More Than a Vocation, A Profession: Ethel Gordon Fenwick and the Drive for Nurse Registration.

For most, their pantheon of nursing reformers from the 19th century is a list containing precisely two people: Florence Nightingale, whose superhuman efforts during the Crimean War translated into a drive in England to make nursing a respectable occupation for middle class women, and Clara Barton, whose equally driven work during the American Civil War ultimately culminated in the creation of the American Red Cross. And certainly, these figures are both foundational, but the road from them to modern nursing is incomplete without the addition of a third name, that of Ethel Gordon Fenwick (1857-1947), who spent three long decades fighting against not only the British medical community, but the previous generation of nurses, to establish nursing as a credentialed profession comprised of individuals who met standardized requirements and earned national registration.

Unlike Nightingale, with whom she would clash professionally many a time in the years to come, Fenwick did not have to overcome overbearing familial resistance to her dreams of a medical career. She was born Ethel Manson in Elgin, Scotland in 1857 to a prosperous farmer who had trained as a physician but ultimately never practiced as one, and a mother who came from an offshoot of the Clan Rose who had served under Robert the Bruce. Her father died at the age of 46 when Ethel was less than a year old, and though that might seem like the setup to a classic Victorian tale of misery at the hands of a new stepfather, her mother chose well in remarrying, wedding MP George Storer in 1859 and transplanting herself and her three children to live at his home at Thoroton in Nottinghamshire. 

The Storers were an important family, with strong connections to the medical community, and sent young Ethel to a private boarding school, Middlethorpe Hall, led at the time by the physician Dr. Matthew Wilkinson. Middlethorpe had a reputation as being a school of choice for forward-thinking families, the Wilkinsons in particular having close ties with the Garretts, one of whom, Elizabeth Garrett Anderson, would go on to become England’s first licensed woman physician. Spending her time in circles such as these, it was not surprising that Fenwick chose a career in medicine early on and, thanks to the groundwork laid by Nightingale before her in making nursing a “respectable” occupation for the daughters of the middle class, Ethel did not have to face anywhere near the familial outrage that women even ten years before had to weather in announcing their intended career in medicine.

At 21 years of age, Ethel was considered too young to work in a general hospital, and instead joined the Nottingham Children’s Hospital as a probationer nurse, paying a fee to do so, as was customary at the time. The hospital had been founded in 1869, and Ethel’s parents were actively involved in its fundraising campaigns prior to her arrival. It was a small, two ward, 24 cot facility, and Fenwick was only there for some five months, but her performance and diligence impressed the Matron there, whose goodwill would be crucial later in securing Ethel an invitation to work at London Hospital. In between those appointments, Ethel did another stint as a probationer, this time at the Manchester Royal Infirmary, where Matthew Wilkinson was one of the guiding medical forces. This was grueling work, with something on the order of a seventy percent burnout rate because of the strong constitutional demands placed on the nurses. 

Working long hours at physically and mentally draining tasks, however, was Ethel’s base state, and would remain so for the rest of her life, and she thrived in this environment, winning the admiration of all the Matrons she worked with, and earning enough trust to be given charge of Barnes Convalescent Home, near Manchester Royal, when that Matron had to temporarily leave her post. By 1879, then, armed with a cluster of glowing recommendations, Ethel had moved up to the post of senior sister of the women’s medical ward at London Hospital, an amazing advancement for somebody not yet 23 years old. Soon she had placed over her a new matron, Eva Luckes, who was to be her life-long nemesis in the battle for nurse registration, but who for the moment was simply her rival for the affections of one Dr. Bedford Fenwick.

Meanwhile, Ethel had set her sights on a new life goal - acquiring the position of Matron, which she duly accomplished in 1881 at the age of just twenty-four, and not just at any hospital, but at St. Bartholomew’s Hospital in London, an institution which had been in operation since the year 1123. To lead the nursing staff here at any age would have been a coup, but to receive the position before one’s twenty-fifth birthday was a testament to the sterling reputation she had earned with everyone she had yet worked with, and Ethel would tackle the job with her characteristic thoroughness and well-nigh inhuman work ethic. 

It was a post of incredible responsibility, which included the overseeing of the wards, coordination with the medical officers, preparing all of the nurse wage lists, regulating the behavior of the nursing staff to align with the moral standards of St. Bartholomew’s, keeping track of the linen inventory down to each used scrap, communicating requisition requests to the Treasurer, receiving reports from the night staff, and keeping accurate financial records of the ward’s expenditures, all while living on site and keeping to a schedule at all times devoted to the good of the wards, forsaking virtually all contact with the outside world. 

When Ethel set foot in Barts (as St. Bartholomew’s was more commonly known), the institution was in a phase of transition. The previous Matron, Maria Machin, had attempted to implement reforms, but ran constantly aground on the determination of the existing Sisters and staff not to change their ways. Ethel, however, was having none of that. She had a vision, one which was at odds with the Nightingale tradition, but which she resolutely believed was the future of the nursing profession. She increasingly believed that the approach towards nursing as a Vocation the primary requirement of which was devotion and moral rectitude, as important as it was to rescuing nursing from its low social standing in the mid-19th century, needed to be replaced with the idea of nursing as a profession like any other, based in rigorous training and professional medical standards culminating in some sort of nation-wide certification process. 

During her time at Barts, Ethel put this plan into motion, creating a training program that grew from a two to a three year process, with both practical and theoretical instruction to move the modern nurse away from the model of the Angel of Mercy, and towards that of a highly trained and knowledgeable practitioner of up-to-date medical procedures. Meanwhile, she was also acting to improve the quality of life of the nurses in her care, improving the food they received, arguing for and receiving increases in their salary, and securing more holidays and fewer working hours for them under the theory that well rested, nourished, and financially secure nurses are, on the whole, better nurses.

Ethel oversaw the professionalization of nursing at St. Bartholomew’s from 1881 to 1887, including the creation of the Trained Nurses Institute in 1886. By the time she left to marry the afore-mentioned Dr. Benford Fenwick, most of the staff had received some manner of formalized training, steadily pushing out the collection of well-meaning but uninformed nurses she had inherited, and she was getting herself more deeply involved with the cause that would come to define the rest of her life - the drive for a national registry of nurses.

Today, we think of nurse registration as a self-evidently good thing - it is generally better to know that the person who will be your regular contact point with the medical profession is one who has passed some basic level of standardized proficiency testing than to just roll the dice and hope for the best. During the late nineteenth and early twentieth centuries, however, the idea was a controversial one. On one hand, Florence Nightingale was determinedly set against it as a move away from her notion of who nurses fundamentally were - for her, a nurse was an individual born for the job, who had received some sort of higher spiritual calling to do it, and whose nature as a ministering spirit of succor was her most important qualification. Ethel’s idea of nurses as essentially normal individuals who received an efficient and mechanical training regimen to do their work within required parameters moved away from this ideal in ways that Nightingale was never entirely comfortable with.

On the other hand, there was the larger medical establishment, which was wary of nurses potentially intruding in the domain of doctors if they were to have their own detailed medical training and certification processes, and the vast body of nurses who had no training, who felt threatened by the new qualifications, and worried that it all betokened their replacement by the rising generation of institute-trained and officially sanctioned nurses produced by people like Ethel Fenwick.

Though Ethel gave up her position as Matron at Barts upon marrying, she never gave up her role as the leading advocate for nurse registration in the United Kingdom, forming organization after organization (including the Royal British Nurses’ Association in 1887 and the International Council of Nurses in 1899) to lead the fight, speaking in public about the benefits of having nurses held to the same level of professional standards as doctors, and writing in the pages of The British Journal of Nursing (which she edited for over a half century) about not only nurse registration, but the importance of women’s suffrage to the advancement of women in the workplace. 

As we have seen in the cases of Elizabeth Blackwell, Sophia Jex-Blake, and Maria Montessori, the stridency and self-assuredness which are often so necessary in the pioneering figures of a movement to see it doggedly through its lean and hard early years often become a hindrance later on, and this was also the case with Ethel Fenwick. Once nurse registration was finally achieved after three decades of struggle in 1919 through the Nurses Registration Act, Fenwick’s unwillingness to compromise her vision of exactly how registration should play out, and who should be in charge of it, isolated her from the movement, and though she was, in honor of her hard work in the name of the cause, put down as Registered Nurse #1 on the roll book, she was soon sidelined for her intransigence, kicked out of the committees driving the new effort. 

Disillusioned with how the movement she had led through its hardest times had cast her aside so completely, Fenwick devoted her still considerable energy and resources to a new cause, the creation of the British College of Nurses in 1926. She had seen what happened to her Royal British Nurses’ Association under a royal charter, with its requirements that individuals from outside the organization had to be included in leadership positions, and so she decided to create a College run by Registered Nurses and just Registered Nurses with no outside interference. It included Irish nursing reformer Margaret Huxley (1854-1940) and infectious disease expert Susan Villiers (1863-1945) among its Fellows, but in spite of a substantial initial endowment, it closed in 1956, within a decade of the passing of Fenwick herself.

Ethel Gordon Fenwick’s fighting spirit was arrested at last only by her death at the age of ninety in 1947. Her separation from her spouse, her rejection by her own cause, her decades of struggle with the medical establishment and her fellow nurses, her years of battling to create a medical education institute just exactly the way she thought it should be, all seemed to feed her energy rather than eat away at it, and the Fenwick described by her family in her eighties was a woman still very much engaged with life and her profession, writing spirited articles in between trips to find good deals to add to her beloved antique collection. Today, just over a century after the passing of the Nurses Registration Act, there are some 780,000 RNs in the United Kingdom, and some 4.9 million more in the United States, where Fenwick’s work was carried on by Isabel Robb, Lovinia Dock, and a host of others who, state by state, built professional standards for the American nurse, little knowing that their efforts were just part of a chain that began when a twenty-four year old woman strode onto the grounds of a hospital that had been plying its trade since the 12th century and took a stand against seven centuries of accumulated tradition to ensure a better standard of care for her patients, and a better standard of life for those seeing to that care.

FURTHER READING: 

Jenny Main’s Ethel Gordon Fenwick: Nursing Reformer and the First Registered Nurse (2022) started life in the 1970s as a pamphlet to revive the memory of this pivotal but largely forgotten figure in the history of nursing, and was subsequently expanded into a full book. The original parts on Fenwick are great, but intercut with them are long sections about the main events of each year covered by the book, so you’re only actually with Fenwick perhaps forty percent of the time, which I found mostly frustrating but others might find to be sort of fun side details that lend a larger context. Fenwick is also a figure in Susan McGann’s Battle of the Nurses (1992), which covers the half century from 1880 to 1930 when the several different approaches to nurse registration were battling it out and deftly courting different politicians to gain leverage for their particular bills and plans. Both are pretty easy books to find, so take your pick!