A Caring Profession in Canada

NURSING & ITS EDUCATIONAL TRAINING
For over 350 years, nurses have had a profound effect on the quality of Canadian life and were fundamental to the development of New France. The Catholic nuns who arrived in Quebec in 1639 to establish a medical mission that was expanded to become the Hôtel-Dieu cared for both the spiritual and physical needs of their patients and introduced the first nursing apprenticeship training in North America.

During the nineteenth century, Catholic orders, such as the Grey Sisters of the Immaculate Conception and those from other denominations, such as Anglican and Mennonite, recognized the need for health care for frontier settlers and carried their medical missions across Canada.

In early English Canada, the task of nursing, including midwifery, often fell to female family members, with the occasional consultation by a physician. The few hospitals that existed employed working-class women who provided the mostly indigent patients with rudimentary bedside care.

Before the emergence of formal training for nurses in Canada, nursing skills were passed down from one generation to the next by female relatives and neighbours through both verbal instruction and compiled manuals of domestic and herbal remedies. With the advancement of industrial and urban growth, along with advances in medicine in the late nineteenth century, it became more and more difficult for female relatives to care for the sick in their homes unless they could afford to obtain medical and surgical care. Those who could not afford to obtain medical and surgical care in their home were often sent to a hospital for treatment.

Formal Training for Nurses, the Beginning 
These hospitals were usually financed through charitable funding, had low medical standards, and were generally staffed by working class women who had no formal training as nurses. In fact, many of the women only became nurses because they had been dismissed from their previous employment due to drunkenness and misbehaviour, as nursing was not generally considered a desirable employment.

In the late nineteenth century many hospitals began to transform their image from a place that generally only cared for the lower classes of society because of their low medical standards, to places of successful medical care that would serve all classes of society.

In order to allow this transformation to occur, it became evident that something needed to be done so that the hospitals would be staffed with qualified and competent staff.

The result was the establishment of training schools for nurses where students would be taught the proper procedures for patient care. Dr. Theophilus Mack established the first nursing school in Canada in 1874 at Mack’s General and Marine Hospital in St. Catharines, Ontario.

The basis of the hospital-based nursing programs was to provide for the needs of the hospitals by providing service.

Hospital administrators immediately began to recognize the improvements the trained nurses were making to patient care, and began to replace their untrained nursing staff with student nurses, who spent two or three years working in the hospital wards in exchange for training and certification. This system of staffing hospitals and training nurses not only supported the hospitals but it also enabled them to keep up with demands for increases in patient care.

At first, enrolments in nursing schools were very small, but by the beginning of the twentieth century it became apparent that the hospital trained nurse would dominate the field and the number of nursing schools and nursing students quickly increased.

The greatest expansion of nursing schools in Canada occurred in the first three decades of the twentieth century. In 1901 there were 65 nursing schools across the country and a total of 280 nurses and student nurses. By 1930 there were 218 nursing schools and over 9000 student nurses in training.

As more nurses were needed, the number of students admitted to the nursing school increased. This system continued as the dominant system for staffing hospitals in Canada until the 1940s and was the basis of training nurses until the 1970s.

THE FIRST STUDENTS
Students who applied to hospital based nursing schools were generally accepted on a probationary basis if they met the school’s requirements of age, gender, education, health, and character.

Student nurses were usually between the ages of 18 and 35, they were female and unmarried, they were in good health, and they had completed grade eleven or grade twelve or thirteen ( Ontario). If after the probationary period (usually 1 to 5 months) the student was deemed suitable, she would be accepted into the program and finish out her first year.

The successful completion of the probationary period or the first year was often marked by a capping ceremony when the student nurse would be given her nurse's cap, which signified her completion of the first major step to becoming a professional nurse.

Once the student nurse made it past the probationary period, some of the fortunate were granted a monthly stipend for their service to the hospital for the remainder of their training. Others received their room and board in exchange for their services. Still others received some remuneration in the last year of their training.
Prior to the 1920s, very few student nurses abandoned their training because of the strict rules of behaviour imposed on them, since the model of femininity and sexuality that was advocated by the rules was the same as the model for all women at that time.

After the 1920s, the model of femininity and sexuality began to change and the ideals of respectable femininity and sexuality advocated by the nursing schools stood in contrast with the more liberated sexual mores being advocated for the “new woman”. Even though these changes occurred, many of the students still did not abandon their training since they realized that in the grand scheme of things, their training was only a very short period of time. Once the student nurses graduated they would experience more personal autonomy.

THE PROGRAMME
Students were generally assigned to patient care “wards”  upon entering the school, where they would learn how to carry out treatments and general patient care in a uniform, standard and efficient way, by observing and working with the more senior nursing staff.

This part of the training was left up to the superintendent of nurses and the head nurses in the hospital.

Throughout their training, student nurses were taught how to care for the sick rooms, which included preparing food, feeding patients, cleaning the rooms, disinfecting utensils, and bed-making.

They were taught how to observe the patient's physiological symptoms, which involved checking the state of the patient's secretions, pulse, breath, skin temperature, sleep, appetite, diet, stimulants, and medication. They were also taught bedside and surgical care which involved applying bandages, poultices and dressings, administering enemas and catheters, as well as preparing patients for operations and assisting doctors in the operating rooms.

Lectures were also part of the nursing program, but since the basis of training in the hospital programs was service or practice, the lectures only made up a very small portion of the program. The lectures were often taught for two hours once a week by visiting physicians and surgeons who tended to only teach medical terminology, anatomical and physiological parts of the body, as well as the names of drugs. In addition, the lectures were not always well attended by the student nurses. The lectures were usually offered before or after a student’s 12 or 13 hour shift on the ward, and if a student had not finished all of her work, she had to stay until it was completed and miss the lecture.

THE GRADUATES
With the beginning of formal training, trained nurses struggled to distinguish themselves from untrained nurses. In order to make the distinction clear, trained nurses began to use the term 'graduate nurse' which was later replaced by the term 'registered nurse'.

Nursing provided women with mobility, personal and financial independence, allowing them to release themselves from some of the constraints of a male dominated society. In addition to allowing personal independence, nursing also allowed women to travel. Nurses were needed everywhere and with the wages they received, nurses were able to support themselves.

Once the student nurses completed their training they would be able to enter one of three sub sectors of the health care market which included hospital staff positions, private duty work, and public health service.
In the early part of the twentieth century, hospital staff positions were rarely filled by graduate nurses since most of the hospitals acquired their nursing labour through student nurses. This situation allowed many graduates the opportunity to enter into private duty work or public health service where they enjoyed a greater degree of independence since they tended to work with little or no supervision from a doctor.

The graduates and teachers of the nursing schools turned their attention to the professionalization of nursing by lobbying for licensing legislation and establishing professional organizations notably the College of Nurses and the Registered Nurses Association of Ontario. By the 1960s, hospital nursing had become increasingly scientific and specialized particularly in areas such as critical care and neonatal care. For the first time, visible minorities and men were encouraged to enter the profession. In the 1970s, nurses turned to organized labour to improve their working conditions and salaries

The registered nurse requirement remained the mandatory entry into the nursing profession for the rest of the twentieth century. At the close of the century this changed and a Bachelor of Science in Nursing degree became the mandatory entry requirement.

IMPORTANT DATES
1639 The Augustine Order of Dieppe, France, establishes Canada's first hospital, the Hôtel-Dieu de Québec.

1642 Jeanne Mance establishes Montréal's first Hospital, the Hôtel-Dieu.

1789 Marie-Angélique Viger (Soeur Saint-Martin) takes responsibility for the pharmacy of Hôtel-Dieu de Québec. She soon establishes an outstanding reputation for herbal cures.

1844 Four Sisters of Charity of Montréal (known as the Grey Nuns) begin an arduous 59-day journey by canoe and portage to the mission at St. Boniface, Manitoba to provide medical, religious and educational services to the Métis and settlers.

1869 The Sisters of Charity of Providence reveal their pharmaceutical secrets in Traité élémentaire de matière médicale, the first book of its kind in Canada.

1871 The Grey Nuns found St. Boniface Hospital in Winnipeg, the first in the region. Between 1891 and 1916, they go on to found missions providing medical services in the areas now known as Saskatchewan, Alberta and the Northwest Territories.

1874 The first training school for nurses in Canada opens in St. Catharines, Ontario. Professionally trained nurses are now needed to assist with new therapies and surgical techniques, and improved patient care.

1885 Canadian civilian nurses serve in the Northwest Rebellion, caring for wounded soldiers in field hospitals in Saskatoon and Moose Jaw, Saskatchewan.

1897 The Victorian Order of Nurses (VON) is established by the National Council of Women with its president, Countess of Aberdeen and wife of the Governor General.

1898 Four VON nurses travel to Fort Selkirk in the Yukon to bring medical care to desperately ill prospectors in the Klondike.

1899-1902 Twelve Canadian nurses serve in the South African War and are credited as lieutenants for pay and allowances.

1900 The Victorian Order of Nurses establishes outpost nursing stations in remote and rural areas of the country.

1904 The Canadian Army Medical Corps creates its own nursing service. Officer status has remained an important aspect of Canadian military nursing, with its own authority, responsibilities and privileges.

1908 The Canadian National Association of Trained Nurses is formed. It later becomes the Canadian Nurses Association, representing over 100,000 Registered Nurses in 11 provinces and territories.

1910 By 1910, 70 nursing schools had opened in Canada from Montréal to Medicine Hat, Alberta.

1914-1918 Canadian nurses embark on their first major military undertaking. Some 3,140 nurses use their skills on a large scale to deal with the devastating injuries Canadian soldiers suffer as a result of high-powered artillery, machine guns and poison gas attacks.

1917 Hundreds of VON nurses from across Canada come to Halifax to assist the thousands wounded by the explosion in Halifax Harbour when a munitions ship collides with another vessel.

1918 During the great influenza pandemic, which killed 30,000 Canadians, the VON sends out emergency calls to every one of its branches, which respond immediately. In Toronto, 16 nurses visit 900 patients in a single day.

1919 The University of British Columbia introduces a university degree programme in nursing, the first of its kind in the British Empire.

1920 The Canadian Red Cross establishes outpost nursing stations.

1920 The Newfoundland Outport Nursing Committee is formed. This Committee was the brainchild of Lady Constance Harris, the wife of Newfoundland's governor.

1922 Nurses win the legal right to use the term "Registered Nurse."

1922 The federal government sets up mobile nursing clinics to serve Aboriginal people in remote regions of the country.

1923 Public health nurses in Vancouver receive credit for their contribution when the city achieves the lowest mortality rate of any North American city.

1925 The University of Montreal, in conjunction with the Marguerite d'Youville Institute (Grey Nuns), found the first francophone nursing degree programme in the world.

1930 The federal government opens the first nursing station for Aboriginal people, on the Fisher River Reserve in Northern Manitoba.

1930s Quebec's lay nurses become the first in the country to form unions.

1939-1945 Nearly 4,500 Canadian nurses with the Army, Navy and Air Force serve overseas, often in field medical units just behind the front lines.

1947 The Grey Nuns write the groundbreaking Le soin des maladies for students in their university nursing programme.

1950 Canada experiences a shortage of nurses. As a result, nursing schools begin to recruit men and members of ethnic minorities. Hospitals begin to recruit married nurses to return to work, and trained nurses from the Caribbean, the Philippines and other countries.

1950-1951 Canadian Nursing Sisters serve in the Korean War. Between 1951 and 2004, Canadian Nursing Sisters also serve in Europe with the North Atlantic Treaty Organization (NATO), and in peacekeeping operations ranging from Egypt in 1956 to Haiti in 2004.

1970s Nurses in all provinces begin to turn to collective bargaining to achieve their aims.

1975 The Aboriginal Nurses Association of Canada is founded.

1995 A nurses' training programme is created in the Northwest Territories to encourage northerners, many of them Aboriginal, to become nurses in their own communities.

2004 There are 84 bachelor's degree and nine doctoral nursing programmes in Canada.