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Hospital 125th: Nursing – the evolution of the profession

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23/11/2018
Nursing is hard work and certainly a vocation for the very dedicated.

 
And it has become more complex as medicine has evolved - there is simply more to learn.
Nurses used to train on the job and Palmerston North Hospital was in the vanguard of nurse training until that role passed to technical institutes and universities from the 1980s.
 

Early days

 
When the hospital opened in 1893, nursing staff comprised the Matron Ellen Dougherty and nurses Eleanor Tasker and Agnes Kerr. Tasker and Kerr worked 12 hours on end, and when necessary three or four more hours. Shifts began at 6am or 6pm.
 


The hospital's first Matron and 'nursing instructor' Ellen Dougherty was registered as a pharmacist in New Zealand on 11 December 1899. She was previously a dispensing chemist in Palmerston North from November 1893 to 1 January 1899. She was just one of 14 female pharmacists at the time.

 
Their duties included sweeping, mopping and dusting the wards. There was no electricity and as darkness fell the nurse on duty could be seen going over to the hospital with a long pole with a taper at the top, lighting the gas above.
 
Uniforms were heavy navy serge right down to black shoes, with high stiffened collars, white aprons buttoning on to ‘baby bodices’, stiff turned-back white cuffs, and a high white cap frilled around the front.
Later this uniform gave place to one of blue and white striped galatea.
As the hospital grew, the Palmerston North School of Nursing was set up at the hospital in 1895 to meet the need for qualified nurses. Like other hospitals around the country, nurses received instruction from the matron and medical superintendent.  Eleanor Tasker was the first nursing graduate of Palmerston North Hospital.
 
Following the Nurses’ Registration Act in 1901, nurses from Palmerston North had to travel to the larger hospital at Whanganui to sit state examinations.
 
In 1906, there were 11 nursing staff at the hospital and by 1913, seven nurses had graduated from the training programme, including the first Māori nurse, Erena Mere Taare.
 


Palmerston North Hospital's first Māori nurse Erena Mere Taare.

 
Two of the 50 nurses who left in 1915 to serve in the war were Palmerston North-trained – Ina Bennett and Mabel Crook.  In total, 12 Palmerston North Hospital-trained nurses served in the war and one of them, Mabel Jamieson, lost her life when the ship Marquette was sunk in the Aegean.
 
Matrons and their assistants continued to train nurses until 1934 when the first full-time tutor, Lillian Banks, was appointed.
 

The first school of nursing

 
Matron Banks was instrumental in getting a building erected dedicated to a school of nursing.
In 1934, she organised the first Preliminary Training School, which was for three weeks’ duration with nurses spending two days of each week, including Sunday, in the wards. In the first year there were two nurse intakes with a total of 18 students in all.
 
In both the state examinations in 1935, nurses from Palmerston North were ‘Top of Dominion’ – Nurse Lawson in May and Nurse Toms in November.
Banks was appointed Matron in 1937 and by then four groups of students were entering the preliminary training school each year. The course duration extended to four weeks and a second tutor was appointed.
 
By the 1940s nurses were being paid for attending some classes as study days and block systems were developing throughout the country. Nurses continued to attend some lectures in their own time for many years.  For example, it was not unusual for nurses to do morning duty at Awapuni Hospital, cycle to the main hospital in time to attend a lecture at 4pm, then cycle back to Awapuni.
 
In 1942, the Tutorial Block was erected to meet the need for trainee nurse space.  It was the first of its kind in the country, that is, a building separated physically from the hospital and the nurses’ home, and designed specifically as a school of nursing.
 
In 1954, an extra classroom, office, the hall and a large cooking room were added, which was equipped as a demonstration kitchen. Practical cooking sessions were part of the curriculum but these were dropped in 1957.
 
At this time, matrons began to play a part in working at a national level for betterment of employment conditions for nurses.
 


The nurses home in 1950.

 
Programmes offered by the School of Nursing included General Nursing, from the 1930s. This programme was for three-and-a-half years and was open to young women only. It did not include maternity nursing and there was a pre-requisite of two years’ secondary education. The emphasis was on medicine and surgery.
 
This format continued until 1957 when the ‘new curriculum’ was introduced. Changes were: the extension of the preliminary training period to 12 weeks; inclusion of maternity training in a three-year programme; introduction of psychology and social sciences; increase in the community health component; and a change from the medical/surgical model to one based on body systems.
 
Further modifications were made in 1969 and 1979. Concepts of mental health and psychiatric nursing were introduced in 1969 and later there was more material from the social sciences.  By now males and females were undertaking the same general-obstetric nursing programme.
The last group to take this programme entered in 1983.
 

Maternity nursing

 
A separate programme in maternity nursing had started back in 1926. It was six months long and undertaken by young women who were already registered as general nurses.  By the 1950s about 20 nurses undertook this programme every six months.  This continued until 1961 when ‘new curriculum’ students registered as general and maternity nurses.  The six-month maternity programme continued until 1977.
Back in 1948 an 18-month maternity nursing programme had been arranged for young women who had no previous formal nursing education. Some nurses, however, had completed it at the Board’s Ōtaki Maternity Hospital before that date.
 
The programme was phased out by 1970 with the introduction of Community Nursing, which included maternity nursing.
 

Male nurses

 
Small classes for male nurses commenced at Awapuni Hospital from 1948 to 1950. It was then discontinued and it was not until 1967 that male students were again accepted at the Palmerston North Hospital School of Nursing.  Men followed a three-year programme and in 1969 they undertook the theoretical section of the maternity nursing project, as offered to female students. In 1979 they undertook the practical aspect as well. By this time men and women followed exactly the same programmes and men were no longer registered as ‘male nurses’.
 

Community Nursing

 
When the Community Nursing programme was established in 1965 the School of Nursing accepted 10 students and continued to take in two classes a year. It was reduced from 18 months to 12 months in 1980 and at that time the name was changed to Enrolled Nursing.
There were over 80 students by 1982 and then numbers reduced from 1983.
With the transfer in 1972 of the control of psychiatric and psychopaedic hospitals from the Department of Health to local hospital boards, the psychopaedic nurse training school already established at Kimberley Hospital in Levin came under the control of the Palmerston North Hospital School of Nursing.
 

In-hospital training phased out

 
The Palmerston North Hospital School of Nursing survived for nearly 100 years, by which time nursing education was well established in the general education system in New Zealand.
The peak of student numbers was from 1974-1977 when there were over 770 nurses in training. Usually there were over 300 general nurses and more than 100 community and maternity nurses undertaking programmes at any one time.
 
In 1980, a Department of Nursing and Health Studies was established within the Palmerston North Technical Institute and the need for local hospital-trained general nurses rapidly diminished. The first students from the Palmerston North Technical Institute qualified as Comprehensive Nurses in 1982 and a final intake of 34 student general nurses was accepted at the Palmerston North Hospital School of Nursing in 1983.
 
By the end of hospital training 2559 nurses had been trained since 1902.
 


Matron Ellen Dougherty and staff.

 
Jane Dransfield, who worked at the hospital initially as a charge nurse in obstetrics and then as Nurse Advisor from 1990 to 1998 says: “Palmerston North Hospital was one of the last to close down the enrolled nursing scheme – nurses from this programme had shorter training and lower entry requirements. Back in the 70s they had 18 months training, this was then reduced to a year, then phased out.
“So back in the 1970s there were four nursing models – psychiatric; psychopaedic, which catered for people with intellectual disabilities; general, which included obstetric; and midwifery, which was open to registered nurses only.
 
 “It was determined that we needed a fully professional workforce and that that the ‘apprenticeship model’ should be dropped and replaced with an education-based comprehensive nurse programme.
 
 “It was as early as 1972 that the polytechnic in Wellington starting teaching comprehensive nursing. Over the next 10 or so years comprehensive nursing was taught in polytechs and later in universities as well. But midwives were still doing St Helen’s hospital-based training. A separate three-year degree for a midwifery qualification started in selected polytechnics in the 1980s.
 
Those nurses who fought for a separate qualification in midwifery later ended up starting the College of Midwives.
 
Jane was a registered nurse with psychiatric training and was one of the first general nurses to qualify in this area.  “I trained at Porirua where there were about 2000 patients.  After that I did midwifery training for a year, worked for over 20 years at Hutt Hospital, then went to Palmerston North Hospital as a midwife. 
 
“There was a lot of restructuring and little job security in 80s and 90s, as the Government tried various health models for best effectiveness and so there was a lot of disruption to careers with various small, regional hospitals being closed down.”
 
Helen Gilmour-Jones, who taught nursing at Palmerston North Hospital School of Nursing and then at UCOL in the 1980s, says: “Polytech education took a different perspective from hospital-based training.  There were advances in nursing practice and technology to keep up with, more focus on biology and biochemistry, and more time in class building theoretical knowledge in all areas of nursing, in order to became more reflective practitioners.
 
“There were 48 in the first polytech class and this doubled every two years until an intake of 128 each year was reached.
 
“At one time as nursing education evolved you had three different lots of students on the job: polytech nurses were working alongside enrolled nurse students and hospital apprentice nurses.
 
“These changes in nursing education were quite challenging, as many staff, and patients, couldn’t understand the need for change. Some nurses thought it reflected on their qualification, when in fact they were highly skilled and competent. The difference was that rather than being part of the workforce while training, students from the polytechnic would be supervised by already qualified nurses, who in the beginning were all hospital-trained anyway.
 
“Currently UCOL has over 150 students entering nursing in Palmerston North each year.
 
“We still do not have a lot of male nurses in New Zealand. Thirty years ago there was a lot of resistance towards them, particularly from male patients. I believe this has changed and the workforce is a lot more diverse now.”
 
Both women say that despite all the changes and pressure of the job, there remains a lot of collegiality and humour among nurses. “The culture is such that nurses will share – they are good peer reviewers and open to running things past their colleagues.”
 
In this way there is still a lot of learning and sharing of ideas on the job.
Celina Eves, MidCentral’s Director of Nursing and Midwifery, says the nursing workforce of today makes up almost half of the DHB’s entire staff.
 
“Our nurses are passionate, caring and incredibly hard-working. We have many nurses in senior positions who trained here at Palmerston North Hospital and have moved up to bigger and better things. We are immensely proud of our amazing nurses and the work they continue to do every day.”
 
- Written by Paula McCool

 

Read more about the Palmerston North Hospital's 125th Anniversary here. 

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