HLTB03 Midterm Notes: Health, Illness, and Health Care in Canada
¾ One clear indication of the status of the nurses is expressed by the relative incomes of nurses and other health care
¾ Their incomes have increased steadily both in absolute terms and in comparison with the average income of the
¾ Of the three designated health occupational categories, nurses have made the greatest relative gains. However,
levels that are about one third of the average for physicians and surgeons.
¾ The most common justification for the latter trend is that medical training is more arduous and is of much longer
and sacrifice undertaken by the individual in order to fill the important medical positions.
¾ Historically, as will be discussed later, nurses have been trained on the job, providing cheap hospital labour in a
prolonged apprenticeship period that is not regarded in the same way as is, for example medical-ward experience and
internship. At the same time, the fiscal returns and inducements for nurse training are not nearly as significant as a
¾ A second argument for the relatively low wages that nurses receive is that nurses are much more poorly organized
and less assertive than is the medical profession.
¾ The wage levels of nursing aides, assistants, and orderlies have remained relatively constant, at levels of about two-
thirds of average occupational earnings. From a fiscal vantage point, this implies that nursing, as an intermediate
health occupation, can both exert pressure on and be subject to pressure from at least two levels t doctors and
managers from above, and auxiliary health care workers from below.
¾ Therefore, by way of example, health care administrators make decisions influenced by the fact that individual nurses
are less costly than physicians but more costly than auxiliary health care workers.
¾ Registered nurses, for example, are typically excluded from legislation that enables physicians and surgeons to
prescribe medication technology and health care treatment models that serve to redefine the place and role of
various health care workers. If diagnosis of a cancer, for example, can be made by a laboratory technician with the aid
of a sophisticated instrument, and if cancer can be treated with drugs prescribed by a physician, where does the
nurse fit in?
¾ So far there is mixed evidence with regard to the future of nursing. There is a general tendency for licensed health
care personnel, included registered nurses, to be replaced by unlicensed health care providers, but there are
considerable variations among providences in this regard.
¾ As health care is restructured, full-time nurses are increasingly being replaced by part-time nurses, nursing is
gradually shifting to non-institutional settings relative to hospitals and other long-term health care sites, and nurses
are subject to new forms of surveillance and intensification of their work.
¾ Nursing education is a significant variable in the development of the health care system. Education acts as a conduit
for nursing knowledge, status, and credentials, but it also serves to stamp into place particular conceptions of nursing.
Work and Education in the Canadian Context
¾ Nursing education, like other forms of vocational training, began outside the formal system of public education in
¾ Vocational training was more strictly concerned with imbuing person in specific jobs with the competencies and
discipline that would make them production workers.
¾ Public school system was subject to conscription by private capitalist interest concerned with obtaining at public
expense a cheap, compliant, and differentiated labour force; schooling thus became penetrated by the logic of
¾ A major consequence of the struggles that ensued over the nature and content of state schooling was the emergence
in the 20th century of the education system as the primary channel of individual access to the job market.
instrument to guarantee status for certain prestigious occupational groups such as medical doctors.
¾ Nurse training, which began in Canada within the hospital system, was absorbed into the state education system only
through a protracted series of developments. The interconnection of such factors as the rising cost to hospital of