The founding of psychiatric nurse training and its aftermath.

The first national training scheme for attendants upon the insane began in 1891. The Medico-Psychological Association considered this initiative as essential if asylums were to have therapeutic credibility and recruit high-quality attendants. The initiative failed because poor pay and conditions of service were obstacles to recruitment and better standards of care. The Association then sought to integrate asylum and general nursing, leading to a double sense of betrayal on the part of the asylum nurses. They felt betrayed by the failure of the training scheme to improve their career structure and by the threat to their jobs posed by the proposed merger with general nurses. They responded by unionisation, so that two decades after the introduction of training, its only major effect had been to politicise nurses and engage them in disputes with their hospital superintendents and employing authorities. Training raised expectations in the attendants which neither the Association nor the institutions had intended to satisfy, and it was not seen by attendants as of benefit either to them or to patients.