The Nursing Dispute at Guy's Hospital, 1879–1880

Abstract

Nursing reforms were rarely introduced into nineteenth-century hospitals without some conflict between their governors and their medical staff. Most historians have seen this as a chapter of nursing history, not part of the history of the medical profession. The nursing dispute at Guy's Hospital, which lasted from December 1879 to September 1880, suggests that wider issues for the medical profession's authority within hospital management were at stake in these disputes and not just their Janus-like attitude to reform. The medical staff at Guy's remained intransigent when a new system of nursing was introduced because they felt that reform threatened their authority at a number of levels. The doctors' rhetoric emphasized the effect reform had on patients, but from the start they questioned the governors' authority to introduce reform and asserted that they should have been consulted before any changes had been made. This issue of authority remained central to the dispute. Public accusations of mismanagement eventually forced a confrontation and the medical staff's collective resolved collapsed with the threat of dismissal, allowing a compromise in favour of the governors. The new system of nursing remained in a modified form and the doctors were invited to take part in a joint management committee that they themselves had initially demanded. An apparent defeat gave the doctors a formal role in the hospital's management that ultimately extended their authority. The dispute is just one example of how the medical profession attempted to assert control over hospital management. In other disputes, like the very public one at Guy's, doctors were forced to compromise and often back down, but out of an apparent defeat they emerged with a negotiated role in the hospital's management that left them in a stronger position than before. Conflict therefore was the medical profession's main vehicle to increased authority.

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