Book Review: A Century of Service: A History of the Irish Nurses and Midwives Organisation, 1919-2019 by Mark Loughrey. Irish Academic Press, 2019. ISBN 9781788550628

Reviewed by Eugenie Hanley

Mark Loughrey’s work on the Irish Nurses and Midwives Organisation offers a complete and comprehensive narrative of the INMO’s services between 1919 and 2019, exploring the socio-economic and political factors which contributed to the organisation’s establishment and expansion. Loughrey, former general nurse and nurse researcher, investigates the backgrounds of its leaders, demonstrating how some of their beliefs impacted INMO’s tactics including letter writing and industrial action. Loughrey’s narrative places nursing improvements in the broader context of women’s rights and trade unionism. He examines how the Department of Health and An Bord Altranais’ detachment from nurse realities delayed progress. The use of new archival material from the Nursing and Midwifery Board of Ireland Archives, Dublin and the Irish Nurses’ and Midwives’ Organisation Archives and Library, Dublin, enriches Loughrey’s argument that the INMO were wholly responsible for nurse progress. Therefore, it could be argued that the book’s account is from a more nurse-based perspective than previous studies. Additionally, Loughrey outlines how internal factors including apathy towards the completion of surveys impacted changes. The book is an important contribution to the history of trade unionism, women’s history, and nursing history which has tended to focus on nurse education and registration. The book is meticulously researched, combining interviews with INMO members, An Bord Altranais Archives, INMO publications and informed secondary sources.

Loughrey begins by contextualizing trade unionism in pre-independence Ireland. The impact of syndicalism and women’s suffrage on its founders is vividly illustrated. Loughrey provides an in-depth account of the abysmal work conditions such as poor accommodation and lack of standardised salaries which influenced the establishment of the Irish Nurses Union in Dublin in 1919. Having highlighted the connection between the organisation’s founders, Louie Bennet and Marie Mortished and Irish Women’s Workers Union and the Irish Transport and General Workers ‘Union, he demonstrates how ordinary members fear of sympathetic strikes contributed to disunity within the INU in its infancy. The Catholic Church managed Ireland’s voluntary hospitals and therefore, nuns controlled nurse apprenticeship training and staff nurses. Loughrey emphasises that nursing was viewed as a vocation and therefore, nurses were required to prioritise patient welfare before their own plight. Additionally, he indicates that in an attempt to gain increased support by the 1930s, the INU changed their name to the Irish Nurses Organisation (INMO), cut financial ties with the IWWU and exploited the celebrity of its new conservative leader Annie Smithson.

The INMO’s relationship with the Catholic Church is thoroughly researched, identifying the close connection between religion and nursing. Loughrey articulates that although that the religious sometimes hindered progress, the INMO adopted a deferent attitude towards the Catholic Church by the 1940s owing to the large presence of Catholic nurses in the INO. However, the author indicates that they backed the Catholic Church against Browne’s Mother and Child Scheme because it acted as leverage to secure improvements for nurses in religious-run hospitals.

As Loughrey moves into the mid-nineteenth century, he compares tactics used by the INO to achieve nursing reforms, from ineffective letter writing to conciliation and arbitration. The book demonstrates that by this period, the INO had the ability to organise themselves for example, the established new sections which held separate meetings. Moreover, they slowly improved their bargaining position with affiliation to the Irish Conference of Professional and Service Associations in 1960 which increased the threat of strikes. Loughrey suggests that the government were under no pressure to implement reforms because the INMO showed they would not take drastic measures.

Importantly, the book asserts that the organisation tirelessly campaigned for post registration courses and third level education in a university setting because they perceived it as a stepping stone towards professionalisation. The book shows that new treatment methods, British nursing reforms and the establishment of new nursing grades prompted demands for increased salaries and reduced working hours. However, Loughrey acknowledges that nurses were denied professional status because their duties were not clearly defined and nursing lacked a distinct body of research. The introduction of third level education as a result was slow when compared to other areas of civil service and nurse training continued to be problematic into the 1960s. It was not until the 1990s, that the Minster for Health, Brendan Howlin, established a nursing degree at University College Galway.

Loughrey discusses how second wave feminism and EEC directives transformed nursing in Ireland in chapter eight, ‘Marriage, Money and (Moderate) Militancy, 1970-7’. He reassures the reader that the INMO had a labourist agenda whilst also demonstrating its connections to the IWWU and the Irish Housewives Association. Loughrey states that the removal of the marriage bar meant that women could now be the breadwinner and therefore, they did not accept substandard work conditions anymore. However, pre-existing gender inequalities prevented significant change for nurses. While noting that the 1974 Anti-Discrimination (Pay) Act was a milestone, Loughrey argues that the same pay for same work principle meant little for nurses as there were few male nurses to be used as a benchmark to improve working conditions.

Loughrey charts the INO’s increased support of industrial action from the mid-1970s, citing the new leadership of P.J. Madden, a larger representation of ordinary nurses on its executive council and mounting frustration with the government. He focuses on how the 1978 March and the 1989 strike at St James hospital taught nurses that the threat of mass resignations or strike action was a successful tactic with immediate results. Moreover, Loughrey devotes one chapter, ‘Resemblance amid Rupture: The 1999 National Nurses’ Strike, 1991-9’, to the only strike the INO held. He shows that sympathetic support from unions including SIPTU and longevity of the strike unified nurses nationally.

According to Loughrey, by the twentieth century, nurses learned from their actions, evolving into an effective organisation with new protest strategies, the creation of new officers and greater representation on governmental bodies. In the final chapter, Loughrey summarizes recent nursing developments, noting that the INMO are one of the largest public service trade unions in Ireland, advocating a humanitarian approach to healthcare. Loughrey argues that while there are problems in Irish healthcare system, the government are not in an ‘ethical’ position to order nurses not to strike. By focusing on the little funding and human resources nursing has received compared to medicine, he highlights existing inequalities between the two professions. The author praises the INMO’s tenacity in overcoming the odds, promising that there is more to come from them.

A Century of Service is an insightful book that reveals the INMO’s major role in the struggle for superannuation, pension schemes and third level education for nurses and midwives. It demonstrates how frustration with slow reforms influenced greater support of industrial action. Loughrey shows how the organisation developed from a small union to become a large and respectable union today, with the capacity to prompt significant improvements. No reference is made to Catholic Church’s interference in third level nurse education from the 1950s. However, Gerard Fealy’s A History of Apprenticeship Nurse Trainingin Irelandand Joseph Robbins’ Nursing and Midwifery in Ireland in the Twentieth Century: 50 Years of An Bord Altranais (The Nursing Board), 1950-2000have sufficiently researched nurse education. The book is a significant contribution to the history of nursing and unionism, offering an overdue explanation of why inequalities persist in nursing today.

Biography

Eugenie Hanley will commence a PhD in History at University College Cork this September, researching maternity and child welfare services in Cork, Limerick and Waterford, 1922-1960. She holds the title of PhD Excellence Scholar from the College of Arts, Celtic Studies and Social Sciences, Michael Joseph McEnery Memorial PhD Scholar, and PhD History Tutorial Scholar. In 2017, she was awarded the John. A. Murphy Prize for achieving the highest grade for her research dissertation in Irish History. Eugenie holds a first class Master’s degree in History and a bachelor’s degree in Arts from UCC. Her main areas of interest are the history of healthcare and women’s history in Ireland.