Nursing in Canada
In the late nineteenth and early twentieth centuries women made inroads into various professions including teaching, journalism, social work, and public health. These advances included the establishment of a Women’s Medical College in Toronto (and in Kingston, Ontario) in 1883, attributed in part to the persistence of Emily Stowe, the first female doctor to practice in Canada. Stowe’s daughter, Augusta Stowe-Gullen, became the first woman to graduate from a Canadian medical school.
Apart from a token few, women were outsiders to the male-dominated medical profession. As physicians became better organized, they successfully had laws passed to control the practice of medicine and pharmacy and banning marginal and traditional practitioners. Midwifery—practiced along traditional lines by women—was restricted and practically died out by 1900. Even so the great majority of childbirths took pace at home until the 1920s, when hospitals became preferred, especially by women who were better educated, more modern, and more trusting in modern medicine.
In the Prairie provinces, the first homesteaders relied on themselves for medical services. Poverty and geographic isolation empowered women to learn and practice medical care with the herbs, roots, and berries that worked for their mothers. They prayed for divine intervention but also practiced supernatural magic that provided as much psychological as physical relief. The reliance on homeopathic remedies continued as trained nurses and doctors and how-to manuals slowly reached the homesteaders in the early 20th century.
After 1900 medicine and especially nursing modernized and became well organized.
The Lethbridge Nursing Mission in Alberta was a representative Canadian voluntary mission. It was founded, independent of the Victorian Order of Nurses, in 1909 by Jessie Turnbull Robinson. A former nurse, Robinson was elected as president of the Lethbridge Relief Society and began district nursing services aimed at poor women and children. The mission was governed by a volunteer board of women directors and began by raising money for its first year of service through charitable donations and payments from the Metropolitan Life Insurance Company. The mission also blended social work with nursing, becoming the dispenser of unemployment relief.
Richardson (1998) examines the social, political, economic, class, and professional factors that contributed to ideological and practical differences between leaders of the Alberta Association of Graduate Nurses (AAGN), established in 1916, and the United Farm Women of Alberta (UFWA), founded in 1915, regarding the promotion and acceptance of midwifery as a recognized subspecialty of registered nurses. Accusing the AAGN of ignoring the medical needs of rural Alberta women, the leaders of the UFWA worked to improve economic and living conditions of women farmers. Irene Parlby, the UFWA's first president, lobbied for the establishment of a provincial Department of Public Health, government-provided hospitals and doctors, and passage of a law to permit nurses to qualify as registered midwives. The AAGN leadership opposed midwife certification, arguing that nursing curricula left no room for midwife study, and thus nurses were not qualified to participate in home births. In 1919 the AAGN compromised with the UFWA, and they worked together for the passage of the Public Health Nurses Act that allowed nurses to serve as midwives in regions without doctors. Thus, Alberta's District Nursing Service, created in 1919 to coordinate the province's women's health resources, resulted chiefly from the organized, persistent political activism of UFWA members and only minimally from the actions of professional nursing groups clearly uninterested in rural Canadians' medical needs.
The Alberta District Nursing Service administered health care in the predominantly rural and impoverished areas of Alberta in the first half of the 20th century. Founded in 1919 to meet maternal and emergency medical needs by the United Farm Women (UFWA), the Nursing Service treated prairie settlers living in primitive areas lacking doctors and hospitals. Nurses provided prenatal care, worked as midwives, performed minor surgery, conducted medical inspections of schoolchildren, and sponsored immunization programs. The post-Second World War discovery of large oil and gas reserves resulted in economic prosperity and the expansion of local medical services. The passage of provincial health and universal hospital insurance in 1957 precipitated the eventual phasing out of the obsolete District Nursing Service in 1976.
Over 4000 women served as nurses in uniform in the Canadian Armed Forces during the Second World War. They were called "Nursing Sisters" and had already been professionally trained in civilian life. However, in military service they achieved an elite status well above what they had experienced as civilians. The Nursing Sisters had much more responsibility and autonomy, and had more opportunity to use their expertise, then civilian nurses. They were often close to the front lines, and the military doctors – all men – delegated significant responsibility to the nurses because of the high level of casualties, the shortages of physicians, and extreme working conditions.
Most provinces prefer that the Registered Nurse hold a Baccalaureate degree typically a Bachelor of Science in Nursing or similar (degree names vary slightly depending on the granting institution). Currently, many RNs have been "grandfathered in" and are practicing with a previously obtained 3 year diploma achieved at the college level. This cohort of RNs are encouraged by the Canadian Nurses Association and their respective provincial colleges to return and upgrade their education to that of the Baccalaureate prepared RN due to research suggesting that the degree-prepared RN have improved outcomes for patients and families. RN education now is mandated to 4 years in length through a degree granting institution (a university). However, some institutions have "accelerated" programs at 3 years in length, where students study full-time through the summer. Additionally, there are 2 year programs, but entrants into these programs typically have been granted previous non-nursing degrees. RNs and RPNs throughout Canada study a diverse range of mandated subjects including, but not limited to: physiology, anatomy, pathophysiology, epidemiology, microbiology, nutrition and dietetics, pharmacology, organic chemistry, nursing theory and nursing skill. Extensive hands on practical training, colloquially referred to as "clinical" by students, starts early as year one and extends to graduation.
RNs can pursue further education at the Masters or Doctoral level, receiving a Masters of Science in Nursing or PhD, respectively. Additionally, there are several different types of Master's degree. Depending upon field of study, the RN can choose to study to become a Nurse Practitioner, an Advanced Practice Nurse, a Registered Nurse First Assist (Surgeon's assistant); in addition to many other fields of study. Currently in Canada, there does not exist the Certified Registered Nurse Anesthetist role, unlike the United States.
Registered Practical Nurses (RPNs), which are not to be confused with Registered Psychiatric Nurses, or Licensed Practical Nurses (LPNs) in Canada are educated at the College level after two years of study and are granted a diploma upon successful completion. Training is quite similar to RN educations with much of the same subjects, however given the reduced period of study, students receive a more focused foundational body of knowledge; this results in the inability of RPNs to provide care to acutely unstable patients. Students are exposed to hands on practical training as early as first semester of year one, continuing to graduation.
Types of nurses
- Registered nurse (RN).
- Licensed practical nurse (LPN) or licensed vocational nurse (LVN), known as registered practical nurse (RPN) in Ontario and Quebec.
- Registered psychiatric nurse (RPN) - are licensed to practice only in British Columbia, Alberta, Saskatchewan, Manitoba, and the territories.
- Nurse practitioner - an RN with additional training and certification who can perform additional tasks including ordering and interpreting tests and prescribing medications
The profession of nursing is regulated at the provincial and territorial level in keeping with the principles of professional regulation endorsed by the International Council of Nurses. The College of Nurses of Ontario regulates both RNs and RPNs in contrast to the other provinces and territories where RNs and LPNs are regulated by separate bodies. In the western provinces, psychiatric nurses are governed by distinct legislation.
All registered nurses and nurse practitioners in the province of Alberta are expected to maintain their clinical competence in order receive an annual practice permit from the College and Association of Registered Nurses of Alberta which also sets standards for scope of practice and provides practice support.
The role that nurses have played in the development of Canada has been recognized through the designation of seven National Historic Sites of Canada related to nursing. Five nurses' residences (the Ann Baillie Building, Begbie Hall, the Hersey Pavilion, the Pavillon Mailloux and the St. Boniface Hospital Nurses' Residence) were designated in commemoration of the growing professionalism of nursing and of the expanded role of nurses in health care over the course of the 20th century. The La Corne Nursing Station and the Wilberforce Red Cross Outpost were designated, in part, in honour of the role played by nurses in delivering health care to isolated areas.
- History of nursing
- History of Nursing in the United Kingdom
- History of nursing in the United States
- Nursing in the United States
- Alison Prentice, Canadian Women: A History (1988).
- C. Lesley Biggs, "The Case of the Missing Midwives: A History of Midwifery in Ontario from 1795-1900," Ontario History, (1983) 75#1 pp 21-35
- Jo Oppenheimer, "Childbirth in Ontario: The Transition from Home to Hospital in the Early Twentieth Century," Ontario History, (1983) 75#1 pp 36-60
- Anne Woywitka, "Pioneers In Sickness and in Health." Alberta History 2001 49(1): 16-20.
- Sharon Richardson, "Women's Enterprise: Establishing The Lethbridge Nursing Mission, 1909-1919." Nursing History Review 1997 5: 105-130. 1062-8061
- Sharon Richardson, "Political Women, Professional Nurses, and the Creation of Alberta's District Nursing Service, 1919-1925." Nursing History Review 1998 6: 25-50. 1062-8061
- Sharon Richardson, "Frontier Health Care: Alberta's District and Municipal Nursing Services, 1919 to 1976." Alberta History 1998 46(1): 2-9.
- Cynthia Toman, "Front Lines and Frontiers: War as Legitimate Work for Nurses, 1939-1945," Social History / Histoire Sociale (2007) 40#79 pp 45-74.
- Cynthia Toman, An Officer and a Lady: Canadian Military Nursing and the Second World War (2007)
- Ann Baillie Building National Historic Site of Canada. Canadian Register of Historic Places. Retrieved 30 October 2011.
- Begbie Hall National Historic Site of Canada. Canadian Register of Historic Places. Retrieved 30 October 2011.
- Hersey Pavilion National Historic Site of Canada. Canadian Register of Historic Places. Retrieved 30 October 2011.
- Pavillon Mailloux National Historic Site of Canada. Canadian Register of Historic Places. Retrieved 30 October 2011.
- St. Boniface Hospital Nurses' Residence National Historic Site of Canada. Canadian Register of Historic Places. Retrieved 30 October 2011.
- La Corne Nursing Station National Historic Site of Canada. Canadian Register of Historic Places. Retrieved 30 October 2011.
- Wilberforce Red Cross Outpost National Historic Site of Canada. Canadian Register of Historic Places. Retrieved 30 October 2011.
- Biggs, C. Lesley. "The Case of the Missing Midwives: A History of Midwifery in Ontario from 1795-1900," Ontario History, (1983) 75#1 pp 21-35
- Coburn, David. "The development of Canadian nursing: Professionalization and proletarianization." International Journal of Health Services (1988) 18#3 pp: 437-456.
- Gibbon, John Murray, and Mary S. Mathewson. Three centuries of Canadian nursing (Macmillan Co. of Canada, 1947)
- Lancaster, J., H. Jessup-Falcioni, and G. Viverais-Dresler. Community health nursing in Canada. (Elsevier Canada, 2011)
- McIntyre, Marjorie, and Carol McDonald, eds. Realities of Canadian nursing (Lippincott Williams & Wilkins, 2013)
- McPherson, Kathryn M. Bedside matters: The transformation of Canadian nursing, 1900-1990 (University of Toronto Press, 2003)
- Oppenheimer, Jo. "Childbirth in Ontario: The Transition from Home to Hospital in the Early Twentieth Century," Ontario History, (1983) 75#1 pp 36-60
- Richardson, Sharon. "Women's Enterprise: Establishing The Lethbridge Nursing Mission, 1909-1919." Nursing History Review (1997) 5: 105-130. 1062-8061
- Richardson, Sharon. "Political Women, Professional Nurses, and the Creation of Alberta's District Nursing Service, 1919-1925." Nursing History Review (1998) 6: 25-50. 1062-8061
- Richardson, Sharon. "Frontier Health Care: Alberta's District and Municipal Nursing Services, 1919 to 1976." Alberta History (1998) 46#1 pp: 2-9.
- Tipliski, Veryl Margaret. "Parting at the crossroads: the emergence of education for psychiatric nursing in three Canadian provinces, 1909-1955." Canadian Bulletin of Medical History/Bulletin canadien d'histoire de la médecine (2004) 21#1 pp: 253-279.
- Toman, Cynthia. "Front Lines and Frontiers: War as Legitimate Work for Nurses, 1939-1945," Social History / Histoire Sociale (2007) 40#79 pp 45-74.
- Toman, Cynthia. An Officer and a Lady: Canadian Military Nursing and the Second World War (2007)
- Woywitka, Anne. "Pioneers In Sickness and in Health." Alberta History 2001 49(1): 16-20.
- CIHI Regulated Nursing Professions Database - provides supply and distribution statistics for the three nursing professions in Canada.
- Canadian Nurses Association
- Registered Nurses Association of Ontario
- Canadian Federation of Nurses Unions