The movement for District Nursing, which was always near to Miss Nightingale's heart, and which, in conjunction with Mr. Rathbone and others, she had done much to promote, received considerable extension by the action of Queen Victoria in 1887. The bulk of the sum presented as the “Women's Jubilee Gift” was devoted by the Queen to “the nursing the sick poor in their own homes by means of trained nurses.” She appointed the Duke of Westminster, Sir Rutherford Alcock, and Sir James Paget to be trustees of the Fund, and to advise upon its administration. Sir James Paget consulted Miss Nightingale, who, in several conversations, impressed upon him her view that the essential things were the training of nurses for the work, and the association of them in “Homes.” The lines of the “Metropolitan District Nursing Association,” which had for many years been largely supported by nurses trained in the Nightingale School and by grants from the Nightingale Fund, were adopted as the basis of the “Jubilee Institute for Nurses,” and the Association presently became affiliated to the Institute. In an introduction which she contributed in 1890 to a book giving account of these matters,[217] Miss Nightingale struck a warning note. “The tendency is now to make a formula of nursing; a sort of literary expression. Now, no living thing can less lend itself to a formula than nursing. Nursing has to nurse living bodies and spirits. It must be sympathetic. It cannot be tested by public examinations, though it may be tested by current supervision.” The Royal Jubilee Institute in some ways advanced Miss Nightingale's cause, but she had misgivings. “Vexilla regis prodeunt; yes, but of which King?” Was the oriflamme, which was now beginning to wave above the nursing sisterhood, “of heavenly fire, or of terrestrial tissue?” “We are becoming the fashion,” Miss Nightingale was fond of saying; “we must be on our guard. Royalty is smiling on us; we must have a care.” Such misgivings were speedily to be justified.
The nursing world was for some years rent in twain by a dispute about Royal Charters and Registration. The controversy lasted for seven years (1886–93); Miss Nightingale was in the thick of it, and during the more critical period of the dispute (1891, 1892) it was her main public preoccupation. In 1886 the Hospitals Association[218] appointed a Committee to inquire into the possibility of establishing a General Register of Nurses. The Committee violently disagreed; in 1887 the majority retired, and the minority founded the British Nurses Association with a view to carrying forward a scheme of Registration. In 1888 the Hospitals Association appointed a second committee which proceeded to collect opinions from the various Nurse Training Schools. These Schools were for the most part opposed to the idea of a General Register; but there was difference of opinion among leaders alike in the medical profession and in the nursing world. “I have a terror,” wrote Miss Nightingale to Mr. Bonham Carter (April 20, 1889), “lest the B.N.A.'s and the anti-B.N.A.'s should form two hostile camps, judging one another by that test chiefly or alone. This would be disastrous. The Unionists and the Home Rulers show us an example of what this is. They are two hostile camps, dividing families. It is like a craze. The test, e.g. even of a good doctor or of an acquaintance is, to which camp does he belong? Even a doctor, canvassing for an appointment, is asked whether he is Home Ruler or Unionist. I can remember nothing so distressing since the Reform Bill, which I remember very well, when the two sides would not meet each other at dinner.” I do not know that feeling between the pro-Registrationists and the anti-Registrationists went to the length of war-to-the-knife-and-fork; but the “Nurses' Battle” (as it was called in the newspapers) was hot and prolonged. From a fighting point of view, the two sides were fairly matched. On each side there were eminent doctors. The “anti's” had an advantage in that they included the greater number of those who had the longest and closest knowledge of nurse-training; but the “pro's” had a Princess at their head. The Princess Christian had accepted the presidency of the British Nurses Association; and when the time came for applying for a Charter, it was the Princess who petitioned the Queen. “This makes it awkward for us,” said Mr. Rathbone to Miss Nightingale; and undoubtedly it did. There were courtly personages even among Miss Nightingale's devoted adherents who were inclined to trim; and there were other persons, who, having never perhaps thought out the questions, were predisposed to do as the Princess did. Let each man in the battle have such credit as is due for his personal loyalty. “In any matter of nursing, Miss Nightingale is my Pope,” wrote Mr. Rathbone, “and I believe in her infallibility.” “Nothing can save us,” he said to Miss Nightingale herself, “except your intervention.” She was not slow to give it. Suggestions were made by intimate friends—Sir Henry Acland and Sir Harry Verney—that she should see the Princess Christian and endeavour to come to terms; and later on, in 1893, when the Empress Frederick visited Miss Nightingale, they renewed the suggestion. But the Princess Christian had made no overtures; she was committed to the particular scheme advocated by the Association of which she was President; and, to Miss Nightingale, opposition to that scheme was a matter of vital principle. She threw herself into the fray with an equipment of argumentative resource derived from her unequalled experience, and with a passionate conviction inspired by long brooding over a fixed ideal.
The objects of the British Nurses Association were “to unite all qualified British Nurses in membership of a recognized Profession”; “to provide for their Registration on terms satisfactory to physicians and surgeons as evidence of their having received systematic training”; “to associate them for mutual help and protection and for the advantage in every way of their professional work”; and “with a view to the attainment of these objects, to obtain a Royal Charter incorporating the Association and authorizing the formation of a Register.”[219] It was around the second and the fourth of these objects that the principal battle raged. The case of the Association was prima facie a strong one. A Register of Nurses, duly certified as competent, would, it was argued, be a protection against impostors. The certification was to be by a Board which would insist on a certain standard of professional proficiency. Three years' training in a hospital was suggested as the preliminary test. The case, on the other side, as developed by Miss Nightingale and her allies, was that the apparent advantages of a Register were deceptive. Who was to be protected? Not the hospitals: they protected themselves, without any general register, by their own methods. If any one was to be protected, it must be the public; but the Register would rather mislead than protect them. The placing of a name on a register would, at best, only certify that at a certain date the nurse had satisfied the required tests; but the date might be long ago, and the fact of registration would tell nothing of her subsequent conduct or competence. The registration of midwives stood on a different footing from that of nurses; for in the former case, a certain definite technical skill is of the essence of the matter: in the case of nursing, character is as much of its essence as any technical qualification. As for the three years' training in a hospital, there were hospitals and hospitals, training-schools and training-schools; and who was to guarantee the guarantors? The General Register would not raise the profession of nursing; it would do an injury to the better nurses by putting them on a level with the worse, and to the profession by stereotyping a minimum standard. The British Nurses Association had published a preliminary “register.” Miss Nightingale analysed it, and found that in the case of nurses “trained” at one hospital, the private Register of that Hospital excluded nearly one-third of those entered on the B.N.A.'s register; and that another Hospital's Register included, as “duly certificated,” only one-third of those entered on the B.N.A.'s register as trained thereat. “You cannot select the good from the inferior by any test or system of examination. But most of all, and first of all, must their moral qualifications be made to stand pre-eminent in estimation. All this can only be secured by the current supervision, tests, or examination which they receive in their training-school or hospital, not by any examination from a foreign body like that proposed by the British Nurses Association. Indeed, those who come best off in such would probably be the ready and forward, not the best nurses.”[220] The much vexed question of “internal” or “external” examination was, it will be seen, involved in this dispute. But to Miss Nightingale a larger and a more vital issue was at stake. It was a conflict between two ideals—or rather, as she would have said, between a high ideal and a material expediency. Mr. Jowett, though he agreed in her view “that nurses cannot be registered and examined any more than mothers,” was distressed that she was so greatly perturbed over what seemed to him so small a matter. “It is a comparative trifle,” he wrote (May 26, 1892), “among all the work which you have done, and you must not be over-anxious.” To Miss Nightingale it was not a trifle, but a trial—a possible parting of the ways. It was diverting attention from training-homes to examination-tests; it was sacrificing a high calling to professional advancement. “There comes a crisis,” she wrote to Mr. Jowett (May), “in the lives of all social movements, rough-hew them as you will, when the amateur and outward and certifying or registering spirit comes in on the one side, and the mercantile or buying-and-selling spirit on the other. This has come in the case of Nursing in about 30 years; for Nursing was born about 30 years ago. The present trial is not persecution but fashion; and this brings in all sorts of amateur alloy, and public life instead of the life of a calling, and registering instead of training. On the other hand, an extra mercantile spirit has come in—of forcing up wages, regardless of the truism that Nursing has been raised from the sink it was, not more by training, than by making the Hospital, Workhouse Infirmary, or District Home a place of moral and healthful safe-guards, inspiring a sense of duty and love of the calling.” The true way of “protecting the public” was “to extend Homes for Private Nurses on sound lines, aided by the Nurses' Training Schools and Hospitals”; not, by means of a Chartered Register, to encourage nurses “to flock to the Institutions which gave the easiest certificate at the least trouble of training.” Miss Nightingale could not, then, regard the dispute as a trifle. It caused her days and nights of grievous anxiety. Her meditations are full of despondency and searchings of heart both bitter and self-reproachful. The Princess Christian, with the best intentions, was giving her name to undermine Miss Nightingale's ideal. This could not justly be attributed in blame to the Princess; the fault must have been with her, Florence Nightingale, who had misused her opportunities, and had failed to impress her ideal on other minds. She was an unprofitable servant. But here, as in all things, the sensitive reproaches of the night-watches left no trace of themselves on the work of the day; or rather, they left their trace in greater activity and devotion.
It was in 1889 that the occasion came for resolute action. The British Nurses Association announced their intention of applying for a Charter, and proceeded to enlist public support. Miss Nightingale set to work on the other side. She made the acquaintance at this time of Miss Lückes, then, as now (1913), the Matron of the London Hospital, who was strongly opposed to the idea of registration. The acquaintance speedily ripened into friendship, and henceforth Miss Nightingale was looked to for support and sympathy by the Matron of the London, hardly less than by her of St. Thomas's. Other nurse-training schools came into line, and a manifesto was issued announcing their intention to oppose any petition for a Charter. There was desultory skirmishing for some time between the Registrationists and anti-Registrationists. There was a lively polemic in the newspapers. There were as many fly-sheets and pamphlets as if it were a theological dispute in a University.[221] In 1891 the British Nurses Association applied to the Board of Trade to be registered as a Public Company, without the addition of the word “Limited” to its name. The Memorandum and proposed Articles of Association were duly filed, and the foremost place was again given, among the declared objects, to a register of trained nurses, and to power to determine from time to time the test for registration. Miss Nightingale and her allies took up the challenge. Through Sir Harry Verney she approached the President of the Board of Trade (Sir Michael Hicks-Beach) with a statement of the case against the Association. A counter-petition was presented; and after full consideration the Board refused the application. The first engagement had thus resulted in a victory for Miss Nightingale. In the same year there was a Committee of the House of Lords to inquire into the London Hospitals. Mr. Rathbone, coached by Miss Nightingale, gave evidence on the question of the registration of nurses, and the Committee reported against it. A second victory! But the Registrationists now brought up their most formidable reserves. Permission was obtained from the Sovereign to use the title “Royal.” Thus strengthened by favour in the highest quarter, the Royal British Nurses Association petitioned the Queen for a Royal Charter. The petition was referred in the usual course to a special Committee of the Privy Council, and the two sides marshalled their forces. A campaign fund was raised by the anti-Registrationists. Miss Nightingale appealed privately to the Lord President of the Council and wrote various letters, Memoranda, Statements. She enlisted support from the medical profession. Her old pupils, now in charge of nurse-training schools throughout the country, rallied round her. Two petitions, of special weight, were presented to the Privy Council against the Charter. One was from the Council of the Nightingale Fund, the body which had been the pioneer in promoting the training of nurses. The other was the “Petition of Executive Officers, Matrons, Lady Superintendents, and Principal Assistants of the London and Provincial Hospitals and Nurse Training Schools, and of Members of the Medical Profession and Ladies directly connected with Nursing and the Training of Nurses.” The list of signatures, which occupies twenty-three folio pages, was headed by “Florence Nightingale.” In the preparation of these documents, Miss Nightingale had a large share, though much of the work—especially in the instruction of the lawyers, in consultations and so forth—was done by Mr. Bonham Carter.
The Committee of the Privy Council sat in November 1892 to hear the case.[222] Of the first day's proceedings Miss Nightingale wrote an account in which, as will be seen, she did not let the Registrationist dogs have the better of it, but which betrays at the same time serious anxiety about the result:—
(Miss Nightingale to Sir Harry Verney.) 10 South Street, Nov. 22 [1892]. Yesterday was the first day of the Privy Council Trial. We had to change our senior counsel at the last moment, because Mr. Finlay was engaged on an Election Committee. And our previous four days were, therefore, as you may suppose, very busy. We were fortunate enough to have Sir Richard Webster. Sir Horace Davey opened the Ball on behalf of Princess Christian. His speech was dull, and contained only the commonplaces we have heard for a year in favour of the Royal Charter. The Judges were: Lord Ripon (who only stayed half the time), Lord Monson, and two Law Lords [Lord Hannen and Lord Hobhouse]. They appeared to have been chosen as knowing nothing of the matter and as not having been on the Lords Committee on Hospitals. Our side, Sir Richard Webster, followed with a masterly speech—masterly from being[363] that of a shrewd man of sense, without rhetoric, and from his splendid getting up of our case at short notice. He put very strongly our contention that character, unregistrable, rather than technical training, makes the nurse, and other of our points. The Judges adjourned till Monday in the middle of his speech where he was saying as we do—What is the use of saying that a Nurse has had 3 years' training at such a Hospital? how can you certify the Hospital? He will resume this subject and others on Monday. The Judges asked all the questions—not to the point—that you can fancy men perfectly ignorant of the subject to ask, and which we have answered over and over again. Sir Richard Webster said to Bonham Carter at the end of yesterday, “The judges are dead against us.” The Charter pledges itself to admit on the Register only nurses of three years' Hospital training—which the Judges pronounced could do no harm. But it provides for itself what may put into its hands the whole control of what constitutes training. Is it not wonderful these men do not see this? Well, “we are in God's hands, brother, not in theirs” (the Privy Council's). In all my strange life through which God has guided me so faithfully (O that I had been as faithful to Him as He to me!), this is the strangest episode of all—to see a number of Doctors of the highest eminence giving their names to what they know nothing at all about. Sir James Paget told me himself that the names were asked for at a Court Ball,—following each other like a flock of sheep; to see their Council of Registration made up of Sirs, only one of whom knows anything about nurse-training (Sir James Paget himself asked me, why can't nurses lodge out as students do!!); to see these able, good, and shrewd men ignoring that such a thing is sure to fall into a clique. They have let Princess Christian fall into such an one already. She is made a tool of by two or three people. “Lift up your heads, ye gates, and the King of Glory shall come in. Who is the King of Glory? The Lord strong in battle.” O God of Battles, steel thy soldiers' hearts against happy-go-luckiness, against courtiership, fashion, and mere money-making on the part of the Nurses and their Societies! P.S. This trial will cost us £700 at least.
The Committee took time to consider their advice to Her Majesty. In May 1893 the decision was announced. The Committee advised Her Majesty in Council to grant a Charter in accordance with a Draft revised by them. On June 6 the Charter was granted.
Each side claimed the victory. The Nursing Record (June 15)—an organ of the Registrationists—claimed that they had won all, and even more than all, that they asked, and declared proudly that henceforth “members of the Royal Chartered Association will hold a higher position than any others.” The Hospital, on the other side, argued that all this was ill-founded, but if the “British Nurses” wanted to be congratulated on nothing, “we are willing to congratulate them” (June 24). The fight before the Privy Council now became a fight in the press on the meaning of the verdict. The anti-Registrationists, headed by Miss Nightingale and the Duke of Westminster, put their interpretation in a quiet letter to the Times (July 3), which the Royal British Nurses Association hotly denounced as “untrue in fact and injurious in intention” (July 6). The fact was that the Lords of the Council had steered a middle course. They granted the Charter; but in it for the words “the maintenance of a list or register of nurses, showing as to each nurse registered,” etc., they substituted the words “the maintenance of a list of persons who may have applied to have their names entered therein as nurses,” etc. There was nothing in the Charter which gave any nurse the right to call herself “chartered” or “registered.” What the promoters hoped we need not discuss; what the opponents feared was a Charter in such terms as would give the Corporation an authoritative, and perhaps ultimately, an exclusive right to register nurses, and thereby would give it also indirect control over nurse-training. No such Charter was obtained; and in this sense the opposition of Miss Nightingale and her friends had prevailed. The controversy is not dead; but, so far, her view has continued to prevail,[223] and the official registration of nurses is still a pious hope to its supporters, a heresy to its opponents. Miss Nightingale greatly deplored the feud, but sought to bring good out of evil. “Forty years hence,” she wrote to Mr. Rathbone (Feb. 26, 1891), “such a scheme might not be preposterous, provided the intermediate time be diligently and successfully employed in levelling up, that is, in making all nurses at least equal to the best trained nurses of this day, and in levelling up Training Schools in like manner.” “Great good may be done,” she wrote to Mr. Jowett (May 1892), “by rousing our side to an increased earnestness about (1) providing Homes for Nurses while engaged in their work of nursing, and (2) full private Hospital Registers, tracing the careers of nurses trained by them.” There were no years in which Miss Nightingale herself gave more thought and trouble, than in 1891–3, to personal care for the affairs of the Nightingale School.
In a Paper which Miss Nightingale was invited to contribute to a Congress on Women's Work, held at Chicago in 1893, she treated the whole subject of nursing.[224] This paper embodies in a methodical form her characteristic views, and in it she takes occasion in several places to touch obliquely upon the controversy described in preceding pages. “A new art, and a new science, has been created since and within the last forty years. And with it a new profession—so they say; we say, calling.” She dwells on the conditions necessary to make a good training school for nurses. She dilates upon the dangers to which nursing is subject. These are “Fashion on the one side, and a consequent want of earnestness; mere money-getting on the other side; and a mechanical view of nursing.” “Can it be possible that a testimonial or certificate of three years' so-called training or service from a hospital—any hospital with a certain number of beds—can be accepted as sufficient to certify a nurse for a place in a public register? As well might we not take a certificate from any garden of a certain number of acres, that plants are certified valuable if they have been three years in the garden?” Then there was “imminent danger of stereotyping instead of progressing. No system can endure that does not march. Objects of registration not capable of being gained by a public register!” The whole paper is written with a good deal of gusto. The volume in which it appeared was dedicated to Princess Christian.
In the following year Miss Nightingale had some correspondence with the Princess, who, as President of the Royal British Nurses Association, had made a scheme for enrolling a “War Nursing Reserve” through the Hospitals, and had written to consult Miss Nightingale about it. The Hospital Sisters were according to this scheme to be placed “in subordination to the Army Sisters”—nurses with the larger experience under those with the smaller. This seemed to Miss Nightingale a mistake; and she noted other details in which the scheme appeared to her inadequately considered. She pointed these things out faithfully to the Princess, but the correspondence on both sides was cordial. The letters from the Princess made Miss Nightingale exclaim, “How gracefully Royalty can do things!” And on her part she desired to be conciliatory. “We should, I think, be earnestly anxious,” she wrote, “to do what we can for Princess Christian as she holds out the flag of truce, in order to put an end as far as we can to all this bickering, which does such harm to the cause.”