Theme Nursing

Written by Madonna Grehan, The University of Melbourne

Defining Leadership in Nursing

Defining leadership and nominating leaders in Australian nursing can depend on one's personal standpoint. The annals of Australia's conventional nursing history have tended to focus on leaders as pioneers in a celebratory sense: the first trained nurse to lead a hospital, the first training school, the first to study overseas, the first professional association and so on. Prominent individuals who have achieved milestones provide useful role models, so it is not surprising that the convention of equating prominence with leadership has endured in this vast profession. Leadership in nursing implies a collective focus on strategic direction and purpose. It too is a movable feast, depending on one's personal standpoint. Australian nursing has been characterised by multiple, discrete organisations claiming to represent nurses' best interests and jostling for superiority. Fundamental beliefs about nursing's status as a vocation, profession or industry have informed much of this diversity and, inevitably, nursing's internal disagreements. This entry therefore comes with caveats.

One of the challenges in defining leadership in Australian nursing, and identifying leaders, is the sheer size and complexity of this mass profession for women. Nursing's links with the military, its history of unionism, the specialisations that have developed, the proliferation of groups aiming to represent nurses, all are worthy of extended discussion but are mentioned here only briefly. A convention in nursing history is the recording of victories, some of which are revisited in this entry, but 'failed' movements can be just as instructive; they are likely to feature many nurses who have done extraordinary things but whose merits or qualities as leaders are not recorded because their particular cause did not succeed.

Finally, applied to nursing, the term leadership does not imply cohesion, nor does it necessarily mean that recognised leaders were benign or even successful. Nurses judged in the past to be leaders and visionaries have had promoters and detractors, illustrated by the biographies of Miss Jane Bell (Gardiner, and Miss Gwen Burbidge (Burbidge & Hamilton, Jane Bell has been fêted for her role at the Melbourne Hospital where she was lady superintendent from 1910 to 1934, and for her contribution to nursing's professional sphere and to developing aspects of nurse training. However, alternative perspectives on Miss Bell's contributions argue that she was an indomitable and difficult woman who believed that her way was the right way and therefore the only way. For some, Jane Bell's convictions limited nursing's horizons.

One of Bell's trainee nurses was Gwendoline Burbidge. Later the matron at Fairfield's Infectious Diseases Hospital from 1939 to 1960, Burbidge is remembered by many of her pupils only as a disciplinarian. Yet Judith Godden's extended biography of this prescient nurse educator and manager points out that Burbidge was the only Australian nurse to undertake a Rockefeller Fellowship. Burbidge had big plans for modernising nursing. She introduced male nurses to the Victorian bedside and was responsible for many other innovations. But challenging orthodoxy in Australian nursing was not always welcome and Burbidge's direction ultimately did not attract the support necessary for widespread recognition of her abilities. She retired relatively early, choosing to disengage from nursing altogether, unlike Jane Bell who dominated nursing politics in Victoria well into her seventies. Both women can now be recognised as leaders in nursing and acknowledged for their leadership of causes. But precisely what leadership means and who is nominated a leader in Australian nursing is likely to remain a matter of debate.

Nursing Leaders in the late 19th and early 20th Centuries

In 19th-century Australia, nursing was an unregulated occupation undertaken by men and women. Nurse training schemes were introduced in large and smaller hospitals but they lacked uniformity. A perception existed that nursing was practised by persons of disrepute, unqualified for the important work of caring for the sick. By the turn of the century, and reflecting a worldwide trend, a fundamental transition in nursing's gender base had occurred; nursing was a feminised occupation. A movement of hospital-trained nurses around Australia determined that voluntary, professional self-regulation was the mechanism to differentiate themselves from untrained people who did nursing and/or called themselves nurses. The professionalising movement sought to emulate what was happening in Britain, where Ethel Fenwick, an English nurse and suffragist, had founded the British Nurses Association in 1887. Fenwick also established the International Council of Nurses (ICN) in 1899, at a satellite meeting of the International Council of Women.

There were diverse views in Australia on achieving the goal of self-regulation. State boundaries and state interests were the basis for that diversity. Between late 1899 and mid-1901, three different self-regulating bodies were established, setting a pattern that has been difficult to change. The New South Wales-based Australasian Trained Nurses Association (ATNA) was founded in December 1899. It aspired to organise nursing throughout Australia, and notionally the Pacific. By 1907, it had branches in Queensland, Western Australia and Tasmania. In South Australia, a colonial branch of the Royal British Nurses Association (RBNA SA Branch) was established. The Melbourne-based Victorian Trained Nurses Association, awarded Royal Charter in 1904 (hence RVTNA), was formed in June 1901, having rejected an invitation to join the ATNA as a branch.

Nursing promoters of this professional cause in Australia were single women with freedom from family life. They were matrons, other senior nurses of the large hospitals (including religious nurse members such as the Sisters of Charity at St Vincent's Hospitals), as well as nurses who owned private hospitals or ran accommodation homes for trained nurses. Susan McGahey (Forsyth, was a founding member of the ATNA and superintendent of nursing at Prince Alfred Hospital in Sydney, described by historian Sue Forsyth as 'arguably the most prominent nurse leader and reformer in New South Wales … between the years 1890 and 1910' (Forsyth, 1997, 20). In 1904, McGahey became the ICN's second president, serving in absentia owing to Australia's distance from ICN activities abroad. While McGahey's presidency was deemed to be ineffective, her appointment was important for Australian nursing's profile and sense of confidence in this new age of nursing.

Florence Chatfield (Law,, a founder of the ATNA's Queensland branch, and Margaret Graham (Lincoln,, founder of the RBNA SA Branch, typified the resolute single women who applied their whole lives and energies to advancing their idea of nursing as a profession. Martha Farquharson had been a colonial representative of the RBNA in the 1890s. She was an honorary member of the Matron's Council of Great Britain and Ireland, and a foundation member of the ICN with the office of councillor. Farquharson worked in NSW and in Victoria, where she was a well-loved and respected lady superintendent at the Alfred, the Melbourne and later Bendigo Hospitals and wrote regularly in nursing journals. These women saw trained nursing as a vocation, one that offered them a higher purpose. They aimed to lead by example and inspired great loyalty from their subordinates.

The structure and leadership styles of the professional associations around Australia emulated similar entities run by men, such as the British Medical Society, and doctors certainly wielded power and influence over this movement. Representation by nurses on the inaugural councils of the ATNA and VTNA was limited, although they made up most of the membership. The sole office-bearer position available to nurses in the beginning was that of honorary secretary. Not until 1911, its tenth year of operation, did the RVTNA elect its first nurse, Miss Julia Ayres, as president. The RVTNA's Elizabeth Glover, clearly, was embarrassed about the humble role of women in the movement's formation. In 1904, she told a meeting of the National Council of Women of Victoria: 'with bated breath I must confess it, women were not the promoters. However, if we cannot lead, we can but follow' (Trembath & Hellier, 146).

Women's modest position within these organisations has elicited criticism that the leading nurses involved were merely 'handmaidens' to the male-dominant force of medicine. But historian Sioban Nelson believes it is possible to detect the opportunities in professionalising that these women saw for themselves: 'an arena for power, influence, intellectual development and feminine authority' (Nelson, 1999, 29). Given that previous efforts by nurses to establish professional associations in Australia had failed dismally, the adoption of a symbiotic relationship with doctors was pragmatic. Seen from this perspective, the apologetic Elizabeth Glover and her twenty-nine co-signatories to the RVTNA's founding, as well as their counterparts around Australia, believed they were leading nursing in its new professional form and acting as role models for subordinates in deferring to their male medical colleagues.

While largely ineffective outside metropolitan areas, a specific view of what nursing was, who should practise it, and under what conditions, was carved out by these regulatory pioneers. Many of their determinations were absorbed into statutory regulation, which applied across Australia by 1930. The new nursing regulatory bodies established boards that were chaired by male doctors, while country hospital managers also had board positions. More often than not, the nursing appointments went to matrons of large hospitals and private hospital owners, the very individuals whose experience had been honed in nursing's professional sector, and many of whom saw military service in World War I. The professional associations, meanwhile, continued to have doctors and other men on their governing councils. There seemed to be no expectation that women could, or should, manage any of these organisations themselves.

It is striking just how many senior nurses in the first half of the 20th century were members of both the professional associations and of the newly formed Australian Army Nursing Service (AANS) Reserve or its successors. Judith Godden reports an example illustrative of this connection: all of the matrons appointed to the Sydney Hospital between 1891 and 1956 had seen military service. Nellie Gould, Elizabeth Glover, Jane Bell (Gardiner,, and Evelyn Conyers (Reid, typify nurses prominent in the professionalising arena who also had military appointments. Gould was a member of the inaugural council of the ATNA and served in the Second South African War and in World War I. Nellie Gould is credited with initiating the Australasian Trained Nurses Journal, the first professional journal for nurses in Australia and a significant platform for shaping opinion about the profession.

Elizabeth Glover, inaugural honorary secretary of the RVTNA, contributed to the development of Una, the association's journal, published from 1903. A private hospital owner, Glover was inaugural lady superintendent of Victoria's Army Nursing Service Reserve, serving from May 1904 until 1913. In that position, she was replaced by Jane Bell, matron of the Melbourne Hospital. Miss Bell was a member of the RVTNA Council, served in World War I, and was later a member of Victoria's inaugural Nurses Registration Board, established in 1923/24. Bell then became inaugural president of the Royal Victorian College of Nursing, the RVTNA's successor (Gardiner). Evelyn Conyers, a foundation member of the RVTNA, was appointed matron-in-chief of the Australian Army Nursing Service overseas in late 1915. Conyers was Fairfield Infectious Diseases Hospital's first matron, and, like Jane Bell, was a member of Victoria's inaugural Nurses Registration Board (Reid). There are numerous other examples of nurses straddling many realms.

Nurses who were dominant in the civilian and military spheres had enormous influence over nursing's direction for the next forty years. As civilian and military matrons, they entrenched conventions accepted in 1900, a pattern that became hard to alter. In the professional sphere they advocated only for trained nurses and remained unconcerned about trainee nurses, whose conditions of employment and pay were poor. They also continued to defer to doctors in the management of their organisations. Seen from the perspective of nurses as students and employees, nursing's leadership at this point was not benign, nor was it aiming to improve the lot of all nurses.

Union Leadership

Numerous actors and agitators: trained nurses, trainee nurses, hospital owners, doctors, governments, and those we now call 'clients' and 'consumers', all had opinions on what sort of financial reward nurses should expect for their endeavours. In 1921 a new leadership, seen in two groups operating independently of each other, introduced Australian nurses to the radical idea of unionism. This leadership challenged the professional establishment's structure, method and direction.

Gretta Lyons is the most prominent name associated with the 1921 founding in Victoria of an industrial organisation called the Trained Nurses Guild (TNG). Described as 'an ardent feminist … out to help every woman who had to work for her living' (Australian Nurses Journal, 15 November 1923, 564), Lyons was a former president of the RVTNA who believed that the existing professional associations were ignoring nurses' economic conditions, particularly nurses who were employees and trainees. The RVTNA 'eschewed the pursuit of industrial objectives' on the basis that nursing was a vocation and only working-class occupations resorted to government to influence wages and conditions (Trembath & Hellier, 129). The ATNA took the same stance.

Miss Lyons' supporters in pursuit of better pay and conditions for nurses included Mary Carlile, Bessie McPhail and Muriel Peck. Carlisle was an inspectress for the Public Health Department. McPhail had served in World War I and was employed at a repatriation hostel for incapacitated soldiers. Muriel Peck was the first infant welfare sister appointed in Victoria, pioneering advice to mothers on child-rearing via a 'mothercraft carriage' of the Better Farming Trains in the 1920s (Who's Who in the World of Women). Lack of action by the RVTNA prompted Miss Lyons to register the TNG with the Commonwealth Court of Arbitration as an organisation representing 'employees in the nursing industry', a stand that alienated the RVTNA's leadership coterie because it relegated nursing to the status of a trade (Trembath & Hellier, 142). The Guild did not apply for an award covering Victoria's nurses and Miss Lyons died in 1923, but the agitation did force the RVTNA into setting a fee schedule.

Meanwhile, in Queensland, trainee nurses formed a Nurses Association in 1921 to agitate for improved conditions. The ATNA's Queensland branch reacted by registering itself with the Commonwealth Court of Arbitration as a union of nurses called the Australian Nursing Federation (ANF). It argued against the need for an award but the Arbitration Court determined otherwise. With an award pending, the ANF (later RANF) had little choice but to form a federation, with the ATNA and RVTNA as state branches, in 1923. The problem was that this new network was just like its predecessors; it was not controlled by nurses and its inaugural president was a male doctor, so little had changed when it came to the fundamentals.

In leading state-based nursing causes, the radical actions of the Queensland Nurses Association and the TNG signalled to Australian nurses the potential benefits that might result from nurses controlling their own affairs. Increasingly, nurses became aware that arrangements in Australia were out of step with world trends. Away from Australia's shores, Ethel Fenwick's ICN had flourished into an organisation hosting international conferences where nurses could discuss developments in the profession, just as men's professional groups did. The ICN advocated women's suffrage, the importance of nursing's role in public health, and better nursing education. But only those organisations that were national, and governed by nurses, were accepted for membership of the ICN. Australia notionally had a federal body in the ANF, but men served on its council.

Georgina McCready née Johnstone (Cornell,, a supervisory sister with the NSW Public Health Department, paved the way for ICN affiliation to happen. With the encouragement of feminist activist Jessie Street (Radi, and others, in the early 1930s McCready founded a NSW Nurses Association, an industrial organisation entirely controlled and operated by women. As the NSW Nurses Association's inaugural honorary secretary, McCready was 'the first woman to hold such a position in an industrial organisation in Australia' (Cornell, Subsequently, this organisation became the NSW Branch of the ANF, and the ANF then formed itself into a national organisation governed by nurses. In 1937, membership of the ICN was granted, opening up the international world of nursing to Australian women.

While Susan McGahey was Australia's first president of the ICN, she was Irish by birth. Olive Anstey (Cornell & Hamilton, is recognised as the first Australian-born ICN president, an office she held from 1977 to 1981. As the authors of Anstey's biography note, her attitude was that the 'collective force of nursing was of benefit to mankind' and, given the right direction, could be used to reduce poverty and ill-health around the world. The ICN now has thirteen million nurse members. Its professional activities include contributions to health programs and healthy policy worldwide. The ICN currently (2013) has an Australian nurse, Rosemary Bryant, as president.

McCoppin and Gardner argue that from the 1940s to the 1970s, nursing's unions were part-industrial, part-professional and, while their leadership was not without achievement, it was not aggressive. That position changed in the 1980s when Australia's nursing unions underwent a marked shift in leadership style and direction, moving from a moderate stance to a 'more radical and more ideological' style under Irene Bolger in Victoria and Jenny Haines in NSW (McCoppin & Gardner, 266). Bolger's incumbency in the Victorian branch of the ANF is remembered for committing members to a fifty-day strike in 1986 that received national television coverage. This new direction alienated many nurses but, in Victoria, it empowered others to initiate the walk-outs that began the strike. Unprecedented in the numbers of nurses who participated, the sustained industrial action eventually forced the Victorian government to accede to the nurses' log of claims. Under the banner of the ANF, nursing unions are still state based and have substantial individuals at the helm. McCoppin and Gardner refer to some of them- Marilyn Beaumont, Patricia Staunton and Marea Vidovich- as having also achieved prominence at federal level, with a leadership style that placed 'an emphasis on negotiation' (McCoppin & Gardner, 273). A former federal secretary of the ANF, Gerardine Kearney, is now president of the Australian Council of Trade Unions, the third woman to hold the position.

Nursing Education Leadership

Developing nursing education has been a fundamental focus for nurses' activism throughout the 20th century, beginning with the struggle for uniformity of training from 1900. Plans for university-based education in nursing gathered pace in the late 1920s. In Victoria, the idea was advanced in the early 1930s by two camps: one headed by Miss Jane Bell, the other by Miss Stella Pines. Neither side triumphed, but this difficult episode in Australian nursing leadership is illustrative of how nursing's history has tended to focus on dominant characters in disputes, while ignoring others.

A nursing graduate of Sydney Hospital, Stella Pines gained qualifications in midwifery (Sydney), infant welfare (Karitane Hospital, Dunedin), public health nursing (McGill University), and nurse teaching and administration (University of Toronto). She served in World War I and held the certificate of the Royal Sanitary Institute London. Stella Pines was a passionate advocate for university education, having witnessed it in North America. She even borrowed an American convention in signing herself RN (Registered Nurse), an acronym then uncommon in Australia. Stella Pines made a long-standing contribution to developing social service in South Australia, Victoria and Queensland and earned particular praise for her innovative role in formulating occupational therapies for the mentally ill in asylums. Pines was involved with the National Health and Medical Research Council and wrote regularly for newspapers, giving advice on public health matters. She left Australia around 1940, for a position in Johannesburg. There she founded the Transvaal Anzac Club, providing support for Australian and New Zealand soldiers (Advertiser, 1 July 1941, 4).

Pursuing her commitment to nursing education, in the 1930s Miss Pines had steered a lobby group of Victorian nurses and 'public-spirited citizens' with the aim of introducing a university pathway for nursing (Trembath & Hellier, 162). Pines had considerable support for her specific plan, particularly from those who believed that nurses had a role to play in public health, but her scheme lacked the support of the University of Melbourne. Stella Pines' leadership effort was not insubstantial but it has gone unrecorded. By contrast, the role of her opponent in this stoush, Miss Jane Bell, is celebrated. Despite the failure of Pines' specific scheme, education continued to feature highly in nursing's direction, particularly after World War II.

The relationship between civilian and military nursing has already been discussed. Historian Jan Bassett estimated that around 3,500 nurses served in some capacity during World War II, around one quarter of the nursing workforce, on a conservative estimate. The war gave nurses new responsibilities overseas and on the home front. With so many nurses signing up for war service, shortages were dire. When Australia's federal government determined that a stable civilian nursing workforce was important for national security, nursing was made a reserved occupation in 1942 and thus subject to the restrictions of the Directorate of Manpower. Through the directorate, senior nurses were propelled into a 'new domain of planning and administration- national workforce issues … [putting] senior nurses in a position to view the training, preparation and workforce needs of nursing nationally' (Nelson & Rabach, 81).

Grace Wilson (McCarthy, was one of those leading senior nurses. A decorated military nurse who served throughout World War I, Wilson had been in charge of Victoria's army nursing reserve for years. In the 1930s, she supported Stella Pines' push for university education in nursing. Wilson served again in World War II for a year before falling ill in 1941. In 1943, she was appointed to the Manpower Directorate in Victoria, as head of the Nursing Control Division. Her biographer, Jan McCarthy, wrote that Wilson's skilled leadership, her foresight and her dedication to nursing inspired immense loyalty in her subordinates. These experiences of informing government policy at close quarters must have given Grace Wilson and other nurses confidence in their ability to see nursing's national significance.

Other military nurses have been recognised for their inspirational leadership, which combined extraordinary administrative skills and a personal dignity. Matron-in-Chief Annie Sage (Hamilton,; McCarthy, became colonel in March 1943 when all military nurses were given ranks as commissioned officers. This applied equally to the Royal Australian Air Force Nursing Service and the Royal Australian Naval Nursing Service. Matrons became majors, senior sisters became captains, and sisters became lieutenants. Nurses serving at this time were expected to lead their subordinates, including men. From all accounts, Colonel Sage viewed her co-nurses as colleagues and accorded them respect. She made visits whenever possible to nursing units based throughout the Pacific and, in 1945, she flew to Indonesia to personally take charge of the surviving nurses who had been prisoners-of-war there for two years. Like that of Grace Wilson, Annie Sage's leadership was considered exemplary, characterised by her sense of responsibility for the welfare of others.

The standing that women leaders were accorded in the military sphere did not necessarily apply when those senior women returned to civilian life, as Annie Sage discovered. From 1947 to 1951, Sage was lady superintendent at Melbourne's Royal Women's Hospital, where she was judged to be a highly effective leader, improving communication channels, modernising nursing practices, and even making the radical suggestion that married nurses should be employed to redress staff shortages. In April 1951, Sage supported an experienced nurse in pursuing a formal complaint about a doctor's treatment of a patient, a situation in which Sage's authority over the clinical field of patient care was tested. The medical superintendent, not a military man, and his team 'put Sage in her place and she resigned' (Nelson & Rabach, 83). Sage instead turned her energies to making a difference to nursing outside the stifling male-controlled environment of a women's hospital.

Events of World War II provided plenty of impetus for the direction of nursing. A total of seventy-five Australian service nurses had died, some in horrific circumstances, and others endured terrible conditions as prisoners-of-war. Their sacrifices provided a specific focus for developments in nursing education. Senior nurses such as Annie Sage and Muriel Knox Doherty (Cornell, were conscious that career opportunities for trained nurses in Australia were limited, but postgraduate courses in dietetics, teaching, occupational therapy, industrial nursing and administration were only available overseas. Energy and effort went into raising funds for nursing centres in Australia where postgraduate courses could be offered. Politicians were approached for financial support. The ANF created the National Florence Nightingale Committee to develop an 'Australian College of Nursing' based on the style of Australia's medical colleges (McCoppin & Gardner, 24); in some quarters, this entity was referred to as the 'Australian Post Graduate School of Nursing' (Pratt & Russell, 11). The National Florence Nightingale Committee had branches in every state. It consisted of civilian and ex-military nurses, many of whom were matrons of large hospitals and active in the professional sphere.

Government funding for a national school, ultimately, was not available, and divisions between NSW and Victorian interests could not be overcome. The outcome was two colleges: the NSW College of Nursing and the College of Nursing Australia (based in Victoria). They were run by astute women, for the benefit of nurses and nursing, not for hospitals or doctors or other interest groups, a marked deviation from the direction of the ATNA and the RVTNA. The colleges' official founders have come to encapsulate the aspirations of nursing's leadership in this post-war period. Agnes Lions (Cornell,, Margaret Guy (Cornell,, Georgina McCready, and Muriel Knox Doherty were signatories to the NSW College's founding. In Victoria, Annie Sage, Edith Hughes-Jones (Williams,, Vera Jackson, Myrtle Quicke and Jean Lamont were signatories to the College of Nursing Australia's founding. The colleges in NSW and Victoria were both successful in devising and delivering postgraduate courses. After sixty years of operation as two separate entities, the two colleges voted to merge, forming an Australian College of Nursing in November 2011.

In the 1960s, building on the success of the two colleges, nursing education interest turned to a far more radical plan: abandoning hospital-based apprenticeship training in favour of a tertiary pathway via Colleges of Advanced Education and initially at diploma level. This was a lengthy and difficult campaign over twenty years, described by one involved as a 'collective battle' (McCoppin & Gardner, 92). The movement called for a particular style of leadership to make the transition happen. Governments and universities had to be convinced, as did hospitals and those nurses who did not support the changes. Senior nurses had to put state loyalties aside and think nationally because negotiating with the tertiary sector involved the federal government as well as state governments. The campaign was a co-ordinated exercise between the two colleges and the unions via the National Florence Nightingale Committee of Australia. It was 'the first time that all state organisations had worked together for a common and clearly enunciated goal' (Pratt & Russell, 258). The transfer was announced in 1984 and completed in 1993.

This was a momentous and hard-fought change driven by nurses, many of whom were nurse educators. Individual women have been acknowledged for their leadership in developing and implementing this vision as a collective endeavour, maintaining morale and resisting enormous opposition over the twenty years that the campaign ensued. To name a few, Helen Bailey (Piercey, was an experienced educator in Western Australia who worked for the state government. In Queensland, Joan Penridge (Hamilton & QUT School of Nursing, had a lengthy career in education and administration, as did Joan Godfrey (Hamilton & Godfrey, Also instrumental in effecting the move to tertiary education were directors of the colleges and other individuals. Among them in Victoria were Patricia Chomley, Pat Slater (Hamilton, and Mary Patten. Pat Slater is credited with introducing the first undergraduate college-based nursing course in Australia, in 1974. Merle Parkes (Parkes & Hamilton, is recognised as an architect of nursing's tertiary curriculum and for strategic work promoting the transfer in Western Australia, Tasmania and NSW. Sister Paulina Pilkington RSC made a major contribution in NSW.

The transfer was the product of a collective and tenacious leadership but should not just be attributed to these named individuals. With the transfer of education, nurses employed in the tertiary education sector became associated with leadership in nursing, challenging assumptions, providing mentorship and inspiring students and colleagues. New networks were forged to advance nursing's interests, such as the Australian Council of Deans of Nursing (1993) and the National Nursing Organisations (1991), the latter including Australia's nursing unions. In contrast to the earlier decades of the 20th century, the nurses involved in these entities were unified in their purpose to demonstrate that nursing matters.

Nursing's demographics have had an influence on the nature of the profession's leadership. The dominance of single women with military service as matrons waned as restrictions on married women in the workforce were relaxed following World War II. From the 1970s, men gained approval to train in nursing, bringing to an end its almost total feminisation. This shift has made an impact, with men making up around 7.9 per cent of Australia's nursing profession in 1999 (AIHW, 13). Specialist fields in nursing have expanded in recent years, with the establishment of new professional colleges such as the Australian College of Mental Health Nurses (established 1975) and the Australian College of Operating Room Nurses. Mental health nurse leaders agitated for de-institutionalisation of the mentally ill and have forged consumer involvement in developing health policy. Philosophies of self-determination and empowerment have encouraged Indigenous nurses to be leaders in their own right, forging a path to gain admission to nurse training schools in the 1950s. In South Australia, Faith Thomas (Durdin, and Lowitja O'Donohue ( were among six Aboriginal nurses to graduate in 1954. Sadie Canning (Goold & Liddle) is thought to have been the first Aboriginal nurse to be appointed matron of a public hospital in Western Australia. Under the leadership of Wiradjuri woman and nurse educator Sally Goold (Goold & Liddle), Indigenous nurses formed the Congress of Aboriginal and Torres Strait Islander Nurses in 1997. CATSIN now has representation from all over Australia and advises government on Indigenous health affairs, nursing employment and education as well as cultural practice.

Military Nursing and Leadership

Nursing's relationship with the military, and war itself, has had a significant impact on how leadership in nursing has been perceived by both nurses and non-nurses. Contrary to conventional wisdom, from the Second South African (Boer) War to other conflicts since, war has taken women from conventional roles to new and more challenging ones, both in the military sphere and on the home front. At the beginning of the 20th century, the idea of military work as 'service' enabled nursing to be cast as a formal and important military role for women, one with an even higher purpose than civilian nursing. Those who joined the military in senior positions attracted substantial public attention and adulation, often in stark contrast to women who did not have this experience. Australia's three Royal Red Cross recipients from the Second South African War (1899-1902) were accorded such praise: Ellen [Nellie] Gould from NSW, Martha Bidmead (Clark, from South Australia, and Marianne Rawson (Grehan, from Victoria.

When the Australian Army Nursing Service (AANS) Reserve was founded in 1902, it emulated the hierarchy of the existing defence force. Lady superintendents' and matrons' appointments were awarded to women with recognised education and training, many years of bedside practice, a capacity for teamwork (sometimes disparagingly reconstructed as 'obedience' to medicine), and calm dispositions. When the reserves were called to serve, war zones conditions called for new styles of leadership and logistical skill, as historians Jan Bassett and Kirsty Harris have shown. Nurses had to establish and administer hospitals in difficult conditions, manage rations, improvise when equipment was lacking and so on.

On home soil, military nurses had different roles. Harris cites the example of Miss Lily Elizabeth Hill, appointed matron of 3rd Military District (Victoria), who worked with her state counterparts and the Melbourne-based Director General of Medical Services (DGMS) to staff the overseas military nursing service. Miss Hill was well placed for this new and complex work. Hill was matron of the AANS Reserve and a Melbourne Hospital graduate with at least ten years' nursing experience, as well as representing the Reserve on the Council of the RVTNA. Grace Wilson's logistical role in the Directorate of Manpower was discussed earlier.

Nurses' engagement with war zones has generated a unique leadership that otherwise might not have occurred or captured attention as leadership. Military nurses have demonstrated extraordinary courage and endurance in the face of difficulty. For example, historian Jan Bassett credits five AANS nurses' survival as prisoners-of-war in World War II to the leadership of Captain Kay Parker (Bassett, Captured when Rabaul fell in 1942, Parker and her nurses were interned in Japan where they endured terrible conditions until August 1945. Parker's leadership was a selfless one. Maintaining the group's fading morale when one of the nurses developed tuberculosis, Parker then protected the other nurses from this highly contagious disease by providing the patient's care herself.

Matrons Olive Dorothy Paschke (McCarthy, and Irene Drummond (Gorrell,, who died on active service, have also been recognised for their leadership under extraordinary duress. In February 1942, they commanded around two hundred AANS nurses and civilians in a forced evacuation by sea, following Singapore's invasion by Japanese military forces. Prior to the aerial bombing and sinking of their vessel, Drummond and Paschke formulated plans for rationing of provisions and prioritised sleeping spaces on the overcrowded transport. Two days later, Matron Drummond was washed ashore to Radji Beach, Bangka Island in Sumatra. With twenty-one other nurses, Drummond was marched into the sea by Japanese soldiers and shot. As they proceeded to the water, Matron Drummond ordered her nurses to hold their heads high and not look back. Paschke and Drummond displayed leadership qualities to which trainee nurses were encouraged to aspire. Vivian Bullwinkel (Heywood & Lemon, was the surviving witness of the massacre who told of Matron Drummond's last words to her nurses. Bullwinkel, Betty Jeffrey (Hudson, and others then spent three years as prisoners-of-war, during which time several of their fellow nurses died. These two unassuming women became the public face of a fund-raising campaign to establish perpetuated memorials to their colleagues, centres for the profession to offer education courses and recreational facilities. In their dedication to the memorialising goal, Bullwinkel and Jeffrey were the 'visible' leaders in this episode of nursing's movement towards professionalisation, although not the only ones. Like the advances in education, this was a collective effort.

Perditta McCarthy ( was the only nurse and the first woman to be elevated to the rank of brigadier, granted on her retirement. Like many of her colleagues, she served in two wars, in her case, World War II and Korea (1950-53). McCarthy was cognisant of the commitment to nursing shown by her predecessors, having written several biographies for the Australian Dictionary of Biography, some of them cited in this entry. Vietnam (1962-75) and wars in the Middle East, as well as peace-keeping roles, have continued to provide opportunities for nurses both civilian and military to lead on a global stage, although those who turn to the field, managing tent hospitals at a moment's notice, are less fêted than military nurses in the past.

Reflecting on military nurses and leadership, Colonel Jan McCarthy ARRC (Ret.) believes that the Australian military has produced, and continues to produce, leaders in nursing because military nursing's philosophy recognises and develops individuals as assets to the nation, whether in the regular defence force or as reservists. McCarthy notes, too, that military nurses have been responsible for raising the status of non-nursing women's military services, citing the work of Colonel Kathleen Best (Lincoln, in developing the Australian Women's Army Medical Service and the Australian Women's Army Corps, as well as that of Alice Ross-King (Finnie, Ross-King was awarded the Military Medal in World War I and the Florence Nightingale Medal for service in World War II. The citation for Ross-King's latter decoration reads: 'no one who came in contact with Major Appleford could fail to recognise her as a leader of women. Her sense of duty, her sterling solidity of character, her humanity, sincerity, and kindliness of heart set for others a very high example'.


This entry has raised only a small number of examples of leaders and leadership in nursing. Further research in the nursing disciplines of public health, occupational health, maternal and infant health, bush nursing, infectious diseases, remote and rural nursing and other specific areas of practice will in time yield more knowledge of remarkable nurses and evidence of their leadership.

Additional sources: McCarthy, Jan, Personal communication with Madonna Grehan, Melbourne, 30 November 2012. The Australian Nurses Journal, vol. 21, no. 11, 15 November 1923, p. 564.

Published Resources

Australian Women's Register Entries


  • Bassett, Jan, Guns and Brooches: Australian Army Nursing from the Boer War to the Gulf War, Oxford University Press, Melbourne, Victoria, 1992. Details
  • Durdin, Joan, They Became Nurses: A History of Nursing in South Australia, 1836-1980, Allen & Unwin, Sydney, New South Wales, 1991. Details
  • Godden, Judith, Australia's Controversial Matron: Gwen Burbidge and Nursing Reform, The College of Nursing, Sydney, New South Wales, 2011. Details
  • Harris, Kirsty, More than Bombs and Bandages: Australian Army Nurses at Work in World War I, Big Sky Publishing, Newport, New South Wales, 2010. Details
  • McCoppin, Bridget & Gardner, Heather, Tradition and Reality: Nursing and Politics in Australia, Churchill Livingstone, Melbourne, Victoria, 1994. Details
  • Minchin, Maureen, Revolutions and Rosewater: The Evolution of Nurse Registration in Victoria, 1923-1973, Victorian Nursing Council, Melbourne, Victoria, 1977. Details
  • Pratt, Rosalie & Russell, R. Lynette, A Voice to be Heard: The First Fifty Years of the New South Wales College of Nursing, Allen & Unwin, Sydney, New South Wales, 2002. Details
  • Sherson, Susan, Being There: Nursing at the Melbourne Hospital, Melbourne Hospital Graduate Nurses Association, Melbourne, Victoria, 2008. Details
  • Smith, Russell G., In Pursuit of Nursing Excellence: A History of the Royal College of Nursing, Australia 1949-1999, Oxford University Press, Melbourne, Victoria, 1999. Details
  • Strachan, Glenda, Labour of Love: The History of the Nurses Association in Queensland 1860-1950, Allen & Unwin, Sydney, New South Wales, 1996. Details
  • Trembath, Richard & Hellier, Donna, All Care and Responsibility: A History of Nursing in Victoria, 1850-1934, Florence Nightingale Committee, Australia, Victorian Branch, Melbourne, Victoria, 1987. Details
  • Williams, Jennifer, Victoria's Living Memorial: History of the Nurses Memorial Centre, 1948-1990, Nurses Memorial Centre, Melbourne, Victoria, 1991. Details
  • Williams, Jennifer & Goodman, Rupert, Miss Jane Bell OBE (1873-1959) Lady Superintendent, the Royal Melbourne Hospital (1910-1934), Spectrum Publications for The Royal Melbourne Hospital Graduate Nurses’ Association, Melbourne, Victoria, 1988. Details

Book Sections

  • Prince, Anne, '"Really Rather Extraordinary": The Leadership of Matron Beryl Campbell in the Australian Army Nursing Service in World War I', in Francis, Rosemary; Grimshaw, Patricia; and Standish, Ann (eds), Seizing the Initiative: Australian Women Leaders in Politics, Workplaces and Communities, The University of Melbourne: eScholarship Research Centre, Melbourne, Victoria, 2012, pp. 131-144. Details

Edited Books

  • Who's Who in the World of Women, Victoria, Australia . . ., Centenary edn, The Reference Press Association, Melbourne, Victoria, 1934. Details
  • Goold, Sally & Liddle, Kerrynne (ed.), In Our Own Right: Black Australian Nurses' Stories, eContent Management Pty Ltd, Maleny, Queensland, 2006. Details

Journal Articles

  • Forsyth, Sue, 'Historical Continuities and Constraints in the Professionalisation of Nursing', Nursing Inquiry, vol. 2, no. 3, 1995, pp. 164-71. Details
  • Forsyth, Sue, 'Nursing Leaders and Feminist Issues', International History of Nursing Journal, vol. 3, no. 1, 1997, pp. 20-31. Details
  • Grehan, Madonna, '"From the Sphere of Sarah Gampism": The Professionalisation of Nursing and Midwifery in Colonial Victoria', Nursing Inquiry, vol. 11, no. 3, 2004, pp. 192-201. Details
  • Nelson, Sioban, 'Deja Vu and the Regulation of Nursing in Victoria', Australian Journal of Advanced Nursing, vol. 16, no. 4, 1999, pp. 29-35. Details
  • Nelson, Sioban, 'From Salvation to Civics: Service to the Sick in Nursing Discourse', Social Science and Medicine, vol. 53, no. 9, 2001, pp. 1217-25. Details
  • Nelson, Sioban & Rabach, Jennifer, 'Military Experience: The New Age of Australian Nursing and Other Failures', Health and History, vol. 4, no. 1, 2002, pp. 79-87. Details
  • Strachan, Glenda, '"It is natural for every woman to be, to some extent, a nurse": Nursing in the Latter Half of the Nineteenth Century in Australia', Journal of Interdisciplinary Gender Studies, vol. 1, no. 1, 1995, pp. 22-31. Details

Newspaper Articles

  • 'Johannesburg Anzacs', The Advertiser, 1 July 1941, p. 4. Details


  • Australian Institute of Health and Welfare, Nursing Labour Force 2001. National Health Labour Force Series no. 26. Cat. no. HWL 26, Australian Institute of Health and Welfare (AIHW), Canberra, Australian Capital Territory, c.2001. Details


  • Grehan, Madonna, 'Professional Aspirations and Consumer Expectations: Nurses, Midwives and Women's Health', PhD thesis, The University of Melbourne, 2009. Details

Online Resources