celebrating the evolution of nursing regulation in british columbia 100 Years of Nursing Regulation 1912 - 2012

EDUCATION & EXAMINATIONS

Few if any education and professional standards existed in the early 1900s. Within any group of nursing students, some had high school diplomas while others could barely read. Each education program was different and varied in length from six weeks to three years. Because nursing was not particularly valued as a career, most students came from poor families and had little education.

However, education was very much on the minds of the 68 women who met in 1912 to form the Graduate Nurses Association of B.C.

The First World War began to change young women’s attitudes about nursing as a profession. Before the war, nursing was considered a dedication and a service to the community rather than a job, and nurses put up with long hours and poor wages. But during the war, women could earn good wages doing war work, and with other options available nursing lost some of its earlier appeal. Hospitals were crowded with the wounded from France and there were shortages of all supplies, including nurses.

After the Registered Nurses Act was passed in 1918, Helen Randal, as registrar of the Association, put her energies into conducting the first survey of hospital training schools in the province. Then she began carrying out annual school inspections.

In 1921, GNABC recommended that prospective student nurses be 19 years old and have at least one year of high school. Schools were urged not to accept younger students because it was felt that women of college age might not be attracted to nursing if the standards were too low.

In 1924, GNABC established standards for the approval of nursing schools and went on to create standards for admission, equipment, teaching methods and curricula. As standards increased, and the Great Depression took its toll, smaller training schools closed.

A pivotal moment in nursing education occurred when the Survey of Nursing Education in Canada by Dr. George M. Weir, head of the department of education at the University of British Columbia, was published in 1932. The Weir Report, as it was more commonly referred to, found that hospital-nursing schools turned out a disciplined workforce, but did not provide the quality of education necessary for highly competent nurses. He concluded that nursing education should be placed within the general education system and the minimal education requirements for professional nurses should be four years of high school followed by three years of nurse training. Perhaps the most significant aspect of the report was that it enabled nurses and others to talk about nursing as a profession.

At the time, British Columbia had fewer training schools than other provinces in Canada, with the exception of Prince Edward Island. By 1939, with the combination of the economic impact of the Great Depression and RNABC’s increased standards for approval, only seven schools were still open – in Victoria, Vancouver, Kamloops, New Westminster and Cranbrook.

The outbreak of the Second World War in 1939 meant that women were once again drawn to the better salaried jobs offered in the war industries. Nursing salaries in the early 1940s were well below these other salaries and still lower than pre-Depression nursing salaries.

As a result, nursing shortages were again growing – a situation that has been consistent from the turn of the 20th century and continues today. Attempts were made to counter the shortage by granting temporary licences, permitting married nurses to work and encouraging private duty nurses to work as general staff nurses. Student nurses were allowed to marry, but only to servicemen.

RNABC started sponsoring refresher courses for inactive nurses and later hired an instructor to update nurses returning from the war. This was the beginning of a more visible role in continuing education for RNABC.

The end of the Second World War ushered in the era of university education for nurses. Although the University of British Columbia had offered a degree program in nursing since 1919 – the first university in the British Commonwealth to do so – there were few baccalaureate programs in Canada in the 1950s. Most nurses were still receiving hospital-based training.

By the 1970s, radical changes in nursing education were being discussed. A RNABC survey in 1973 stated: “Education is suffering as a consequence of inordinate service demands.” It was proposed that nurses be educated in the classroom rather than the traditional on-the-job apprenticeship.

The roots of that proposal went back to Helen Mussallem’s 1962 report on nursing education for the Royal Commission on Health Services that said nursing education in Canada was in a “deplorable situation” and that “75 per cent of hospital school instructors are unqualified.”

(Helen Mussallem trained at Vancouver General Hospital, and went on to receive a bachelor of nursing from McGill University and a doctor of education from Columbia University. She received numerous awards throughout her illustrious career, including being named a Companion of the Order of Canada.)

Although hospital nursing schools had done a credible job, it was clear that they were not situated to provide education for the future. These hospital-based schools were functioning where the first priority was patient care and not education. A component of these programs provided the services of nursing students for patient care in one setting, usually in the one hospital. This exposure did not provide sufficient breadth and depth of education to prepare nurses with the foundation required for specialized knowledge and skill to work in a variety of settings and outside hospitals. Nor did the educational preparation include the foundation for career progression into administration, education and research as well as clinical practice roles.

Hospitals began closing their schools of nursing, and community colleges started offering two-year programs with students’ time focused on classroom instruction and practicums. RNABC remained responsible, through the Nurses (Registered) Act, for establishing standards for the education of nurses in British Columbia and approving nursing education programs in the province.

The final shift in advancing nursing education began in 1982, when RNABC delegates at the annual meeting resolved “that by the year 2000, minimum education requirements for entry into the practice of nursing in B.C. will be successful completion of a baccalaureate degree in nursing.”

That goal was missed by just a few years. The B.C. government finally announced its support for the transition to baccalaureate programs in 2002, with the changes phased in over several years starting in 2003. The last non-baccalaureate program ended in 2007.

Today, the College of Registered Nurses of B.C. is responsible for assessing all nursing education programs in the province. The Education Program Review Committee reviews nursing education programs and courses required by applicants for registration, and makes recommendations about whether the Board should recognize them for the purpose of registration, and any terms or conditions of recognition.

The quality of nursing education in B.C. is borne out by the results of the Canadian Registered Nurses Examination – the pass rate for graduates from B.C. schools of nursing writing the exam for the first time consistently surpasses that of candidates who graduated outside of Canada.