History of Nursing in Pacific Canada

[Staff education, typed ms., n.d.] Johns, Ethel [between 1930 and 1940]

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i    1
Staff Education
Ethel Johns, Sditor, The Canadian Bursa
Pwum     # 4wakm>.     •# —in* it■■■ n ml f im t           **      «i«ia.immmmi     **■#      «*4»*«'##     A^3** J*«m ♦> 4 *%*Si     fek« **     1% **.*&*%     ** «»«*•«»
But we 411 mot uaa so ambitious a term*  fa called la "la&rnlag on tha job.** Itaraaa
wara prepared ia m hit^er^miee fashion for positionsof responsibility* tha underlying
aotiva being tha tm$vmemen% of the hospital service rather them of tha nurse har&alf•
?ha staff conference is a case in point.   t first theaa eonfereweee ware quit©
simple, though aomatimas extremely painful.     I ramambar one young superintendent
who said that her first a*«#f conference ga*e her an idea of what It would ha Ilka to
hava an autopsy without an anaesthetic.
Staff conference® are not alw&ya aa depicted in tha hospital si&gazinesj a
group of morning stars eingiag together*   They are a^metimaa an orgy of fault*findinff
at which tha nursing service geta tha worst of it.   Tha ataff conference, aa such,
JUl not in any trua aanaa an educative process. Bat  it does mmke a beginning. It
brings departments together*   It given tha head nurae a chanee to look at tha haad
of tha laundry and to have the haad of the laundry look back at her.   Preaently tha
haad nurae begins to understand why tha claim linen waa lata and why radiators make
neieea which aannot i&imedtately ha stopped.   Tha engineer begins to understand that
it may ba neeeeeery to kaap tha radiator going and tha windows opan.   In other
worda, tha ataff conference makes the whaala of tha hospital revolve mora antoothiy.
It ia an eminently practical thing*   It benefits thoaa who give and thoa® who take,
but it ia not educative in tha broad sense.
Moat of ma believe that an executive, a really good executive, lika a really
good teacher, ia born and not made.   On tha othar hand, aha mey he either developed
or ffttitrated by tha paopla reepensible for directing har.   **** ma B*m ^m* ** &&w been doing, more or leaa unconacioualy, to try to develop nurae executives.   Any
Wise auperintandent of nuraea looks over her staff and gives lliaa So-and-so an
opportunity in a certain department because aha feels that later on she may be able to
take some definite responsibility in that department*  She tries her out and perhaps
even allows her to assume charge when the regular head is away.  She watches her and
nurses her along.   That is staff education.  Her is all such education confined to
large institutionsj  Jfar fro® it - the superintendent in a small hospital may be
a true educator, a real leader.
Now, let us look at the broader field of staff education.   In sane of our
hospitals there already is a deliberate plan to improve, to educate, to help our
graduate nurses.  You say it ought to be done everywhere.  It should be, but it
cannot be done everywhere because there is a certain environment, there are certain
conditions, which must be present if staff education is to be intelligently carried on.
Superintendents of nurses will agree that no program can hope to succeed in any
hospital unless the women who are going to participate Ja* M went it themselves.
Sometimes they do not want it but would prefer to dance and amuse themselves*  After
alljwhy not?  They are young I  And it is possible that they may be reaching out
after something else than ^lectures**, something definitely cultural in its values,
something which haa no direct connection with nursing, but which they know would enlarge
their mental horizon and stimulate their imagination.  What has been tried?
One experiment is now being tried out which is being watched with great
interest, and that is the form of staff education which is effected by exchanging
nurses from one hospital with nurses from another.   fhat plan is being carried
on under the auspices of the Canadian Nurses Association, in a modest way and has
some interesting implications. • 5 •
fvo 7f    There are now in Canada- I happened to meet than in Montreal the other day, -
nursaa from New Zealand, from Australia, from Horwey and from England, all getting
experience as staff nurses, and some formal education along with it, under a scheme
which drew them from the far corners of the earth.   Obviously the chief value
of this exchange does not lie in the learning of nursing techniques, which after all
are much the same in all countries, but in the fact that it &#ee opensthe windows oft
the mind to live|in a country other than your own, even to struggle with a language
not your own.  So you see that we have already gone far.
It will be claimed, and I think rightly, that these programs are more likely
to be successful when they are applied $o the teaching aspects of nursing. Then the
hospital will retort  *We donft want to develop teachers; we want to develop
administrators.*  And the hospital is right.   But the hospital will have to face
this situations mery head nurse, though she may be primarily an administrator, is
whether she wants to be or not, a teacher.    And some of the moat effective teaching
is given quite unconsciously.   So we cannot split hairs here.
There is a need7whlch we hope may be met, of a deliberate plan to make
experience of this kind worth while.   I can imagine no better place in which it
could be studied than in the nursing section of a hospital association.   I refer to
a possible interchange of nurses between different hospitals ithin any city or province.
This immediately opens up another question.   If we sent our nurses to a new
hospital environment are we sure that they are going to get the sort of experience
that wa want thsm to have?    It hasjbeen my privilege to have the direction of
students overseas and also in this country for whom such opportunity was sought^
and I may say that as yet there are relatively few hospitals, even where an elaborate
teaching program is being carried on, where you can be certain that a young nurse
seeking experience on the wards will really get it.  Why?  iwnra  Because the
hospital load is heavy, because the care of the patients, the administration of tha • 4 *
ward, must come first.   The observer site in a corner; if she is alert she may
see something.   On the other hand she may feel(and students often do), frustrated
and bored because there is no one to put har in touch with the valuable opportunities
which she knows are there but does not quite know how to utilize.   Ivan whan there la
time, it is an extremely delicate task to interpret to the student what is worth watching
and what may be disregarded.    The student herself may not know what to look for
and there ia need for developing in our hospitals someone who is able to separate the
essential from the nonessential, the interesting from the dull, the unusual from the
repetitious, and thus to make the experience worthwhile.   It cannot be dene by a
busy hospital head nurse and carried along with the rest of har duties. That is not
I stress field work,(and this is field work) because I do not believe that it is
possible to develop executives unless they know ho%   it feels to be *on the job.* It
simply does not take.   They get a great deal    through University courses, from
cultural reading, from direction along this, that and the other line; but you knew
yourselves & those who are head nurxes oi|fho have been « that there is no way to get
the thing under your skin unless you "take the buffet and cushion the shock."   You
donft learn these things by observation entirely, though you do in part.   You learn tham
by experiencing tham, and there the hospital comes in.
We must net Jeopardize our patients by allowing responsibility to be taken by
young women not yet ready to handle it, and yet as I look about our country and seethe
terrific load that we place on the student head nurse, the wicked amount of
responsibility that is placed, in too many instances, on student nurses, almost
unsupervised, at night, I think perhaps we need not be too anxious about giving a bright,
young, alert young graduate a little more rope.
Now let us turn to what might be done by way of supplementing experience by ~ 5 -
theory.   I have said that first you must be certain that your staff nurses
want it.   Furthermore, you must be certain that they are not too dead tired to profit
by anything etcept a bed where they can put their feet up.   It is useless to give
tired woman the best course of lectures in the world.   I know of no group of
students who are what I would call "leeture~resistant* to the point that nurses are.
You may hav*„large audience in front of you, as I have this afternoon, and you may
say to yourself: "I have five, ten, fifteen interested listeners*1.   But you may be
deceiving yourself. The truth may be less flattering.
I can illustrate that by a little story;  In one of our large Canadian hospitals
they have a good course for their young student nurses on "Professional Problems."
I donft know whether The Canadian Nurse was looked upon as a professional problem, but
anyway I was asked to come up and speak to them.   These were charming girls, in their
senior &El5fe, thirty or forty of them, bright, pretty, alert.   I said to myself:
"What a chance," and did my  level best.   Sitting right in the front row was one
young thing who nerer took her eyes off me during the whole of the twenty-minute talk.
I thought to myself: "There is a young soul which I have really kindled", and went away
with a distinct glow.   About two weeks later, the same puxg earnest young soul
turned up in my office and said, "I came down to ask something about the Canadian
Nurses Association and I was told I had better ask you about the Journal.  I said;
"Were yeu at the meeting the other night"? "Oh yes, I was there".  So I drew her out
a bit, and not one single thing, though I had poured out my aoul before her, not one
thing had stuck.   I finally asked her, "Did you hear anything I said?"  And she
replied, "Wall, you know, I was the chairman of our graduation dance and 1 had a
lot to think about".
I have found that there are a good many "chairmen of the graduation dance"
in any nursing audience, and you may have a row of young graduates, in a staff
education lecture course who will not hear one word.   That is what I mean whan I say - 6 -
wa are lecture-proof.   It rolls off us like water off a duckfa back.   We have bean
so bludgeoned by the lecture method all through our training in most schools that
we can give the appearance of listening when we are not.   Whatever Urn    form your
program in theory is going to take, don't confine it to the lecture method. If you do
it will not stick.    Either you must have a lecture course so arresting that they
cannot possibly think of the "graduation dance" or its equivalent; ot you must somehow
arrange that they themselves participate. And there must be at some point in that
course, and at intervals all through it, physical aa well as mental activity.
Suppose you do find your group really wants a program, the next thing is to find
out how often they want it and whether you are duplicating any other nursing activity
which may be going on in your district.   Then find out what nights in the week
are distinctly unpopular; there are nights that are, and you should be intelligent
enough to know tham.   Having done that, then you must get the nurses to co-operate with
you and listen to what they tell you.   If they decide they do want a few lectures,
all wall and good, but it eeema to fee that if staff education is to be of any
use at all, it must draw cut the capabilities of these young women; in other words,
make tha® participate, and do things.
How can that be done?    I am not speaking here of large cities that have
tremendous resources, I am thinking of the smaller towns.   It is no use giving a
repetition of the undergraduate course or having men come in and give a re-hash of the
lectures already given in the School of Nursing.   The program has got to take
another and more vital form.
In my experience, one of the things that does interest is something like a jury
panel or a mock trial.   A group of nurses once had a "trial" of a certain
authority whom they considered stiff in her attitude towards tham.  It was extremely
good tempered and funny and it brought out some excellent points in administration.
| grant you that humour of this sort is a two-edged sword.    But whatever the topic, • 7 -
handle it by debate or by demonstration and not by the lecture method alone.
We all know students strike fire from one another.   A group of women who see
one another day after day naturally has its little antagonisms and disagreements and
is not going to enjoy being "educated* all by its lonesome.   There is a great deal to
be aaid for co-operation on the part of a group of hospitals in a given centre, visiting
from one to another, putting on demonstrations, in which they have the satisfaction
of showing "The General" or "St. Josephfs" how much better they are than the "General"
or "St. Joseph's" respectively.   Bring in the human motive of competition.  Above
all, rataa&ber that these women are young.   I have always felt that no woman is fit
to be a superintendent of nurses if she has completely forgotten how it feels to be
Let us suppose that three or four hospitals have decided to pool their resources ,
and thatA,S, and C. will put on such* a demonstration or lecture.   These hospitals
shpuld be willing to spend a little money as well as effort to built up staff education.
Certainly the hospitals will never do this until we nurses somehow or other contrive
to catch the imagination of our Hospital Boards.    I don't think we have succeeded
in doing that yet, except in some  isolated cases.    I sometimes wonder whether wa
should not interest both the physicians and the hospital administrators far more
if we could occasionally catch one of them and just let him see ^something of this
kind going on.     In ewery  hospital we have Dr* So-snd-So, who the moment he walks in
at the door, causes everybody to feel a thrill of apprehension nm^il he departs.  He may
be one of the best and most valuable men the hospital has, but he is everlastingly
critical and is eternally saying: "Hursing is not like it was when I was young".   It is
no use pitying the gentleman and his lost youth,which has gone along with his other
illusions.   Don*t worry about that» b**t I* &®  tan be lnvelgled{and he would have
to be inveigled) into watching good team work in nursing procedure, done by young
graduate nurses whom he had been accustomed to see around his warts, I believe
that that terrible word "Hursing Education" or even the word "Curriculum" might be
accepted calmly without the violent agitation that goes on every time these things are
mentioned. ~8 -
This agitation reminds me of a little story:
I was brought up in Morth Wales and we had a little donkey that was the pride of
our hearts and which wa used to take out along the winding roads.   It was long
before the days of automobiles, but as we went along, we did occasionally meet that
terrible monster, a traction engine.  Whenever that donkey was confronted with that
traction engine he used to go into a sort of a trance ith his four feet stretched
out,rMs head bowed down aa in an attitude of deep thought, or prayer.  He didnft in
any way antagonize the traction engine; he didnH attack it, he didn't even try to
escape from it.   All that he did was to pretend it was not there.
This is what the administrators and the medical men are doing with regard to
nursing education.   They donft attack it- at least not much - thsy don't fight it,
unless they think they can get away with it.   Thay ignore it; it is simply not
there.   They think that if only they <Pan ignore it long enough it wonft be there.
But it is there, to stay.   knd we nurses have ear traction engine, that is the
subsidiary worker, in hospitals and out.   For years, the nursing group, when
confronted with the question of the non-professional worker has put out mfe feet, bowed
tear head and tried to pretend she is not there.   We have got to face our traction
engine too.
ffcBut let us get back to staff education.   I am not going to put forward
any detailed program.   I am simply going to reiterate that there are certain thinga
that are essential to success.   First, there must be direction, a guiding mind.
Second, there must be a group that are willing to sacrifice a certain amount of time
and leisure, but not too much.   Third, that ycu must not confuse and duplicate
similar work being done under other auspices.   Fourth, that you get the interest
of your medical men and hospital administrators, because without that there is no tr e
staff education. r
• 9 -
The hospital is an educational institution.   If not a single lecture were given
in it, it would still be one of the greatest of schools.  Certainly no one with any
kind^ heart or intelligence can live in such an environment and not learn.
Yet a young general duty nurse said to me: "They are talking about havi'hg a
program of staff education, but what is there in it for me?  Salaries are poor; there
is very little chance of promotion.   Would it be worth making the sacrificed" We
need to think of the general-duty nurse, her status, her scope, her possibilities.
There is raw material for your staff education.   It is from among these girls that
the head nurses of tomorrow are going to come.   It is from their ranks that the
superintendents, and the supervisors are going to be drawn, and it Is to them that
the appeal must be made.
The hospital is one of the     institutions of learning in this or any other
country.  Education of some kind is going on in mery hospital whether you realize
it or not, and you are not long inside the door before you know what kind it is.
Staff education is not confined to the nuraing group.   It is participated in by
everyone from the Board of Directors down.   Either it ie rationally and deliberately
planned, or it is haphazard. Bit  there is no discharge in this war.  It goes on.
Let me leave one word with you: Staff education to be of any use at all should be
enjoyed and enjoyable.


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