Nursing through the years
From working like domestic servants to challenges today, nurses ‘generally triumph’
Nurses today are dealing with “limited resources and challenges
The mention of Florence Nightingale at the top of an interview about the history of nursing in Canada doesn’t seem to surprise Helen Vandenberg.
Vandenberg, a registered nurse and associate professor at the University of Saskatchewan, explains that while she specializes in Western Canadian history, which has its own nursing stories and which was settled later than the East, “We can say that nursing started in the 1600s in this country. Interestingly, it has three influences: French Canadian Catholic practices which were pre-nightingale, British which was Nightingale, and American which has its own history.
“We’ve had multiple influences, and there are regional differences.”
Vandenberg explains that it’s common for many to consider Nightingale the “mother of modern nursing.
“What a lot of people don’t realize is that in her time, hospitals were like poor houses, and nurses were like domestic servants,” Vandenberg explains. “Patients were directly on top of open sewers, nothing was ever laundered and there was zero sense of cleanliness.
“Nightingale — because this was not a period of educated women — had to prove to the powers that, through her mechanisms of cleanliness and order and fresh air, not to mention her abilities as a master statistician, that by doing these things, the mortality rate would plummet.
“And it did.”
Nightingale’s efforts coincided with the birth of the printing press. The changes she implemented after returning from the Crimean War would be told far and wide, thanks to journalists and their reports of her successes.
“The lady with the lamp” was a compassionate medical professional who treated humans as humans and not as mere bodies. Nightingale would become famed and beloved, supported in the opening of St. Thomas, the first nursing school that would train nurses in the Nightingale way.
“That was the dawn of professional nursing,” explains Vandenberg. “And because she was politically astute, and well-known to some of the politicians of the time, she gained favour with them. Her methods would reach the colonies and would be picked up by various countries, modified, of course, depending on where you were.”
Prior to Nightingale, the physical image of the nurse as many of us seem to know it was vastly different too, says Vandenberg.
“Nursing has a very gendered history,” she says, explaining that before Nightingale’s era, 50 per cent of nurses were men. Uniforms, contrary to popular belief, were not white, but rather solid blue, with white aprons and caps. Eventually, uniforms evolved to include checkered styles, or variations of pink and white or brown and white. Nursing uniforms took influence from the military, and as nurses rose up the ranks, their uniforms would change.
“There was also this image of the poor looking after the poor,” says Vandenberg. “Dickens talks about a nurse who was drunk and slovenly. It was really around character, rather than about professionalism and credibility. And that’s likely because early nursing was just about working as a labourer, learning from those ahead of you, but in no formal or academic way. In fact, many historians have characterized early nursing as cheap labour, so that hospital costs could be kept low.”
The impression of women and women’s work, Vandenberg says, was poor — there was a general belief that women didn’t deserve an education, and although medical professionals were appreciated for their education, nurses were not respected in the same way.
Today, nursing school standards are considered some of the most challenging in the world; nurses have worked diligently through the years to earn the respect, appreciation and wages deserved. In the 1930s, nurses looked for reforms and to ensure industry standards, registering nurses and guaranteeing specific benchmarks and criteria in their education. Before this reform, Vandenberg estimates, some 20 per cent of nursing instructors did not even have a high school diploma.
“Behind the scenes, these women were not being treated very well. Nursing was part of (the) religious orders, so there might have been a sense of sacrifice,” says Vandenberg.
“And while they were elevated to some degree, cast as angels or heroes, the women were saying, ‘We don’t want that. We want a decent wage and an education.’”
Since Nightingale’s day, Vandenberg admits much has changed for the better — but there’s still a long way to go.
“There are a lot of ideological things going on that need to be reassessed,” she says, “including the national health policy, which hasn’t
- Helen Vandenberg R.N.
been touched since 1984. We’re creating a lot more student nurses, but we’re also being squeezed beyond capacity.
“We’re not alchemists; quality can’t be created out of thin air. When hospitals were established, they were created in the image of a factory for the production of health, and unfortunately, our nurses — especially through the pandemic — are seeing the effects of similar limited resources and challenges.”
Despite such trials for today’s nurses, Vandenberg is hopeful.
“I think one of the things that stays pretty firm throughout history is that nurses do contribute to the quality and excellence of health care in forms people wouldn’t think,” she says. “Like many of the early hospitals built by French Canadian nuns, they quietly deal with what they’re given and generally triumph.
“At times we think we live in an uncaring world, but how do nurses think? They think about the things they can change. What they can do. How they can help.”