The emergence of the occupation of district nursing in nineteenth century England
This research examines the genesis of district nursing in England, and in particular explores the way in which district nursing became a paid occupation over the course of the nineteenth century. District nursing is defined as the care of the sick poor within their own homes, which is consistent with a nineteenth, rather than a twentieth, century meaning. At the beginning of the century an occupation of district nursing did not exist, yet by the end a formal occupation had emerged, and some associations of district nursing were attempting to create a profession which would attract educated women. In order to explore the processes involved, empirical data were obtained from the records of nineteenth century district nursing associations and organisations for their affiliation. These were interpreted and analysed within the theoretical framework of the sociology of work, occupation and professions, the concept of occupation being regarded as crucial in explaining the emergence of district nursing. Since district nursing was an exclusively female occupation, particular emphasis is given to the gender division of labour. It was found that social changes associated with urbanisation and the rise of capitalism in an age of enlightenment thinking, facilitated a move from an informal to a paid occupation. This was not, however, a linear progression, since philanthropic pursuit, particularly that of women, played an important role in the formation of most associations and in constructing power relationships. The first associations were Protestant Sisterhoods where subjective labour (Freidson 1978) dominated and controlled the work of paid nurses. By the end of the century most nurses were part of the official economy (Freidson 1978), yet the involvement of philanthropic effort continued. Diversity among emerging associations hindered the development of a unified occupation with a discrete area of work and occupational identity, which in turn circumscribed the attempts of some organisations to create in district nursing a profession of educated women.