ORIGINALLY PUBLISHED | SEPTEMBER 1934 | THE FARMER
Women living in the rural parts of Canada are sometimes puzzled when they hear that there are many hundreds of graduate nurses in all provinces who can find no work. Puzzled because the woman of the small villages and the countryside knows her own needs and sees just what an abundance of work awaits the hand and skill of the trained nurse in every neighborhood. Puzzled, unless or until she begins to realize that on the one hand the average country dweller cannot afford to pay the prices asked by the hospital nurse, while, on the the other the trained nurse must have a living wage with permanent employment assured her if she is to practice her profession in rural sessions. Yet the problem as it exists is so big and so pressing, and so suicidal as to both would-be patient and would-be nurse that it ought not to be allowed to perpetuate itself any longer, for it concerns not alone the individual but touches vitally the greater aspects of public health.
So big indeed are the issues involved in it, or its satisfactory solution, that it caused in recent years the preparation and publication of an exhaustive 600-page report on “Nursing Education in Canada” by Dr. G. M. Weir, Minister of Education and Health in the British Columbia government, who was asked by the Canadian Nurses’ Association and the Canadian Medical Society to take a complete survey in all provinces, to record his findings and to make whatever recommendations he saw fit.
So big, too, that at the recent annual meeting of the former body, a very large part of the three days’ convention was taken up with papers devoted to it, followed by the most thorough discussion of all aspects of the question. So big that such discussions lead very directly and inevitably straight toward the even bigger problem now facing our people, as to how far and in what manner we are prepared to go with regard to socializing our medical, hospital and nursing services. The nursing problem in Canada as dealt with in the Weir Report may be stated simply enough, though neither its implications or solutions offer anything in the nature of simplicity.
In 25 of our cities, containing only one-third of our total population, two-thirds of our registered nurses are either employed or attempting to find employment. Of these--at the time the Report was issued and things have not materially altered to date--40 per cent of those in private duty field were without work continuously, while another 20 per cent had only intermittent jobs.
Throughout the country, it was shown by the Survey that a full 60 per cent of all ordinary illnesses in town or country were serviced, not by the graduate nurse, but by the practical nurse. This percentage covered city and country, but it is safe to say that if it had been for the rural districts alone the proportion would have been 90 per cent practical nurse and 10 for the trained expert.
It was shown, too, that only 3 out of 8 persons needing skilled nursing assistance can afford to pay for it if it means a private duty nurse. Shown, too, that even while unemployment penalizes so many, many hundreds of graduate nurses, numbers of Canadian hospitals, big and little, continue each year to graduate hundreds of others, while at the same time employing on their own staffs a comparatively small number of them, the bulk of the assistance being provided by the overworked, underpaid undergraduates who are part of the administrative machinery. On this point and on all of the aspects of education of the hospital nurse the Weir Report summarizes the results of its exhaustive research and suggests the pressing remedies indicated, but at the moment we are not so much concerned with these educational angles of the problem as with the query posed by Dr. Weir, “How can the gap between the needy patient and the needy nurse be bridged?” for this is the thing most concerning the general public.
The measures recommended are indeed of very particular interest to men, women and children in the rural districts, because it is there that the extension of the public health services proposed will prove of greatest usefulness and benefit. The cities already enjoy the advantages of hourly nursing systems, already possess the Victorian Order of Visiting Sisters, already are within easy reach of free clinics, of public or semi-private wards in hospitals and of municipal public health nurses in needy homes. But to a very large extent our rural areas in Canada remain in an exceedingly backward state as to health services. So it is of interest to note that the Weir Report comes out unreservedly for socialized nursing and medical services in these words: “It is indeed obvious, that in the light of the evidence presented throughout this Report, that the present imminent health situation in Canada demands a radical reorganization and control of our nursing services. The right type of nursing service should be made available to the needy patient. Economic obstacles separate [sic] the patient from the nurse should be removed and the gap bridged… Socialization of nursing services with adequate distribution of the financial burden through a form of state health insurance, is, in the judgement of the Survey, a most important factor in any successful attack on Canada’s major health problem.”
Another expression of a similar point of view was made very recently by His Honour the Lieutenant-Governor of Ontario, Dr. Herbert Bruce, when he said in addressing a graduating class of nurses in St. Catharines Hospital: “It is of significance that 90 per cent of the nurses in Canada are in a position geographically, to serve only 64 percent of the population and that only 3 out of 8 persons requiring the services of a nurse are financially able to employ her. I suggest that the federal and provincial departments of health should be given the authority to evolve and and operate a plan to correct the unfortunate breach between those who need such services and those who could supply them if the proper machinery were available.”
The expression used by Dr. Bruce, “should be given the authority” opens up an aspect of the whole problem which has not been sufficiently understood or emphasized, viz. That if we are to acquire centralized authority over public health at Ottawa and a national plan, there must come about a change in the British North America Act, under which the various provinces now possess control over their own educational and health policies.
Undoubtedly such an alteration or amendment to the Act as would permit of the necessary centralization of authority, followed by a national health plan for the whole Dominion, would be welcomed eagerly by all public health authorities or workers in Canada, including the nursing associations.
Evidences of the enthusiastic support likely to be forthcoming from the latter is seen in the forthright statements made by Miss Ruby Simpson, O.B.E., the very able Director of Nursing Services in the Saskatchewan Department of Public Health, when she was interviewed in Toronto after her recent election to the office of president of the Canadian Nurses’ Association.
“I believe in state health insurance,” said Miss Simpson, “and in centralized federal control of all health matters, with provincial sub-control of purely local problems. I believe that the public as well as the medical and nursing professions ought to be represented on this central body, and I believe than even if the North America Act needs amendment in order to establish federal control of our health policies, that no constitutional or other impediment should be placed in the way of the needed reforms.” Above everything else, Miss Simpson, who was honoured by the King for her distinguished social service work in the west, and who has an enviable record as a health worker, wants action. “Now is the time,” said she “to implement the surveys and studies we have made. We must have courage to experiment with new things, new ideas, new methods. This ought to be the keynote of the nursing profession in the future.”
As proof of the desire of the Nurses’ Association to try new things and to admit new ideas, a resolution passed at their June meeting shows an unmistakable trend toward a bigger, better grasp of health problems as these affect, not alone the nurse, but the general public.
Hitherto the reproach has been sometimes made (and occasionally deserved) against the nursing profession that social and national aspects of public health have been obscured in their discussions, by a too professionalized point of view. Now that day seems to have happily passed as the following resolution indicates:--
“The executive of the Canadian Nurses’ Association will approach provincial registered nurses’ associations and request that they will develop a central nursing bureau in place of the present registry, which will give a better nursing service to the public and will bring about a measure of direction to the subsidiary-nurse.”
Here at last we have recognition of the fact that the “practical” nurse who exists in her thousands in Canada and who--in rural parts of Canada particularly--has done excellent service, ought to be not only recognized, but registered at such proposed bureaux, and to a certain extent regulated as to the type of work assigned to her. The great weakness of the hospital trained graduate nurses’ associations in the past has been that while objecting to the continuance of “practical” nursing and nurses, they have never guaranteed that their own members would see to it that the field occupied by the practical nurse was adequately served at prices which the rural public could pay. But if the proposed provincial bureaux are established, we may look for the development of the system under which many useful and necessary types of “subsidiary” nurses, visiting housekeepers, or what not, may be graded and made available to the public in an organized, regulated way. A big step forward.
All that now seems lacking in order to bring to us in Canada centralized authority over health matters at Ottawa, state health insurance, with medical, nursing and hospital services made available to all of the people all of the time, with preventative medicine put into real operation through a national health plan, is the solid backing of an informed public opinion looking actively (and with votes) to these highly desirable objectives. What better work could be done by our rural women than to see that all of their members are so informed and will take active measures to further the cause of socialized medical, hospital and nursing services in all part of the Dominion?
Both medical and nursing professions are ready for the change; see it coming and are adjusting themselves to it because they note the approximations to state medicine already in operation in Alberta and Saskatchewan; in contract systems of medical practice, in our great research bureaux and the serum laboratories; in industrial medicine and above all in the thoroughgoing provincial system of socialized medical and nursing services now being planned in British Columbia. If the general public were alive to its own best interests and as ready for the change as the two professions most concerned, matters would move quickly; but as things are, the lethargy of the average voter may delay the coming of these so necessary socializations for many years.
By Anne Anderson Perry