Canadian Nurses Foundation

My relationship with the Canadian Nurses Foundation (CNF) was interesting and varied from

great hope to despair as to its future and its goal of providing selected nurses with the

opportunity to pursue graduate education. My commitment and dedication to this goal was

another spin-off from my cross-Canada surveys of nursing education in both hospital and

university schools of nursing. I knew that, if nursing service was to improve, the education of

nurses for that service must, likewise, be improved. Along with many other “senior” nurses, I

recognized that advanced education for nurses was imperative if nurses were to be accepted as

an equal voice in the decision-making circles of the health care system. A personal note adds

validity to this statement. As CNA’s Director of Special Studies (1960-63) I attended the

CMACHACNA Committee meetings to report on the status of nursing education in Canada and

to describe to the committee the projects undertaken by CNA which had been initiated as a

result of the recommendations of my Pilot Project on the Evaluation of Schools of Nursing. The

first meeting I attended was held at CMA headquarters in Toronto. The group from CNA entered

the committee room through the side door. All other representatives seemed to come from

somewhere else. At the next meeting, after I obtained my doctorate in 1962, I was met at the

front door by the CMA General Secretary. I was astounded to be ushered in, to walk on the

richly-carpeted hallway, and to be told that the CMA president would like to see me. Three times

I was referred to as DOCTOR Mussallem. Then, I was taken to the committee room at the rear

of the building. I was suspicious that my doctorate (the first earned by a nurse in Canada) might

have been responsible for this unusual gesture and the CNA Executive Director, Penny Stiver,

confirmed my suspicion.

In 1961, while I was Director of Special Studies, the CNA Executive Committee -influenced,

perhaps, by the findings of the Pilot Project for Evaluation of Schools of Nursing –decided that

“… the time had come when the Canadian Nurses Association should consider establishing a

foundation”. A Special Committee, called the Canadian Nurses Association Foundation, was

created in 1961 to work out the details necessary to establish such a foundation.

In February 1962, the Special Committee, Canadian Nurses’ Association Foundation, presented

its report. The Executive Committee decided at this meeting that the Foundation would be

known as the Canadian Nurses Foundation (CNF), and that its purposes would be: to provide

financial support in the form of awards to nurses pursuing graduate studies at the masters and

doctoral levels; to provide grants for nursing research; and to administer funds donated to the

Foundation for the above purposes. CNF came into being in 1962 when the Kellogg Foundation

awarded CNA a donation of $150,000 (U.S.). The preparation of the brief for the Kellogg

Foundation requesting $150,000 (U.S.) for the establishment of CNF (and the accompanying

strategies) and CNA’s success in obtaining these funds – to be spread over a five year period

–was due primarily to the expert and scholarly work of Katherine MacLaggan. The CNA

Executive Committee was preparing to have this Foundation set up within CNA but as the

Kellogg Foundation required a receipt from a “charitable” agency for income tax purposes, a

foundation was created by CNA to facilitate this request. In the early years of the Foundation,

office space and administrative services were provided by CNA.

When the Kellogg grant arrived in Ottawa, CNF was advised that the amount allocated for 1962

scholarships must be awarded before the end of August 1962. Word of the new scholarships

was disseminated and a number of applications were received at CNA headquarters. Then, I

gather, a Selections Committee needed to be appointed. As it was early August, few staff or

other suitable persons were available. I had just successfully defended my doctoral dissertation

at Columbia and had returned to Ottawa, as promised. On arrival, I was advised that I was to

work with Katherine MacLaggan to select the first “scholars”.

At the appointed time, I met with Katherine in her room at the Chateau Laurier. We worked very

hard to develop criteria and to assess each application. A decision had to be made. Should all

applications be ranked and scholarships awarded to only the top few, or should we ensure that

each application was “worthy of an award” and spread the money over the qualified

candidates? After assuring ourselves that each candidate merited an award, we chose the latter

option. Two applications were rejected due to incomplete documentation. All the monies for

1962 were disseminated and, in retrospect, I believe we did an exceptional job.

In May of 1963, when I became CNA Executive Director, I inherited the responsibility for the

administration of CNF. The monies from Kellogg were well used on fellowship and scholarship

awards as, initially, CNA bore the entire administrative costs. However, the CNF Board,

composed of half CNF members and half CNA members, had great ideas about CNF’s potential

as a free-standing organization without CNA connections or controls. The CNF Board was

appointed, and the part-time Executive Director (Lois Graham-Cumming) designated a member

in each province as a CNF representative. The provincial associations were by-passed and,

indeed, CNF attempted to set up an organization as “strong and powerful” as CNA. They would

be free to solicit large sums of money for CNF and not “be hampered” by CNA. This “completely

separate” organization did not survive for long and, in 1966, CNF became more closely allied

with CNA while maintaining its separate identity as required by the Letters Patent. I later

became Executive Secretary/Treasurer of CNF.

One of CNF’s perennial problems was always to find sufficient funds to maintain the scholarship

program. The need was very great and hardly any other monies were available for nursing

students studying at the masters or doctoral level. When the Kellogg money ran out, great

efforts were made to obtain more funds but results were dismal. Each Selections Committee

was faced with the problem of making awards with shrinking budgeted funds. One year, in the

early 70s, when Glennis Zilm, Assistant Editor, was writing an article for The Canadian Nurse,

she asked me what would be done at the next Selections Committee as funds were so low. I

said, “Let’s go for broke!” She published my remark and, due to the efforts of provincial

associations (some gave a yearly donation based on membership), the funds grew and then

stabilized. It was a real roller coaster ride and I spent many of my precious “extra hours” doing

CNF work. Often, I was asked why I worked so hard for CNF. My answer was honest and

simple. When I studied for my masters and doctoral degrees with a very small income –having

to decide between buying a book or eating dinner –I became dedicated to doing what I could, in

my lifetime, to prevent others from facing similar circumstances.

WHO Expert Study Committee to Advice on the Program for the International School for

Advanced Nursing Education (Edinburgh) – 1964

For me personally, and Canadian nursing generally, the three international I projects I

completed in 1964 added to the beginning of CNA’s involvement in the world of health and

gained for us some stature on the international scene. In addition to my responsibilities as CNA

Executive Director, I completed the projects under the auspices of the World Health

Organization.

The first assignment was as chairman of the WHO Expert Study Committee advising on the

program for the International School of Advanced Nursing Education at the University of

Edinburgh. The one-week project began 16 February 1964 and I can, to this day, recall how

cold I was when I arrived at my room in the Bruntsfield Hotel in Edinburgh. I thought I would

never be able to sleep that first night in my cold, damp room which was 10 feet wide by 24 feet

long with a ceiling at least 14 feet high. My bed was a cot fitted with knitted nylon sheets top and

bottom, and one comforter. At one end of the room was a very small hot water heater. When I

got into bed, the cot was so small and the nylon sheet so tightly drawn that I just kept slipping

out. In desperation, I pulled the one heavy chair in the room over to the side of the bed to at

least keep me on the bed. The next morning, when I complained that my room was too cold and

my bed too small, the management assured me that I had one of their best rooms!

The entire first four days in Edinburgh were spent on curriculum development for the yet to be

established WHO International School for Advanced Nursing Education. After the first few days,

although I was chair of the meeting, I had to intervene to support the North American model of

developing aims and objectives based on philosophy. Miss Stevenson, Director of the School,

was adamant in her resistance to our “stupid” proposals. She was of the school of thought

where a syllabus was followed. The syllabus had no relation to the school’s philosophy (there

was none in writing, but one did exist) and, certainly, aims, objectives and anticipated outcomes

were never considered. Our meetings became a tense “we” and “they” struggle which I handled

as tactfully as possible. Eventually, most of the University’s faculty “saw the light” and became

enthusiastic and supportive. We all became such good friends, in fact, that I was invited out one

evening to hear Andy Stewart, a favourite of mine. Due to pressures involved in writing the

report each night, I regretfully declined but we did agree that Saturday was possible. We had a

wonderful evening. One faculty member was assigned to sit next to me in our box seats “to

interpret”. Despite the thick Scottish accent, no interpretation was necessary when he sang,

“There was a soldier, a Scottish soldier….”

During my week in Edinburgh, I wrote in my room each night using the day’s discussions to

gradually develop the curriculum in readiness for a final presentation. After the first day, Miss

Stevenson would absent herself “to attend to pressing duties”. Writing in my room was a chilling

challenge. It was so cold, I wrapped myself in my Newfoundland seal coat and wore lined

gloves. Writing this way was very awkward so down I went to complain, again, to the hotel

manager. I was told there would be more heat –there was none. After another hour of frigid

room and cold, slippery bed, I complained again. This time, a maid brought me two hot stone

pigs. A little better, but still tricky trying to sleep cuddled around the stone pigs. Despite the

large chair I had placed next to the bed to restrain me, I kept slipping off my cot. After another

hard day of meetings, I decided that enough was enough. I would not spend another night in my

chilly room. Down I went, yet again, to see the manager. “If you don’t do something, I shall take

a chill,” I warned. Those must have been magic words because, when I arrived back in my

room, a large, electric heater had appeared. What bliss!

The final curriculum outline for the International School was completed Friday evening in

readiness for presentation the next day to the Director of the School and others from the clinical

setting from both inside the hospital and from the community (public health nursing).

I remember that Saturday morning, seated at the head table in the Conference Room with Miss

Stevenson, the Director on one side, and Lyle Creelman, WHO, on the other. I outlined the

curriculum –starting with philosophy, aims and objectives as developed by the faculty of the

school (minus Miss Stevenson) and the WHO consultants. Just before I commenced our

presentation, Miss Stevenson said to me, “I disagree with everything you have done. ‘Noon’ will

approve.” Facing a roomful of WHO personnel, staff of the university school, ward sisters in full

uniform and public health nurses in their regalia, I started off with a full explanation of the project

and how we had developed it. After 15 minutes or so, I began to outline the curriculum and our

rationale for it. Then silence. Although Miss Stevenson chose not to speak, all the others were

more supportive than I could have ever imagined. The chief public health nurse even said that it

was the first time she actually knew what the program was all about. Two of the sisters, in their

fetching bonnets agreed. Miss Stevenson, with palpable reluctance, agreed to “try it out”. She

did and the program became a great success. Reports still refer to our work on the curriculum

“way back in ’64”. It was, in fact, more than the development of a curriculum it was the

establishment of the first English-language WHO nursing education program for post R.N.

nurses world-wide: the very first program having been the French-language school for

Advanced Nursing Education in Lyon, France.

When our presentation was complete, we were invited to explain our proposal for the School of

Advanced Nursing (SAN) to the medical faculty. We proceeded to the faculty’s new and modern

building and, although it was winter outside, it was a bright, warm day inside. All of the senior,

rather imposing members of the medical faculty were seated at the head table, with Lyle

Creelman at one end. I was seated at a side table. After the introductions, I was asked to make

the presentation. The room was very warm and, when I was finished speaking, sweat poured

down my face. I had worn an attractive, pink wool dress which was appropriate for the occasion

but not for the heat in that sun-baked room. I eyed the raised Venetian blinds which were letting

in the hot sun and decided to sidle, unobtrusively, to the window and lower the blinds. With

everyone’s attention elsewhere, I pulled the cord to release the blinds. Unfortunately, it was the

wrong cord and only half the blind released with the most awful clatter. I held on to the cord for

dear life. The Dean of Medicine came to my rescue saying, “Steady, lass. Steady. What are you

trying to do?” Although I thought my intentions were obvious, I hesitantly explained. Lyle looked

away in agony but, with the blinds down, the room was somewhat cooler. All of the members of

the medical faculty, except one, were not too impressed with our presentation and listened to us

with polite disdain. One member of the faculty, however, spoke with great enthusiasm about our

new approach to nursing education. After our presentation, we were invited to the office of the

President, known in Scotland as Principal. We were offered sherry but I declined.

At the urging of the President, who wanted to toast the completion of the project, I relented and

hoped that, on an empty stomach, I would not feel the results too soon. The Principal was a

fascinating man who, at that time, was one of the world’s top scientists in the field of space

exploration. He asked if we had any questions and, of course, I had one. “Was it necessary,” I

asked, “for the head of a university to have been an academic?” I was interested as, in

Canada, the physician administrators of our hospitals were being replaced by “lay

administrators” who were graduates of hospital or business administration programs. The

President paused for about 10 seconds … it seemed forever … and replied in a Scottish brogue,

“Yes, it is important to have been a professor in a discipline so that you can speak the

language.” I have never forgotten his reply and have used it to advantage over the years.

Lebanon -May 1964

After intensive work at CNA following the project in Edinburgh, I was invited, by WHO, to

conduct a survey of schools of nursing in Lebanon. I was also asked to give one major speech

and to be a member of a panel discussion at the First Middle East Nurses Assembly to be held

in Beirut, Lebanon. The CNA President approved these field trips saying that probably no one

would notice that I was gone. I was excited to be visiting the land of my ancestors. When the

initial correspondence came early in 1963, I shared it with my father. He was so pleased but,

sadly, he died in June 1963 and never heard the great stories I could have told him about my

visit. Although Dad rejected the land of his birth –he wanted to be a real Canadian and do his

best for Canada –he was interested in Lebanon and so pleased that his daughter would see

“the old land”.

Although there was a long lead time prior to my departure for Lebanon, communications were

very poor. It was difficult to receive WHO authorization for my flight and to be informed about

hotel reservations in Beirut. I did put together notes for my speech and preliminary plans for the

survey of schools of nursing but the information I received was so slim that I felt ill-prepared.

Despite telegrams, I did not even know the name of my hotel in Lebanon but I decided to go

anyway.

The flight was long -Ottawa/Montreal/London, England -with a long wait for a connection to

Beirut, via Frankfurt. The planes were slow so I slept most of the time after leaving London. I

woke at one point and saw snow-covered mountains. For a moment, I thought I was crossing

the Rockies on my way home to Vancouver. Then, I started to worry about how to find

accommodation for the first night as we were arriving after dark. When the aircraft stairs were

lowered, I was first off the plane. As I walked across the tarmac, I felt very lonely. Unexpectedly,

I heard a faint, “Dr. Moo sell um” –the Arabic pronunciation of my name. Relieved, I approached

the lady and gentleman and said, ”I’m Dr. Mussallem, from Canada.” A swarm of at least 20

men with flash cameras came out of the darkness and the night turned into a great, white flash

of light. An elegant man approached and bowed from the waist saying, “Welcome to Lebanon,

land of your father.” He was the Lebanon Minister of Tourism. Next came the Minister of

External affairs, then Mme. Sultan, Director of the Red Cross School, and then other

government officials. I was whisked into the VIP Lounge where arak and other liqueurs and

wines were offered. My passport and luggage tags were handed over to airport officials while I

sat with the welcoming delegation and talked, and talked. The Lounge was very warm and I

had, as usual, travelled in a woollen suit. Eventually, a baggage handler appeared to announce

that my luggage was not on the plane. “Find it!” shouted the ministers, clapping their hands in

the typical Middle East clap command. We waited and waited but no luggage arrived. Finally, I

was escorted to my hotel, The Orient Prince. A kindly nurse from the American University

generously offered to lend me a night dress and slippers. Although she was about twice my

size, I didn’t care. I slept soundly. In the morning, I was awakened by the sound of a jet

overhead and then heard prayers from the Mosque, followed by the voices of vendors far below

my window loudly extolling the virtues of their attractive1y-arranged carts.

At 6 a.m., a waiter, in fez, arrived with my breakfast. He knocked and, at my invitation, opened

the door and stood there with my tray, screamed, put my breakfast on the floor — and ran. His

startled eyes were as large as billiard halls. When I sat up, I did not realize that my night dress,

miles too big, had slipped completely off.

My first day in Beirut was a busy one. Dressed in my now perspiration soaked suit (my luggage

arrived two days later), I met with senior officials in the health department. Immediately after

each introduction, the official would ask, “Are you Christian or Moslem?” In Lebanon, for every

senior position in the entire government, there was always an equally ranking

person of the other religion. I was also introduced to my national counterparts. The one that accompanied me

everywhere was Christian but, when we went on distant trips to Tripoli and Tyre, my Moslem

counterpart came along as well. Her English was limited as was my Arabic. My driver was

Moslem. I recall so clearly the exciting ride back from Tripoli along the beautiful coast of

Lebanon. There were no guardrails along the road despite the sheer drop into the

Mediterranean on one side. I was especially frightened when the driver and my Christian guide

got into a heated argument and several times, in his anger, the driver almost drove over the

cliff.

There were many things my guides did in the name of my father. We visited the Cedars of

Lebanon. “We take you there in the name of your father,” my guides said. On the drive to the

coast, we visited the tomb of Kalil Gibran. At that stop, a Lebanese lady was asked to prepare

chicken for us. She had just killed the chickens by wringing their necks and spices were rubbed

into the meat with her bare hands. When we were ready to eat, I noted that the chicken was not

well cooked and I feared that all the bacteria had not been killed. My counterparts and the

driver, however, ate their portions – and mine, as I was “not hungry”.

I recall returning to my hotel that afternoon (work began at 8 a.m. and ended at 2 p.m.), to find

the lobby filled with men in Arab headdress. The hotel manager said all of these men were

relatives –all Mussallems.

My arrival had been reported, in English, French and Arabic, in the 30 daily newspapers. My

“relatives” had read of my arrival and had come down from the mountains to welcome me. The

oldest man spoke no English but, through an interpreter who accompanied him, told me how he

was related to my father. I had no way of verifying this information but I thanked him, graciously,

for coming. Likewise, when I was in Zahle, my counterpart called “a cousin” who took me to her

home. In less than half an hour, every room in the house was filled with Mussallems or

Moussallems (as it is spelled in French). They all claimed to be relatives. Mussallem, in

Lebanon, is as common a name as Smith or Jones is in Canada.

The main reason for my visit to Lebanon was to conduct a survey of schools of nursing and

hospitals as I had done in Canada for the PPESN. I started with the three main schools and

hospitals in Beirut the Red Cross School of Nursing, The School of Nursing at AUB, and the

Moslem School of Nursing –an Arabic School and Hospital. The entire survey process and

techniques used were modified from those of the PPESN (see Report, p.94-137).

We then proceeded to Tyre, Sidon and Tripoli. In all, 11 schools of nursing were surveyed. Almost half of

the schools were privately run by doctors and standards were very low. Survey results revealed

that only two of the schools –AUB and Red Cross –met the desirable standards.

During our travels outside Beirut, tensions were mounting and there was a real threat of war. I

remember, so vividly, sitting in the back of our car, alone, traveling to Beirut. My counterpart sat

in the front with the driver. Six soldiers stopped the car and –three on each side –pointed their

bayonets at us. Tremulously, I volunteered, “I have my Canadian passport.” “Shaddap!” said my

companion. I understood Arabic well enough to surmise that my companions were attempting to

explain our trip and tell the soldiers that we were all government officials. Apparently satisfied,

the soldiers shoved a bayonet into the car as though to push us on –and off we sped.

There were, however, many pleasures in Beirut: looking out over the Mediterranean; sampling

the best of Lebanese food; taking pleasure trips on Sunday to remote villages or casinos; and

eating strawberries at the St. George’s Hotel patio. (As WHO personnel, I was forbidden to eat

the strawberries but I did –only three times. They were worth dying for.) Many quaint items were

sold on the streets of Beirut but I was particularly intrigued by the never-ending boxes of

Chiclets offered for sale by grown boys. One night, at dusk, a very large boy approached me

brandishing his Chiclets. I said “La” (no) but he kept following me, shoving the gum in my face.

In desperation, I yelled “Rhou min hown”, the equivalent of “Get to h— away.” He really ran. I

suppose he had never expected such language from a lady in European dress.

Leaving Beirut was another sad, if memorable, experience. We left the hotel at 3 a.m. to allow

time for all the required clearances. On the way to the airport, we were again stopped by armed

soldiers. They made us get out of our car, opened our suitcases and picked through everything

— especially the negligees. We could do nothing but keep quiet and watch the charade. Later,

as we approached the airport, the sun rose and bathed the beautiful hills of Lebanon with

glorious light. Such a contrast from my noisy welcome: men dancing the Dabke in the streets;

record players and radios blaring out music; and hordes of people lining the streets –some in

Arabic costume, some in European.

After the Lebanon survey, I participated in the First Middle East Nurses Assembly where I

presented a major address on Research in Nursing, chaired a panel, and gave many press

interviews. These were unique events as they were conducted in three languages, English,

French and Arabic, with volunteer interpreters. The equipment was rather primitive but,

somehow we managed.

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