The patients cry "Oh Nurse!"emdash;and there is no nurse. Why ? Here’s the revealing story of a sick profession
RIGHT NOW Canada is going through the most critical nursing shortage in her history. That’s no news to the overworked nurses themselves, or to the hospitals that are shipping convalescents home days before their time so that they can look after more serious cases. But if you’ve ever lain in hospital and banged the nurses’ bell in vain, or if you’ve scurried around trying to find a trained nurse to take care of a sick person in your home, this shortage has been driven home to you in a concrete and terrifying way.
What’s wrong with the nursing situation in Canada, anyway? Here we are with more registered nurses than ever before—33,000 today compared to 20,000 in 1938—yet many who are desperately ill are going without proper attention and hospitals are forced to turn patients away.
^be Toronto Central Nurses Registry is a booking agency for 1,200 private duty nurses. Between May and December last year 17,272 persons phoned the registry to engage private nurses. For 4,751 of them the answer was no; all the nurses were busy. It wasn’t always this. way.
Between 1932 and 1936 the registrar often had as many as 500 unwanted nurses awaiting calls. The situation is just about the same in every large city in the country.
In rural areas it’s much worse. Small hospitals are finding it practically impossible to hold their staffs and since there aré no registries in the country, nurses available for private duty are difficult to locate. Long before the situation got as bad as it is now, the Canadian Nurses Association made a survey that revealed that 90%, of the trained nurses in Canada were conveniently ava'lable to only 46%, of the population.
The shortage also varies greatly according to provinces. British Columbia has one nurse for every 234 persons, while in Saskatchewan there is one nurse for every 579. For all Canada there is one nurse for every 350 persons, which is remarkably
high and better than the U. S. figure of one for every 400.
ALTHOUGH the public suffers from the shortage, the nurses themselves are also hard hit. Here’s an hour from the life of a nurse in the maternity ward of a large city hospital, told in her own words:
“I tried for an hour to get back to a young mother with an ice bag. During that time I took several telephone calls, a doctor detained me for some minutes, and the case room, where I was obliged to give the anaesthetic, was continually busy. Besides this, I helped carry out to their mothers and back again a score of babies—each one separately—in addition to warming and nippling their complementary formulae. Twenty minutes before going off duty I still had two dozen glasses to wash and put away, the feeding bottles to scrub and boil, a aressing tray to reset and another treatment to give. No matter how hard you try you can’t catch up with the work. And I’m wondering what my patients think of me for giving that kind of lick-and-promise care.”
The hospital situation has been aggravated by the recent income tax rulings which lowered the exemption for married women to $250. About a quarter of Canadian nurses are married. The Canadian Hospital Council’s official publication was flooded with letters of protest and it was predicted that unless the ruling were altered so many nurses would quit that whole wards in many hospitals would have to be closed.
In spite of this overwork the shortage is not caused by girls keeping away from the nursing schools. According to the Canadian Nurses Association, between 1939 and 1945 the number of student nurses in Canada increased 44%,.
What’s the reason for the shortage? There is actually no one cause, but a combination of causes which arose before the war, were aggravated by it and remain at least equally serious today.
Even when nurses were out of work there still weren’t enough to care for the sick who needed them. According to a CNA survey, during the thirties only 38%, of persons who had to have the care of trained nurses could afford them. Now that people can afford nursing care they can’t get it.
More people go to hospitals these days too. The numerous hospital prepayment plans are causing many who once might have been treated at home to go into hospital. Doctors are busier than ever; they like to get their patients into hospitals where they’re handy. There is a larger proportion of old people now than ever before and older people need more hospital care. At the same time there has been a temporary jump in the birth rate and maternity cases want hospitalization. As a result, hospitals across the country are carrying out expansion plans and many new hospitals are being built.
Some 4,000 Canadian nurses joined the armed forces. Many of these married while in the services, others are staying on to look after the wounded in DVA hospitals, and many of those discharged have transferred to more lucrative lines of work.
Positions open to nurses, such as doctors’ secretaries, airline and steamship hostesses, first aid attendants in large factories and plants, laboratory workers, physiotherapists and other skilled technicians of various kinds, are taking more and more nurses away from the bedsides.
But it seems that. there is a great deal more wrong with the nursing situation than just the shortage.
The nurses themselves, long noted for their stoical endurance and patience, are now speaking out in a soft but Continued on page 48
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compelling voice. To put it bluntly, they want more pay and shorter hours.
Nurses say they’d never strike to enforce their demands, but just the same, 33 of them at Belleville, Ont., resigned in a body last September and refused to go back to the wards of the Women’s Christian Association Hospital unless the board granted them an eight-hour day and an increase from $105 per month to $135. Nurses are quick to point out that this was not a “strike”—these nurses gave the regular required two weeks notice.
Many of the older nurses are pretty sticky when it comes to professional ethics. Commenting on the Belleville walkout, an official of the Registered Nurses Association of Ontario said, “I blushed for them. It was not a professional way of doing things.”
When the General Central Registry of Graduate Nurses in Toronto decided to raise its fees by one dollar a day, making them $7 for an eight-hour day, $8 for a 10-hour day and $9 for a 12hour day, there was much opposition from the nurses themselves. One of the dissenters explained her opposition this way: “Suppose a person is criti-
cally ill and needs a nurse all the time. That is $21 a day just for nursing service, not counting the doctor, hospital, and all the rest of it. Not very many people can afford that.” When it was pointed out that painters in the same district, some of them with no training, were drawing in $1.25 per hour, she countered with, “Yes, but you can let your painting go if you want to, but when you’ve got a critically ill child you’ve got to have a nurse.”
About 30% of all graduate nurses are now engaged in private duty work. The income tax department estimated their yearly earnings in Toronto at $1,500. The average rate for the Dominion is about, one dollar a day less than in Toronto.
The Pay Impasse
Pay for graduate nurses in hospitals is not good. DVA hospitals pay the best—from $1,380 to $1,740 a year without maintenance—but these nurses must be highly qualified and do teaching and administration work. In most other hospitals the pay ranges from $850 to $1,140 plus maintenance.
Hospital authorities maintain they’re paying every cent they can and that they are just as sorry about the situation as the nurses. They point out that maintenance costs have increased as much as 30%. and that the only way to raise more money would be to increase rates that have already gone as high as they can go.
Although some hospitals are attempting to establish the eight-hour day, most nurses still work longer hours. And as one nurse pointed out, “Eight-hour day or no, you just can’t walk out and leave patients who need care.” During the war and since, the nurses’ duties have been stretched both ways. Because maids are scarce, they do maid’s work; because there aren’t enough doctors they often have to
perform tasks that rightfully belong to medical men.
So far we’ve been discussing graduate nurses. What about their training?
According to both students and educators, it’s perhaps the worst feature of the whole nursing situation. Students say the three-year training program is too tough. Teachers say that students have to do so much hospital duty that their education suffers.
Work Their Way Through
By far the greatest number of Canadian nurses are trained in 169 hospital schools across the country which are financed, controlled and maintained by hospital boards. Some of the schools supply the students with uniforms and books but in others they provide their own. Hospitals in Prince Edward Island, Saskatchewan, Alberta and British Columbia give students a small monthly allowance (average $6), but most of this goes to pay for books.
After the first four months the students get practical experience in the hospital wards as well as lectures and classas. The biggest complaint from student nurses is that they are called upon to do too much of the hospital work, including a lot that has nothing to do with learning to be a nurse. Some claim that they are being exploited as free labor.
There is no doubt that they work long hours. A survey made last January in Ontario hospitals (over one third of all those in the Dominion) revealed that in one half of the schools students were putting in from 56 to 60 hours of duty per week. Only one school had the eight-hour day.
A student from a hospital on the prairies had this to say: “In our hospital we had a 10-hour day but often when it was busy we worked without hours off during the day or stayed on duty until eight or nine at night. Or if an emergency should come in just as you are supposed to go off duty and another nurse is needed, well, you just forget what you had planned for your one afternoon off a week.”
That nurses’ training is no bed of gauze is shown by a recent health check. The rate for active pulmonary tuberculosis among nurses in training is 3.8 per 1,000, considerably above that of all girls in the same age group. Nurses also suffer excessively from colds and flu, according to one teacher, and their mental health suffers due to a narrowing of interests. In practically all schools nurses are required to make up after graduation any time lost through illness.
Anyone who has known a nurse in training knows something about the semimilitary discipline to which they are subjected. As one nurse said, “The pro by (students are on probation for the first four months) is the smallest, meanest thing in the hospital. She is required to stand up when any nurse or doctor enters the room where she is working or studying.” Then she added, “Of course strict discipline is necessary in a hospital as a slip may mean a patient’s life, but sometimes discipline can be overdone.”
Another student told of how, after being senior night nurse with only two
junior assistants on a floor with 40 patients, and after getting off duty at 9 a.m. instead of 7, she was recalled from her bed, had to get back into uniform and go back to the hospital because the supervisor had found some rubber sheets hanging on a rack in not just exactly the manner she wanted them.
No Time for Fun
For the three years she is in training the student nurse practically hibernates so far as social life is concerned. Three nights a week are compulsory study nights, on tliree others she must be in by 10 o’clock. On one big night each week she can stay out till 11, but she’s usually too tired to enjoy it.
Well, you say, maybe the students are overworked, but look at the good training they get. But is it such good training? Listen to Miss E. K. Russell, Director of the University of Toronto School of Nursing and one of the foremost authorities on nurse training on the continent:
“Our present methods of training are not giving a fair deal to nurses or patients . . . Our procedure for hospital nursing service and for nursing education is ill-organized, uneconomical and wasteful; it is outdated and outmoded.
“Many hospitals are trying to limp along by having their patients nursed by students; students service the public wards of some hospitals entirely. Result: endless confusion and dissatisfaction from patients; and confused, and therefore wasteful use of the students’ time and administrative confusion in the constant effort to patch up a thoroughly unsound working situation.”
Miss N. W. Fidler, president of the Registered Nurses Association of Ontario, is equally blunt. The trouble, she says, is that training schools and hospitals are too closely connected.
“The nursing school in almost all instances has been created as a moneysaving device, whereas a good school must, in its nature, cost money,” says Miss Fidler. Too often, she adds, direction of training and direction of nursing service are lumped together under the same individual, who is chosen not for her educational ability but for her competence as head nurse. “In many cases,” adds Miss Fidler, “interest in and knowledge of education is considered a negative qualification, as it is feared that this will detract from the efficiency of the (nursing) service.’
Both Miss Russell and Miss Fidler feel that the present training methods are contributing to the shortage of nurses, not by keeping prospects out of the schools, but by making nurses so disgusted with hospitals that they are unwilling to continue working in them.
Neither nurses nor educators are inclined to blame the hospitals. They give the hospitals credit for having established the first training schools and for having trained the bulk of Canadian nurses. But they definitely do feel that the time has come for some far-reaching changes.
The nursing profession has some very definite ideas about these changes. Here, in brief, is the program of the Canadian Nurses Association:
Nursing schools financially and administratively independent of the hospitals to which they are attached;
Adequate teaching staffs;
The schools, and not the hospitals, to decide how much hospital experience the students should have;
The hospitals should pay the schools for the services of the student nurses;
Cutting the training period to two years, since only about two thirds of the time in present courses is used to learn and practice nursing.
All this would cost money. Where’s it to come from? The sick are now being charged to the limit, and endowments are few and uncertain. The answer, according to the CNA, must be bigger Government grants.
The Canadian Red Cross thinks enough of the CNA’s ideas for independent schools to allow them a grant of $160,000 to test out the idea.
Nurses’ Aids Can Help
There is also a move afoot for the “grading” of the three classes of nurses that now exist.
The first of these classes is the highly skilled registered nurse. Then there are all the unregistered, more-or-lesstrained war aids, nurses’ aids, practical nurses, subsidiary nurses and so on.
These nursing assistants, who can be turned out much more quickly than graduate nurses, can go a long way toward relieving the pressure in hospitals, sanatoriums and homes.
The third class of nurses is the relatively small group who take postgraduate work or all their training in one of the six university schools of nursing scattered across the country which give degrees in nursing. Most of the graduates from these university schools go into teaching, public health or administration.
The nursing profession is also gunning for more control over training, standards and registration. Each province has its own nursing act which provides for the registration of graduate nurses and which prevents anyone who is not a graduate nurse from posing as one. But these acts do not prevent anyone, regardless of qualifications, from carrying on nurses’ duties.
The nurses struggling for these reforms know they’ll have to win wide public support to get anywhere. After all, they feel, the public are the “customers” who have the greatest stake in the problem. They’ll foot the bill either way—in increased cost for better nursing or in suffering because of inadequate nursing.
And, the profession hopes, when it has won its points no one will be able to describe nursing, even jokingly, as one young graduate did:
“A nurse is a marvellous compound of science and nature. She is registered like a Holstein cow, starched like a full-dress shirt, and salaried like a farm hand.” ★