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Working Nurse l WorkingNurse.com 21 July 15–August 12, 2019 The most essential aspect of district nursing was that the nurses cared for patients in their homes, making skilled nursing care available to a whole range of people who could not (or would not) go to a hospital or hire a private physician. This model of nursing had little direct precedent in England, par- ticularly since it was tied to no specific church or religious order. However, it proved very successful and was soon imitated outside Liverpool. Rathbone's experiment also inspired Nightingale, who began to lobby Parliament for legal reforms and new laws to improve health- care for the nation's paupers. Several of those reforms passed in 1867, by which time three other cities had established their own district nursing programs. Meanwhile, Rathbone had taken on an even tougher task: improving the standards of care in Liverpool's poorhouse infirmaries. In 1865, he hired 12 more nurses for that effort, including former Nightingale Nurse Agnes Jones. Again, this difficult but successful project was undertak- en at Rathbone's own expense. [Editor's note: You can read more about the workhouse infirmaries in our profile of Agnes Jones, available at WorkingNurse.com.] FRIENDS IN HIGH PLACES A lthough he remained a partner in the family business until 1885, Rathbone decided to pursue his social interests in the English House of Commons, successfully standing as a member of Parliament in 1868. He would sit as a Liberal MP — first for Liverpool, later for Carnarvonshire and North Carnarvonshire — until 1895. Rathbone remained keenly interested in district nursing. In 1874–75, he helped to establish London's Metropolitan and National Nursing Association for Providing Trained Nurses to the Sick Poor, with Florence Lees, another former Nightingale Nurse, as its superintend- ent. Similar associations appeared in Glasgow, Scotland, and Dublin, Ireland, within a year. In a letter to Rathbone in April 1875, Nightingale, by now a strong pro- ponent of the district nursing model, remarked that there was enough demand to justify hiring "10 times the number of nurses," noting "[t]he extreme severity of the cases nursed by the district nurses." THE QUEEN'S NURSES U ntil the 1880s, district nursing was still primarily a privately funded local endeavor. However, in 1887, Queen Victoria announced that she would contribute £70,000, the bulk of the money raised for her Golden Jubilee, to nursing-related causes. Rathbone, Lees and Nightingale pushed for that money to be used in establishing a national institute for district nursing. The queen eventu- ally agreed and the Queen Victoria's Jubilee Institute for Nursing was incorporated in September 1889. District nurses would now be formally known as the Queen's Nurses, with uniforms and caps selected by Victoria herself. Queen's Nurses also received an annual salary. Although the initial £70,000 endowment had been a substantial sum for that era — the equiv- alent of about $11 million today — the insti- tute's work was expensive, especially as the num- ber of district nurses grew. In 1897, Rathbone persuaded the queen to contribute an additional £68,000 from her Diamond Jubilee fund. NURSING LEGACY B y the time Rathbone died in March 1902, there were about 1,000 Queen's Nurses across Great Britain, as well as almost three dozen affiliated organizations. Those figures would double by the start of World War One. The creation of the royal institute, today called the Queen's Nursing Institute (QNI), was a watershed moment for British nurses, firmly establishing district nursing as not only an effec- tive model of care for low-income communities, but also a respectable, well-paid profession for women. To the end of his life, Rathbone was justifiably proud of the district nurs- es and their achievements. In 1901, months before his death, he wrote a Christmas message for the Queen's Nurses, remarking, "You are not infe- rior servants, doing inferior work for inferior wages, but trained and skilled workers carrying out intelligently the treatments prescribed by Doctors." Florence Nightingale had similarly high praise for Rathbone himself, extolling his aptitude for "securing unity yet independence of action … so essential to the continuance and development of a great charity." After his death, she called him "one of God's best and greatest sons." Aaron Severson is the associate editor of Working Nurse WN in 1901, rathbone wrote to the Queen's Nurses, "You are not inferior servants, doing inferior work for inferior wages, but trained and skilled workers carrying out intelligently the treatments prescribed by Doctors."