Florence Downs shaped nurses' intellectual foundations through her writings and through her involvement in nursing education and research for more than 30 years. Her work as Editor of Nursing Research (1979-1997), Director of Post Graduate and Research Programs at New York University, New York City (NYU) (1972-1977), and Associate Dean for Graduate Studies at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (1977-1993), influenced the profession's discourse on the importance of research and doctoral education for nurses, and the integration of research with clinical practice.
Dr. Downs' philosophy and service to nursing flows throughout her articles and books, but to understand how she formulated her world view, there was a need to go beyond traditional sources to hear her story. From oral history interviews with Downs, the roots of her intellectual framework emerged, as did an understanding of how she constructed her "conceptual universe." Downs' narrative also revealed the language she developed for articulating the importance of nursing research and doctoral education both inside and outside nursing. Downs' dedication to nursing emerges as inseparable from her humor and her faith in nursing's ability to create a viable intellectual discipline and a community of scholars. This paper will address the first part of Downs' career, from her decision to become a nurse, to the early 1970s when she was immersed in doctoral education at NYU.
Method: Oral History
From 1997 to 1999, the researchers conducted almost 15 hours of oral history interviews with Florence Downs at the Center for the Study of the History of Nursing, University of Pennsylvania School of Nursing, and in her home. All interviews were tape recorded, transcribed, and edited for readability.
Oral history is an intellectual process of connecting individual experiences with the broader canvas of social change, and providing the foundation for different ways of generating historical questions (Portelli, 1997). Oral history encapsulates daily life from which the framework for larger trends, social experiences, and movements can be constructed. The method of oral history is predicated on an active relationship between two groups or individuals-the historian(s) and the narrator-and their respective societies-and essentially involves multiple parallel conversations. Both parties bring their own agendas to the interview, which is constantly renegotiated in the course of the conversation. The fact that, in this oral history, nurses interviewed a nurse established a certain level of interpretation and bias-the interviewers become part of the environment under investigation-and shows that the form of the interview depends upon the extent the interviewer belongs to the reality under investigation. An oral history, then, is the product of the subjectivities of the narrator and historian. Florence Downs herself noted that data obtained in an interview situation depends to a large extent on the ability of the interviewer to obtain the cooperation of the subject to give information pertinent to the subject (Downs, 1964).
Oral history interviews provide a channel for women, in particular, to safely describe their power. Nurses' words, while perpetuating traditional myths and stories, can also provide new ways to think about how nurses' intellectual terrain was negotiated and actualized in the university and practice arena (Patai, 1991). This type of data can be used to describe the everyday, personal realities leaders like Downs encountered. When narrators are empowered to tell their stories through the oral history process, the importance of the story as a data source is elevated. The oral history process reveals lived experiences of nurses, their culture and history, and allows understanding of nurses' work at very local, specific levels, in the context of individuals' experiences and language as they negotiated their roles.
Results/Narrative
Florence Downs wanted to be a nurse "as long as [she] can even remember . . . (FD, 26 November, 1996)."1 The only daughter and the oldest of three children of a nurse and a dentist, she credits her mother not only with providing her a vision of nursing, but also of infusing her vision with the promise of baccalaureate education for nurses. Downs graduated from high school at the age of 16, as her mother was dying of cervical cancer:
By the time I was ready to graduate from high school she [her mother] was really in terrible condition . . . My mother and I had gone up to Russell Sage College because [she] thought that if I was going to go into nursing I should go to a baccalaureate program. My mother was wise to a lot of these things because there were hardly any baccalaureate programs . . . My mother was poking around in the closets and looking at fire escapes, and she decided she didn't like the looks of the place. She didn't think it was up to her standards. In any case, before that kind of decision could finally be made, my mother died. In fact, while she was still extremely ill, she was in tears because I had gone to work and my mother did not think that I should have gone to work. My mother wanted to see me in college. It is interesting that when I graduated with my baccalaureate degree, my father said to me, "I never knew you were smart." (FD, 26 November, 1996)
Downs eventually entered nurse training school at St. Luke's Hospital (New York City) in 1944 as part of the United States Cadet Nurse Corp, a United States Public Health Service program enacted in 1943 during World War II to overcome nursing shortages in civilian hospitals and the growing demand on the war front. The popular program subsidized the educational expenses of student nurses, who in turn, gave a non-binding promise to serve in military or in civilian hospitals during the war (Sarnecky, 1999). Downs remembered, "I guess [I learned about it from] the newspaper. They had all those great advertisements, with the gorgeous women and the hats." She also knew, however, that she did not want the restrictions and regimentation of the armed forces: "They had the WACs and I didn't want to wear that khaki underwear. I don't know if the women really did but I imagined they did . . . , and I just didn't want to get involved." (26 November 1996) Her search for a hospital for training began at New York Hospital,
but I didn't like the way that they treated people . . . First of all I had to wait, they were so off handed about everything like it didn't really matter, and so I went from there to St. Luke's [who] treated me very nicely . . . I still remember my father packing me off in White Plains, putting me on the train . . . My father cried on the platform. I had been on that train platform for months and months taking the train to New York [to work]; you would have thought that I was going to the end of the world . . . I was never a homebody. I wanted to get the heck out of there (16 November 1996).
Her resistance to regimentation continued into her training years. Downs commented, "I was a problem all the time. I hated it [the training] and the only reason I finished is that I was so stubborn and I wasn't going to quit . . . I hated the regimentation. You had people watching you all the time, you had to be in by 10:30 p.m., and then of course, your boyfriend went out with somebody else after he dropped you off." (26 November 1996)
Downs also credited her own tenacity and persistence to her mother, and described these characteristics as having roots at quite a young age:
. . . I always remember something that happened when I went to school and when I think back on it, I think that it is characteristic of me. The first day I went to school, we were let out for lunch, and some kids of course had lunch in school and some kids got picked up at the curb. I said to myself, "I guess I am supposed to go home," and I took off. I had never been away from the house this way, you realize. My father nearly had a stroke because here is his little 5-year-old taking off on her own; I had to cross a main highway. Was I worried? I often think back on that because I was faced with a situation and I figured well, this is what I have to do. I didn't know exactly how I was going to do it obviously, but I figured somehow or other, we will get home. (FD, 26 November, 1996)
Early on, Downs' intelligence, her ability to "be patient", and her decisiveness in unfamiliar situations helped her develop skills she used in both her personal life and her career. Her belief in the importance of belonging to a group and developing a community of people with similar interests developed early. Because Downs skipped a grade and a half, she was ready to graduate at the age of 15. But, her mother thought her too young to start nursing school or college, so Downs bided her time with courses in music and art, which she loved. She received private voice instruction for a time, and her vocal skill almost led to an opera career. She credits her involvement in an elite a cappella choir in high school for creating a foundation for her strong feelings throughout her career for establishing and fostering "belongingness" in a group and a sense of community. The choir director's insistence on blending became a life lesson.
What Miss Caukens would do was pull each one of us out to sit in the balcony to listen to the whole that you were a part of. She didn't want to hear anybody's voice louder than the other . . . I still have this very, very strong feeling about the "belongingness" in a group and how important it is for people to value those group relationships. As far as the doctoral program was concerned, I really, really believed that it was extremely important for people to form those links and to understand that those were going to be really valuable to you in later years, and I think that that has proved to be so. (FD, 26 November 1996)
Downs also firmly believed in the need for nurses to establish a community of researchers both within nursing schools and departments, and throughout university communities in general. For nursing in particular, this was a novel idea as the very concept of nurses undertaking research was a very new phenomena during Downs' tenure at NYU (Fairman, 1999). Nevertheless, she actualized her beliefs through her prolific publication history (which actually began as a doctoral student), and through her participation in NYU activities outside of nursing, many times to the chagrin of Martha Rogers (Chair, NYU Division of Nursing). For example, she held the position of University Ombudsmen (1970-1971) during times of great social upheaval and student unrest on campus, and served as chair of the School of Education's Dissertation Proposal Committee (1968-1975), where she was the only nurse, and frequently the only woman. Downs believed faculty and students needed an environment structured to support development of a community. "It [community] can be created. You have to allow people to be free, and make a few decisions on their own and be able to make links to other people that are mutually satisfactory and supportive . . . I valued it for the faculty. I can see what happens to a faculty when they don't have it. If a faculty doesn't have it, the students don't have it either." (FD, 26 November 1996)
Her strength of "being patient", along with an evolving sense of community that facilitated both independent decision-making and intellectual linkages between individuals, may have generated her interest in the nascent psychiatric nursing field of the 1950s, which was gaining strength with the publication of Hidlegard Peplau's classic text, Interpersonal Relations in Nursing 1952. Psychiatric nursing may also have been attractive because, as Downs recollected,
I was able to make the biggest messes of any soul that ever put a foot in nursing . . . I was a klutz. And I remember this very famous doctor making rounds on the ward . . . I mean, everyone bowed. I was giving a patient a bath and he made me very nervous and I tipped over the tub. This is the story of my life. I was on call in the O.R. In those days, they had these sterilizers, these great big things you had to fill with water. I overflowed them, I messed up the whole O.R. schedule, I was very good at that. (26 November 1996)
Downs noted,
I always wanted to be a psychiatric nurse. Always. I just really liked psychiatric nursing and I loved to try to do it the way the book says. There was a nurse who was the head nurse there [at Bloomingdales, Westchester division of New York Hospital]. I was sitting with this depressed patient and I had read the book about how, first you offer them the spoon, and if they won't take it, then you go through all these steps and finally you feed the patient. I didn't know she was standing behind me and she said, "How can you be so patient?" I said, "that is what it says in the book." . . . My textbook said that is the way you were supposed to do things and that is the way I did it. (21 November 1996)
Downs eventually entered the graduate psychiatric nursing program at NYU in 1960. She noted,
What I was able to do and later on when I worked, when I was in the psychiatric nursing program, it was the same kind of things: working with patients on an individual basis, being patient. Sort of like a therapist, keeping at it and working at it until you could begin to see some things happening. I always felt much more independent somehow. (26 November 1996)
Psychiatric nursing also meshed well with Downs' developing intellectual framework. After her training at St. Luke's Hospital she married her husband, Bill, who traveled extensively. His absences, and several years of working in a communicable disease hospital, and as a pediatric and public health nurse, stimulated Downs to go back to school at St. John's University in New York. (She graduated from the baccalaureate program in 1956.) While at St. John's, she became engaged in courses in philosophy, logic and reasoning. She recollected,
I took philosophy and logic and epistemology and all those things and I just loved it. I mean I was in my element. And I kept taking courses and I realized that it would be sort of smart of me to matriculate on a degree and so I sort of came in through the back door . . . It changed my whole way of reading . . . It opened my eyes to a whole lot of things that I had never thought about . . . We got heavy doses of Aristotle and Aristotelian reasoning, which is far more complex than those simple little old "if-thens", far more complex. And the other thing, there is some kind of correlation between all that and research, I am sure of it. When I hit research [at NYU] again, I thought, "this is great stuff." (20 February 1997)
As she expanded her intellectual foundation at St. John's, she began to think about psychiatric nursing practice in a more nuanced and inquisitive way. "Psych is so esoteric in a lot of ways," she explained. "Everybody was talking about things like empathy, and so being the kind of thinker that I am, I wanted to know what this empathy thing was. It was one of those things that when you do it, you know it. But I didn't know how you knew it when you did it, nobody could explain what it was. This kind of questioning drove poor Dorothy [Mereness] (the psychiatric nursing program director at NYU) out of her mind." (26 November 1996)
Downs began a long career at NYU, and developed a professional community with nurses such as Dorothy Mereness, Martha Rogers (Chair, NYU Division of Nursing), Claire Fagin (then an instructor at NYU), and Jacqueline Fawcett (a later student), along with a host of other future nursing leaders who came to the NYU graduate programs. The transition to doctoral studies occurred almost serendipitously (MA in passing). She remembered,
You see, the ink was not dry on my Bachelor's [degree] before I was in the Doctoral program at NYU, and somewhere in there is where things started to gel. While I was at the ANA convention in Chicago [as a student representative], Claire Demouth [once an instructor at St. John's and then a faculty member at NYU] . . . was staying in this room with about seven others, and among the people who were with her was Martha Rogers and Dorothy Mereness. Claire introduced me to them, and we went to Palmer House, and I still remember sitting on the little green velvet chair, having a cocktail with Martha Rogers and Dorothy Mereness . . . Dorothy [Mereness] was opening a psychiatric nursing masters program, it was going to be their first masters program, and she had federal money. And they were looking for folk to go into this program. The truth is that they had so many credits in this program, they figured if they added a few more, you could get a doctorate. They gave me the story about checking my scores on the various tests . . . So, the next thing I knew, I was in the doctoral program [Downs started the doctoral program in 1957]. (26 November 1996)
Although Downs was admitted to the program, Mereness was "concerned about the fact that I was a Catholic because I had to study Freud and things like that. She felt there might be a conflict. I told her I would discuss it with the priest if there was a problem (26 November 1996)." Downs describes Mereness as a strong, opinionated woman who frequently disagreed with Martha Rogers, the chair of the division (the nursing division was part of the School of Education at NYU). Their disagreements over issues such as the curriculum, academic credentials, and the importance of clinical practice created a sometimes tense but always exciting environment at NYU. Downs was influenced by both of them. Downs recalled,
Mereness had an EdD and Martha had a DSc. Martha believed everyone should get a PhD and Dorothy believed everyone should get an EdD. Actually I transferred back and forth three times. I had taken enough courses to have both degrees because the EdD had 89 credits and the PhD 79. Actually I had over 100 credits when I got out of the place. Really, there was nothing left for me to take so they got rid of me . . . I didn't know where I was coming from. I went into this doctoral program and I didn't even know what a doctorate was. (FD, 26 November 1996)
Downs began to teach at NYU three years into the doctoral program, but very quickly her responsibilities expanded into other areas such as administration in 1964 and research supervision in 1968. "Rogers," Downs noted,
recognized that I had talent, and I did have talent. She was in a big hurry for me to get that doctorate because she had big things in mind for me. She had just gotten a grant and in those days, grants didn't look anything like they do today. She had gotten money for research in psychiatric nursing from the Feds and she needed a director for this stuff. I had just finished the EdD and Martha called me in and said, "This is what I want you to do." I had been teaching and I said, "I don't know anything about how to do this." And Martha said to me, "This is a bootstrap operation." Then I said, "but my shoelaces are breaking," and Martha said, "Tie knots in them." (FD, 26 November 1996)
Downs and Rogers disagreed on important aspects of nursing, including whether there should be linkages between research and clinical practice, and the dangers of insularity and parochialism. Downs noted, "I've always had this clinical orientation because eventually, everything winds up with the patient. And you don't have to be standing there with your hands on the patient for it to get there." (FD, 7 December 1996)
Rogers on the other hand, "believed that nursing was unique and nursing could do anything and didn't need help from anybody in order to get it done. Now", Downs added, "that is nice, except that there are a lot of resources around that you ought to be using. You really didn't have to reinvent the wheel, and we reinvented the wheel every day of the week because Martha said nurses could do it all" (FD, 26 November 1996). Downs went on, Rogers "wanted to come at this [nursing] from the creation of a science. She carried this so far that she did not believe in clinical experience. She said that [clinical practice] was experience and this [nursing] was an intellectual science with knowledge that counted. [I believe] knowledge counts but you have to practice, what can I say? (FD 7 December 1996)"
Rogers believed that doctoral preparation for nurses was necessary in order to represent themselves legitimately to other members of academe, but she also saw Downs' participation in activities outside of the nursing division, even those committees to which Downs was appointed by Rogers, as disloyal. Downs recalled,
When I had my doctorate and I was moving out into the university, she resented it greatly because she thought that all your allegiance should be to nursing and to her. For you to go out and belong to these other things was really not putting all your energy into the place that she thought it should be . . . She didn't see it as expanding your horizons and bringing these people around you in order to strengthen the kinds of things that you did. She really saw it as kind of dependence on them, and therefore very, very dangerous . . . and a lot of these people [outside of nursing] were paternalistic in their own way . . . (FD, 7 December 1996)
Downs believed she could learn a great deal from the rest of the academy, and wrote extensively from the late 1960s on about the need to synthesize and integrate theories from other disciplines to generate nursing theories (Downs, 1967, 1969). "Martha believed," Downs noted,
that nurses could do anything and not only could they do it, they should do it, that we should be self-sufficient. She was also so fearful of what she referred to as "the boys across the park" [medical school, NYU administration]. Martha and I ran into difficulty after I had my doctorate because I didn't like being in the ghetto [the nursing department]. Furthermore, I thought I had a lot to learn from those folk out there. (FD, 20 February 1997)
During these turbulent times when Downs both studied and worked at NYU, she managed to maintain her sense of humor. During Downs' time at NYU, Rogers was developing her theories, publishing her series of books and thinking about a symbolic representation for her theories. Downs claims she gave Rogers the idea for the "slinky-like" representation that many now associate with Rogers' theories.
She was always talking about the helix and things going round and round. I saw the slinky one day and I thought, "This is just like Martha. This is what she is talking about." So I bought it for her and she loved it. One night [a bunch of us were playing with it] it got bent out of shape and I said, "Oh Martha, but that is much better because life isn't really so regular like that" . . . but Martha didn't like that idea at all. She really wanted things nice and regular, and she got herself another slinky that wasn't stretched out. (FD, 26 November 1996)
In 1968, just four years after finishing her doctoral studies, Downs became the first director of the post-masters program and research at NYU division of nursing. "You see," Downs noted, "I had a title and I had all the responsibility but I had no authority. When push came to shove, Martha said she was in charge of the doctoral program, and that is just the way it was. (FD, 30 July 1997) These were difficult times for Downs, as she struggled to maintain her own program of research, teach, oversee the doctoral program and keep track of up to 250 students. Even so, she maintained her sense of humor, and valued the community of scholars she entered when she arrived at NYU and that she helped to create through the mentoring of doctoral students. Her humor and perspective are evident in these events: Rogers asked Downs to develop objectives for the doctoral program in anticipation of an accreditation visit by the National League for Nursing.
So, Martha Rogers told me to write some objectives and goals and all these other good things you do for the program. It was May and it was hotter than the shades of hell, and I said "They are not accrediting the doctoral program and they don't care what goes on in the doctoral program." And she said, "Well, we need to put things in there anyway." So, I am sitting [at home] in the kitchen and making these things up as I go. I had about seven or eight objectives and I thought to myself "gee whiz, these people will be like saints." So I wrote another one, "Able to sprout great white wings, they may soar heavenward to the great library in the sky." The stuff is all hand written, mind you, so I take it into the office and I put it on Martha's desk. Martha hands it to the secretaries to type, they type and nobody looks and they bring it to the accreditation board. Well, needless to say, when the accreditors were reading this the night before, they got a very big surprise. Oh, but this goes further. We needed some brochures so Martha just told people to take the objectives out of the NLN accreditation report and make up the brochure. And sure enough, there was objective number 9, and hundreds of objective number 9 went out. You would be surprised how many students objective number 9 recruited. They would come and say, "I wanted to see who had the sense of humor around here." (FD, 30 July 1997)
Objectives one to eight came from her sense of "scholarship." "You have to understand, I was sitting at the kitchen table trying to manufacture these, on the idea of being able to conduct original research, the intellectual piece of this thing." (FD, 30 July 1997) Ultimately what mattered, "was the people that came there, it was the things you did. We had a sense of community, a sense of going somewhere, of being vibrant, of being on the cutting edge of things." (FD, 30 July 1997) To Downs, "the people" mattered most, from the patients who benefited from new nursing knowledge to the community of scholars producing the knowledge. "I think it [sense of community] is just so important," Downs said, "and it is important for you later on in your life. People keep in contact with one another. If someone calls me on the phone, they will say, `I saw so and so when I was at . . .' Those kinds of things are the sustenance that you need to maintain a scholarly life. Where did I get these ideas? I don't know where I got these ideas." (FD 30 July, 1997)
Conclusions
Florence Downs' oral history presents a snapshot of the intellectual development of nursing. It is a personal perspective, but one that presents experience as a crucial part of developing meaning. Throughout her career Downs viewed her experiences as instructive for others, as seen in her struggles with Rogers and Mereness. Her ability to be productive and a mentor for numerous doctoral students while situated between these two strong women illuminates the important combination of her persistence, patience, humor, and availability. Her narrative also points to the untidy and disorderly development of ideas and experiences, as well as the importance of time and place during a period when nursing theory and science became both highly structured and immensely entrepreneurial.
Downs' narrative also indicates the importance of personality in the structure of ideas, the development of a scholarly "collective," supported in part by the social context of the 1960s and 1970s. Her tenure at NYU coincided with a period of incredible reformulation of nursing education and practice-a time during which the foundation for post-modern nursing education and research was laid. 2 Nursing education evolved from functional, procedure-based training in the 1950s to a more flexible analytical approach in the 1960s and 1970s. Social movements such as the Women's and Civil Rights movements supported greater opportunity for women in colleges and universities around the country in all academic disciplines (although Downs refuted the idea that her gender influenced her academic or university activities). Federal funding of nursing education, from the high level sustained during and after the war years, in part due to the GI Bill, to the various Nurse Training Acts of the 1960s and 1970s in response to cyclical nursing shortages, supported both baccalaureate and graduate nursing programs. Graduate nursing programs tended to be reactive rather than proactive, responding to public outcries about the care of the mentally ill or the elderly population (Fairman, 1999). In general, doctoral programs began to flourish during the 1960s and 1970s as more and more nurses joined the increasingly strident debates about nursing science and nurses' intellectual standing. In 1955, 13 nurses held doctoral degrees, in 1965, 38, and by 1970, 110 nurses (Pitel & Vian, 1975). Downs' program at NYU produced many of these nurse doctorates.
Downs was part of a growing cadre of nurse scholars and leaders, including Hildegard Peplau at Teachers College, who saw nursing as an intellectual discipline with strong links between the generation of new knowledge and its application to clinical practice. These were extraordinary ideas for the times, and it may be that Down's persistence, patience and sense of humor helped her to advance her particular ideas. Downs did not, however, speak particularly about leadership in individual terms-she rarely used "I" in her recollections-but approached leadership from a "collective" or community perspective.
Downs' stories also indirectly refer to the cultural and linguistic barriers confronting nursing and how she surmounted them. Her reference to the Division of Nursing as a "ghetto," and her continued efforts to reach beyond the Division indicates she realized the utility of the academy, the need to "talk the language," and the importance of not being a victim, as was the tendency of many nursing leaders at the time. Her efforts to create a community for nursing in the broader academic world allowed her and the students she mentored to undermine the traditional authoritative discourse constructed by other disciplines about nursing. Metaphorically, she crossed the cultural terrain of science defined by traditional academic disciplines such as mathematics or philosophy. In doing so, she forged a new social identity for nursing as an intellectual discipline.
And finally, this is not a "true" story, but it is Florence Downs' story and our interpretation of it. Downs' oral history provides a way of opening a "discursive space for subjected knowledge" to write the historical record (Gluck & Patai, 1991, p.104). Downs' oral history is a vivid testimony of the revolution taking place in nursing in both fact and consciousness.
FOOTNOTES
1All quotes unless otherwise cited are drawn from the oral history interviews conducted by the authors. Oral history data will be noted as "FD, [interview date].[Context Link]
2The authors wish to thank the reviewers for this idea.[Context Link]
References