Nursing in wartime

Published: 09 November 2009

This article marking Remembrance Day explains how international conflict has compelled both nursing and the RCN to evolve and develop

Providing health care to sick and injured soldiers and civilians has enabled nurses to demonstrate their skills and how they can benefit society. Major reforms and improved public awareness have followed conflicts and, along with pioneering work, has shaped the diverse nursing workforce we know today.

RCN Archives Manager Susan McGann says the profile of nursing has always risen when there is a war. 'Wartime increased the reputation of nursing. There were never enough nurses, so the work they did was valued by the government, the public and the media.'

A key time for nursing was the Crimean War, from 1853 to 1856, as Florence Nightingale and her 38 volunteer nurses highlighted the poor conditions where injured soldiers were treated.

Then the Boer War, between 1899 and 1902, tested Britain's first army medical service, which helped to lead to the creation of Queen Alexandra's Imperial Military Nursing Service.

World War One

It was during World War One that the need for a professional body to represent nurses became clear.

Nurses were concerned about the numbers of voluntary aid detachments (VADs) who were brought in to support health services. They had minimal training and always worked under nurses' supervision.

Dr Christine Hallett, an RCN member and Reader in Nursing History and Director of the UK Centre for the History of Nursing and Midwifery, says the public image of VADs and nurses was very positive, but patients didn't always understand the difference - meaning nurses felt their profession could be undermined.

She says: 'Nurses felt VADs were only able to do what they did because they were under their supervision.Nurses' efforts during the war and the feeling towards VADs may have given the momentum to push for recognition and a national curriculum for nurse training.'

The war and issues raised by VADs highlighted the lack of a unified representative body for nursing, and in 1916 the College of Nursing was founded (it did not receive its Royal Charter until 1947).

Closer to the front line nurses played a crucial role, with many working just 10 miles behind the trenches in casualty clearing stations, where nurses worked with doctors to stabilise soldiers' conditions, assisting with surgery and pioneering treatment both of shock and with blood transfusions.

World War Two

Military nursing was well established by the outbreak of World War Two, but it was on the home front where nursing had to step up to the mark.

The College of Nursing took a crucial role in the first year of the war by taking on the administration of the Civil Nursing Reserve on behalf of the government. Run from Cowdray Hall in London, this service centralised information about qualified nurses from England and Wales, many of whom were not working at the time or were retired, and put them in touch with hospitals and other services in need of staff. In Edinburgh, the Scottish Board of the RCN ran the Civil Nursing Reserve for Scotland for the whole war.

Susan McGann says: 'There were lots of shortages because qualified nurses who had been in civilian hospitals or district nursing wanted to go to the front and joined the different military nursing services.'

She adds: 'This work meant the government recognised the College of Nursing as a professional body that mattered.'

As travel was discouraged unless absolutely necessary, the College's Council was replaced with an emergency committee, and the General Secretary, Frances Goodall, had a bedroom in the basement of Cavendish Square where she slept during the Blitz.

Lesley Wade, Chair of the RCN's History of Nursing Society, says she read in notes compiled during the so-called phoney war from 1936 to 1940 about former RCN President Lucy Duff-Grant, who spent months preparing Manchester Royal Infirmary for the impact of the conflict.

In the subsequent Blitz, hospitals in cities and near ports were inundated following German bombs attacks. Many suffered direct hits themselves, and forced surgical teams to operate in underground theatres.