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by r Johns
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reu b.fes*© the ar*du*t* ffltr***
rio  {til strict ?ive).
19,  1350.
 toy Mm Johns
1 am taking for granted that any group of nurses provlneially
©rgani*®©: will b® ©omposlt© in its membership and Hint In *
m«etlng sueh as this, there will b* repi*©s©ntativ«s of all the
prlnolpal toraneb®© of snrsingj furthert that tills drawing together of the various group* presupposes a
interests, and a coaiaon alii*
For a* th© tera Cosaawiii {Jround ha* as undertone of saaanlna whleii
Implies a pause for breath*  ah opport    to stand ©till and
t© look baek over th* road w* hav© travailed, aa wall a* forward
t© that whleh 11®© ©©for© ma*  An overnight ©sap aa It w«r*, on
Common 43r©und, and a friendly talk about th* adventur®© of th©
day1* march*
In th© last quarter of a eentury nursing has travelled fast and
far*  fher© Is possibly no othor ©ailing whleh ha© developed
more rapidly or extensively*  How perhaps this p*rlod of ax-
pans Ion Is over, and w© ar© entering another phase,  « mora
difficult, l©ss sp«eta©ular phas©, that of.finding our r©al 1«t©1
In th© eonmtnity of which w© ar© a part*  fhat nurses ar© vaguely
©onseiaus of this ©hang© is shown hy th* surveys now h*lng earrled
on not only iv.  Canada and th© tfnited States, hut even tn ©©rtain
European eountries*
In th© United Stat©* th© driving fore© hahlnd their survey *®&
tmmmU
th© ehi©f ©sua© of unrast among; iaae-lean nnrs*s is economl© bm&~
adjustment*  "there seems to he a general l»preasi©n that there
is nor© eoMpetltlon than there need to b®, and in ©©*• phases of
nursing m .-r© unemployment*  It has been made ©laar that net
all nurses either I   -mtlonal, private duty, ©2* puhll© health,
manage t® put hy enough to keep than in' their old age*  It is
'©lalaed that there Is over prodution of nurses, and that if the
training 1 tin® to pour out inereaalngiy large elass«s
that the unemployment problem will beeome unmanageable*
On th© other hand, th© 0©smitt«©«s findings ar© being ©hallenged*
DM e©unt«r ©lairn is being aad* that faulty distribution and not
over produetlon is th© real trouble, that there is plenty ©f work
to d® and not too many p©opl© t© do it if ©©rtain adjustments
could h© «ad®«       ;i*l member* ©f th® puhlle elaim that if
her   a, publl© h©alth agencies, miA nursing ©       as would
g«t together and present their ease, and whew a wt"   oeas to
make a few eourageou© ©©cpariaamti. that the eeonoai© situation
would improve a;   1 unemployment prohlesi he relieved*
 ** 8 -
To what extent nursing conditions in Canada ar© similar to those
in th© limited states ©an only be determined when th* final report
of Dr* weir*a l   f is availabl©*  After hearing his preliminary
report in Reglna last summer my own impression is that th* similarity :   k*d 99 far as the flnanolal aspeets of the situation
ar© concerned*  In the milted States it is apparent that th®
vat© duty nurses are feeling the pineh more than th© other groups*
Whether that is trne in Canada you know better than X do*
fhe questions I should like to ask art these?- If it is admitted
that ©ertaln changes are inevitable both in our edueat I system
and in our businesa methods, who        -a the responsibility ®f
making these ehangeef  Is it desirable that the private duty nur~
sss should fight their battl© alonef  should hospital nurses and
pnbli© h«al'th nurses ©onf ins themselves to the problems of their
own particular group?  Or should w© all get together and try to
find common ground?  Your snawers to these questions *111 show
whether or not you ar© a dyed~lm~the*wool epeelalist*
15* not misunderstand m** 1 am not making amy sweeping criticism
of specialisation of function*  It was inevitable ©nc© th* earlier
years were past, that nursing should develop along specialised
lines - that some should shoos© hospital work, some bedside nursing,
©there publie health, ©th©rs teaehlng*  this development of spec*
lal I   l &M as is all to      1,   t now there **mi»
to be an increasing tendency toward specialisation, not only in
function but in farm of organisation*  By this I m«an a rather
©lear cut distlnetien between hospital nurses, teaching nurses,
public health nurses, private duty nurses, with respect not only
to their work but to their professional group activity, and even
to their professional thinking*
There is sow   [ to be said for flocking with ©ne»a own kind*
One |   ': feel e   » at home in all.the ^seetions"*  As a
battle acarred veteran of the hospital field I feel at heme in
that group*  : hen It comes to private duty my feelings ar« a
bit mixed*  1 have done private duty mH$  in" the Innocence of
my heart, once offered some advice Cin pub!1.©) to private duty
nurses*  f© say that 1 was properly ©hastened for ay temerity
is to put it    -y*  Ifou hav© only to i   It the back namber*
of th© Canadian lurse to see what happened to me*  But even teat
dldn*t make me stop* I  still cherish at one of my happiest memories a refresher course we arranged for private duty nurses at th®
University of British Columbia*  there nmmr was a more responsive
group*  Thwy ©am® ©arly and they stayed law**  I© as© telling me
that private duty nurses are not Interested In education and administration*  fhey are, if you give them a ©hanee*
If X muat confess It, it Is th© pubii© health nurses who ask© my
blood run cold.  1 hav© a permanent inferiority ©omplex In that
 # § i
©*«n©©ti©n*  Psycho-analysis would probably trao© it back to
th© feet that in ay long past training days we got no ehane© to
"carry th© bag*1 * to get the feel of it - to know the might of
it, as student nurses do today*  But 1 stand less in owe of pub*
I heal;   i than 1 once did*  Ton see in Surope 1 had to do a
little publi c heal thing myself*  I know it will shock aom© of my
audience to know that, totally wl       i* health ©xp©ri©n©e,
and clutching 3£*ry Qardnor's classic in ay hand as my only gaid*,
1 organised a sort of visiting nurse servise In a remote town in
Hungary, up near the Roumanian border.  w* nm^*& that servlo®
in count       i a tv   kg school job - it Just had to be don©
and th©r© was no on© else to do it*  Later on a colleague from
th© Paris office, a public health nurse, cam® out to look the Job
over*  she shuddered at intervals and turned pale    hers*
Fortunately, th© records were in Hungarian, so she will never know
how bad we really were*  However, when th® looking over was done -
»h* said - "Well, I mould**! have believed a hospital woman could
even have made a shot at it".
A year later I went out to look at a training school job she had
had to see through*  It was a good $&b  too * but did I admit lt1
Cortalnly not*  What 1 said was - "Well - oonalrf    a public
h*alth©r did it, It Is a wonder it isn't worse**  We grinned amiably at each other, for parhaps we had begum to lesrn that on the
western side of th© Atlantic these distinctions ar® sometimes
tak«n a little more seriously than they need to be in th© Balkans*
If it is agreed that specialisation ought not to go so far that
it threatens professional unity, what ©an be done about it?
There ©an only b© on© answer t© that question*  Seek common ground
fro-- the beginning.  Develop an edueettonal system •    will ^.ve
m«vy pupil mure® an el   sry undersi   ig of all fee principal
branches of nursing*  Tea will note that I say an elementary under*
standing, not a specialised      *ney«  Let her Bcarry the bag*
under the supervision of a public health nurse who is ala© a teacher*
lb© terms ar® not always synomynous you know.  l*t her watch at
©I©a® rang* and ectually asalst a private duty rmvme  who Is also a
teaoher, to ear© for a patient in a middle ©las© home.  Let her
e©r>    to u        chastening i a of th© regular hospital
grind m and when sh« has umdergon© the wholesome discipline of all
ree experienecs, then and th©n only lot her spec   a.
/<.ftor th© training days are over stoat th<
*ttc if  After ©11, what m
yox agree that we have a ©evt.-v.-- tnl
then?  Will th® bond of under-
on ground have wet
Interest in learning to be
nurses and In teaehlng the women who shall succeed us to be mirses?
I am sure you will all admit that we have.  at© the public health
and private duty nurses right if they say that \ adminis
tration and nurse education are none of their business?  Boos not
m basic training to women desiring to
enter th® public health field?
 * * »
It is true that In Canada arid in some of the luropean countries
notable experiments *Jm       le la orienting the c   i toward
public health from the fe* I know of no experiment s*
drastl© that it alas to ©;. iel bedside experieno© en
tirely.  Th* public 1       e cannot dissociate herself from
what concerns her, both as pupil and aa teacher*
Th* trs    school gives, or claims to give, basic training for
private    nursing.  Is it not remarkable that it is the exception rather than the rule, to find a well organi»«d, wall taught
series of lectures and d©       m on the special problems and
the speeisl skills of nursing in the home given to it   - nurses
by private duty nurses?  They alone are qualified to gtv* such
in      ru  Are t'b©7 t© do so?  Tm  they always
respo   en they are?   -.1 yet a private duty section In any
as   tioa might well „"»-:.dKr a great eervlce by organising such
a series, and selecting from Its membership women ©apabl© of giving
it.  Perhaps you h*v* done it here. If so, I wish you    i let
m* have ycair out lines, and borrow your teachers for use in other
ard porta *j the i      I*
It la certain that hospital e:   \vea cannot claim the right to
disregard privat© duty problems*  A large proportion of private
nurses work in hospit*.ls, is **i c-.-tial
if a proper woi    relationship is to be ©stab;   L  It would
be interesting to make an experiment or two in this connection*
-pose a I e of th® private i       went on duty
in the training school office for a week - Just to see what it
feels like in that supposedly peacful     on a busy Monday morning, for example* And  supposing - just to even things up a little,
- that one of the younger and more self *   lent of the training
school offie© staff took a good hard 24 hour privat® duty case once
in a while.  Then they could talk it over for the benefit of their
respective ^sections* at the next meeting of the Oraduate Sara***
Association.  It would be a lively meeting well worth attending,
and it might foster mutual respect for the other's follow point ©f
view,
surely th© sw   ttendent of nurses, usually wade responsible for
everything, from the elevator boy to th© chief surgeon, might b*
excused from worrying about -public health*  It hurts a* to acknowledge it, but It is just possible that the hespltal executive
aight learn **m<      m the pabis© health -   ng exeeutiv©
f *du©ation*  There are publie health nursing services
whose of     r Is largely duw t© th* em * in which
they instruct their young recruits, and prevent their old guard
frest getting set in their wayaj* and rusty in their thinking.
Thar® was a time when nurses engaged in the administrative and bed-
aide    jig phase of hospital work felt they had no responsibility
r teaching the ?   •«  That unhappy state of affair* Is passing*
There is renewed emphasis on the '   fcane© of the head nurs© as a
 » § «
teacher, and an effort is being made in progressive hospitals to
give her a chance to do bedside teaching.  It looks as thouga
administration and teaching insist ©a mixing in apit* of w©ll
m«ant efforts to keep them apart*
fher® Is nt   ■; desperate about our professional state.  F***>
i than
sibly nothing aorse than growing pains*  After a period- of
tri'   -ary and perhaps too rapid expansion, it may be good for
us to undergo a little iholesom© d©flati©a*  'Th© survey ©u$at
to show whether there is over production of nurses in Canada or
not*  It will investigate faulty distribution*  We shall be
better equipped to Interpret Its findings and to put its r©@om-
aendations into prectle© if, In th® interval, our professional
groups get together and listen to each other's troubles*  w*
may find that hospital and public health csecutiv© a and private
duty leaders, eould work out sehemes which would benefit all concerned.  The public would be more inclined to listen to us and
to help us if we knew our own minds and spoke with one voiee*
If In the proeeae we get a little mixed tad are no longer quite
s\ire whether we are members of the public, or hospital workers,
or nurse ©   ors, or privat© duty nurses, or public health nurses,
no great harm will have been don*.  Perhaps we shall find that we
ar® no more and no lose than just plain nurses after all, yes, and
abers of the publi© t©o*
In closing I should like to suggest that your provincial organisation i    to constitute a forwa for Informal discussion of all
common problems. . H»re if anywhere you find ©eswon ground.  The
private dut;/ xiureo* meet «L .-,■ ea, tavl  the public
health nurse with both*  Would you think me presuming if 1 sug-
geatefi & few topics? yea ^lnk of son©, frank talk
about the following questionsf *»
1. Is the presaut ettuafl ah I     t>ie©t to general duty in
hospitals satisfactory t*i -
Rl
The hospital*
Th© general duty nurse*
if not why not?  Mas this whole question     elation to privat*
duty nursing?  Could it b© studied together by boi    >upa?
2. How should registries be organised and direeted?  Should
glgtries exercise any degre© of supervision over the nurses Who
obtain employment through th«m?  Public health aura** accept
supervision and seem to thrive on it.  Have they any suggestions
to mak© in this conneetlon to th© private datv eroup?   y not
talk It on       ^
5. If It is true that nuraee      y fall to mak© prevision for
retirement ana old age, ©*uld * l*ry re-.    nt
allowance scheme be worked out?  That very thing has been done
 ~ 6 _
for teachers*  *,;hy net for nurses?  It is just here that the
nursing profession needs help.  1 ithout the advice and direction
of experienced       men we shall not succeed In putting our
hous© In ©rder.  0©-®p©rativ© und©rtakings of any kind are es
sentially business enterprises, and must be established and con-
sound I   Ml* Ml   I.
ducted       nm* with sound I   *»* as   a*  We shall not
be called upon to sacrifice our professional Independence nor our
ideals in    tlon If we show a wi.   pa*** to face the Isaue
squarely and to com© half way with raspect to adjustments*  The
people whom w« s©rv« are eont«nt that w© shall speolalis© in our
skills aa much aa w® like but they Insist that, from the economic
point of view, we get together and help them find a way out*
** nu@t remember that people do not understand what we call prefer n»  To them a doctor is a doetor, not a
pediatrician or a    otologist*  Similarly, a nurse la a nurse,
no matter what branch she specialises in.  To the public both are
people who may reasonably be * she] 01    ill but
who, for some reason, do not always fulfil that expectation. H*
branch of nursing ia ao firmly established that it is independent
of all the others* such remalna to be den© before we can really
claim to be a profeaelon at all* Listen to what fir* Weir has to
s&y about the fftalitg •* our teaching in schools *f nursing* If
you hav® courage read this grisly comparative table which pats the
nursing group at the bottom of the list as far as Intelligence
tests are eomaemed. Better get together and do something about
all that.  so one group can do it t# th«ma©Iv©s.
Those ©f you who know England will remember the open fields one
finds ©ven In London which are spoken of ae th© Comaon.  They are
not parka, th@y *»re m      ;j.  Ihey are a aort of wild land
open  to the aky.  Plaeee where people have a       i-ht to seek
the sun and the air.  around, which because it la §tr.:     all
alike, becomes ia some myaterloua way, not ©ceroon but holy ground*