Medicine And Books

Gender and the Professional Predicament in Nursing

BMJ 1995; 311 doi: (Published 29 July 1995) Cite this as: BMJ 1995;311:338
  1. Mick Carpenter

    Celia Davies, Open University Press, pounds sterling12.99, pp 220, ISBN 0 335 19402 8

    Nurses have always borne a double burden in relation to governmental and medical power: subordinated and undervalued as carers in a system with a curative bias, and oppressed as women within a system of male dominance. The times, however, have been changing, in response to the revaluation of biomedicine's contribution to health and the challenge of modern feminism. These two forces came together in 1986 in the proposed reform of nursing education, Project 2000, the implementation of which is currently reshaping the nature of nursing.

    Celia Davies, as a researcher working for the United Kingdom Central Council for Nursing, Midwifery, and Health Visiting during 1984-6, was an insider on the processes that led to these reforms. She is also someone who—as professor of women's studies at the University of Ulster—has continued to follow their progress as part of broader research on women and working life. The combination of these insider and outsider perspectives make a fascinating and important book which focuses on nursing's central predicaments as primarily a woman's occupation in what is still a man's world. Nurses themselves have often sought to resolve their problems in isolation from the wider society, and even feminists have often neglected the role of nursing as the single most important form of paid work for women. Gender and the Professional Predicament in Nursing connects the concerns of both nurses and feminists.

    An early illustration of the fetal circulation (1757) from the Fothergill collection in Pennsylvania Hospital, Philadelphia. From the second edition of Diseases of the Fetus and Newborn edited by G B Reed, A E Claireaux, and F. Cockburn (Chapman and Hall, ISBN 0 412 39160 0), a comprehensive, two volume work of 1590 pages.


    Davies's central argument is that the “personal troubles” of nursing and nurses are part of a deeper and many layered “gendering” of health care and society. The book admirably peels back these layers and shows how traditional forms of marginalisation by medicine and government have been added to by the new forms of “masculine” rationality based on managerialism. So though for a time in the 1980s Project 2000 seemed to put nursing at the centre of a plan to humanise health care along holistic principles, this has since been sidelined by the concerted struggle for power between doctors, managers, and politicians set in train by the 1990 NHS Act.

    You should read this book, therefore, if you want to understand that the current turbulence—reflected in the way, for example, that nurses are reappearing on the picket lines and reconsidering their opposition to industrial action—may stem from a much deeper sense of betrayal than the difference between 1% and 3% in pay. Yet its wider significance is the convincing case it makes for seeing the professional predicament of nursing as a central problem that must be solved if we are to create a health service to meet everyone's needs.—MICK CARPENTER, senior lecturer, department of applied social studies, University of Warwick.

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