Professional closure : the case of the professional development of nursing in Rotorua 1840-1934 : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
The argument that the development and progress of nursing in Rotorua were influenced by the forces of professional closure, and that nursing practice throughout New Zealand reflected this during the period 1840-1934, is the focus of this thesis. Rotorua provides a unique backdrop against which to examine the professional development of nursing as it encountered and exerted the forces of professional closure. For centuries the Maori had utilized the curative powers of the thermal district, incorporating this ancient knowledge into their lifestyle and culture. As Europeans gained access to the region, they recognised and exploited the therapeutic properties of the mineral rich springs, mud pools and thermal waters. Health and tourism became inextricably intertwined at Rotorua, as the government developed the spa resort with aspirations of achieving international acclaim As the boundaries between various medical and health services became more distinct, claims to professional exclusivity emerged. Each health occupational group adopted rules of closure as they attempted to secure a position of privilege in the expanding health care system. Nursing's rules of closure effectively marginalised and excluded the untrained nurse while elevating the status of the trained nurse. As the new century unfolded, institutionalised medical care expanded in Rotorua with the development of scientific knowledge and new technologies. In the spa setting of the Sanatorium Hospital and Baths, nursing complemented medicine. The difference between the trained and the untrained nurse became increasingly apparent. However, legislation aimed at improving standards of health and welfare effectively subordinated nursing to medicine in Rotorua's intensely patriarchal, hierarchical hospital structure. The value of the trained nurse, highlighted during World War I, was reinforced during the national emergency created by the 1918 influenza pandemic. The New Zealand Army utilised the spa treatment for sick and wounded soldiers, then as it withdrew its services from the hospitals, Rotorua's school of nursing for a short time (1923-1932), prepared nurses to replace the military nurses. The school closed, unable to maintain the required standards as nursing strengthened its rules of closure and tightened control over its own professional practice. For more than ninety years the status of nursing in Rotorua parallelled the status of nursing in New Zealand generally. During this period the emerging profession attempted to shed its image of domestic servitude to claim an elite and exclusive position within the developing health care system. However, unable to achieve the vital element of professional self-determination, nursing failed to significantly raise its status above that of a vocation, prior to 1934.