During the Director’s orientation in New York, a previously-prepared questionnaire was sent to
the director of each participating school of nursing. The questionnaire had been adapted from
the Application for Accreditation (diploma program of National League for Nursing) and its
– to obtain as clear a picture as possible from the school of its educational program for
those who would make the visit and those who would evaluate the program; and
– to assist the faculty in making a critical evaluation of its program.
Later, many schools indicated they had derived great value from completing the questionnaire
and, if the Pilot Project had gone no further, they would have found this step a most helpful one
in the evaluation of their school. This response was gratifying. Every one of the 25
questionnaires, with requested additional material, was returned to National Office by November
1957 –prior to the return to Canada of the Project Director.
The main portion of the preliminary phase of the Pilot Project, however, was the one-day visit to
each school across Canada which participated in the Project. During this phase, it was deemed
advisable that a one-week survey visit also be made to one school so that the necessary
alterations to the evaluation process could be made prior to phase two –the survey of the
remaining 24 schools of nursing.
This complete, one-week survey was to serve as a trial run. There was some concern that the
detailed evaluation process might not be appropriate as this was an entirely new educational
process in Canada. On completion of the trial survey, the Director was gratified to find that the
process worked very well. In fact, only minor revisions were necessary. She remembers that,
when they read the report of the first one-week survey to members of the school of nursing and
senior hospital staff, they were amazed. Their school was considered to be one of the best and
most innovative in Canada and they had anticipated a glowing report. The regional visitors had
written in as objective a manner as possible and the summary contained a listing of “Areas of
Strength” and “Areas Requiring Study and Improvement”. The director of the school, who was
also a member of the Special Committee, was appalled at the number of weaknesses listed but
none were challenged. Helen found the process to be extremely uncomfortable.
This, the first school to be surveyed, was located in one of Canada’s largest cities and their
living facilities, therefore, were better than those found in many of the smaller centers. The
second regional visitor for this survey was a religious sister. As there was a bar in the dining
room, Helen was so embarrassed at the thought of Sister looking at a bar, that she always
seated herself facing it. On completion of the survey, during dinner, Helen suggested to Sister
that this was a time for celebration. Much to the Director’s surprise, Sister recommended they
have a sherry and, being so relieved to have the first survey over, they even managed a second
one with a brandy to finish off the evening. Helen was very glad that she had packed her bags
for early morning departure before dinner as she could just barely make it to her room. In those
days, as a result of her “Presbyterian upbringing”, she had rarely consumed alcohol.
The four-month preliminary phase of the Pilot Project concluded with an interim report to the
CNA General Meeting in Ottawa where the Director also chaired a panel presentation
“Guidelines for the Future”. The continuing task of keeping CNA membership informed
throughout all phases of the project was still a priority. Press releases were prepared, articles
were published in The Canadian Nurse and memoranda were sent regularly to executive
secretaries/directors of each provincial association, the Special Committee, the Executive
Committee and selected governmental and non-governmental agencies.
The intermediate phase was spent primarily in completing the survey of the remaining 24
schools of nursing across Canada. In the Preface to The Report of the Pilot Project, Helen
wrote, “… items that should be recorded when travelling ‘from Cape Race to Nootka Sound’.
There was ample opportunity for the unusual to happen…” And happen it did. Then she went on
to say, “The modes of travel and accommodation were many and did not lack variety.” When
the survey was finally completed, over 57,551 miles had been travelled and cross country
interviews had been conducted with 1,759 people, exclusive of contacts at meetings of nurses
and allied professional groups. Additionally, there were numerous contacts with press, radio and
The one-week, comprehensive survey of the 25 nursing schools was as varied as the size and
the geographic location of the school; the control; the type of program –three year diploma, two
year plus one year’s internship, programs with a university affiliation, and even a diploma course
within a psychiatric hospital. Also taken into consideration was the ratio between anglophone
and francophone schools. At the time of the Pilot Project for Evaluation of Schools of Nursing,
there were 174 diploma schools of nursing in Canada. Selection of the schools to be surveyed
was made using scientific sampling techniques which were later validated by
The data obtained from the schools surveyed during the Pilot Project is carefully documented in
Spotlight on Nursing Education: The Report of the Pilot Project for the Evaluation of Schools of
Nursing in Canada. As stated in the preface of that publication, “Someday the other part of the
story may be written.” This is the “other part” of that unique and fascinating story.
1957 Prince Edward Island
My first trip to Prince Edward Island was fascinating. As we approached the Island, I could see
great stretches of red earth from my plane window. It seemed to cover a huge part of that little
province island. I also noted, with pleasure, the long stretches of sandy beach but, as it was
early spring, I was not consumed with the idea of going swimming.
On landing, the ANPEI President and Executive Secretary met me at the foot of the airplane
steps. They welcomed me most hospitably and insisted on driving me around Charlottetown, by
car, before checking me into my hotel. I was worried, unnecessarily, that my hotel reservation
would be cancelled if I arrived too late. Little did I know then that, on the Island, “everyone knew
everyone else.” Many of them were, in fact, related through families which had lived in PEl for
As we drove along, my companions were not impressed by my enthusiasm for the red earth. It
is, apparently, iron-saturated clay which sticks to one’s car and anything else with which it
comes in contact. Our first stop was the historic Parliament Buildings. As we approached the
front steps, my companions greeted, by his first name, a tall, distinguished gentleman -Premier
Matheson. What a rare experience for me to meet the Premier of a province minutes after my
arrival! After greeting the Premier, I was given a tour of the Parliament Buildings and the historic
chambers where the debate, which led to Confederation, was held. A Commissionaire had been
charged with showing us all the details of the Chambers. Despite being well informed, the rum
on his breath was sufficient to intoxicate a bystander. Reverently, we read the well-known
inscription, “Providence being their guide they builded better than they knew”. Our guide then
insisted I sit in the chair once occupied by a Father of Confederation. So many times I have
seen the picture of the gathering of the “fathers” after the signing, but the photograph really
came to life for me as I viewed the windows always seen in the background. We drove along the
beautiful coast to Cavendish to see the home of Anne of Green Gables. This was 1957, years
before the marketing of Anne and the emphasis on tourism. The Islanders, although cautious of
publicity, were aware of the need to keep the economy viable.
“Let Us Pray”
During the PPESN years, it was customary to have a prayer before each CNA meeting.
Sometimes, the Lord’s Prayer was recited and, at other times, one of the religious sisters or a
CNA officer led another prayer. I was rather sorry when this practice ceased as it gave all of us
a quiet respite before the furore started. It was also an excellent way of calling a meeting to
When Sheila Nixon, Regional Visitor, and I had completed writing the report of the survey of a
large, well-recognized school in a large metropolitan city, we discovered that the school was not
nearly as well organized as we had thought. Nor did the school have the quality of education
one would expect. It was, in short, a poor program. On Saturday morning, as was the schedule
for all surveys, the completed report was to be read before the entire faculty and others in the
school who wished to attend. One of the main reasons for reading the report was to allow those
involved with the educational program to correct any misunderstandings that had been written
into the report.
The Director of the school was very apprehensive so I decided to wait a few moments, until
everyone was settled, before proceeding. While we waited, Sheila, not knowing the microphone
was on, said, in a loud voice, “I think it is time for a good prayer”. I was not amused, nor was the
school’s director. After hearing the report, I’m sure she thought the Sheila’s remark had been
“The Owen Sound Incident”
During a school of nursing survey, the views of students regarding their educational program
were not overlooked. They made a significant contribution by describing to us various aspects of
their program. Usually, our conference with the students was scheduled for one hour but,
frequently, it continued much longer. The group of students, selected by the president of the
students association, was usually comprised of officers of the student organization together with
students from each class in the school. Members of the faculty were requested not to attend this
discussion so that it might be informal, with as free an exchange of ideas as possible. As the
students discussed, informally, various aspects of their courses, it was possible to identify the
real philosophy of the school and the degree to which the program was planned for, and with,
the students. It also opened up new visions of what the students perceived as their role as
graduate nurses in the whole health care system.
The faculty usually accepted our reasons for wishing to speak with the students alone, although
some were more gracious than others. At one school in central Ontario, I had just begun the
discussion with students when I had a tickle in my throat. I signalled to the Regional Visitor to
carry on and, not wanting to disturb the group, tiptoed quietly to the door to get a drink of water
outside the room. When I opened the door -lo and behold -there
was the Director of the school,
a very tall lady, bending down with her ear to the keyhole, trying to catch every word. Never
have I seen a more startled look on the face of a Director. I quietly excused myself and carried
on down the hall. She didn’t follow or ask if I needed assistance. I was embarrassed for her and,
as there was no way of rectifying her action, I never mentioned it again. I must confess,
however, that this incident tainted the remainder of the survey for me because neither of us was
at ease with the other.
“Wash My Horses”
The survey of the school of nursing in Rimouski, Quebec was unique for me as it was my first
experience in a completely francophone environment. I hadn’t appreciated that this city and its
hospital and school of nursing was so isolated from Anglophone Canada. When we met with the
students, not one spoke English fluently. These were all bright young girls in their late teens but
they seemed completely unaware of any major events in the rest of Canada. The students
urged one of their number to speak with me in English — and she really tried. All the other
students were consumed with gales of giggles at her efforts as her English was almost
unintelligible. I found out later that this was not unusual in French Canada of that period. The
opposite was, of course, also true in Canada’s Western provinces and in most parts of Ontario.
On these surveys, I was very fortunate to have Sister Denise Lefebvre as senior bilingual
evaluator and another Francophone sister who acted as Regional Visitor. I was responsible for
the overall survey arrangements and translated the French-language report into English for the
Board of Review. I attended all of the French-language interviews but, wisely, did not interfere
with Sister Lefebvre’s comments, etc.
As sometimes happened in the Gaspe, there were difficulties with transportation and we were
forced to stay in Rimouski until Sunday. I told Sister that I was going out to make a hair
appointment for Saturday. When I returned triumphantly with an appointment for 11:30 a.m. the
next day, I proudly explained how capable I felt, having negotiated all the arrangements in
French. Sister doubled over with laughter. Apparently, I had asked to have my horses (chevaux)
washed and set instead of “mes cheveux”. My French communication skills were very limited in
those pre-CNA days.
Based on the National League for Nursing model, we always insisted on staying at hotels rather
than accepting hospitality from the hospital or school of nursing we were evaluating. This, we
believed, would ensure that the survey visitors would not feel indebted to the hospital which
might color the objectivity of the report.
In one town in Nova Scotia, however, there was no suitable hotel — in fact, no real hotel at all.
This was a preliminary visit and I was alone so I was housed on the private ward of the hospital.
After several sessions with senior administrators, faculty, etc., I had dinner and returned to my
room on the private ward. While reading my notes, I saw a young student pass my door and
look in –but she said nothing. A few minutes later, she walked by again, rather slowly. When
she went by a third time, appearing to hesitate in front of my half-opened door, I went to the
door and greeted her. She immediately asked, “Would you please help me?” “Of course,” I
replied. She explained, rather timidly, that the patient in the room next to mine looked rather
strange and would I please come and have a look. I could tell immediately that the man was
dead –very dead. I instructed her to call her supervisor while I remained with “the patient” until
she returned. “Oh, no,” she quivered, “I’m afraid of the supervisor. She will be very angry with
me.” When I told her that she had no alternative, she started crying but, again, I insisted that
she call the supervisor RIGHT AWAY. With tears streaming down her face, she reluctantly left
the room to call. I remained until I heard the supervisor approaching and then left the dead
patient’s room via the bathroom we shared in common.
This incident raised many questions for me. Why had a student, in her sixth month of training,
been left in charge, on the evening shift? Why was the young student able to communicate with
me, a stranger, but afraid to call her supervisor? How could one ever condone such a situation
— first from the patient’s perspective and, secondly, was this “nursing education”?
When we were conducting the survey of the Glace Bay, N.S. school, we resided at the “Island
Hotel”. It was touted by John Fisher, “Mr. Canada,” as the only hotel in Canada at that time to
hang pictures of Canada on its walls. It was a comfortable hotel with the best sanitary features
–especially in the bathrooms – sterilized drinking glasses, toilet seats, etc. I had always
wondered how all this sterilization took place but I was soon to find out.
As my plane had been delayed, the hotel had allowed me to remain in my room until flight time.
As I was resting in the room, the maid came in and started cleaning the bathroom. After
exchanging a few pleasantries, she enquired, “Would you like to see how we fix our sterile
glasses?” Of course I would. So, with my own eyes, I saw how she ran the glasses under very
hot tap water, wiped them dry with my used bath towel and put on the “Sterilized Glass” paper
cover. Likewise, the toilet was sterilized. I was appalled. Should I apprise the management of
this practice — but I didn’t. In retrospect, I’d rather I didn’t know what might go on in any hotel
purporting to have “sterilized bathrooms”.
5.1.5 Writing of the report in Ottawa and Maple Ridge
The final phase of the pilot project included a detailed evaluation by the CNA Board of Review
and the writing of the report for the entire project. In retrospect, it boggles the mind that the final
report was ever written. It was so hot that long-ago summer in Ottawa –no air conditioning –that
Helen was permitted to go home to B.C. to write. So it was in the spacious recreation room of
her mother and father’s home in Maple Ridge that the landmark report was written.
Helen wrote every day and almost every night. After breakfast with her parents, she took the
reports of the 25 schools, minutes of meetings, correspondence, etc. from under her bed and
went downstairs to write. She kept these priceless documents under the bed because, in case
of fire during the night, she could rescue all the survey data. No photocopiers in those days!
Because of the nature of the report and the many tables she had developed, the Director
worked with pen and pencil and a manual typewriter. As each section was completed, she toyed
with the idea of mailing it back to National Office but was intimidated by the dilemma of writing
new material in a descriptive report without being able to refer to previous chapters.
Helen remembers well, during the intensive writing process, hearing her father say to her
mother, “I think Helen has taken on too big a job.” Her mother replied, “Don’t worry. She’ll get it
Each report –the record of joint observations and study by two visitors to each English-language
school and three visitors to each French-language school–averaged 13,000 words and included
approximately 14 tables for each school. Helen had little help in determining the format to be
used in compiling this massive amount of raw data. Flashes of inspiration were essential and
assistance from family members with a scientific background was a great value.
When the rough draft was completed, the long hours of fascinating work and the tight deadlines
had all been worthwhile. The completed report was then typed, duplicated and sent, with much
trepidation, to the Board of Review well in advance of their scheduled May 1959 meeting.
5.1.6 Presentation of Final Report to Executive Committee and Board of Directors
When Board members met in Ottawa to discuss the report, they compiled a list, for each school,
indicating areas of strength and areas requiring study and improvement. They also decided, on
the basis of criteria used, which of the schools surveyed would have met the requirements for
full accreditation, had such a program existed at that time. The voting of the Board of Review
was believed to be significant in determining whether or not Canadian schools of nursing were
ready for an accreditation program. It was recognized that the criteria used to evaluate the
schools were not formulated by Canadian nurses. Following evaluation of the 25 schools, Board
members were asked if they considered the criteria used to be applicable to diploma schools of
nursing in Canada. There was consensus that, generally speaking, these criteria were
To review the survey reports, Board members used the criteria as a basis for judgment in
evaluating each part of the program, using as a guide the booklet prepared for this procedure.
This booklet, as well as all other materials and the survey report, was divided into the following
sections of the educational program:
1. General Information on the School and the Controlling Hospital
2. Philosophy and Objectives of the School
3. Organizational and Administrative Aspects of the School
4. Instructional Personnel
5. Student Personnel Services
7. Evaluation of the Program and the Student
9. Setting for the Educational Program
10. Records, Reports and Announcements
Under each section in the booklet were the statements of criteria used for evaluating each
school. After studying the written report, each statement was considered and each member
indicated whether or not this criterion was met by the school. If the data were not clear, this was
indicated and an explanation was later provided by the senior visitor (the Project Director).
To provide as clear and detailed a picture as possible of the decisions of the Board, the data
were presented in table form. These data indicated the total of number of schools, as well as
the number of schools according to size, which met the criteria.
Although all members of the Board of Review did not vote the same way on each criterion, a
very large percentage agreed of whether or not each criterion was met. When a member did not
vote due to the fact, for instance, that she was a member of the school staff being visited, a
record was made only of the number of Board members voting. In all cases, a substantial
majority was required before a criterion was considered to have been met or not met.
In June 1960, the entire report was presented to the CNA Board of Directors and the report, and
recommendations were presented to the annual general meeting of the Canadian Nurses
Association held in Halifax.
Helen recalls, so vividly, the day in February 1960 when she presented her report to the
formidable Board of Directors. When she had completed her presentation, she sat down with a
sigh of relief. Unbelievably, the cold, calculating, critical members of the Board rose to their feet,
as one, and gave her a standing ovation! Never, in anyone’s memory, had that Board given a
standing ovation to anyone. Indeed, they rarely clapped or hardly cracked a smile, no matter
what the issue. The President gave the Project Director such a moving tribute that the tears
dripped down onto Helen’s clenched hands. Nurses of that generation never cried but, after the
project’s long, convoluted journey, emotions just took over.
A four-month hiatus had been planned between the presentation of the report to the Board of
Directors and presentation to the General Meeting in June. There was no money to pay the
Director for this period. Helen decided to return to Teachers College, Columbia University,
where she had earned her Master’s degree. A new semester was starting when she arrived, so
she made an appointment to see her adviser, Dr. Anderson. Dr. Anderson had heard about
Helen’s Canadian triumph and told her, then and there, that she was to earn a doctorate. One
never said “No” to Dr. Anderson, but Helen thought she would do only one semester’s work until
the CNA meeting in June. Dr. Anderson, however, knew she had gotten through to Helen and
continued to goad her on.
5.1.7 Halifax June 1960
In June, the Director returned to Canada –first to Ottawa to touch base with CNA and then to
Halifax to present her report to the membership. Sister Lefebvre, the Chair of the Special
Committee, gave the first presentation and called Helen “Miss Accreditation”. Replying in kind,
the Director addressed Sister as “Mother Accreditation” –that was ~ acceptable. When Helen
had laid bare all of the findings of the national two-year study and had pounded home the
recommendations, the entire body of French-speaking delegates rose, en mass, and sang “Elle
a gagne ses epaulettes, malleuron malleurette….” Not to be outdone, the English-speaking
group rose and sang “For she’s a jolly good fellow….” What a glorious ending –or was it the
ending –of an exciting professional journey!
That biennial meeting in Halifax will always stand out in Helen’s memories. The report was not
only accepted enthusiastically by CNA members but the media made it into a national event.
CBC Halifax carried interviews with the Director on its newscasts and relatives and friends in
Vancouver were able to view and listen. She had car and driver at her disposal and enjoyed the
VIP treatment which came from all sides. While staying at the Admiral Beatty Hotel, where
service was generally excellent, Helen remembers calling room service to order breakfast. To
her request, room service replied, “Popper rice?” Mystified, the Director repeated, “I wanted to
order my breakfast”. The operator repeated, patiently, “Popper rice?” Helen tried again –same
response –and finally gave up. At breakfast the next day, she discovered that room service was
asking if she wanted pop or ice!
View all posts in this series
- Autobiography Introduction - December 12, 2011
- Pilot Project for Evaluation of Schools of Nursing
- Appointment as Director of Special Studies – CNA
- Survey of 25 Schools of Nursing
- Executive Director – Canadian Nurses Association
- Canadian Nurses Foundation
- 1965 – 1966 CNA activities and CNA House - January 2, 2012
- PAHO/WHO Project in Commonwealth Caribbean - December 12, 2011
- 1965 International work
- 1969-1975 International Work - January 3, 2012
- Commonwealth Nurses Federation – West Africa, 1981 - December 12, 2011
- Encounters with Fidel Castro - December 22, 2011
- Autobiography Outline - December 12, 2011