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

Registration

The movement for the registration of nurses began in Great Britain and quickly spread to Canada. In August 1909, Dr. Helen MacMurchy of the Canadian National Association of Trained Nurses (founded in 1908 and the forerunner of the Canadian Nurses Association) told the Victoria Nurses Club that while no women should be prevented from nursing, no one should be allowed to put on a uniform and call herself “trained” without first going through the necessary training.

The next year, the Graduate Nurses Association of Vancouver (GNAV) began working towards securing a registration act from the provincial government. A draft bill was written with the B.C. Medical Association and presented to the GNAV membership as well as to the Vancouver General Hospital Alumnae Association, the Victoria Trained Nurses Club and others. That first draft was never presented to government because it was apparent that a provincial association with strong leadership was needed if they were to be successful.

When the provincial association – the Graduate Nurses Association of British Columbia (GNABC) – was established in September 1912, the first order of business was nurse registration. A committee was struck to draft a bill, which was presented to Premier Richard McBride in December that year.

Despite organized efforts by GNABC members, the bill was laid over by the legislature’s executive committee. With the outbreak of the First World War in 1914, the fledgling association turned its attention to donating money and materials for the war effort.

The bill was reintroduced in 1916 and met with resistance. Some believed nurses were seeking a monopoly. Some felt that by setting high nursing standards, a person of modest means could not afford to hire nurses (many of whom worked in private practice). Jo Ann Whittaker, author of The Search for Legitimacy: Nurses Registration in B.C. 1913-1935, wrote: “Doctors did not want nurses to be able to make their own rules but rather to continue to defer to them.” When government proposed that nursing be controlled by the College of Physicians and Surgeons, GNABC withdrew the bill.

Finally, after a change in the provincial government and passing of the enfranchisement referendum giving women the right to vote and hold provincial office, the Registered Nurses Act was passed into law on April 23, 1918. In May of that year, Helen Randal was appointed as the first GNABC registrar.

A registration act was finally in place, but it would take another 70 years to achieve mandatory registration.

The next 10 to 12 years were dominated by debate over education standards and working conditions for nurses. It was the exploitation of student nurses by hospitals that eventually caused nurses to demand educational standards and prevent unlimited expansion of poor-quality schools, which in turn led to GNABC submitting, in 1934, proposed amendments to the Registered Nurses Act.

In 1935, the Registered Nurses Act became the Nurses (Registered) Act. The new act not only changed the name of the association to the Registered Nurses Association of B.C., but included amendments that helped elevate the stature of the nursing profession. For example, it prevented hospitals with less than 50 patients from having nursing schools, legalized the minimum age for student nurses at 19, and set junior matriculation as the minimum education requirement for entry to a nursing education program.

Despite the growing acceptance of the RN designation as a confirmation of professional competency, registration with RNABC was voluntary. Nurses went to school, got their diplomas and practiced. Unless they chose to become registered with the Association, there was no other body ensuring that graduates had the required qualifications to practice nursing.

In 1988, after years of consultation, deliberation and fine-tuning, RNABC was successful in having the Nurses (Registered) Act changed so that registration for practising registered nurses became mandatory. B.C. was one of the last provinces in Canada to enact mandatory registration legislation.