Ethel Gordon Fenwick: First Registered Nurse

Ethel Gordon Fenwick drove the movement to make nursing a registered profession. She was the principal founder of the International Council of Nurses, and some historians rank her contribution alongside Florence Nightingale's. Most nurses have never heard her name.

Fenwick launched her campaign for compulsory registration of nurses in 1887. It became law in the United Kingdom in December 1919, after a 32-year fight, and long after nurses in several other countries had already won registration by following her lead.

Early Life

Ethel Gordon Manson was born in 1857 in Scotland to a wealthy family. Her father, a prominent medical practitioner, died when she was a toddler. Her mother remarried, and the family moved to Yorkshire, where her stepfather served as a member of parliament. His influence likely shaped her political instincts.

Like most daughters of wealthy families, she was educated privately. She was described as intelligent, spirited, and strong-willed, and she supported the suffragist campaign for women's voting rights. As with Nightingale, nursing was one of the few respectable paths to a career and independence open to a woman of her standing.

From Lady Probationer to Matron

Fenwick trained as a paying probationer at the Children's Hospital in Nottingham and later at the Manchester Royal Infirmary. After qualifying, she moved to London and worked as a sister in Whitechapel and Richmond. Her ambition was to run a training school.

In 1881, at 24, she was appointed matron of St. Bartholomew's Hospital in London. Under her leadership the St. Bartholomew's Nurse Training School became one of the best in the country. She insisted students receive theoretical instruction alongside ward work and extended training from two to three years.

She was convinced nurses were professionals in their own right. Only properly trained women should be able to call themselves nurses, and they should not be exploited by hospital administrators or physicians. As matron she cut working hours, secured paid holidays and an adequate diet, and ran an epidemiological study on illness and infection among the nursing staff.

After six years she resigned to marry Dr. Bedford Fenwick in 1887, since women of her standing could not marry and keep a career. That same year, with her husband's full support, she began her public campaign for compulsory registration.

Campaign for Nurse Registration

Statutory registration for physicians became law in the UK in 1858. Talk of registering nurses started in the early 1880s within the Hospital Association, but that body held that one year of training was enough. Fenwick disagreed and broke away with a group of matrons to found the British Nurses Association in 1887. It received its Royal Charter in 1893 and became the Royal British Nurses Association (RBNA), with Princess Christian as president and a large number of physicians among its members. The RBNA's goal was to unite nurses as a recognized profession and require registration as proof of training. Even there, Fenwick met resistance: critics said her standards for entry were too high.

In 1894 she left the RBNA and founded the Matron's Council of Great Britain and Ireland to keep pressing for registration.

The first registration bill reached parliament in 1903. It was defeated after strong opposition from doctors, hospital administrators, and some nurses, including Florence Nightingale. After two more attempts and the interruption of World War I, the Nurses Registration Act passed on 23 December 1919. Fenwick watched from the public gallery at 62 as her life's ambition became law. Her name was the first entered on the register, making her Registered Nurse No. 1.

Other nurse leaders, influenced by Fenwick, had already carried the cause abroad. The first state registration law in the world passed in 1891 in the Cape Colony, pioneered by Henrietta Stockdale, a friend of Fenwick's and an RBNA member. New Zealand passed its Nurse Registration Act in 1901, and the first US legislation came in 1903 in North Carolina.

British Journal of Nursing

Fenwick acquired the Nursing Record in 1893, and in 1902 it became the British Journal of Nursing (BJN). She edited it for more than 50 years, until shortly before her death.

It was a journal for nurses, owned and written by nurses, edited by a trained nurse. It ran educational articles and nursing news, and Fenwick used it to push the causes she cared about: registration, higher standards in nursing education, fair treatment of nurses, and women's suffrage. She was a sharp writer and an acclaimed journalist who served as president of the Society of Women Journalists from 1910 to 1911. As the BJN put it after her death, "She wrote as she thought and spoke, with rapier-thrust directness and with utter conviction."

Founder of the International Council of Nurses

In 1893 Fenwick represented the RBNA at the Congress of Representative Women at the World's Fair in Chicago, where her idea for an international nursing organization took shape. When prominent nurses gathered for the International Congress of Women in London in 1899, she presented her plan at the Matron's Council annual meeting. It was accepted unanimously, and a committee was elected on the spot.

The first ICN constitution was adopted in 1901, with Fenwick as the first president and Lavinia Dock, a leading US nurse, as secretary. The first ICN Congress met in Berlin in 1904, though only Great Britain, the USA, and Germany yet had nursing organizations able to affiliate.

Continued Advocacy

Fenwick campaigned for the profession for the rest of her life, pressing for higher standards and urging nurses to keep learning. At the 1912 ICN Congress she proposed what became the Florence Nightingale International Foundation, which still funds postgraduate study for nurses and midwives through national committees tied to the ICN.

In 1926, in opposition to the College of Nursing that had formed in 1916, Fenwick founded the British College of Nurses. Only registered nurses could join, and only nurses could serve on its board and committees. She was its first president and held the office until her death in 1947, at 90, never having fully recovered from a fractured femur the year before.

A Controversial Leader

Fenwick shaped nursing not only in the UK but across the British colonies, the USA, and beyond. She held her ground throughout her career, a trait she needed to build nursing into a recognized, independent profession in a male-dominated world. She has been described as colorful, ambitious, confrontational, and argumentative, which may be why she is less famous than she should be. As ICN CEO Howard Catton put it, "our profession owes her a debt of gratitude."