An art, science and devotion: Hamilton nurses past, present and future
National Nursing Week marks the 200th anniversary of Florence Nightingale’s birth
“Her efforts were proportioned to the greatness of the occasion.”
An obituary in a London newspaper eulogized Florence
Nightingale, a pioneer of modern nursing who trained and managed nurses treating British soldiers during the Crimean War.
It was in cramped, rat-infested wards in Turkey in 1854 that she tended to the wounded in the dark of night, inspiring the iconic image of her as “the lady with the lamp.”
The 200th anniversary of Nightingale’s birth is being marked for National Nursing Week, May 11 to 17. She was born May 12, 1820.
Consider that decidedly British phrase again: Efforts proportioned to the greatness of the occasion.
Nursing has evolved dramat
ically since the 19th century, but in this sense it has not changed: the occasion — helping to save the lives of patients, or easing their journey toward death — remains great.
So do the efforts, which have never received more attention than during the COVID-19 pandemic, along with the risks that go with the job.
“The pandemic has brought the nurse to the world, in a way,” says Sandra Carroll, the vice-dean and director of McMaster University’s school of nursing.
“It has given nurses more visibility to those who didn’t think of them day in and day out; that this is how it is, and you never know what you’re going to get in this profession.”
Carroll knows first-hand what that’s like.
She worked as a nurse in the 1980s during the early days of the AIDS epidemic, when there was mystery over why patients were dying, and how the virus that caused the disease was contracted.
“It was a traumatic time, going to work in acute care, having your finger poked with a needle, or a patient bleeding on you, and not knowing if you would get sick,” she says. “But you still went in, honoured your commitment, and tried to be safe in your practice. And from all that we ended up with universal precautions in patient care.”
Nursing in settings such as long-term care and public health has been elevated in the public eye, through the sickness and death during COVID-19. But nursing in the public imagination has long been shaped by media, with the focus on acute care in hospitals or in war zones.
One such wartime nurse is memorialized on a plaque in Hamilton General Hospital: Mae Bell Sampson.
In 1910 she trained and worked at the General, at a time when nursing duties included hauling buckets of coal. Early in the First World War, she was the first nurse in Hamilton to enlist.
She cared for wounded soldiers on the front lines in France and Greece, sometimes logging 36-hour shifts. She was working aboard a hospital ship off the coast of Ireland on June 27, 1918, when it was sunk by a German submarine, killing 258 people, including Sampson.
The plaque in the General says she made “the supreme sacrifice.” And: “Her soul liveth.”
Nursing’s roots in Canada go back to the 17th century, when nurse Jeanne Mance founded the first hospital in New France: the Hôtel-Dieu in Montreal.
Carroll says nursing originally grew out of social norms when women were not permitted to work outside the home, unless they were helping care for the poor or sick.
Today the profession is diverse, with nurses wielding increasing authority in patient care.
Nurse practitioners (NPs) — as distinct from registered nurses, or RNs — can diagnose patients and order narcotics and tests. In 2012, Ontario became the first province to allow NPs to admit and discharge patients from hospital.
NPs were introduced in Canada in the early 1960s, and today there are more than 3,300 in hospitals, clinics, and longterm care facilities.
McMaster’s school of nursing offers eight degree programs, with about 1,800 students enrolled. It graduates more than 500 students each year, is ranked second among nursing schools in Canada by the QS World University Rankings, and 16th globally.
One of the school’s graduating traditions is a pinning ceremony led by students on the same day as convocation.
Like similar pinning ceremonies around the world, it is inspired by one that was held in the 1860s. That was when Nightingale presented medals to nursing graduates, after she was awarded the Red Cross of St. George for her work in the Crimea.
The symbolism of the ritual invokes the historic connective tissue of nurses through the ages, and perhaps also that nursing has long been more than an occupation, but rather a calling. Carroll offers another word. “It is a devotion.”
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Stephanie Cox is used to the reaction, when she tells someone she works as a nurse practitioner in pediatric oncology.
Invariably the person has a pained expression on their face.
Cancer. Kids.
She hears it in their voice. “People find out where I work, and go: ‘ohh,’” says Cox. “They are like, ‘How do you deal with that?’ ”
After high school she left home in Burlington to attend the University of British Columbia for sciences, and after first year pursued nursing. Her first placement, by chance, was in cancer care for children in B.C.
Not only was she not scared off by the work, she discovered she loved it.
Pediatric oncology has been her entire nursing career, now going on 20 years, the last 15 at McMaster Children’s Hospital. She is not immune to the emotion surrounding tragic outcomes for some of their patients, and families going through the most heartwrenching experience of their lives.
“It’s not a bed of roses all the time, but there’s also a lot of joy here; a lot of successes and triumphs,” she says. “I love listening to the kids, their experiences and interests. It’s exposure to a lot of great people who are thriving under adversity.”
When they are not able to cure a patient, she says, their role is just as important, providing care for a child’s final days: caring for them physically, mentally, spiritually; buckets lists, legacies, wishes.
“It’s special to be part of that, supporting the kids, helping families through all that is involved. We walk that journey with them, even when it’s the end of life.”
But it is undeniably an intense place to work, she says. Healthcare teams in pediatric oncology are tight-knit, and it’s a good thing. Colleagues share experiences, lean on each other for support.
And the job also provides constant perspective on the randomness of life and death.
It’s the reason that the fear and tragedy surrounding COVID-19 is processed differently by those who work in pediatric oncology, Cox suggests.
“I work in a place where bad things happen to good people all the time, and we cope and adjust and try to roll with the punches. We learn what’s in your control and what’s not.”
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Growing up in Hamilton’s North End, Andrea McKnight knew she wanted to take sciences, perhaps biology, at university.
Her father, who worked at Dofasco, pushed nursing.
“He felt it would be a great job, and that helped me open my eyes to it,” she says.
She graduated from McMaster’s school of nursing, then got her masters nurse practitioner’s degree from U of T, and started working at Hamilton General in the emergency department 11 years ago. McKnight found she had a passion for providing care to vulnerable patients struggling with life in the lower city.
The experience led to her current position as a nurse practitioner at St. Joseph’s Healthcare in psychiatric care.
Patients admitted often have complicated or unknown medical histories, with “comorbidities” exacerbating their mental and physical illnesses — conditions the patients themselves may be unaware of, if they have never had a family doctor.
“It takes a bit of detective work to figure it out, and sometimes you have to start from scratch to figure out what’s happening,” she says. “Sometimes a patient will present with psychosis, and the diagnosis may be schizophrenia, but it can be medically complicated. Advocating for these patients takes a lot of work.”
The job does have its days. “Every nurse has those moments: ‘What am I doing here?’ But the best thing about working in nursing is knowing you have great colleagues to support you, who have your back when things get tough and you don’t know if you’ll make it through your shift. It’s been the lifeline for my nursing career.”
McKnight is the first nurse in her family, but not the last.
She paved the way for her three younger sisters: one is in nursing school and two are already working as nurses.
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When she gives her speech to the 2020 McMaster school of nursing graduating class, the speaker plans to talk of resilience in the face of hardship, and choosing boldly in their future journey:
“You did not become a nurse to play small.”
The speaker is part of that future: class valedictorian Kolina Tavares.
She will have to give the speech remotely because of COVID-19, but hopes to present it again in person, if given the chance in the fall.
It is a tough blow, being denied the honour of speaking to her classmates in person.
But then Tavares has shouldered tougher in her young life.
Growing up in Kitchener, her father died of colon cancer when she was 15, and her mother has had three liver transplants.
Tavares attended McMaster for science, then switched gears to study nursing through a joint Mohawk College-McMaster
registered practical nurse program.
But soon after she started, she was hit by a car as she rode her bike near campus. She had to leave the program and start all over again.
Once she returned, however, she did not play small.
She did a four-month work term last fall on the other side of the world, in a neonatal ward in Nepal.
“I had felt comfortable in my nursing skin, but in a global placement you’re not surrounded by cohorts, you deal with cultural differences so far from home, it forces you to hone in on what you’ve learned and rely on your independent skills,” says Tavares.
“And you see, from a global health perspective, how they deal with the pressures on the resources and technology available.”
When she returned home she worked in a placement with the healthy babies/healthy children program in the city’s public health department.
She hopes to land a job in public health in Hamilton, and one day work in global health, perhaps abroad.
Tavares is just 25, but it’s been a winding road to find her place.
In her teens, she attended an arts-focused high school to chase her dream of being a singer, and ideally become famous enough to raise money to help people like her father suffering from cancer.
But it was on the first day of class at nursing school at Mac, still uncertain after switching programs, that she discovered she was where she needed to be.
An instructor spoke of nursing as the bridge between healing and compassion; that nursing is both an art and a science.
“That was the moment,” she says. “I thought: I’ve found it.”