Chapter 6 Textbook Notes

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9 Dec 2010
HLTB03 Midterm Notes: Health, Illness, and Health Care in Canada
Chapter 6: Transformations in Canadian Nursing and Nurse Education
¾ The first Canadian training school for nursing opened in St. Catharines, Ontario, in 1874.
¾ The emergence of the hospital system within the context of burgeoning industrial capitalism set the tone for a nursing
force characterized by a unique blend of Christian dedication, Victorian femininity, medical faith, and labour
¾ In this context, nurse training was oriented to produce a cheap, subservient, readily available workforce armed with
the basic knowledge of hospital and sanitary procedures.
¾ Nursing education is now concentrated in universities and colleges, augmented with symposia on credentialing,
specialization, nursing research, and advanced medical technology.
¾ Nurses have promoted their occupation, sometimes through militant action, as a profession with distinct skills and
privileges based on their claims to a unique body of nursing knowledge.
¾ This chapter is concerned with the development of nursing education in Canada. In particular, this chapter
emphasizes the ways in which contradictions in the provision and utility of the education of nurses in Canada have
Nurses and Professionalism
¾ Professionalism is the key concept in most recent analyses of nursing. Nurses are regarded as either as constituting a
profession, with their traditional low status a relic of the past, as falling short in their drive to professionalism, in
which case the reasons for their failure become the focus of analysis.
¾ The interrelated factors are commonly cited to highlight this apparent evolutionary progress: the specialization and
bureaucratization of health care, increasingly sophisticated medical technology, avZP}ÁZ}(vµ[}Áv
professional awareness.
¾ New medical knowledge and health care functions have become unequally distributed among participants in the
health care system.
¾ This has afforded nurses the opportunity to organize and push for increased status and responsibility; they have
willingly emulated the medical profession with the assumption that full professionalism is an inevitable income.
¾ Education is the vehicle for professional status. More education for more nurses, built around a distinct scientific core
of nursing knowledge, would allow nurses simultaneously to adapt to a changing world and to occupy a position of
enhanced importance in the division of labour in health care.
¾ The second viewpoint paints a less flattering image of nurses. It takes as its starting point the obstacle that nurses
face in their quest for status, and concludes that nursing is at best either a semi- or para-profession, most likely
doomed to eternal inferiority to the medical profession.
¾ Nursing is either virtually ignored or given only passing consideration in much of the literature on the sociology of
¾ We are left with an impression that no matter how strongly nurses struggled in the past to establish their
occupational status, they have not worked hard enough. Ironically, this view fits nicely with the first position on
¾ Unfortunately, the debate over whether or not nursing is a profession tends to divert attention from questions of
greater significance.
¾ An alternative explanation of the development of nursing and nurse education focuses on the social relations that
give shape to and are influenced by nursing. Nurses are recognized as dependent wage earners who pose problems
of cost and control to their employers.
¾ Nursing emerges from and acts upon distinct social, structures and practices that are characterized by regular, often
contradictory, patterns. Consequently, issues concerning the training and welfare of nurses are viewed as meaningful
only when interpreted in the context of wider trends associated with health care organization, policy, and finance.
Nurses as Salaried Employees
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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
Canadian workforce.
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.
¾ dZµ]}vov]o}À]v]vPuZv]u(}uo}ÇU^uo]l_(}]v]À]µoUvv
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
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