The Florence Nightingale school of thought developed and was sustained within the nurse training schools that sprang up in hospitals, not only in Britain, but also in Australia, New Zealand and other countries. I argue that within nursing education and practice, nursing as an art was seen to involve the character of the nurse in the exercise of feminine virtues, and the importance of character training in the development of nursing as a female profession/occupation. In this context, science was out of place: the scientific enterprise was a male one and, in the hospital and medical context, belonged to the doctor.

Nursing in nineteenth century industrial England was regarded as an inferior, undesirable occupation practised by morally suspect women. In Martin Chuzzlewit, Dickens epitomised the nineteenth century English nurse in the character of Mrs Gamp, writing that ‘it was difficult to enjoy her company without being conscious of a smell of spirits’ (Dickens 1910:312–313). The contrast of Florence Nightingale’s work in the Crimea, and the subsequent publicity, brought about her identification in the public mind as a ‘ministering angel’ (The Times, London, 20 November 1854). This image was instrumental in elevating secular nursing to a female vocation based on Enlightenment ideals of the womanly virtues and the exercise of the womanly arts through the care of the sick. Indeed, Florence Nightingale described nursing as ‘the finest of the fine arts’ (Donahue 1996).

Enormous effort went into the attempts to position nursing as epitomising feminine ideals of the good woman. Nursing transgressed many prevailing ideas about the role of women in society and it was extremely difficult for nursing to gain acceptance as a legitimate and respectable occupation. Mrs Gamp and the ‘bad woman’ were never far beneath the surface; it is therefore not surprising that Florence Nightingale and her followers placed so much emphasis upon ensuring appropriate character formation among nurses in training (Parker 1990).

The first Florence Nightingale training school began at St Thomas’ Hospital in London in 1860 and became the model for many training schools in Britain and its overseas territories in the latter half of the nineteenth century (Trembath & Hellier 1987). Student nurses were judged on their qualities of trustworthiness, neatness, quietness, sobriety, honesty and truthfulness (Smith 1982). Additionally, nurses were trained to ensure they did not wish to usurp any of the doctor’s functions. Isabella Rathie, the first trained Matron of the Melbourne Hospital, noted, ‘we are in a great measure the handmaid of the medical man and our function in this particular is to be obedient in every detail’ (Rathie, cited in Trembath & Hellier 1987:19).

Thus, the division between art and science as it was manifest within modern secular professional nursing of the Nightingale school of thought can be described as a gendered division. Nursing as a feminine art was developed through character training that resulted in non-assertiveness, obedience and compliance with medical directives. Specific nursing arts comprised nursing procedures such as bathing, bed-making, positioning patients and comforting techniques. While some science content was included in nursing courses, ‘[t]here was minimal, if any, application of science content in nursing practice’ (Peplau 1988:8). Nor were nurses educated in arts subjects of the university, which produced the thinkers of society, for that was primarily the sphere of men. Rather, they were instilled with womanly virtues.

Nursing education was a process of systematically inculcating a task orientation and the moulding of a set of appropriate attitudes within hospital training schools to produce nurses who exemplified the feminine ideal. Science belonged to the rational and objective world of men, of which medicine was one domain. Men were subjects (minds), while women were objects (bodies); nurses were therefore not positioned as rational subjects shaping the Enlightenment project and their own destinies, but rather as passive and compliant objects, subservient to medicine.

Hospital-based nurse training lasted for more than 100 years in Australia and much longer in Britain. Many changes occurred over that time, including considerable strengthening of the science content, particularly from the 1950s onwards. However, the gendering of nursing as a feminine art, developed in the restrictive environment of the hospital, placed limitations upon the possibilities for nursing to develop as a modern profession. It also limited the possibilities for nurses to develop knowledge, skills and attitudes in ways that would enable them to act as autonomous subjects. Nevertheless, it equipped them powerfully to work as moral agents engaged in socially significant work and to develop in-depth knowledge of the human condition in sickness and in suffering, albeit in an unarticulated, scientifically untested form.

In the United States, a 4-year entry-to-practice program had been established within a university by 1919. Within this system, it was possible to ensure the development of knowledge in a systematic and orderly way. By the late 1950s, programs for training nurse scientists had developed in a number of major universities, which stimulated interest in theoretical and scientific bases of practice. These were supported by a huge federal investment in nursing education during the 1960s and early 1970s (Gortner 1983). In the period from the late 1950s to the early 1980s, theories of nursing proliferated as nurse scholars sought to include in the concept of nursing an understanding of biological, behavioural, social and cultural factors in health and illness. Of particular note in this discussion were the attempts made to produce closed systems of thought through nursing theory development and the creation of nursing science.

This scientific orientation in nursing, however, came into conflict with ideas about the art of nursing. These stemmed not only from the Nightingale school of thought, but also from consideration of the art of nursing in relation to humanism and the nature of the human subject, by this time conceived of as including women. It is in this context that most of the debates about the art and science of nursing have occurred.

As has already been noted, a significant feature of the modern era has been the rise of professions, each clearly delineated by a separate body of knowledge. In the early modern era, nursing could not be regarded as a profession because it was seen to be subservient to and complicit in the medical tasks of diagnosis and treatment. With the location of nursing education within universities, and with the goal of securing professional status for nurses, a major task was to establish its own scientific base, separate from that of medicine.

One early nursing theorist, Johnson (1961), distinguished medicine from nursing by arguing that while the scientific basis of medical knowledge was biological systems, the scientific basis of nursing was behavioural systems. She proposed a behavioural subsystem model of the person ‘with behaviour understood as the sum total of physical, biological and social factors/behaviours’ (Parker 1995:334). These ideas were further developed by Roy (1980), who conceived of the person as an open, adaptive system, and nursing as the science and practice of promoting adaptation.

Other theorists, however, argued that these approaches did not sufficiently distinguish nursing from medicine. Like medical knowledge, the knowledge produced through study of systems was overly simplistic and mechanistic. Nursing, by contrast, needed to be conceptualised in broader, more encompassing, terms (e.g. Levine 1971). Ideas about nursing as a holistic science were developed by writers such as Rogers (1970) who conceived of the person as an energy field, coextensive with the environment, identified in terms of unified wholeness, openness, pattern, organisation and sentience.

Other writers further differentiated nursing science from medical science by emphasising nursing’s caring function in opposition to medicine’s curative function. Watson (1985), for example, pulled together two of the central ideas of the modern era by describing nursing as a humanistic science, with caring the central unifying dimension of nursing (Cohen 1991).

Thus, with the shift of nursing education to universities in the United States, strong schools of nursing thought emerged. Each was developed in opposition to medicine, and understood nursing as a behavioural science, a holistic science or a caring science. These conceptual models for nursing practice were the work of a number of nursing intellectuals who had undertaken higher degree work in a range of disciplines, particularly in social sciences and education. Each model was designed to capture the complex dimensions of nursing, although, naturally enough, each one tended to reflect the disciplinary base of its author.

Following the establishment of the basis for nursing science through these models, there were calls to test the models against practical experience and refine them. However, progress was slow, as Flaskerud and Halloran pointed out in 1980, and Fawcett in 1984. There was also concern that the proliferation of models would weaken nursing’s claims to be seen as a profession based in a single unique body of knowledge. Fawcett made the point that ‘[t]he discipline of nursing will advance only through continuous and systematic development and testing of nursing knowledge’ (Fawcett 1984:84). Nursing authors sought to concentrate on the common ground in nursing conceptual models. Fawcett, for example, proposed a ‘metaparadigm’ (an explanatory framework) for nursing built on the central concepts of the discipline—person, environment, health and nursing—and attempts were made to further unify nursing knowledge around these concepts.

Many nurses, however, rejected nursing theories altogether as a means of establishing a science base for nursing. Nursing administrators and clinicians were particularly vocal in their rejection following frustrating experiences of trying to implement them in practice. Nursing theories were seen to reinforce the splits between the theory and practice of nursing, between the education students received and the realities of healthcare service provision, and between nursing thinkers (academics in universities) and nursing doers (nursing administrators and clinicians). In their attempts to develop nursing science through the advancement of nursing theory, nursing theorists, not surprisingly, replicated the binary modes of thought and the dividing practices of the general society.