In the 1840s nursing had not yet become a "respectable profession." The workhouse nurse, whatever her qualifications, was regarded as being on a lower level than nurses in other institutions.

In the early years at Ennistymon Workhouse it would appear that the nurses were chosen by the medical officer, from among the female inmates. Dr. Shannon reports to the board of guardians in June 1843, "I find great difficulty in getting the paupers to nursetend the patients and fear they are sometimes neglected by them."

With the establishment of fever wards "salaried" nurses were employed in all workhouses. The Ennistymon Board of Guardians resolved that "Ellen Sexton be appointed nurse tender for the fever ward at the salary of 6 a year and such rations as the porters had and that she be required to visit the fever hospital of the country and become reacquainted with the duties of nurses there, and that she does so at her own expense."

"Salaried" nurses were assisted by the most eligible of the female inmates; these assistants performed the "more menial services of the sick wards." This position was not totally unpaid. In June 1848 the Ennistymon Board of Guardians resolved that two paupers named Catherine Sullivan and Judith Hough be discharged from the workhouse and appointed as assistants in the temporary fever hospital in Moymore, at a salary of 2 p.a. Assistant nurse tenders also received better rations than the other inmates. Many of the inmates who became nurse assistants were single mothers who went into the workhouse during pregnancy and remained inside after the birth. It seems that this practice occurred at Sandfield House, Liscannor.

The Poor Law Commissioners, under no circumstances would entertain the idea of the nursing staff, trained or otherwise, being responsible to a trained hospital matron, who in turn would be answerable to the workhouse doctor. Like all other workhouse staff they were answerable to the master and matron of the workhouse, who were appointed by the Boards of Guardians and whose status was superior to any officer with specialist knowledge or professional qualifications.

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