In most Western countries psychiatric nursing, from the late nineteenth century onwards, developed as a specialization under medical supervision and within one general training scheme for all nurses. In the Netherlands as well as in the United Kingdom (UK), this occupation, initiated by psychiatrists, more or less distanced itself from somatic nursing. A comparison of the twentieth-century development of psychiatric nursing in these two countries shows similarities in its basic conditions and some of the problems it faced, but also some remarkable differences, which are largely of a social nature. We argue that Dutch mental health nurses, in cooperation with asylum doctors rather than in opposition to them, succeeded in establishing a stronger professional identity than their British colleagues: earlier in time and to a greater extent they had opportunities to voice their views on their work and to define the social and didactic nature of their vocation. Our explanation of these national contrasts focuses on gender, class and social status, which had dissimilar effects in the two countries because of some fundamental differences in the hierarchies and religious affiliations of institutional psychiatry as well as in the more general class structure of the Netherlands and the UK.