NR 393 Week 5 Nightingale and Hampton Comparison Example

Who Controls the Training of Nurses? Nightingale in London and Hampton at Johns Hopkins Compared

Student Name

College of Nursing, Chamberlain University

NR 393: Nursing History

Instructor Name

Month Day, Year

Who Controls the Training of Nurses? Nightingale in London and Hampton at Johns Hopkins Compared

The Question

This paper compares how two founders of modern nursing education answered one question: who should control the training of nurses, the hospital where students work or nursing itself? Florence Nightingale confronted the question when the Nightingale Training School opened at St Thomas' Hospital in London in 1860. Isabel Hampton, later Isabel Hampton Robb, confronted it when she became superintendent of nurses and principal of the training school at the new Johns Hopkins Hospital in Baltimore in 1889. The paper holds the question fixed and compares their answers under three headings: money, authority over students and the standards of training. Their answers came out unequal, and the paper argues that the difference is explained less by their beliefs, which were similar, than by the circumstances each faced: Nightingale had independent money and Hampton did not.

Where the Two Agreed

Before comparing their answers, it is worth stating how much the two founders shared, because the similarity is what makes the difference in outcomes interesting. Both believed that nursing required formal training rather than good character alone, and both rejected the older pattern in which untrained attendants learned by doing whatever a ward needed. Both believed that training should be directed by women who were themselves trained nurses, rather than by physicians or hospital governors, and both insisted on selecting students for character and intelligence and on dismissing those who fell short. Both also saw training as a way to raise the standing of nursing as an occupation fit for educated women, which in their era meant setting it apart from domestic service.

Where they differed was not in these beliefs but in the conditions under which they tried to act on them. If the comparison showed two founders with opposite convictions, their different results would be unremarkable. Because it shows two founders with largely the same convictions arriving at different arrangements, it points to the conditions themselves, above all money, as the explanation.

Money

Nightingale's school was paid for by the Nightingale Fund, a large public subscription raised in gratitude for her work in the Crimean War and placed at her disposal. The fund paid the probationers' board, lodging and wages during training and paid the hospital for its part in instruction (Baly, 1986). Because the fund, not the hospital, paid for the students, the school's council could set conditions: students were to be trained, not simply used to staff wards, and the fund could withdraw its money if the hospital failed to train them.

Hampton had no such fund. The Johns Hopkins training school, like nearly every American training school of the period, was part of the hospital and was financed by the hospital, which received the students' labor in return for their instruction and board. Reverby (1987) argues that American hospitals founded training schools largely because students were a cheap and disciplined labor force, and that this arrangement shaped nursing education for decades. Hampton worked inside that arrangement. Whatever standards she wanted had to be won from a hospital administration whose interest was in staffing its wards.

Authority Over Students

At St Thomas', authority over the probationers was divided but real. The hospital's matron supervised them day to day and reported on their conduct and progress to the fund's council, and Nightingale influenced the school through correspondence and through the council rather than by running it herself. The probationers were a small, selected group, and their training was separate enough from the hospital's staffing needs that the school could dismiss students who did not meet its standards.

At Johns Hopkins, Hampton had more direct authority over the school than Nightingale ever held at St Thomas', but it was authority exercised on the hospital's behalf. Students staffed the wards, and the hospital's needs set limits on their hours and on how much of their time could be spent in instruction. Hampton used her position to introduce a graded course of study and to write one of the early American textbooks of nursing, Nursing: Its Principles and Practice, published in 1893 (Hampton, 1893). Her authority was greater in form and weaker in substance, because the students' work belonged to the hospital.

Standards Beyond One School

The two answers diverge most on how to protect standards beyond a single school. Nightingale relied on example: the St Thomas' school produced matrons and superintendents who carried its methods to other hospitals, and the fund's money gave its model a protected start. Hampton, lacking money, turned to organization. In 1893 she helped found the American Society of Superintendents of Training Schools for Nurses, which aimed to set common standards for training across schools, and she later served as the first president of the national association of nurses' alumnae that became the American Nurses Association. Her strategy was to build professional bodies that could press many hospitals at once, since she could not buy independence for any one school.

The circumstances explain the difference. A founder with independent funding could protect one model school and spread it by example. A founder working inside a system of hospital-owned schools had to change the system through collective organization, licensure campaigns and published standards. Neither approach was purely a matter of conviction; both were responses to what each woman had to work with.

What the Comparison Shows

Held against the same question, the two cases show that control of nurse training was never simply claimed; it was bought or organized. Nightingale bought a measure of independence with a public fund. Hampton organized for it because she could not buy it. The legacy of the second path is visible in American nursing's long reliance on professional organizations, accreditation and licensure to set standards that individual hospitals had little reason to adopt on their own. The comparison also explains why the move of nursing education from hospital schools to colleges and universities in the twentieth century mattered so much: it finally separated the training of students from the staffing of wards, the separation Nightingale's fund had secured in one hospital and Hampton had fought for across many. For a nurse educated in a college program today, the comparison is a reminder that the time a student spends learning rather than staffing was won, not given.

References

Baly, M. E. (1986). Florence Nightingale and the nursing legacy. Croom Helm.

Hampton, I. A. (1893). Nursing: Its principles and practice for hospital and private use. W. B. Saunders.

Reverby, S. M. (1987). Ordered to care: The dilemma of American nursing, 1850-1945. Cambridge University Press.