Trends in the Education of Canadian Nurses, Research Paper Example

Abstract

The history of nursing education in Canada illustrates the great role that social and economic factors have played in the education of nurses.  Trends in nursing education tend to mirror the social concerns and expectations of the day; thus, Canada’s first nursing school was created not to further the education of women, but to staff hospitals with an inexpensive, docile workforce (Kirkwood, 2005). With the broadening of women’s rights throughout the latter half of the twentieth century and into the new millennium, there has been a proliferation in university and college-based nursing programs, along with the growing trend towards post-graduate nursing programs that sought to educate nurses beyond the traditional parameters of the field. willingness of nurses to seek a greater level of academic achievement has resulted in an improvement in the quality of patient care, better relationships between nurses and other medical practitioners, and the increased professionalization of the nursing field.

Trends in the Education of Canadian Nurses

The education of nurses in Canada has undergone many significant shifts since the establishment of formal nursing programs throughout the country. Trends in education reflect the cultural, political, and social changes that have allowed nurses to gradually gain more control over their access to formalized education.  While nursing was once seen as unpaid work completed by women who were called to serve the ill as a vocation intricately linked to religious affiliations (Brigitte, 2005), the profession has since gained a high level of professionalism through the formation of training schools and the eventual development of university-level programs (Nelson, 2002). Although it is no longer uncommon in Canada to find nurses pursuing advanced degrees, both prior to and after having entered clinical practice, the trend of higher education for nurses demonstrates the remarkable accomplishments made by nurses in legitimizing their academic pursuits. While basic education for nurses may seem commonplace today, Canadian nurses spent much of the twentieth century overcoming numerous barriers to education (McPherson, 2003).  This includes the social, economic, and political conditions that dictated the level of education that was acceptable for women embarking on careers as nurses (McPherson, 2003).

Several key trends have shaped our modern understanding of nursing education.  The implementation of formal nurse training programs in the early part of the twentieth century marked an important step in the ability of nurses to pursue higher education (Kirkwood, 2005).  This trend towards the increased education of nurses continued with the gradual acceptance of nursing programs into the university and college system.  It continues to be a pivotal issue for modern nurses as graduate programs, distance programs, and other educational opportunities become available to nurses looking to increase their career prospects and performance within this competitive field (Nelson, 2002).  The exploration of past, present, and future educational trends that support the desire of Canadian nurses to step beyond traditional boundaries illustrates that an investment in higher education will ultimately improve the quality of patient care, the relationship between nurses and other medical practitioners, and the increased professionalization of the nursing field.

Understanding the History of Nursing Education:  1874-1905

Canada’s early history of nurse education is, in part, a reflection of attitudes towards the education of women in general.  The lack of formal training for nurses pre-1874, illustrates that the primary educational trend of this period was to make available only the barest minimum of educational opportunities. This demonstrates both the assumption that women were innately nurturing, and thus did not need formal training to care for the ill, and the belief that too much education was dangerous for women (McPherson, 2003).

Prior to 1874, there was no formal training system for nurses in Canada (Kirkwood, 2005).  Caring for the ill had had a long history of being home-based and largely performed by women within the family unit.  The perception of nursing as a largely female pursuit which relied upon a woman’s nurturing instincts ostensibly justified nurses receiving little in the way of training or payment (McIntyre & McDonald, 2009).  According to Lynn Kirkwood (2005), “arguments against nurses’ educational aspirations, as against the education of women generally, have included claims of intellectual inferiority and of women’s seemingly ‘natural’ propensity to domestic service” (p. 183).  This has also been reflected in the illusion that nursing is solely a vocation, rather than a profession (Mansell & Dodd, 2005).  As a calling, religious or otherwise, nursing was seen as something done out of a desire to help others, rather than for any professional or economic need (McIntyre & McDonald, 2009, p. 186).  Such assumptions about the motivations behind a nurse’s reasons for entering the profession played a role in the slow movement amongst doctors, hospitals, and the general public to accept that nursing brings with it a high level of scientific and practical knowledge.

As Kathryn McPherson notes in Bedside Matters (2003), prior to the introduction of trained nurses into the hospital environment in the later part of the nineteenth century, such duties were performed by “working-class women who had informally acquired skills” (p. 27).  Although such traditional nurses have historically received little respect in terms of their educational levels or professional abilities, McPherson notes that the “untrained nurses’ experience in domestic service often translated into significant skill in attending the sick” (2003, p. 30).  Nursing services were also provided by the untrained women who populated religious orders, especially within French Canada where early hospitals like the Hotel Dieu in Montreal were staffed with French nuns who had learned to care for the souls and bodies of the ill in their convents (Brigitte, 2005).  Once Quebec was established as an English colony, the focus shifted from French-trained nuns providing nursing care to an increasingly formalized style of nursing that was rooted in the hospital rather than the home (McIntyre & McDonald, 2009) and home-care provided by the Grey Nuns under Marguerite d’Youville.  Nursing in English Canada during this period was less dependent on the influence of the Church, taking its cue instead from the work of British nurse Florence Nightingale (Mansell & Dodd, 2005).  The visibility that Nightingale brought to the profession was instrumental in helping nursing to become “a respectable occupation for middle-class women and a source of upward mobility for girls from poor homes and farm regions” (McIntyre & McDonald, 2009, p. 187).

The proliferation of hospitals throughout Canada in the late nineteenth century translated into a need for more nurses who would meet the need for a docile and competent workforce to assist doctors with the care of patients (Kirkwood, 2005).  After three American schools of nursing were founded in 1873, Dr. Theophilus Mack created Canada’s first nursing school in St. Catharines, Ontario in 1874 with the assistance of two American nurses who had trained under Florence Nightingale and were familiar with her teaching methods (Kirkwood, 2005).  Mack’s aim in the establishment of his school was to replace untrained nurses with women whose training would enable them to improve the “sanitation and post-surgical mortality rates” (Kirkwood, 2005, p. 184) of his hospital while also attracting the interest of philanthropists willing to fund his work (Kirkwood, 2005).  While Mack’s work established that training schools could result in a more competent and professional staff of nurses, it also began “the linkage of nursing education in Canada with the needs of hospitals–and the practice of subservience of nursing to the demands of medicine” (McIntyre & McDonald, 2009, p. 187).  The practical reasons for creating nurse training programs had little to do with the social desire to educate women.  Instead, these schools “were just a practical means to an end, and were not intended to further the cause of higher learning or contribute to the overall development of human knowledge” (Kirkwood, 2005, p. 183).  Nurses were expected to fulfil the idealized conception of nurses as women driven by saintly motivations who had no personal needs of their own, as demonstrated by the motto of Mack’s school:  “I See and I Am Silent” (Kirkwood, 2005, p. 184).  The professional and personal desires of these newly-trained nurses was not considered relevant.  Instead, hospital administrators looked to improve the profitability and success of their  hospitals without disrupting traditional gender power dynamics or challenging the societal norms which dictated that women had few aims beyond the innate need to nurture (Kirkwood, 2005).

The educational benefits of this new trend in nursing far surpassed that which had been provided to the untrained nurses of previous decades, many of whom were “generally ward servants who had evolved from the kitchens or the backstairs into the wards” (McPherson, 2003, p. 28).  However, the working conditions in nursing schools required long hours of labour with little time left for professional development (McIntyre & McDonald, 2009).  As McIntyre (2009) states, “the very restrictive environment of the nursing school perpetuated the notion of the nurse as the physician’s handmaiden and discouraged expression of independent thinking or action” (p. 188).  Although physicians provided educational lectures for nursing students, students were expected to attend them after working twelve to twenty hour days (McIntyre & McDonald, 2009).  Jensen (n.d.) notes that this curriculum structure tended to discourage higher learning in many students.  However, given the limited educational opportunities for women during this period, nursing schools provided post-secondary education and career prospects that might not have otherwise been available (McIntyre & McDonald, 2009).

The establishment of nursing schools in Canada marked the first stage in an educational trend towards higher learning.  Although these programs tended to be limited by societal expectations for women at the time, they allowed for nurses to make their first foray into the world of formalized nursing education.

Striving for Higher Education:  1905-1970

Even while nursing schools were growing in popularity throughout Canada, nurse educators and nursing associations were attempting to further professionalize the field by joining forces with universities to develop nursing programs (Pringle & Johnson, 2004).  This trend indicates a desire amongst nurses to broaden their knowledge level and skill-sets and be seen as more than just a doctor’s helpmate.

In 1905, the Graduate Nurses Association of Ontario tried to establish a  university-based nursing education program at the University of Toronto, a request which was rejected along with a similar one made to Queen’s University (Pringle & Johnson, 2004).  The response of universities and hospitals to these attempts to professionalize nursing through academic programs reflects the manner in which nursing schools were becoming accepted as an inexpensive way to provide labour to hospitals while educating young women in a non-threatening and socially-acceptable way (Kirkwood, 2005).  As Kirkwood writes, by the 1930s “the apprenticeship system had become firmly entrenched and was economically satisfactory for hospital administrators.  They feared that replacing students with graduate nurses would undermine their authority and present discipline problems” (2005, p. 189).  In 1919, the University of British Columbia was the first Canadian school to begin a dedicated nursing program; this program followed the sandwich model, allowing for a balance between hospital training and the university curriculum (McIntyre & McDonald, 2009).  The sandwich model ensured that a university education was available for nurses without altering the status quo of  already-established hospital programs.  McIntyre and McDonald (2009) write that the biggest problem in the university nursing program was an overall lack of communication between hospital and university.  Student nurses did not necessarily have the opportunity to use their university knowledge in the hospital environment, and the university had little input in the education their students received after leaving the university (McIntyre & McDonald, 2009).

Motivated by a need to provide student nurses with a solid educational foundation that was not influenced by the mandate of hospitals, the Canadian Red Cross Society developed and funded a nursing education program in 1920 that was meant to demonstrate that nursing programs could take charge of their own curriculum and produce “skilled clinical nurses in only two years” (Jensen, n.d.).  Their funding ensured that six universities (McGill, Dalhousie, the University of Alberta, the University of Western Ontario, and the University of Toronto) in four provinces had the means to begin “certificate programs to prepare graduate nurses for public health” (Pringle & Johnson, 2004).  Each of these programs, with the exception of Dalhousie University, went on to develop long-term nursing programs once the Red Cross funding concluded.  The University of Toronto developed a unique integrated program that was fully independent from the hospital schools, with the university and nursing faculty fully controlling its curriculum and students (Pringle & Johnson, 2004).  These initial university programs were intended for a small and select group of nursing students, primarily those who wished to become “teachers, supervisors, and public health nurses with the leadership skills to reform nursing” (Kirkwood, 2005, p. 190).

The gradual shift of nurse education from hospitals to universities created a “two-tiered system of entry into the profession and two cultures for nursing–the professional culture, rooted in education and science, and a craft culture, rooted in domestic skills” (Kirkwood, 2005, p. 190).  The education of nurses during the first half of the twentieth century was still greatly impacted by the notion that nurses were unprepared, unwilling, or unable to move beyond the traditional perception of nurses as “the ‘good woman,’ nurturing, passive, self-denying, morally superior to men, but subordinate to physicians” (Kirkwood, 2005, p. 184).  This mirrored the overall perception of women within Canadian society (McPherson, 2003).

While the implementation of nursing programs at the university-level marked a crucial trend in the availability of higher education for nurses, such changes were slow going.  It wasn’t until the 1970s that the majority of Canadian provinces would have comprehensive nursing programs in both universities and community colleges.  This can be attributed, in part, to the resistance faced by nursing faculties in the perceived “double jeopardy of being women and being in a ‘vocation’ at a time when technical education was highly suspect as a legitimate endeavour at the university level” (Pringle & Johnson, 2003).

Increased Educational Opportunities:  1970-2011

The latter portion of the twentieth century brought many new educational opportunities to nursing. This included the implementation of degree programs at the university-level as well as the growing popularity of post-graduate educational opportunities.  Such trends reflect the effects of the feminist movement on the overall perception of women in Canadian society (McPherson, 2003).

Nursing education in Canada continued to follow two separate streams until the mid-mid 1990s. During these years there was a shift from hospital-based training to community colleges that fell under the control of provincial governments.  As well, much work was done by nurse educators to determine the structure and curriculum for university-based baccalaureate degree programs (Pringle & Johnson, 2003).  In 1964, the Royal Commission on Health Services found that in Canada there were “188 nursing schools: 170 controlled by hospital boards, one by a lay board, and 17 in universities” (Pringle & Johnson, 2003).  The Commission recommended the streamlining of nursing education so that educational institutions would have full control over all aspects of curriculum, moving past the sandwich educational model in favor of the integrated model first implemented by the University of Toronto.

The creation of community colleges across Canada in the 1960s and 1970s resulted in nursing education being removed completely from hospital jurisdiction, though hospital schools remained in Alberta, British Columbia, Manitoba, and Nova Scotia until the 1990s.  Pringle and Johnson (2003) state that “if nursing could have managed a move to degree education by locating all its programs in universities first […] this would have strengthened the education overall and produced a more autonomous practitioner and critical thinker” (2003). Although the resistance to university-based education slowed the progress of nursing education as a whole, there may have been no practical way to implement university-based education more quickly, given that there weren’t enough potential faculty members to support a great number of university nursing programs (Pringle & Johnson, 2003).

While the educational trends in the second half of the 20^th Century give the appearance of change, “contemporary concerns in nursing education in Canada suggest that the earlier educational pathways have not always represented progress” (Bramadat & Chalmers, 1989).  It is only in the last two decades that nursing education, at both the baccalaureate and post-graduate levels, have begun to make real strides.

Statistical Data in Support of Educational Trends

The majority of nursing programs now take place in universities and community colleges.  Statistical data provided by the Canadian Nurses Association demonstrates an increase in both nursing programs and student enrolment.  These demographic trends suggest that the pursuit of higher learning is becoming the standard in nurse education.

The Canadian Nurses Association National Student and Faculty Survey of Canadian Schools of Nursing (NSFS) notes that as of 2008-2009, 111 schools in Canada offered one or more Entry-to-Practice (ETP) programs, a mode of study which allows for graduates to apply for initial licensure and registration as an RN (Canadian Nurses Association, 2010).  The report makes it clear that the current trend in nursing education is to provide a variety of educational models.  While all nursing graduates must adhere to standard competency guidelines in order to receive licensure and begin practice, the number of ways in which this can be achieved is much more varied than in previous decades.  Of the 111 schools surveyed, 80.2% of them provided ETP programs, with 41 colleges joining forces with university programs to deliver their program mandates.  Additionally, the NSFS reports that admission to nursing programs reached a ten-year high during the 2008-2009 survey period, where “14, 010 students entered ETP programs, […] continuing the upward trend of past years” (Canadian Nurses Association, 2010, p. 5).  Additionally, statistics gathered by Health Canada indicate that while the number of nursing programs for baccalaureate, Post-Rn, Master’s, Doctoral degrees and Nurse Practitioner certification did not change greatly in the early part of the 2000s, diploma-based nursing programs have declined.  As well, the “enrolment rates for diploma programs in nursing have declined by almost half since the late 1990s while enrolment rates for baccalaureate programs have increased almost threefold” (Health Canada, 2006).  These statistics also reflect trends in the current competitive job market, wherein nurses can increase their desirability as an employee, and thus their career prospects, by acquiring post-RN degrees and accreditation.

As reported by the NSFS through its review of the Canadian Council on Learning’s 2009 report, “lifelong learning [allows] individuals as well as communities [to] benefit from higher levels of education:  health, life satisfaction, volunteering, donating, employment stability, and income all increase as levels of educational attainment increase” (Canadian Nurses Association, 2010, p. 7).  The availability of advanced degree programs at a wide variety of Canadian institutions attests to this increased emphasis on higher learning, illustrating how much educational trends have changed within Canada over the past century.  The NSFS reporting that 37.8% of schools surveyed offered one or more post-RN baccalaureate programs for nurses who already had nursing diplomas.  Prince Edward Island, the Northwest Territories, and the Yukon were the sole provinces/territories that did not report any post-graduate nursing programs, likely due to their small populations.  While there were fewer schools offering master’s and doctoral programs (29.7% and 13.5%, respectively), and a lower number of students admitted into said programs, the NSFS report notes that “historically, recessions produce jumps in the enrolment of short-course programs.  Enrolment jumps are therefore likeliest in two-year college programs and university graduate programs” (Canadian Nurses Association, 2010, pg. 8).

Possibilities for the Future of Nursing Education

The history of nursing education in Canada provides insight into the complicated social, political, and economic conditions that have defined the needs of both nurses and the people who are under their care.  Trends in the education of nurses have undergone many shifts over the past century, demonstrating the societal changes in attitude toward the education of women (McPherson, 2003).

An innovative program at the University of Saskatchewan may serve as an example of future trends in nursing education.  Beginning in 2011, the university will offer a Collaborative Bachelor of Science degree that provides an initial ‘pre-nursing’ first year, followed by three years of inter-professional education. Coutts (2010) suggests that this program will help lower the program’s excessive drop-out rate by showing students the realities of the profession from the very start of the program.  The commitment within universities and nursing programs to provide flexibility to their students by designing programs that offer a wide range of choices at both the degree and post-graduate level attests to the newfound interest within the Canadian educational system to remain competitive in an increasingly globalized world (Baumann & Blythe, 2008).  Technological innovations and an increasing societal reliance on the Internet as an effective means of communication have altered the manner in which course content can be delivered to students.  Online and distance learning allow nurses currently working in clinical practice to return to school in order to pursue higher education.  As well, nursing students are less reliant on Canadian schools to fulfil their program needs than in previous decades due to the expansion of international nursing programs which provide an educational alternative (Baumann & Blythe, 2008).  These trends raise issues in terms of standardized curriculum and degree guidelines to ensure that nursing students, both at home and abroad, are receiving the education necessary to prepare them to excel professionally (Benner, Sutphen, Leonard, & Day, 2010).

The educational trends over the last century have included the emergence of nursing schools, the quest to bring the education of nurses out from under hospital control and into the universities, and the proliferation of degree and graduate programs to further professionalize the field.  Such trends would have been unheard of when Theophilus Mack opened his nursing school at St. Catharines General and Marine Hospital in 1874 (Kirkwood, 2005).  These shifts in the acceptance of nurses’ quest for higher learning demonstrates the vast social and cultural changes that have enabled nurses to increase their public profile and empowerment as a group, thus ensuring their continued access to quality education.

References

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Kirkwood, L. (2005). Enough but not too much:  Nursing education in English language Canada (1874-2000). In C. Bates (Ed.), On all frontiers: Four centuries of Canadian nursing. (pp. 183-196), Ottawa, ON:  University of Ottawa Press.

Mansell, D. & Dodd, D. (2005). Professionalism and Canadian nursing.  In C. Bates (Ed.), On all frontiers: Four centuries of Canadian nursing. Ottawa, ON: University of Ottawa Press. pp. 197-212.

McIntrye, M. & McDonald, C. (2009). Realities of Canadian Nursing:  Professional, Practice, and Power Issues (3rd ed.). Philadelphia, PA:  Lippincott, Willliams, & Wilkins.

McPherson, K. (2003). Bedside matters: The transformation of Canadian nursing (1900-1990). Toronto, ON: University of Toronto Press.

Nelson, M. (2002, May 31). Education for professional nursing practice;  Looking backward into the future. Online Journal of Issues in Nursing, 7, (3). Retrieved on 26 June 2011 from             http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume72002/No2May2002/EducationforProfessionalNursingPractice.aspx

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