Survey of 25 Schools of Nursing

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

purpose was:

– 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

television media.

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

nationally-recognized researchers.

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

many generations.

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

order.

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

planned.

“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”?

“Sterile Glasses”

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

finished.”

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

1959-1960

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

applicable.

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

6. Curriculum

7. Evaluation of the Program and the Student

8. Library

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!

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