The division of nursing labor in the hospital: The role of 'scientific management', New York State, 1900-1940.

摘要

Scientific management, a system of organization of the labor process associated with Frederick Taylor, provided particular solutions to the problem of management control of hospital nursing work and led to the replacement of nursing students with graduate "general duty" nurses and the development of a hierarchy of subsidiary nursing workers in U.S. hospitals beginning about 1930. The hospital's reorganization of nursing work can not be understood without reference as well to nursing leaders' professionalization efforts, medical advances, and the changing relative costs of students and nurses. In particular, Taylorist ideas were attractive to nursing's leaders because of their potential for endowing nursing with the prestige of science. Thus scientific management, both as a specific set of practices and an ideology, became an essential tool permitting an historic compromise between hospital and nursing administrators and nursing's professional leaders which is embodied in the modern reorganization of hospital nursing labor.;Evidence from journal articles, conference proceedings, nursing studies, hospital nursing records, and statistics of hospitals, nurse training schools, nursing students and workers shows that professional regulatory efforts, medical advances, and changing relative costs do not sufficiently explain the hospital's new division of nursing labor. Using cross-sectional data on a small sample of New York State hospitals in 1931 and 1935, production functions estimated for hospital nursing services show a significant shift in the organization of nursing work between 1931 and 1935. This shift is unrelated to the hospital's level of medical sophistication. An index of the changing relative cost of graduate and student nurses estimated from time-series data for New York State from 1923 to 1935 shows that the slight decrease in the relative cost of graduates to students is also insufficient for explaining the large changes in the organization of nursing work found between 1931 and 1935. Thus, the evidence points to a change in management techniques, the introduction of scientific management practices, rather than medical-technical advance or changing costs, as the explanation for the transformation of the hospital nursing labor process.