standard than that of the full certificate’ for Indigenous nurses.  Overall, the training offered to Swazi citizens was inferior when compared to South Africa ‘and only permitted its graduates to work in ‘native’ hospitals’. Notwithstanding that neither Dlamini nor Sanyal mentioned the motivation behind European nurses’ travels to British colonies, they were part of the colonial expansionist machine and an extension of the work of earlier medical missionaries. Even as their respective motivations differ, European nurses were critical to the development of nursing education and health care in the colonies. At the same time, these nurses often in leadership roles organized the social world of nursing, whether unconsciously or not around race and class divisions.
More critical analyses are needed of white nurses’ roles in the expansion and preservation of Empire that explores the ramification of their actions on local nurses across different geographical locations. Certainly, nursing and nurses occupy a subordinate position in relation to the scientific project of bio-medicine, but as Julia Hallam argues, ‘the profesionalising project of nursing supports the colonizing projects of British imperialism’. How did these nurses who held leadership roles exercise power in the colonies as they advanced their own career aspirations? Kathryn McPherson cautions against the propensity to “exempt nurses from the system of colonization.” McPherson explains how as “front-line service providers who boasted specific professional skills,” nurses operated in a system that reinforced Indigenous peoples ‘dependent and “uncivilized” status’. In the Canadian context, the hierarchical nature of nursing was explicit as was the colonial Caribbean.
In her discussion of the leaders instrumental in the development of nursing education in the Caribbean, Hezekiah argued that the administrative composition of nursing replicated the hierarchical and ‘prevailing social and class structure of the society, with colonial whites at the top, followed by Barbadian whites, and then blacks as the nurses and students at the bottom of the hierarchy’. Care was also provided along similar lines; white upper-class patients had private rooms, while the majority of patients, comprised of poor Blacks and ‘colored people occupied the bulk of the general wards of the hospital’. Hezekiah (like Sanyal and Dlamini) elucidated how prevailing health problems influenced nursing practice, emphasizing how three Caribbean nurses, Barbadian born Dame Nita Barrow, Berenice Dolly from Trinidad and Dr Mary Seivwright from Jamaica, emerged as leaders in the advancement of professionalization pursuits.
The asymmetrical relationship that existed between Britain and its colonies led to the supposition that Caribbean people were unable to manage their own affairs, but Nita, Berenice, and Mary proved otherwise. In Hezekiah’s contribution, which focuses on Barrow, she maps Barrow’s educational journey beginning with her training in Barbados at the beginning of the 20th century. Barrow’s first leadership position was as a charge nurse of the operating room theatre. A thirst for knowledge led her to pursue a course in public health nursing, and then a course on nursing education and teaching, at the University of Toronto’s School of Nursing, supported by the Rockefeller Foundation. Eventually, Barrow assumed leadership of the public health program in Jamaica. She worked tirelessly and collaboratively with nursing leaders and nurses in the other Caribbean region to improve standards for nurse education. Under Barrow’s leadership, the Jamaican General Trained Nurses’ Association (JGTNA, now the NAJ) was established. The JGTNA had a clear-cut agenda with respect to improving the standard of nursing education, which included registration.
The struggle for registration and to improve nursing in Jamaica proved an arduous task. According to Hezekiah, ‘there was no pressing desire on the part of the government to change the status quo’. Jamaican nurses were hardly oblivious to the inequities due to patriarchal ideologies, coupled with the gender and class barriers that existed in medicine and the larger society. Thus, they wholeheartedly supported the registration bill. Indeed, it was Jamaican nurses’ activism that ultimately led to the passage of the registration bill. A discussion of professionalization ought to incorporate examples of activism and agency as evidenced by Barrow and the Jamaican nurses. It was also the political activism of African American nurse leaders and their allies that led to the integration of the US Army Nurse Corps (ANC), which Charissa Threat discusses in her article.
As Threat argues, despite persisting nurse shortages, the belief in the inherent inferiority of Black people prevented the US Army from enlisting Black nurses to serve and the indomitable Mabel K. Staupers along with the National Association of Colored Graduate Nurses (NACGN), and their supporters disagreed. Staupers and her allies mounted a formidable challenge to the exclusionary practices of the US Army. According to Threat, ‘Black nurses and their supporters emphasized one important fact: women nurses willing to care for soldiers did exist, but race discrimination kept them from doing so.’ Moreover, Threat also demonstrated how Staupers campaign to integrate the ANC was part of a larger agenda regarding ‘nursing service and nursing care’. In building on Threat’s scholarship, Hafeeza Anchrum argues that nurse leaders such as Staupers and Estelle Massey (Osborne) Riddle saw ‘themselves as part of the larger struggle for Black liberation, and to engage with broader issues that had an impact on the Black community and nation, but also on nursing’. Committed to dismantling systems of oppression, nurse leaders such as Staupers, Riddel and Barrow were cognizant that a single-issue focus was an exercise in futility.
Hezekiah, Threat, and others illustrate how professionalization pursuits are influenced by and reflect exclusive and hierarchical ideologies. Collectively, the authors in this Issue reveal how an approach that views professionalization as a neutral process misses other important dimensions such as the specificity of these pursuits across time and place.
Critical components of professionalization are licensure, registration efforts and the creation of organizations to ensure that initiatives come to fruition. But as the contributors in this collection reveal, the professionalization of nursing led to the creation of lower categories of nursing, for Indian or other racialized nurses. In the United States and South Africa, Darlene Clark Hine and Shula Marks both show how elite white women’s quest for professionalization simultaneously created barriers for Black and African women respectively.
Nursing scholars must critically engage with the specificity of colonial and settler colonial contexts spatially and temporally exploring the continuities and discontinuities while being attentive to how certain Eurocentric ideologies influence encounters. While it is tempting to view interactions between, for example, missionary nurses and local populations as amicable based on a religious ethos or evidence of collaboration, these interactions must be historicized and not assumed. How does the longstanding trope of Africa as the “dark continent” or the civilizing mission shape and inform encounters between European nurses and the local population? Is it possible that European health care workers arrived on the continent unencumbered by the racist colonial discourses about the “other” that undergirds colonial and imperial expansion in Africa and elsewhere? Alternatively, how did the local nurses respond to European nurses whose very presence on colonial landscapes often came at their expense? Beginning from the aforementioned premise it means asking how have nurses been complicit in advancing imperialism and settler colonialism? To paraphrase Vron Ware, ‘what was [white nurses’] burden and ‘what she has done with it since’? Has she continued to reproduce, albeit in various iterations, social relations of power to maintain her privileged position in nursing?
As several authors in this volume attest, colonialism and imperialism also facilitated the inward migration of racialized nurses, including young women interested in pursuing nurse training in former colonial centers, such as Britain, Canada and the United States.
Migration and mobility
That almost half of the contributors to this Issue included migration and mobility as a theme speaks to its relevance in nursing scholarship. While Bourne, Nicholson and Brown, Flynn and YHP examined the migration of African and Caribbean nurses (and potential nurses) to Britain, Choy focuses on Filipino migrant nurses to the US. Except for Bourne, all the authors provided a range of rational for their subjects’ mobility. The idea that people move primarily for upward mobility is tackled by Choy and Flynn (‘Caribbean Nurses in Britain and Canada’), who demonstrate how a confluence of factors prompted Filipino and young Caribbean women to migrate. Friends, nursing shortages, recruitment by hospital administrators, and transformation in immigration policies were important drivers of migration. Filipino nurses entered the US first through the Exchange Visitor Program and the 1965 Immigration Act, which enabled them ‘to not only enter the United States but to settle as residents’. Choy underscores the critical role that ‘mass media, both print and electronic forms’ had in informing nurses’ desire to migrate.
Choy situates her analysis of Filipino migration within ‘international, transnationalism and national contexts’ as a useful framework to think about migration in its multi-dimensionality, which considers the multiple actors involved. Choy demonstrates how the macro i.e., immigration policies in the United States and the export economy promoted by the Philippine government, and the micro, i.e., nurses’ decisions, inhere in ways that reveal their interdependency. Parallels also exist in relation to African and Caribbean migrants.
Similar to the US, Britain’s Second World War labor shortage coupled with the fact that Caribbean people had the legal right to settle and work in Britain made the “Motherland” an attractive location. Of course, as Nicholson and Brown, Bourne and the YHP authors illustrate, nurses travelled to Britain prior to the mass migration of Caribbean people. Regarding the demographic of migrants, Nicholson and Brown note it was ‘the educated and/or ambitious young women, from wealthier backgrounds and families of social standing’ in parts of East and West Africa who pursued nursing as a career. The authors further noted that ‘…for citizens with a sense of imperial belonging and entitlement, British hospitals and nursing accommodation seemed to combine career opportunity and parental reassurance about their daughters’ wellbeing away from home.’ The mother of one of Flynn’s interviewee feared unwanted pregnancies for her daughter and used migration as a preventative measure. Clearly, imperialism and colonialism facilitated the mobility of many African and Caribbean migrants which led the Honorable Louise Bennett Coverley to describe the presence of Jamaicans in Britain as ‘colonization in reverse’.
While the authors did not engage substantially or allude to this particular theme, mobility whether temporarily or permanently is a privilege for the few. Yet, migrants and migration are often, in the case of the former, presented as undifferentiated mass and the latter, as a homogeneous process with little or no regard for historical specificity. Even if it is less clear why earlier migrants such as Brewster travelled to Britain, it is more than likely her family was one of the few elites on the island who enjoyed the benefit of mobility.
Attention to why different classes of immigrants such as Brewster or Choy’s nurses choose to migrate challenges the hegemonic interpretation of migration as primarily involving the disenfranchised from less affluent countries. The tendency to equate especially racialized migrants with the stereotypes associated with their countries of origin ignores the diversity of such groups. Put another way, an Indian, Filipino, African or Caribbean migrant nurse unlike her white Canadian migrant counterpart may be viewed as less educated, poor, or subservient. Perceptions of the “other” then impact how migrant nurses are treated by accrediting institutions, colleagues, and patients. It makes sense then that racialized nurses often attribute their mistreatment in the profession to their race.
Given nursing’s idealized construction of itself, especially in terms of its image as a caring profession, criticisms of racism and xenophobia are viewed as an assault. In reference to the United States, but ringing true elsewhere, Evelyn L Barbee noted how, ‘The contradictions between caring, a principal part of the identity of nursing, and racism make it difficult for nurses to acknowledge racial prejudice in the profession.’ Power, privilege, and whiteness must be integral to interrogating difference in nursing.
Race and Nursing
There is much work to be done in mapping the genealogy of race with respect to the evolution of nursing. Acknowledging race’s analytical purchase means being attentive to how it is actualized spatially and temporally. Analyses must be grounded in the understanding that race is far from immutable and that its saliency at specific historical moments might make other social categories invisible. Due to nursing’s composition as a woman-dominated profession gender was, and is still to a certain degree, the analytical lens used to discuss the profession. This is despite overwhelming evidence of how gender, race, and racial difference (which is also about whiteness), and ability and socio-economic status were critical to the development of nursing. Mary Seacole’s experience in London serves as an illustration.
Arguably, Florence Nightingale, credited with the institutionalization of modern nursing, set the stage for the constitution of the “proper nurse” normalized in the body of middle-class white women because they embodied the image of Victorian femininity and respectability. Despite the fact that nursing did not emerge as a middle-class occupation which attracted only middle-class white women, Nightingale promoted this fiction in her campaign to create a new image of nurses and nursing. Notwithstanding that she intimated that ‘every woman is a nurse’, Nightingale had a particular woman in mind. This woman, even if in theory, was nurturing, self-sacrificing and passive. The woman, in the context of Britain and settler societies as some of the authors discussed earlier, was often white. Mary Seacole, the mixed race, Jamaican doctress, and entrepreneur who offered her services to Nightingale’s colleagues during the Crimean War was not that woman. The response to Seacole reveals the intersections of race, gender, class, age, ability and sexuality.
It is difficult to know for sure why Seacole’s application to work with Nightingale was rejected as her letter of application cannot be found, despite the copious archive of applications held in National Archives in London. Some of these applications though provide evidence to support the contention that she was rejected because of the color of her skin.
In her biography of Seacole, Jane Robinson described the application by one Elizabeth Purcell. Despite having apparently unimpeachable references in other respects, on the reverse was a note by one of Nightingale’s colleagues describing her ‘with revulsion, as being “almost black”’. This assessment could also be applicable to Seacole as well. Though not quite Black, Seacole was not white. The disgust registered by Nightingale’s colleague was no doubt influenced by 19th-century racialist discourse of racialized peoples as dirty and contaminated, unlike middle- and upper-class Europeans. The “almost Black” reference is also about whiteness, the antithesis of blackness, which requires more interrogation than mere acknowledgement. The investment of nursing leaders like Nightingale in the ‘value of white middle-class femininity with its cultural associations to chastity [and] purity’, often linked to Christian virtues and morals, has to be unpacked for its racial consequences. How did Nightingale, her colleagues and other nurse leaders, whether consciously or not, privilege and reify whiteness as the norm, not only in the development of the profession but also in colonial and imperial contexts? And how does whiteness as an unmarked category continue to influence nursing and by extension social relationships? How do racialized people conceptualize whiteness? Seacole, too, was cognizant of racial difference.
Seacole, following multiple attempts to render her services to Nightingale’s colleagues, concluded that ‘had there been a vacancy, I should not have been chosen to fill it’. Seacole’s response is worth quoting in its entirety:
The disappointment seemed a cruel one….so certain of the service I could render among the sick soldiery, and yet I found it so difficult to convince others of these facts. Doubts and suspicions arose in my heart for the first and last time, thank Heaven. Was it possible that American prejudices against colour had some root here? Did these ladies shrink from accepting my aid because my blood flowed beneath a somewhat duskier skin than theirs?
Seacole was clearly shocked by the rejection, which is understandable given her extensive experience. Despite sharing with Nightingale, a desire to care for the sick, wounded and dying soldiers; Seacole’s color as opposed to her skills mattered more. There are lessons to be gleaned from how Seacole articulated her understanding of the experience.
One lesson is how racial formations, which are not static, might share parallels regardless of geographical location reflected in the earlier discussion between Australia blood quantum and the US one drop rule. Aware of ‘American prejudices against color’, Seacole wondered whether the British were more like Americans than she previously thought. A second lesson is that aggrieved peoples are often cognizant of racist treatment. Seacole’s question, ‘Did these ladies shrink from accepting my aid because my blood flowed beneath a somewhat duskier skin than theirs?’ speaks volumes. She attributed the rejection by Nightingale’s colleagues to skin color. The almost deity-like Nightingale also referred to Seacole as ‘a woman of bad character’, who kept a ‘bad house [brothel]’. Taken together, Nightingale’s crude description of Seacole coupled with her colleagues’ disgust speaks to the intersection of race, gender, age, and sexuality. Juxtaposed against white femininity, Black femininity is met with derision.
As the example of Seacole demonstrates, vectors of difference are embedded in and influence ideas about who “belongs” to the profession. The hierarchical structure of nursing is far from an innocent creation. The beliefs, values, attitudes, and actions of nursing icons such as Nightingale ought to be interrogated. It is not enough to view these leaders as merely a product of their time. Seacole too was a product of her time. The tendency to center white leaders while simultaneously defending their actions ignores how the professional ideals they propagate are harmful emotionally and materially. In coming to terms that she was rejected on the basis of her “duskier skin,” Seacole wrote, ‘tears streamed down my foolish cheeks, as I stood in the fast-thinning streets; tears of grief that any should doubt my motives’. Nurse leaders’ power is evident in the constitution of nursing image and identity but also in the power to exclude from employment and its educational institutions those they subjectively considered unsuitable.
The product of their time trope not only ignores non-racist white people, but it also downplays power and privilege and continuities between the past and the present.
A focus on race and nursing is fundamental to not only how nursing histories are written but how it is taught to prospective nurses. It means acknowledging how the historical attempt to construct nurses as a monolithic group and nursing identity as universal is rooted in white supremacy; that is, in the beliefs, values, and attitudes that uphold and reinforce racial hierarchies, where white people are viewed as superior and hence naturally hold the right to dominate. For a more global view of nursing, it also means including new icons and leaders in the nursing canon, such as May Yarrowick, Annie Catherine Brewster, and Dame Nita Barrow.
History beyond the academy:
For two of the authors, YHP, and Nicholson and Brown, public histories have demonstrated the potential to empower local communities. Besides recovering and amplifying the voices of those excluded from the historical record, the authors share a commitment to making history accessible, relevant to, and for their communities. Unlike archival institutions that collect and preserve materials that are often inaccessible to the general population, YHP and Nicholson and Brown are intentional about making their information available, a feat made possible by the internet. YHP’s use of the social media platform Twitter means that they have the potential to reach a global audience. Through their website, the public have access to interview transcripts, a gallery of images, a timeline of key events, and other important information on their website. At the time of writing, the YHP will also be launching, later in 2021, a series of events relating to the project that includes an online exhibition, e-book and podcast series. Unfortunately, the Covid 19 pandemic also resulted in the suspension of in-person activities, which meant that YHP was unable to showcase their documentary series to a live audience, which would ‘share a space with the interviewees’. In any event, YHP hopes that users will contribute by providing feedback to their ‘growing resource’.
Kiklees Local TV (KLTV), of which Brown is the CEO, also made their video documentaries available online. For Brown, ‘public history needs knowledge to be participatory and remain publicly available for others to use’. Here, the authors encapsulate what it means to produce knowledge beyond the academy:
Voices and lived experiences that have been omitted from more established channels for research, teaching and safeguarding historical memory are thus brought into alternative informal archival stewardship and learning spaces, via watching online or attending local screenings with friends, family and community elders.
Similar to YHP, the pandemic necessitated virtual screenings, which, according to Nicholson and Brown, ‘brought previously unheard NHS experiences to fresh audiences’. Importantly, too, is the reminder that ‘these historical experiences stay local… and accessible, if not directly owned by the community’. In this case, Nicholson and Brown’s focus is on the West Yorkshire town of Huddersfield. Together, YHP’s and Brown and Nicholson’s articles are an invitation to ruminate on the epistemological and political project of what it means to be co-laborers with communities in the production of knowledge.
This collection centers the voices and experiences of racialized nurses and is unique in bringing together authors who identify as Indigenous, Black, Filipino, Indian and Caribbean. The collection also introduces new actors in nursing history whose work draws on an array of themes and methodological, theoretical, and analytical frameworks. Collectively and individually, the contributors have generated different questions relating to established concerns, introduced new perspectives, and provided rich material critical to advancing nursing knowledge. Moreover, the Young Historians Project and the work by Brown and Nicholson provide a model for an inclusive public history.
While there are no longer global protests for George Floyd, racial reckoning must persist, particularly in light of a global pandemic where racialized peoples are disproportionally impacted. Deemed as essential workers, nurses and other health care workers face particular vulnerabilities, with many working in long-term care facilities in the Global North. In the Global South, vaccination inequity, compounded by challenges faced by healthcare systems, has exacerbated the vulnerabilities of those already disenfranchised. This moment begs the question, will nursing histories of the pandemic reflect a diversity of subjects?
That the face of hospitals, administrators, faculty and students in nursing schools in the Global North are predominantly white, is not only cause for reflection but should be the motivation for institutional transformation. A global view of nursing must also include and memorialize other icons. While this collection is a path-breaking endeavor, there remains a lacuna in terms of the literature of nursing and health care in the Global South. The impact and legacy of colonialism and imperialism in French, Dutch, Portuguese and Spanish-speaking territories, as well as the Asian continent, are areas for additional research. We have to consider how colonization sowed the seeds for transnational ties to germinate, the formation of affiliations and alliances that nurses forge across borders, and their engagement with transnational practices. The absence of racialized men in nursing scholarship, whether in their home countries or as migrants, is another area that requires attention. The role of racialized nurses in the decolonization of health care is also needed. Research on how sexuality intersects with race (including whiteness), gender, class, and religion to not only shape the image of the profession but also nursing work itself would enhance the depth and scope of the historical research.
The murder of George Floyd is a reminder that the production of scholarship, while important, is not enough. There are many tangible ways that our allies can help to transform nursing scholarship. One way is to draw on and incorporate racialized nursing history into the curriculum. Attempts must also be made to ensure that conferences, journals, and other publications take seriously the scholarship of racialized scholars and subjects rather than as an afterthought. Our hope is that this special issue inspires current and new generations of nursing scholars and sparks further research in racialized nursing histories.
Acknowledgements: The author would like to thank Sue Hawkins for the idea of a compilation that focuses on racialized nurses. Thanks to Kristin Burnett, Antoinette Burton, Lydia Wytenbroek and Maria Gillombardo for reading drafts for their editing and other suggestions.
 Kathryn McPherson, Bedside Matters: The Transformation of Canadian Nursing, 1900-1990 (Toronto: Oxford University Press, 1990); Susan McGann and Barbara Mortimer (eds), New Directions in Nursing History: International Perspectives (Oxford: Routledge, 2005); Robert Dingwall, Anne Marie Rafferty, Charles Webster, An Introduction to the Social History of Nursing, (London: Routledge, 1988); Barbara Melosh, The Physician’s Hand: Work Culture and Conflict in American Nursing (Philadelphia: Temple University Press, 1982); Susan Reverby, Ordered to Care: The Dilemma of American Nursing 1850-1945 (New York: Cambridge University Press, 1987); Sue Hawkins, Nursing and Women’s Labour in the Nineteenth Century (Abingdon: Routledge, 2010.
 Shraddha Chatterjee, Queer Politics in India, (London: Routledge, 2018); Susan Reverby, Ordered to Care: The Dilemma of American Nursing 1850-1945 (New York: Cambridge University Press, 1987); Barbara Melosh, The Physician’s Hand: Work Culture and Conflict in American Nursing (Philadelphia: Temple University Press, 1982).
 Taiaiake Alfred and Jeff Corntassel, ‘Being Indigenous: Resurgences against Contemporary Colonialism’, Government and Opposition 40/4 (2005), 598.
 See, for example, Linda Carty and Dionne Brand, ‘“Visible Minority Women”: A Creation of the Canadian State’, in Returning the Gaze: Essays on Racism, Feminism, and Politics, ed. by Himani Bannerji (Toronto: Sister Vision Press, 1993), 207-241.
 Avtar Brah, Cartographies of Diaspora: Contesting Identities (New York: Routledge, 1996), 97.
 ‘Beyond BAME: What does the public think?’ https://www.britishfuture.org/beyond-bame-what-does-the-public-think/.
 See, for example, Enakshi Dua, ‘Canadian Anti-Racist Feminist Thought: Scratching the Surface of Racism’, in Canadian Anti-Racist Feminist Thought: Scratching the Surface of Racism, ed. by Enakshi Dua and Angela Robertson (Toronto: Women’s Press, 1999), 7-28.
 Kristen Burnett, Taking Medicine: Women’s Healing Work and Colonial Contact in Southern Alberta, 1880-1930 (Vancouver: University of British Columbia Press, 2011).
 See, for example, Sharla M. Fett, Working Cures: Healing, Health, and Power on Southern Slave Plantations (Chapel Hill: University of North Carolina Press, 2002); Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890-1950 (Philadelphia: University of Pennsylvania Press, 1995).; Barbara Ehrenreich and Deidre English, Witches, Midwives and Nurses: A History of Women Healers (New York: The Feminist Press, 2010).
 Jocelyn Hezekiah, ‘Dame Nita Barrow and the Development of Black Nursing Leadership in the West Indies’, UKAHN Bulletin 9 (2021), 2.
 Sneha Sanyal, ‘Institutionalisation of Nursing as a Profession in Early 20th- Century Bengal’, UKAHN Bulletin 9 (2021), 2.
 Odette Best and Tracey Bunda, ‘Disrupting Dominant Discourse: Indigenous Women as Trained Nurses and Midwives, 1900-1950s’, UKAHN Bulletin 9 (2021), 4.
 Heather Norris Nicholson and Milton Brown, ‘Huddersfield and the NHS: The Caribbean Connection (2020) A Reflection on Public History and Ways of Knowing the Past’, UKAHN Bulletin 9 (2021), 3.
 Jafari S Allen and Omise’eke Natasha Tinsley, ‘A Conversation “Overflowing with Memory”: On Omise’eke Natasha Tinsley’s Water, Shoulders, Into the Black Pacific’, GLQ: A Journal of Lesbian and Gay Studies 18/2 (2012), 251.
 Ann Laura Stoler, ‘Colonial Archives and the Arts of Governance’, Archival Studies 2 (2002), 91; see also Antoinette Burton (ed.), Archive Stories: Facts, Fictions, and the Writing of History (Durham: Duke University of Press, 2005), Introduction.
 Alex Douglas-Bailey and Josephine Small (YHP), ‘Oral History from Within: African Women in the National Health Service’, UKAHN Bulletin 9 (2021), 6.
 Nicholson and Brown, ‘Huddersfield and the NHS’, UKAHN Bulletin 9 (2021), 3.
 There is also the issue of language barriers in accessing certain archives: encouraging the learning of another language or developing collaborative and respectful partnerships scholars in other countries are a few solutions to address this issue. Nicole Elizabeth Barnes, for example, used archival materials written in both English and Chinese for her book, Intimate Communities, Wartime Healthcare and the Birth of Modern China, 1937-1945 (California: University of California Press, 2018).
 Saidiya Hartman, ‘A Note on Method’ in Wayward Lives, Beautiful Experiences: Intimate Histories of Social Upheaval (New York: WW Norton & Co, 2019), xii.
 Karen Flynn, ‘“I’m glad that someone is telling the nursing story”: Writing Black Women’s History’, Journal of Black Studies, 38/3 (2008), 443-60.
 Nicholson and Brown, ‘Huddersfield and the NHS’, 3.
 Franca Iacovetta, ‘Manly Militants, Cohesive Communities, and Defiant Domestics: Writing about Immigrants in Canadian Historical Scholarship,’ Labour/Le Travail 36 (1995), 227.
 Gretchen Lemke-Santangelo, Abiding Courage: African American Women Migrants and the East Bay Community (Chapel Hill: University of North Carolina Press, 1996), 8.
 YHP, ‘Oral History from Within’, 13.
 For exceptions, see Helen Sweet and Sue Hawkins (eds.), Colonial Caring: A History of Colonial and Post-Colonial Nursing (Manchester: Manchester University Press, 2015); Patricia D’Antonio, Julie A Fairman, Jean C Whelan, Routledge Handbook on the Global History of Nursing (Routledge: New York 2013).
 South Africa’s apartheid system was similar to the Jim Crow Laws in the United States.
 Certain parallels can be made in the Canadian context regarding the training of Indigenous nurses, see, for example, Mary Jane McCallum, “Twice as Good”: A History of Aboriginal Nurses (Ottawa: Aboriginal Nurses Association of Canada, 2007). See also, Mary Jane McCallum, ‘The Indigenous Nurses Who Decolonized Health Care’, Briar Patch Magazine, 7 October 2016. Accessed online 17 Oct 2021, https://briarpatchmagazine.com/articles/view/the-indigenous-nurses-who-decolonized-health-care.
 Best and Bunda, Disrupting Dominant Discourse, 4.
 Ibid., 7.
 For a discussion of the work of the British Colonial Nursing Service, see, Anne Marie Rafferty and Diane Solano, ‘The Rise and Demise of the Colonial Nursing Service: British Nurses in the Colonies, 1896-1966’, Nursing History Review 15 (2007), 147-54.
 For an example of how “othering” works in other contexts, see, Lydia Wytenbroek, ‘Negotiating Relationships of Power in a Maternal and Child Health Centre: The Experience of WHO Nurse Margaret Campbell Jackson in Iran, 1954-56’, Nursing History Review 23 (2015), 87-122.
 Sanyal, ‘Institutionalisation of Nursing’, 2.
 Ibid., 5-6.
 Ibid., 6.
 Madelaine Healey, Indian Sisters: A History of Nursing and the State, 1907-2007 (New Delhi: Routledge, 2015).
 Shokahle Dlamini, ‘Colonialism and Race in Nursing Education at Ainsworth Dickson Nursing Training School, Swaziland, 1927-1980’, UKAHN Bulletin 9 (2021), 2.
 Ibid., 4.
 Ibid., 6.
 Ibid., 2.
 Ibid., 8.
 Ibid., 13.
 Julia Hallam, Nursing the Image: Media, Culture and Professional Identity (London: Routledge, 2000), 17.
 Kathryn McPherson, ‘Nursing and Colonization: The Work of Indian Health Service Nurses in Manitoba, 1945-1970’ in Women, Health and Nation: Canada and the United States Since 1945 ed. by Georgina Feldberg, Molly Ladd-Taylor, Alison Li and Kathryn McPherson (Kingston: McGill-Queen’s Press, 2003), 223-46.
 Hezekiah, ‘Dame Nita Barrow’, 7.
 Ibid., 13.
 Charissa Threat, ‘“The Negro Nurse – A Citizen Fighting for Democracy”: African Americans and Army Nurse Corps’, UKAHN Bulletin 9 (2021), 4.
 Hafeeza Anchum, ‘A New Era in the Fight for Nursing Civil Rights: Mercy-Douglass Hospital and School of Nursing’, (Unpublished PhD Thesis, University of Pennsylvania, School of Nursing, 2021).
 Darlene Clark Hine, Black Women in White: Racial Conflict and Corporation in the Nursing Profession, 1890-1950 (Indianapolis: Indiana University Press 1989); Shula Marks, Divided Sisterhood: Race, Class, Gender in South African Nursing Profession (New York: St. Martin’s Press 1994).
 Vron Ware, “White Woman’s Burden,” Jan 4, 2016, https://briarpatchmagazine.com/articles/view/white-womans-burden
 Choy, ‘To the Point of No Return’, 2.
 Ibid., 3.
 Nicholson and Brown, ‘Huddersfield and the NHS’, 6.
 Louise Bennett-Coverley, ‘Colonization in Reverse’. Accessed online, 17 October 20221, http://louisebennett.com/colonization-in-reverse/. Bennett-Coverley was a renowned Jamaican poet and writer who promoted the use of Jamaican patois as a form of literary expression.
 Evelyn L Barbee, ‘Racism in US Nursing’, Medical Anthropology Quarterly 7/4 (1993), 346-62.
 This is not to ignore the scholarship that is currently available, but to further complicate and nuance future discussions. The following are a few examples of scholars (not necessarily historians) who have focused on race (including whiteness) and nursing. In the British context, Carol Baxter, The Black Nurse: An Endangered Species. A Case for Equal Opportunities in Nursing (Cambridge: Training in Health and Race: 1988); Nona Glazer, ‘“Between a Rock and a Hard Place”: Women’s Professional Organisations in Nursing and Class, Racial and Ethnic Inequalities’, Gender and Society 5 (1991), 3, 351–72; In the US, Evelyn Nakano Glenn, ‘From Servitude to Service Work: Historical Continuities in the Racial Division of Paid Reproductive Labour’, Signs 18/1 (1992), 1–43. In the Canadian context, Agnes Calliste, ‘Women of “Exceptional Merit”: Immigration of Caribbean Nurses to Canada’, Canadian Journal of Women and the Law 6/1 (1993), 85–103; Najja Nwofia Modibo, ‘The Shattered Dreams of African-Canadian Nurses’, Canadian Woman Studies 23/2 (2004), 111–17; Rebecca Hagey, et al, ‘“Immigrant Nurses” Experience of Racism’, Journal of Nursing Scholarship 33/4 (2001), 389–94; Tania Das Gupta, Racism and Paid Work (Toronto: Garamond, 1996); Karen Flynn, ‘Beyond the Glass Wall: Black Canadian, Nurses, 1940–1970’, Nursing History Review 19 (2009), 129-52.
 Despite attempts to promote nursing as a white middle-class women’s occupation that attracted middle-class white women this was not the case. With respect to Canada, see, for example, Kathryn McPherson, Bedside Matters: The Transformation of Canadian Nursing, 1900-1990 (Toronto: Oxford University Press, 1990); For the UK, see, Anne Simnett, ‘The Pursuit of Respectability: Women and the Nursing Profession,1869-1900’, in Political Issues in Nursing: Past, Present and Future, Vol 2, ed. by Rosemary White (Chichester: John Wiley, 1986), 1-17 or Sue Hawkins, Nursing and Women’s Labour in Nineteenth century England (Abingdon: Routledge, 2010).
 Jane Robinson, Mary Seacole, The Charismatic Black Nurse Who Became a Heroine of the Crimea (Little, Brown and Company, 2005), 89.
 J Hallam, Nursing the Image), p. 11.
 Richard Dyer, ‘White’, Screen 29 (Autumn 1988), 44–64.
 Mary Seacole, The Wonderful Adventures of Mrs. Seacole in many lands, 79.
 Robinson, Mary Seacole,123.
 Natalie Stake-Doucet’s indictment of Florence Nightingale generated intense discussion on Twitter with some respondents angry at Stake-Doucet for her portrayal, while others welcomed a different perspective. See, ‘The Racist Lady with the Lamp’, Nursing Clio 5 November 2020. https://nursingclio.org/2020/11/05/the-racist-lady-with-the-lamp/. Accessed online 8 June 2021.
 Mary Seacole, Mary Seacole, 79-80.
 YHP, ‘Oral History from Within’, 17.
 Nicholson and Brown, Huddersfield and the NHS, 3.
 Ibid., 2.
 Sonja M. Kim, Imperatives of Care: Women and Medicine in Colonial Korea (Honolulu: University of Hawai’i Press).
 Karen Flynn, ‘“She cannot be confined to her own region”: Nursing and Nurses in the Caribbean, Canada, and the United Kingdom’, in Within and Without the Nation: Canadian History as Transnational History, ed. by Karen Dubinsky, Adele Perry and Henry Yu (Toronto: University of Toronto Press, 2015), 228-49.
Attention to how whiteness is embedded not only in nursing but also in school graduate programs must be addressed. See for example, Neda Hamzavi, Neda Hamzavi, ‘Exploring the experiences of Black, Indigenous, and People of Colour graduate nursing students in white academic spaces’, (Unpublished MA Thesis, University of British Columbia, 2021). Accessed online 17 October 2021. Exploring the experiences of Black, Indigenous, and People of Colour graduate nursing students in white academic spaces; Patricia D’Antonio, Julie Fairman and Jean Whelan, Global History of Nursing.