The Rise and Demise of the Colonial Nursing Service: British Nurses in the Colonies, 1896–1966

Abstract

For a period of seventy years, from 1896 to 1966, the Colonial Nursing Association (CNA) (renamed the Overseas Nursing Association [ONA] in 1919) recruited 8,400 women to work as nurses throughout the British Empire. The Association operated as a recruitment agency for the Colonial Office (CO), and during its operation, recruits were sent to every dominion and territory of the Empire. Initially, the CO adopted an arm's-length approach, but during World War II it became more direcdy involved in overseas nurse recruitment, establishing the Colonial Nursing Service (CNS) in 1940. The CNS formalized the government's policies in relation to nurse colonial officers who were recruited through the ONA. This development ensured parity for women in the colonial service, promoting mobility across colonies and creating the conditions for international reciprocity in nurse education and training. In effect, it established a British nursing empire, with nursing sisters leading education and training as well as implementing nursing practice in a range of clinical settings across the Empire. When the National Health Service (NHS) was established in Britain in 1948, it compounded the postwar shortage of trained nurses, creating an urgent demand for colonial nurses to staff the NHS, a trend that has continued to the present. In this article, we trace the history of overseas nurse recruitment in Britain through the involvement of the CO and its establishment of the CNS. We explore the notion that British nurses who were recruited to work in the colonies acted as agents of imperialism insofar as they embodied a British nursing empire and influenced nursing practice and professionalism internationally. We argue that the colonial history of nursing reflected wider historical colonial developments; in the rise and demise of the CNS, British overseas nursing arguably reached its zenith at the height of colonial rule and declined as colonies gained independence and fully trained indigenous nurses gradually replaced their British predecessors. It was the policy apparatus established by the CO for the unified CNS that arguably laid the foundations for the greater flow of international nurse recruitment from and to Britain, promoting greater ease of nurse migration, which would be crucial in staffing the NHS. Nursing and Imperialism Even a cursory excursion into the archives of bodies such as the CNA reveals the paucity of prior research into the relationship between nursing and empire. This stands in marked contrast to the explosion of interest in the role that science and medicine played in constructing representations of imperialism. The few existing studies based on the CNA archives1 tend to limit their scope to colonial Africa or attempt to locate the nurses within the discourse of colonial and imperial history.2 This has, perhaps, more to do with the current interest in revisionist histories of colonial Africa under British rule than in the history of nursing per se. Insofar as nursing has been absent from colonial and imperial history until these recent revisionist studies, they are a welcome inclusion and corrective to the record. Nonetheless, there has been little attention focused on the administrative and policy links between formal government involvement and international nurse recruitment. The fact that the CNA changed its name to the Overseas Nursing Association (ONA) in 1919 suggests that it sought to redefine itself outside the discourse of colonialism. This raises questions as to the position of nursing sisters in colonial social relations, with both the expatriate community and their indigenous patients and colleagues. The subject of imperial rule was distincdy male, so British nurses who were recruited in the early years of the CNA's operation were something of an anomaly; often, they were the only white women in the colony. For British nursing sisters, life in the colonies was often isolated and lonely; they had little support, except from the local committee, their main point of contact with the Association, which reinforced the Victorian values of the lady nurse of good character. …