Profiles in Nursing

Elizabeth Grace Neill (1846-1926), a Crusader for Nursing Registration

This social reformer also founded midwife-run maternity hospitals

As the 20th century dawned, there were almost no laws anywhere in the world governing the training, registration or licensure of nurses or midwives. Grace Neill, nurse and social reformer, led the crusade for nurse registration laws in New Zealand to help ensure that patients and institutions received quality care from well-trained nurses and midwives.

A Scottish Widow

Born Elizabeth Grace Campbell in Edinburgh, Scotland, she was an intelligent, well-educated child of well-to-do parents. She passed the University of Cambridge entrance exams with distinguished marks.

Her plan was to study medicine rather than live the idle life expected of the Scottish gentry. However, her father forbade that path, so she turned instead to another career that would enable her to contribute to society: the recently respectable field of nursing.

After training at King’s College and Charing Cross hospitals in London, she became “lady superintendent” of a children’s hospital near Manchester in the late 1870s. There, she met Channing Neill, a physician. Despite her father’s disapproval of the match — he believed a physician was beneath her social class — she followed her heart and married Channing anyway, an act for which her family disowned her.

The marriage was short-lived. Her husband’s poor health led them to move to Queensland, Australia, but the better climate did not save him. He succumbed to his illnesses around 1890.

Finding herself a widow in her mid-40s with a child to support, Neill turned to occupations such as journalism and typewriting. She also got involved in organizing a union for women workers. Her friendship with Queensland’s governor led to her appointment to a royal commission on labor conditions in New Zealand’s factories and shops in 1893. So began a long career in public service and social reforms in labor, charity and nursing.

“To Twist and Twiddle Ministers & Premiers”

As an inspector, Neill often visited industrial centers across New Zealand. She felt useful in that capacity because she believed, probably rightly, that women workers were more comfortable discussing their conditions with another woman. She joined an investigation into charitable aid and was appointed “official visitor” to the Porirua and Mount View Lunatic Asylums, as they were then called.

In 1895, she became deputy inspector of lunatic asylums, hospitals, licensed houses and charitable institutions. The inspector, Duncan MacGregor, also from Scotland, had been glad to find “an able and experienced woman” assistant who could ask the various “numerous and delicate” questions that were considered too indecorous for male investigators in the Victorian era.

Hiring Now

In a tiny department of three, Neill’s workload was extremely heavy. Her responsibilities involved investigating hospitals and charities for signs of mismanagement and fraud, whether by administrators, staff or patients.

It was not a popular role, but she won respect through her unwillingness to be intimidated. In an era that expected women to be deferential to men, she once boasted that she would “bully the male if he be placed in the position of superior officer.”

Nor was she cowed by rank or title. “It was real plums to twist and twiddle Ministers & Premiers & make them think they were having their own way,” she wrote. “Catch me allowing any public official to treat me as ‘putty’ however soft my outer crust might be. They knew I could take it off on occasion.”

Lobbying for Nurse Registration

Believing the profession and the public deserved a higher standard of nursing care, Neil lobbied for a bill establishing national exams and registration for nurses. In a speech before New Zealand’s Parliament, she warned, “The evil of women of low repute adopting a nursing uniform and posing as nurses in private families with disastrous results is keenly felt.”

The legislation Neill helped draft became the New Zealand Nurses’ Registration Act 1901, one of the earliest such laws in the world. She also assumed responsibility for implementation, including developing the training curriculum and appointing the examiners. Within two years, 292 nurses had been registered in New Zealand.

Training Hospitals for Midwives

Neill subsequently promoted separate legislature to establish registration requirements for midwives, enacted in 1904. Because there were few institutions in New Zealand at the time where women could obtain formal training in midwifery, she was tasked with formulating a curriculum and establishing state maternity training hospitals.

The St. Helens Hospitals, as they were called, were intended for “respectable” women: wives of working men, not destitute single women who might undermine the status of the institution. Medical students were also excluded; Neill wanted to emphasize the role of the midwife in maternity care by establishing “a State hospital managed by women, and doctored by women.”

t was an extremely stressful enterprise. Many doctors opposed midwives as a threat to their own income, status and power, and took every opportunity to publicly criticize the St. Helens Hospitals. In 1906, following the death of Premier Richard Seddon, one of her strongest supporters, Neill resigned for the sake of her own health.

A Return to Nursing

After a three-year break, during which she went to live with her son in America, Neill returned to New Zealand and went back to work as a nurse. During World War I, she became sister in charge of the children’s ward at Wellington Hospital. She resumed her role as official visitor to the Porirua Mental Hospital from 1916 to 1920 and then finally retired for good at age 76. She died in Wellington in 1926, aged 80.

Neill described herself as a “nondescript combatant against drink, poverty, factory owners & the medical profession.” Although her long and varied career encompassed women’s employment, poverty, welfare and child care, it is in the area of nursing reform and the establishment of nursing as a profession that she is best remembered today. Hester Maclean, who replaced Neill as assistant inspector of hospitals in 1906, later wrote that “it would have taken a super-woman to succeed her and work up to her standard.”

Neill once declared her own most important achievement, after raising her son, to be what she’d accomplished to make “the pains & risk of childbearing less for hundreds of women in St. Helens Hospitals.”

Editor’s Note:

NURSING LICENSURE

“Without standards, the term ‘trained nurse’ means anything, everything and next to nothing.”

Although Florence Nightingale rejected the idea of nurse licensure, Isabel Hampton Robb, first president of what later became the ANA, lamented in the 1890s that, “In the absence of educational and professional standards … the term ‘trained nurse’ means anything, everything and next to nothing.”

The earliest nurse registration law was the Medical and Pharmacy Act of 1891, enacted in Cape Town, South Africa (then a British colony), through the efforts of Sister Henrietta Stockdale. In 1903, North Carolina became the first U.S. state to enact nurse registration laws, followed by New Jersey, New York and Virginia. California passed its first such law in 1905, but registration didn’t actually begin until 1913.

Early licensure requirements were permissive: You had to meet the requirements to register, but you didn’t need to register to work as a nurse so long as you didn’t represent yourself as an RN. It wasn’t until 1938 that New York passed the Todd-Feld Act, the first law mandating licensure for “all who nurse for hire,” including RNs and LPNs/LVNs.

That mandate, which wasn’t enforced until 1949, also included the first formal nursing scope of practice in U.S. law. Some states didn’t adopt mandatory licensing until the ‘70s.


Suzanne Ridgway has been a freelance writer and grant writing consultant for 15 years and specializes in working with nonprofit health and human service agencies. She can be reached through ridgway-writer.weebly.com or at .


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