History of Nursing in Pacific Canada

A Sense of Values; A Study in Constrasts; Common Ground Johns, Ethel 1931

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 A SENSE OP VALUES
It is a pleasant custom in Central Europe to offer to the guests
assembled for a banquet a table of hors dfoeuvres.  They please
the eye and prick the palate.  They prepare for the good things
to come.  Here is a salted herring, here an olive, a fat pink
* prawn or a sharply acid gherkin.  You wander up and down wondering which to choose and usually end by eating far too many although
everything is designed to stimulate appetite without cloying it - to
give a sense of values for the feast that is to come.
In just such a manner I come before you tonight, balancing my little
tray, offering you nothing much by way of sustenance, but hoping that
what is said now by way of introduction may play its humble part in
sharpening our sense of values.  Becuase we are going to need one.
Canadian nurses and nursing are not surveyed every day.  Dr. Weir
is going to give you something to ponder over for the next few months.
Something that will require critical study, weighing, measuring, balancing - in a word - a  sense of values - and the courage and will to
exercise it.
Let me try to illustrate just what I mean.  A survey, no matter
what its particular technique, does certain things.  It attempts to
give a true and unprejudiced picture of existing conditions, it explains the underlying causes of these conditions and, by implication
at least, suggests a course of action.  The greatest compliment then
that can be paid to any survey is not to swallow it whole but to study
it critically - to analyse, to weigh, to measure it.  If we are to
take it seriously, and that is how we should take it, we shall need
a balance and a measuring rod, a sense of values by which to interpret its findings before we can safely translate those findings in terms
of action.
For no survey is an end in itself.  Unless its recommendations are
in some measure carried out in practice it cannot be said to have fulfilled its purpose.  Any action which may affect not only nurses but
the people whom they serve can only safely be undertaken with a clear
understanding of the relative values inherent in the situation.
What values?  Let us name a few of them.  Let us even be bold and
begin with economic values.  Values in terms of money.
In the past we nurses have been a bit^ealy mouthed and snobbish when
it came to talking frankly about the financial aspect of nursing.
We, like the hospitals, like the doctors, have been unwilling to face
the demands of a changing social order which insists, and not against
reason, that every public service, whether professional in its ehar-
acter or not, must be based on sound economic principles.
And what are these principles?  Briefly these: - for the nurses the
right to such working conditions as will ensure steady employment,
reasonably good living standards, and suitable provision for sickness and old age.  For the public the right to skilled nursing care
at a reasonable cost.
We shall do well to listen to what the public has to say about the
high cost of sickness.  They have reason as the French would say.
Read the articles in current magazines written by lay men and lay
women.  They have a sense of values too.  There even seems to be
a general impression that we nurses are being weighed in the balance
and found wanting. There are those who will say that the interests of the nurse and of
the public are mutually antagonistic.  Perhaps they would be less so,
if we really faced the economic situation, and admitted to ourselves,
and to the public, that the present method of meeting the cost of
sickness needs revision and needs it badly.  If that revision calls
for the abandonment of some of otir cherished individualistic notions
it does not necessarily follow that our professional standards are
threatened.  This business of doing a good dayfs work for a decent
wage is like the salted herring on my tray.  An honest homely fish
and nothing to be ashamed of.  I commend him to your favorable notice.
Now let us turn to professional values.  I belong to a generation
which has striven very hard to attain professional standards in education for nurses.  We believed, some of us, that the road to that
attainment lay through the universities.  In spite of some discouraging experiencesDboth in this country and in Europe^I still
believe it does, though I am not at all sure that we trail blazers
were altogether on the right track.  However, nursing now has a measure at least, of university recognition, but perhaps our sense of
educational values is a little keener than our sense of values in
nursing practice.
You know the English nurses are a bit concerned about the Canadians.
They say that as a result of certain subtle influences - especially
noticeable when the wind blows from south of the 49th. parellel, that
Canadian nurses are losing their sense of real values, that we overemphasize certain educational and professional standards and are willing to sacrifice our birthright for a mess of scientific pottage.
That is as may be.  I hand it to you as the sharply acid little
gherkin on my tray.  You are not bound to accept it. If -ay gherkin tastes a bit sour here is the rosy pink prawn nicely
set off by its green lettuce leaf - like a little bouquet - of praise
perhaps.  Canadian nurses have been much praised.  Real praise, not
flattery.  It used to warm my heart overseas to hear returning European visitors say: tfThe Canadians are the best of all".  American
nurses who went to the International at Montreal last year said: rrThe
Canadians are magnificent11.  And so they are.  But wasnft there a
King who died of a surfeit of prawns - or perhaps it was lampreys.
In any event just to ward off indigestion, we ought to listen to a
wise Canadian nurse, Eunice Dyke of Toronto, who said to an admiring
foreign visitor: "Perhaps we have been praised more than is good for
USMe
Let us make one good resolution.  Let us give our most careful study
to those findings in the survey with which we find ourselves most in
disagreement.  A very natural reaction to any statement of fact that
does not please us is to challenge its accuracy.
The response to the nursing survey now being conducted in the United
States illustrates my point.  Hospital authorities there say of the
■e.
report of the Grading Committee: "A very fin# report - except of
course its findings with respect to over production of nurses by the
hospitals and consequent unemployment".  "Quite wrong there of course".
Private duty nurses on the other hand say that the part about the sins
of the hospitals is splendid but that the section dealing with private
duty is not so well done.  And so on all down the line.
Slowly, whether we like it or not but very surely, the conviction is
being borne in upon nurses in many lands that the professional group
in any given country must concern itself more actively than in the past with regard to the quality of nursing work and practice as distinct
from education.  Perhaps our sense of values is not quite as sensitive as it should be with respect to the kind of work nurses are doing
once they cease being "educated" and begin to practice•  Yet, as a
profession we must stand or fall according to the sort of work we do
and not according to the educational ideals we pursue.
Let us be alert and open minded to what the survey has to say concerning our work and our manners after we escape from the wholesome
restraint of the training school.  If it appears necessary to devize
ways and means of dieiplining ourselves in order to check certain
abuses which may have crept in - well - courage is a nursing virtue.
Discipline is a good word if a hard one.  Like the olive on my little
tray, it has a clean taste - though perhaps an acquired one.
At the risk of being thought sentimental I should like to refer, in
closing, to our need of a sense of human values.  Whether the English
are right about us or not we, in Canada, cannot ignore human values
even if we would.  We tend the flame of life at its beginning, in
its full blaze, as it wafers, as it dies out forever.  It is not a
common task that we do and it cannot be measured entirely by inflexible scientific or professional standards.  Something more subtle is
needed: A Sense of Values. r "Jj . .    In   pee/) '■&  & if** ia<4 //#
A STUDY IN CONTRASTS
During the last five years my particular job in nursing has given
me the opportunity of actually doing some work in eleven different
countries on two continents.
In addition to that privilege my work brought me into touch with
interesting men and women from many lands - the Fellows of the Rockefeller Foundation, who were sent to countries other than their own
for purposes of study in science, in medicine and in nursing.  This
group was truly cosmopolitan in that it included Chinese, Japanese,
Siamese, Filipinos and Negroes as well as Britsh, Europeans and Americans.  By listening to their animated discussions, usually in groups
of two or three, it was possible to get, not only a vivid insight into
conditions in their respective countries, but occasionally a new point
of view on onefs own.
^S  One heard, for example, just how the Toronto public health nursing
system strikes a Pole, &A Hungarian, a Roumanian and a Frenchwoman
respectively, or how a hospital in Montreal looks to a nun in Yugoslavia.  These comments were intelligent and searching.  They were
indeed a study in contrasts in ideals and practice.
fit  was even more illuminating to actually do nursing work in so many
countries.  Yeu know^too^ much easier 3rfMdks to get the "feel" of things
when you are actually on the job.  The field of observation is narrowed - but the experience is all the more intense.
What I have to offer you then, this afternoon, is simply a study in
contrasts based on actual experience. It most emphatically is not
an attempt to evaluate various national nursing ideals in education — 1
and practice and to say: "This is good: this is bad".  Conditions
differ so widely in the various countries that it is impossible to
arrive at a just basis of evaluation even if it were not an impertinence to sit in judgment without full knowledge.  All I shall try to
do therefore is to tell you very briefly what ideals English nurses
seem to treasure most, and how these compare with the aspirations of
nurses in some European countries such as France and Austria, Poland,
Hungary and Roumania.
It is obvious that differences in national temperament, habits of
thought and social customs exist as between these countries.  These
differences profoundly affect nursing ideals and practice and, to some
extent, account for the fact that nursing as we conceive of it flourishes in England and developes more slowly in Latin countries such
as France.
The Minister of Health in Roumania was talking one day about the
difficulties of training nurses in his country*  "Quf est ce vous
voulez, Madame5 cfest une chose Anglo-Saxonne" said he - meaning
thereby that the mental and temperamental "set" of English, American,
Scandinavian and German women favours the acceptance of discipline
and the willingness to perform disagreeable routine duties which are
irksome to the Latin group.
Or to put it another way - I might quote a French nurse who said -
"But of course the English make better nurses than we do.  jpjt j|t is
easier for them to submit to authority, to do what they are told.
The English are so much less intelligent than the French".
Just where does the strength of the English nurse lie?  Are we to
agree with the courtly Roumanian Minister or with the straightforward 0
French woman?
To one observer it seemed that the strength of the English lies in
their common sense and in their deep devotion to duty.  I cannot
do better than pass on to you this estimate of English nurses made
by a religious Sister from one of the Balkan countries.  Just in
passing I should like to explain that, when she wrote this letter
she had been studying the English language for only six months and,
at the time, was observing in the wards of a large London hospital.
She writes:  "We are thinking that English nurses is a little like
the London poiicemans.  When the policemans is holding up his hand
in the street all the peoples is stopping, even the busses. They is
liot going on like in our Balkan countries.  But the English peoples
is not afraiding of the policemans.  They is liking of him very much
because in England the peoples is loving always the order with the
kindness.  When did we go on night duty we is afraiding a little
that .we do not know to work well but Head night Sister is always
saying: fSteady, now, steady1 - and so we steady like she says.  I
think in England all patients is knowing that some one is always steady
for him even in the night".
So much for ideals.  What about practice?  The legal control of professional practice in England is, as you know, vested in the General
Nursing Council, but lay and medical opinion make themselves strongly
felt in nursing affairs in England just as they do, more or less, in
all European countries.  The influence of tradition and of social
prestige must always be reckoned with.  Change, when it comes at all
comes slowly.  Some nursing critics deplore this conservatism and
deference to lay opinion, others consider it a wholesome check on
undue professionalism. Trii fftift '-^N^^^^^y---n^-rm^«femajai more  stress  is laid upon practice rather
than theorye  Requirements for admission emphasize character and
temperament rather than intelligence.  Nursing is still, to some extent at least, a vocation in the religious sense.
It is perhaps true that hospital nursing is that phase of professional
work in which English nurses find their best expression.  Public
health nursing is developing relatively slowly both in England and
in Austria and does not, as yet, constitute the "growing point" of the
profession as it does in France and in the Balkan countries.  Many
causes have contributed to this situation but the English and German
temperament and character play an important part.
The private duty nurses in England have gone further toward developing
a basis of co-operative practice than any other group in the various
countries I visited.  Their system might not bear transplanting but
it is well worth study.  Incidentally they emphasize the importance
of supervision in private duty practice and have even achieved a measure of it.
/**     * Continental nurses criticize the English indifference to formal well
organized courses of theoretical study.  The thorough Germans and
Austrians are just as shocked as the French at what they consider
failure to give good instruction in the underlying sciences.
As illustrating the English point of view I can only quote an English
nursing Fellow who, on her return from a visit of observation in the
United States and Canada was asked what had impressed her most forcibly
in those countries.  Her reply was: "I think perhaps it was their
almost pathetic belief in the virtues of education".  She was not
speaking in any snobbish or condescending way.  She meant what she o
said, that is, that what is learned cannot always be measured in
terms of what is taught.
I am sorry to say that I had no opportunity of observing nursing in
Germany - but German influence is strong in Austria and many of the
leaders in Vienna had obviously been affected by German thought and
tradition in nursing.
As one would expect, in the more progressive schools, grounding in the
basic sciences is thorough, the teaching is systematic and the discipline stricte The very best ward teaching I have ever seen anywhere
was at the Kinderklinik in Vienna. Here nursing technique of the
most highly skilled order is systematically taught by nurses to nurses
on the wards regularly, daily, by the clock. Busy or not. Canadian
hospitals please take notice.
Professional organization however has not as yet gone very far in Austria.  Unfortunately, the difficult political situation of the country
since the war, has caused nursing associations to crystallize on
political rather than on professional lines.  No one regrets this more
than the Austrian^ themselves and they look with pathetic envy at the
countries in which nurses are free to organize as they will.
Public health nursing is not altogether in the hands of nurses in Austria.  There is a tendency to emphasize its social aspects and, for
that reason, a social service worker with some health background is
more commonly found in the field than the graduate nurse.
In France, on the other hand, the public health field is preferred by
nurses to all others.  The best French schools prepare women specifically for the various phases of public health and are inclined to let
the huge city hospitals get along with the services of women of the c
A
trained attendant type.
The French nurse takes naturally to publich health especially in its
Social aspects. A remarkable group of hospital social workers, most
of whom are nurses, staff the social service department of the enormous Assistance Publique Hospitals of Paris. The influence of these
women makes itself felt in the wards to an extent which justifies the
belief that it may some day play a considerable part in raising professional standards among hospital workers themselves.
State registration of nurses in France is conducted under one of the
•he;
governmental departments.  The Conseil de Perfectionment brings together not only the nurse educators of the country but also heads of
hospitals and physicians.  The French National Nurses Association
in collaboration with the Belgian Nurses Association is making itself
responsible for the next International Congress.
Poland has made astonishing progress since the war in the development
of Schools of Nursing.  In most of the Central European countries
the maintenance of public health services Is a matter of government
concern.  It is said that the attempts to conserve the younger
generation by means of infant welfare programs and by combatting tuberculosis are not wholly disinterested but are Inspired by militaristic
motives.  Whether this is true or not excellent policies in public
health have been formulated and are in process of being put into practice in Poland, Yugoslavia and Hungary.
Considerable assistance has been forthcoming from American m&awfca,
especially the American Red Cross and the Rockefeller Foundation.
The School of Nursing in Warsaw which has served as a model for Poland
was financed for some years by an American nurse and has also been 7
assisted by the Foundation.  Its former very able director Helen
Bridge, Is an American nurse.  Upon her marriage and retirement the
direction of the School was placed in the hands of Polish nurses many
of whom had benefited by study abroad.  This school is organized on
the American plan, has a high standard of admission requirements and
attracts a good type of student.  One of its graduates holds a position
in the fllLnistry of "Health which makes it possible for her to exert considerable influence on nursing developments throughout the country.
Another notable Polish School is the University School of Nursing in
Cracow.  This school has, from its beginning, been under the direction of Polish nurses.  Its director.Miss Maria Epstein and her staff
have done a remarkable piece of work under exceptionally difficult
circumstances.
Polish nurses are primarily interested in public health but not to the
exclusion of other branches of nursing.  Some of them have done fine
work as teaching supervisors in the School wards of the great hospitals.
The conditions under which some of these women work would appall most
of us.  Nevertheless, they say, and they are right, that unless the
general standard of nursing in the hospitals can be raised it is hopeless to expect that really sound training can be given to student
nurses specializing in public health.
The National Nurses Association in Poland is organized on professional
lines and is very active.
-In Hungary two schools have recently been organized under the Ministry
of Publie Health which constitute training centres for nurses associated with the official public health program of the Institute of Hygiene.  These institutes of hygiene are found not only in Hungary but in Yugoslavia and Poland,,&bA*>€^^ The
directors are men of outstanding ability and interesting and original .
work is being done especially in the rural districts.
The program could be expanded much more rapidly if more nurses were
available.  Naturally, under such circumstances, emphasis is placed
on the public aspects of nursing and the unfortunate hospital patient
is relegated to the care of attendants.
A close observation of the situation in Central Europe inevitably leads
one to the question whether eventually there may not be in these coun-
tries a more or less dissociation between hospital nurses and public
A
health workers.  Such a contingency seems disturbing to the more conservative among us but it apparently has no terrors for some of the
younger generation on either side of the Atlantic.  The question which
inevitably suggests itself is: Can we all remain bound together in
one sheaf?  That is what nurses are asking themselves the world over.
Consciously or not that question is being asked on this side of the
Atlantic as well as on the other.
Nursing is a thing of infinite diversity.  In some countries the
necessity of training and licensing different grades of workers is
recognized, in others it is ignored.  We find that in a country like
England, where, to quote an observing Fellow: "Nurses are trained on
the slow system" it is an honorable and satisfying career for a woman
to be Head Sister of the same ward for thirty years and that a woman
forty five years old is considered rather young to be a matron.
On the other hand, there are countries in Central Europe where most
of the important posts are held by women in their late twenties and
early thirties.  Does that mean that England is wrong and the Central European countries right? , Not necessarily.  It may simply mean that
maturity and youth haves certain qualities of their own which fit best
into a given situation in different couintries*  To quote Miss Lloyd
Still, Matron of St. ThomaB's Hospital: "No country has the right to
impose Its standards on another country".  No nation is pre-eminent
in nursing.  Do not let us be unduly impressed by long and honorable
tradition - nor by mere size and numbers and excellence of organization.  These are things well worth striving for^but in themselves
are not sufficient unto salvation.
The wind bloweth where it listeth and perhaps some experiment in education is now being worked out in an obscure corner of China or Bulgaria or Spanish America which some day may affect nursing all over
the world.  So great an authority as Dean Goodrich of the Yale University School of Nursing, who returned recently form the Orient, said
that in Peking she had found what she considers "one of the very few
real Schools of Nursing in the world".
In spite of its diversities and its contrasts or, perhaps because of
them, the practice of nursing constitutes a great international bond.
Such ties are not altogether broken even in time of war.  It is to
be hoped that we shall continue to hold fast to our sisters in other
lands so that we may preserve our common heritage.
I cannot do better than close with another quotation from one of the
Fellows, - from a Balkan country where frontiers are frontiers and
hard to get by.  "When I did leave my country in order to study, I
did think that frontiers were very high.  Now that I have worked and
learned in countries which once were our enemies, I am thinking that
no frontier is so high or any language so strange that nurses cannot
n
meet  and speak together. xXvn frf/pti//  //3       J
£ j .0|      £R0
by r Johns
• i .,.--,*%
wen bores*© the Graduate Wiiraos
rie  {til strict ?ive).
19,  1350. toy Mm Johns
1 am takiisg for granted that any group ®t nurses provlnclally
organised will be eewpvaltw in its membership and that In a
mating ameli aa thla, there will be repreaentativ.a of all the
principal toranehea ef nursingj further! that thl. drawing together of the various groups presupposes a
interests, and a oceanon aiau
For a. the torn Cetaaon Ground has an undertone of Meaning which
Implies a pause for breath* am. opport    to stand at ill and
to look back over th. roan we hav. travailed* aa wall aa forward
to that whleh Ilea before na*  An overnight oamp ae it w«ro, on
Common 43rsund, and a friendly talk about the adventures of the
day*a march*
In the last quarter of a century nursing has travelled fast and
far*  fhere la possibly no other calling which haa developed
more rapidly or extensively*  How perhaps thl* porlod of ax-
paneIon la over, and we are entering another phase, & mora
difficult, leas spectacular phase, that of .finding our real level
in the cowawiity of which we are a part*  fhat unreal are vaguely
conscious of this change ia shown by th. survey* now ©wing carried
on not only iv.  Caauadn and the tfnited States, but even tn certain
European countries*
In the United States the driving fore, behind their survey and
:onoml<
the chief cause of unrest among; iase-lsan stars*, is economic m&~
adjustment*  "there seems to be a general iapressicn that there
is more cesapetltlon than there used to he, and in mm® phases of
surslng m .-r. unetapl#yaient#  It haa been saade clear that not
all nurses .ttfewr I   -mtlonal, private duty, or public health,
manage to put by enough to keep them in' their old ag«*  It is
■claimed that there Is over prodution of nurses, and that if the
training i cm. to pour out increasingly large elaaaes
that the unemployment problem will heccne uman&geable*
On the ©th.r hand, the Oamittww'a findings are being challenged*
fh* counter claim is being aad* that faulty distribution mA not
over production is the real trouble, that there Is plenty of work
to do and not too many people to do it if certain adjustments
could be aade.       ,ial members of the public claim that if
hot   a, public health agencies, and nursing ©       t§ would
get together and present their ease, and whov a wl"   aaw. to
make a few courageous esEperiaents. that the •soaonlo situation
would improve a;   i unemployment problem be relieve A« ** 8 -
To what extant nursing conditions in Canada are similar to those
in the Ttaltwd states can only be determined when th. final report
of Dr* w©lr*s l   f is available.  After hearing his preliminary
report In Regina last aunaer ay own impression is that th© similarity :   ked a© far as the financial aspects of the situation
ar© concerned*  In the titaltwd States It is apparent that th.
vat. duty nurses are feeling the pinch acre than the other groups*
Fhother that is true In Canada you know better than X do*
fhe (jneatlons I should like to ask are these?-  If it is admitted
that certain changes are inevitabl© both in our educat   I system
and in our business »«thods, who        -a the responsibility of
making these ehsngesf  Is it desirable that the private duty nur~
see should fight their battle alonef  should hospital nurses and
public health nurses confine themselves to the problems of their
own particular group?  Or should we all get together and try to
find common ground?  Your answers to these questions till chow
whether or not you are a dyed-ln~th«*w©©l specialist*
15© not misunderstand aa* 1 am not making any sweeping criticism
of specialisation of function*  It was Inevitable once the earlier
years were past, that nursing should develop along specialised
lines - that some should choose hospital work, some bedside nursing,
others public health, others teaching*  this development of spec*
lal I   l aac      as is all to      i» t now there emmm
to be an incr.esIn& t»ndeney toward specialisation, not only in
function but in form of organisation*  By this I mean a rather
cl.ar cut distinction betw.cn hospital nurses, teaching nurses,
public health nurses, private duty im&*m$  with respect not only
to their work but to their profossionai group activity, and even
to their profeaslonal thinking*
There Is sons   \  to be said for flocking with ©»©»s own kind*
On© I   ': feel e   ? at home in ail.th© **sections"*  As a
battle scarred veteran of the hospital field I fool at heme in
that group*  : hen It comes to private duty ay feelings are a
oil mixed*  1 have done private duty mH$  in" the innocence of
my heart, once offered some advice (In  public) to private duty
nurses*  f© say that 1 was properly ©haatonad for ay temerity
is to put it    -y*  Itou hav. only to i   It the back number,
of the Canadian lurse to see what happened to mo*  But even teat
&idn»t make me stop* I  still cherish at on© of my happiest memories a refresher course we arranged for private duty nurses at th®
University of British Columbia*  there never was a mora responsive
group*  They cam© early and th©y stayed late*  1© us© telling a©
that private duty nurses ar® not Interested la education and administration*  fhey are, If you give them a eham©©*
If X must confess It, it Is the public health nurses who ask© my
blood rum cold.  I hav© a permanent inferiority eompl©x In that # § #
connection*  Fsyche-analysls would probably trac© It back to
th© fact that in my long past training days w© got no chance to
"carry the bag*1 * te get th. feel of it - to know th© weight of
it, as student nurses do today*  But 1 stand less In awe of pub*
I heal;   i then 1 once did*  Ten se® in Surop© 1 had to do a
little publi c heal thing myself*  I know it will shock some ©f ray
audience to know that, totally wl       te health experience,
and clutching 3£ary Gardner1 s classic in ay hand as my only guide,
1 organised a sort of visiting nurs® aervi©* In a remote town in
ifwmgary, up near the Roumanian border.  w. needed that service
in count       , a tv   kg school job - it Just had to b® don©
and th©r© was no on© ©la© to do it*  Later on a collcaguo from
th© Paris office, a public health nurse, cam® out to look the Job
ever*  she shuddered at intervals and turned pal®    hers*
Fortunately, the records war© in Hungarian, so she will never know
how bad w© r©ally ware*  H©w©v«r, when th® looking over was don© •
ah* said - "well, I wouldn't hav© believed a hospital woman could
even have mad© a shot at it".
A year later I w©nt out to look at a training school job sh® had
had t® s©@ through.  It was a good $eb  too * but did I admit it1
Cortalnly not*  What 1 said was - "Well - consi^    a public
healthwr did It, It Is a wonder it isn't wore©**  W® grinned amiably at ©aeh other, for perhape w© had begun te learn that ©n th®
w©st#rn aid® of th© Atlantic shoe, distinctions ar® sometimes
taken a little aor© seriously than they ne@d to b© in th© Balkans*
If it Is agreed that specialisation ought not to go so far that
it threatohs professional unity, what ©an a* don© about it?
Thar, can only h© on® answer to that question*  Seek common ground
fro- the beginning.  Develop an ©ducettonal system •    will give
mevy pupil nurse an ©1   ary undersi   ig of all fee principal
branches of nursing*  Tea will not© that I say an ©Icacntary umd©r*
standing, not a specialised      *aoy«  Let her "carry th® bag"
under th® supervision of a public health nurs® who is also a teacher*
The t®r*ss ar® not always synmsyiious vow know.  let her watch at
©lei© ranee ©n* actually assist a privates duty nurs© who Is also a
teacher, to car® for a patient in a aiddli ©las© ham®,  tet her
c©r>    to u        chastening i a of th© regular hospital
grind m m& when sh© has uadergome th© wheleimse discipline of all
r.© «xp©ri©n©©8, then mud th©n only l.t her spec   »•
i.fter th© training days are over stoat th<
.ttc d«     After all, what m
yox  agre© that w© hav© a ©avt.-v.-- inl
then?     mil th® bond of umd©i*~
on ground hav© wet
interest in learning to b©
nurses and In teaching th© women who shall «ucc©cd us to b© nurses?
I am sur® you will all admit that w© have.  at® the public health
and prlvat© duty nurses right if they aay that \ adminis
tration and nurs® education ar© none of their business?  Bens not
m basic training to women desiring to
enter th© public h©alth field? * 4 -
It is tru© that In Canada and in cora® of th© ler©p©an countries
ROtabl© expirimenti an       I© in orienting th® c   i tewmrd
public health fr©» th® fe* I know of no experiment se
drastic that it alas to ©J iel b®dsid© ©xp@ri«nc® em-
tirely* Th« public 1 • cannot dissociate herself from
what concerns her, both as pupil and as teacher*
The tra    school gives, or claima to give, basic training for
private    nuraing.  Is it not remarkable that it is th© exception rather than the rule, to find a well orgamist«d, well taught
series of lectures and d®       ©e on the special problem and
the special skills of nursing in the hem© given to it   - murs©s
by private duty nurses?  They alon© ar© qualified to glv. such
in      a.  Are tb«7 te do so? Tm  thoy always
reipo   ®n they arc?   0 yet a private duty section In any
es   tion might wail jv..a*r . gr«at sarvic© by organising such
a series, and s©l©ctlng from Its membership women ©apabl© of giving
it*  Perhaps you h*ve don® it her©. If so, I wish yon    i lot
a© hav® yotir out linos, and borrow your teachers for use in other
ard porta »] the i      I*
It is certain that hospital e: \v©a cannot claim the right to
disregard private duty problem®* A large proportion of private
nurses work in hospit*.ls, is aai c-.-tial
If a proper woi    relationship Is to b© ©atab;   L  It would
b© interesting to naak© an ©xp©rim©nt or two in this connection*
-pes© a l © of th® private i        went on duty
in th® training school ©ffie© for a week - Just to see what it
feels Ilk© In that supposedly peacful     on a but? "ondsy morning, for ©xastpl©*  And supposing * just te even things up a little*
* that en© of th© younger And store self *   dent of th® training
school office staff took a good hard 24 hour private duty cas® «nee
In a While* *Bmn  they could talk It ever for th© benefit of their
respective ^sections* at th© m©xt meeting of the Oraduat© Sureea*
Association.  it would b© a lively meeting well worth attending*
and it might fester mutual respect for th* other's follow point ©f
view,
surely the aw   itendent of nurses, usually wad® rcaponelbl© for
everything, from the ©levator boy to the chief surgeon, might be
.xeuecd from worrying about -public health*  It hurts we to acknowledge it, but it la Just pesslbl© that th© hospital ©xccutiv®
might leant ■©»<      <m th© public health I   ng ©x©cutiv©
f ©ducation*  Thar© ar© public health nursing a«rvi©®®
whoa© ef     r Is largely due te the em * in which
thoy instruct their young recruits, and prevent their old guard
frem g©ttimg set in their way©* and rusty in their thinking.
Ther© was a time when nurses engaged in th© administrative and bed-
aid©    jig phase of hospital work felt they had no responsibility
r teaching th© ?   •«  That unhappy stat© of affairs Is peselag*
There  is r©n®w®d emphasis on th® '   fcanc© of the head nurs© as a » g «
teacher, and an effort Is being mad© in progressive hospitals te
glv© h©r a ohanc© to do b©dsid© teaching.  It looks as though
adsiinistration and touching insist on mixing in ©pit© of w©ll
mmnt efforts to keep them apart*
There  Is m-        ■; desperate about our pr©f«sslonal state.  Foe*
i than
sibly nothing mora© than growing paina*  After a period- of
tri'   -any and porhaps too rapid expansion, it may b© good for
us to undergo a little ihol©a©m© deflation*  'Th© survey ought
to show whether th«r© Is over production of nurses in Canada or
not*  It will investigate faulty diatributlon*  W© shall be
better equipped to Interpret Ita findings e.n& te put its recom-
m®ndation8 into practice if, in th® interval, our prof«ssional
groupa g®t together and llat.n to ®ach other's troubles*  w©
may find that hospital and public health caecutIves and private
duty loaders, could work out schemes which would benefit all con*
ccrnod.  Th® public would b® store Inclined to listen to us and
to help us if w© knew our own minds and spok© with one voice.
If In th© process w® got a little rained and ar© no linger quite
a\ir© whether ami ar® m©»b©ra of the public, or hospital workers,
or nurs© «*   ors, or private duty nursas, or public health nura©i,
no groat harm will hav© be®n don®.  ?©nhape w@ ©hall find that w©
ar© no more  and no las® than just plain nurses after all, yes, and
abers of th© public t©o*
In closing I ihculd like to suggest that your provincial organisation i    to constitute a feme for informal discussion of all
common problems. . Here if anywhere you find common ground.  Th©
private dut;/ tmra&e m©ot «L .-,- *>m, tavl  the public
health nurs® with both*  Would you think a® presuming if 1 suggested & few topics? yen -...ilvSc of aono, fxvnk talk
about th© follow-in,;, quest ionsf •
1. Is th© presant iltuet em  I     tpllt to genoral duty in
hospitala satisfactory tet *
Rl
Th© hospital*
Th® goncral duty aura©*
if not why not?  Mas this whol© question     latlon to private
duty nursing?  Could It b© studied together by boi    >upef
2. How should r®gistri«s b® organised and directed?  Should
glltri©s ex©rclse any degr®® of auperviil©m over th© nurses Who
obtain employment through them?  Public health nursas accept
supervision and s.«m te thrive on it.  hav© they any suggestions
to mak© in this connection to th© private gnty eroup?   7 not
talk it on       ^
5. If It Is true that nurs®a      y fall to stake provision for
retirement and old ago, ©euld * ieey rat    nt
allowance schost© b© worked out?  That v«ry thing has bean den© ~ 6 _
for teachers*  *,;hy not for nurses?  It Is just her© that th©
nursing profession needs help*  1 ithout th© advle® and direetlon
of experienced       men we shall not succeed In putting our
h©us« In order.  0©-®p©ratIv© undertakings of amy kind ar® es
sentially business enterprises, and muat b© ©itebilshed and con-
sound I    SIS Ml   I,
ducted       me with sound I   *es m       s*  W© shall not
b© called upen to sacrlfic© our professional lnd©p©nd®n©@ nor our
Ideals ir*    tlon If me  show a wi.   -*»•■ to fac® th® Issu©
squarely and to com© half way with respect to adjustments*  The
people whom w© s«rv* ar® content that w© shall spealalis© in our
skills as much a® we  Ilk© but they Insist that, from th© ©concwl©
point of view, w® get togothor and help them find a way cut*
te must remember that p©®pl® do not under®tend what w® call prefer u*  To thorn a doctor is a doeter, n©t a
pediatrician or b    otologist*  Similarly, a nurs© is © nurs®,
no matter what branch sh© specialises In.  To th© public both ar©
p«epl© who may reasonably be m mhm   01    ill but
who, for some reason, do not always fulfil that expectation. If©
branch of nursing is so firmly established that it is ind®p©nd«nt
of ill the others. such remains to be den© bofor© w© can really
claim to b© a profosslon at all* Listen to what Br. Weir has te
g&y about the fftft&ity •* our teaching in schools ef nursing* If
you hav® courag® r*ad this grisly eomperatlv© table which pats th©
nursing group at th© bottom of th© list as far as Intelligence
testa are coneermed. Bitter got tegether end. do something about
all that*  ho on© group can do it t# themi©Iv©s.
Those ©f you who know England will romemher th© open fields on©
finds ©ven In I^omdon which are spoken of aa th© Cowaon.  Tb@y ar®
not parks, th@y &re m n*      Step are a sort of wild land
©pen to the sky.  Plaoou where p®opl« hav® a       i-ht to s»@k
th® sun and th® air.  around, which became. It is eft-: all
alike, becomes in some mysterious way, not common but holy ground*

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