The 1919 Act that introduced a register of trained nurses was controversial. The years leading up to it saw a furious debate that divided the health care community, putting nursing as a profession under intense scrutiny.

The fight for state registration of nurses in the UK began decades before the act was passed 100 years ago. By 1886, both doctors and teachers had to register, and midwives in 1902. So why not nurses?

From the start, there was disagreement on how and why a register should be formed. Anti-registration views were strong among doctors, hospital governors and even nurses themselves. On the other hand, nursing organisations who were firm advocates for a register recognised the need for regulation and training.

But would a register, as one pamphlet put it, “separate the chaff from the wheat”? Would registration deter new nurses to a profession already suffering vacancies? And does a register guarantee the best patient care?

 


The main challenge in establishing a register of nurses, was that no one could agree on how to define nursing in the first place. What was it that made nursing care unique? 

Text title saying: A Science
Technical expertise and clinical training were and are essential skills for a nurse. However, viewing nursing as a science risked placing the profession in the hands of the medical world. On one hand, matrons and sister tutors taught nurses on the wards, whilst doctors taught anatomy and physiology in the classroom. Tension between medicine and care was problematic. 

Title text saying: A Vocation
As emphasised by Florence Nightingale, nursing has long been considered a moral calling. As a predominantly female profession, it required qualities assumed innate in women: self-sacrifice, compassion, sympathy and kindness. These were expected to run parallel to clinical skill, but at the same time considered uniquely female. Those against registration felt nurses should be managed by female matrons, not male doctors, and thus it should not be considered a science. 

Title text saying: A Compromise
Whilst this debate for regulation continued, the College of Nursing struggled to appease the different sides. It wanted nursing to grow as a credible profession and provide the best possible staffing throughout the Great War. The College helped to ensure that the Registration Bill was finally passed. The failure to clearly define nursing, however, was to have long-lasting effects. 

 
It is not certificated nurses who injure their profession by criminal practices, and through ignorance of the basis of scientific nursing, but the women who assume their name and their uniform. It is only right to the public and to the certificated nurse that there should be a line of demarcation between trained and untrained. The consequences involved are too serious for present conditions to be permitted to continue
Ethel Gordon Fenwick


  1. Eve Bendall 
    Following training in paediatrics in Bristol, Eve Bendall became the paediatric member to the General Nursing Council in 1965. In this interview she talks about her early days in the GNC and her post as Chairman of the Education Committee.
  2. Elizabeth Raybould 
    began training in 1945 at Central Middlesex Hospital. Elizabeth devoted most of her career to nurse education and became a member of the General Nursing Council in the 1970s.
  3. Jean Page
    Spent many years taking minutes for the newly established College of Nursing Council. In this interview she remembers some key personalities involved in establishing the College.
  4.  Lucy Duff Grant
    Finished her training in 1916. She was a Founding member of the College and became its President from 1950 – 1952. She sat on the council for the newly established General Nursing Council. In this interview, she recounts the relationship between the International Council of Nurses and the College, as well as Bedford Fenwick’s ‘dominant’ personality

Royal College of Nursing · ABC of State Registration

An audio version of the ABC of State Registration read by: Cathryn Peppard; Frances Reed; Janan Nuri; Kat Black; Philip Segall; Razwana Akram and Stella Swain. 

Signing up

First men

Tom Christian registered as a mental nurse on 30 September 1921. Christian trained at Banstead Mental Hospital and received his certificate from the Medico-Psychological Association in 1903, by the time he was 25. He was promoted to Chief Charge Nurse at Banstead and was president of the Banstead branch of the National Asylum Workers’ Union. It was the Union who nominated him to serve on the General Nursing Council.  George Dunn was the first man to join the supplementary register for male nurses. He trained as a nurse between 1902-1905 with the Royal Army Medical Corps. At this time, military training was the most common way for men to enter the general register. His son, also named George, became a nurse in 1937.  

Overseas nurses

Jamaican nurse Eva Lowe trained at St Nicholas’ Hospital, London from 1932 and registered in 1935. Despite being well qualified, she was rejected many times before finding employment. She received vague and unsatisfactory excuses for her rejections, some based on false concern for Lowe’s welfare.  The first black woman to have her name on the nursing register is not known, though we do know that other hospitals in London and Birmingham were admitting black probationers from at least the early 1930s. Many stories of 1920s UK based black and Asian nurses are yet to be uncovered.

Struck off

Having a register meant that, for the first time, a nurse could be struck off. Enforcing this could be problematic. Mabel Tribe registered in 1923. Two years later she was convicted of forging a certificate of character. It came to light that in 1918 she had also been found guilty of fraud. Tribe was struck off, yet refused to return her certificate and badge and continued to work as a nurse. Despite continuing convictions – like stealing 54 tins of preserved fruit in Bognor Regis – she was appointed head of a government hospital during the Second World War.

Education, in the limited sense of the word – book learning – will never make a nurse, the elements of making the true nurse must be in the woman.
The Hospital, March 1917.


Mission accomplished?

One hundred years ago, those caught up in the great nursing registration controversy were striving for the same thing. They all wanted enough nursing staff with the right skills and knowledge, in the right place and at the right time. This fight continues today in the RCN’s Safe Staffing campaign and Fair Pay for Nursing campaign

So what does ‘good character’ look like today? To register with the Nursing and Midwifery Council (NMC) a nurse must meet health and character requirements, as well as have the right education and training. The NMC’s Code asks for attributes from kindness and honesty to accuracy and diplomacy.

The questions that Matrons and nursing leaders were asking in 1919 still stand. Can qualities like compassion and courage be taught? Does being on the state register guarantee those qualities in a nurse? And ultimately, how do we ensure the best patient care?

A group of nurses and midwives, starting on the left with black and white historical pictures moving to the present in modern uniforms on the right

This exhibition was coordinated by the History of Nursing Forum and Library and Archive Service. Special thanks go to Alison O’Donnell, Moyra Journeaux, Stephen Bourne and our lenders Barts Health NHS Trust Archives and Museums, the Royal British Nurses Association (RBNA) collection held by King’s College London Archive and the Nursing and Midwifery Council. Exhibition webpage built by Kat Black.