Authority and leadership: the evolution of nursing management in 19th century teaching hospitals



    1. Government Relations Officer (Retd), Ontario Nurses Association, Toronto, Ontario, Canada; Adjunct Assistant Professor, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Carol Helmstadter
Faculty of Nursing
University of Toronto
34 Chestnut Park
Toronto, ON
Canada M4W 1W


Aim  This study shows why some 19th century nursing managers were successful and some were not.

Background  With the exception of Florence Nightingale, almost nothing has been written about 19th century nursing managers.

Method  Classical historical method is used. Extensive use is made of secondary sources. Primary sources are found in the archives of the 12 London teaching hospitals, the Radcliffe Infirmary, the Convents of St John the Divine and the All Saints Sisters, and 16 000 Nightingale documents in the Collected Works of Florence Nightingale.

Results  Success in delivering a highly competent nursing service depended on the matron’s leadership and legitimate authority but she also had to have the support of her hospital board to gain access to allocation of scarce resources.

Implications for nursing management  While the 19th century hospital environment was very different, how nurses directed under different circumstances clarifies our knowledge of successful nursing management in 2007.