In 1960, when Helen Mussallem wrote the preface to Spotlight on Nursing Education: The Report of the Pilot Project for the Evaluation of Schools of Nursing in Canada, she noted that only factual information was presented in the report and that “…someday the other part of the story may be written.” Someday is here. Helen’s adventures and experiences, during this exciting and critical professional journey, provide a unique, fascinating glimpse into the turbulent world of nursing education in the 1950s.

Does Canada need a national program of accreditation for diploma schools of nursing? When this question was first asked, decades ago, at a CNA biennial meeting, Helen Mussallem was serving with the armed services (WWII) and such matters had never crossed her mind. Indeed, in her early years of nursing practice, she was convinced that such subjects were best left to the “old maids” in the profession. Resolutions “approving the principle of accreditation” were passed almost biennially until 1955 when a significant step was taken. Nursing leaders of the day looked with approval at the U.S. accreditation system and believed that such a program would have a great positive impact on Canadian schools of nursing.

Accreditation was the main theme at the 1955 CNA General Meeting. Helen remembers it well: a hot, stuffy room for approximately 150 delegates –air conditioning was a luxury in those days! The opening session, although well planned, ran into some minor obstacles. When the minister did not arrive to deliver the opening prayer, some kind soul found a prayer in her purse and gave it to the president to read. Unfortunately, also during the session, the president, G. Sharpe, lost her front tooth and the organist lost the music for the opening to God Save the Queen. CNA was one of the first professional health organizations to provide translation services to its members but this also proved hazardous as so many people tripped over the electrical connections laid across the floor that they had to be disconnected.

Discussion on accreditation raged on. Helen was sitting in a pool of perspiration when she heard the president ask Miss Mussallem for her opinion. She remembers somehow getting to the microphone and saying that there should be an accreditation program as soon as possible. How profound! As director of Canada’s then largest school of nursing, she was sure a more scholarly statement had been anticipated.

For Helen, life at the Vancouver General Hospital School of Nursing continued as busy and exciting as ever until, unexpectedly, Trenna Hunter, president of CNA and fellow resident of Vancouver, asked her to become Director of the Pilot Project. No hesitation here! Helen’s response was a quick and positive … “No!” although she would be willing to serve as a Regional Visitor. “No” was her only possible answer because both her parents had serious health problems and because she had become inextricably linked with her young niece, Lynette, who taught her the meaning of “unconditional love”. Professionally, she enjoyed her work at VGH School of Nursing and had implemented some exciting and innovative curriculum changes. Why leave all of this for two years?

As time passed, Helen began to feel considerable pressure to accept this assignment and, reluctantly, a positive answer emerged. “Yes.” Little did she know how much that response would change the whole course of her life.

Arrival in Ottawa  (5.1.2)

It was agreed that Helen would begin her work on the Pilot Project for Evaluation of Schools of Nursing in September 1957. As her first working day was to be the day after Labour Day, she arrived at Uplands Airport in Ottawa on Sunday and was whisked away to her home away from home, the Bytown Inn. As she travelled through the city, she couldn’t believe her eyes and thought she had been transported back to the Middle Ages. There were old street cars rumbling all over, everything looked old and dingy. The Bytown Inn was an old wooden structure and her room was on the ground floor. The only view to be had was of a gas station and her nose was constantly assaulted by fumes from the garage. If it had been possible to return home then and there, she would have been ecstatic! The next day, she begged to have her room changed and, finally, one was found for her on the second floor. When she had looked around, she asked curiously what the rope was for and was told that, in case of fire, she was to use the rope to slide down to the ground floor! To add to her welcome to Canada’s capital, a staff member from CNA called later to say that she had forgotten to meet her plane. What a feeling of gloom and doom!

Initial Planning of Pilot Project for the Evaluation of Schools of Nursing  (5.1.3)

Helen was tense meeting the staff at CNA’s office at 270 Laurier Avenue. The four senior staff were gracious and kind but, oh, the loneliness of it all! The next day she was off to Toronto and Montreal to meet members of the Special Committee for the Project, all well known and respected Canadian nurses. They were all so clever and knowledgeable that she was almost paralyzed talking with them. She remembers wearing the “proper” suit bought for the Project: navy blue with detachable collar and cuffs, the latter to be washed and pressed each night –no wash and wear in those days. Also, as so few women travelled in the 50s, attaché cases were great, heavy ones made for men. She was justifiably proud of her genuine leather, hand-crafted briefcase but it weighed so much, even empty that she suffered from a sore arm for ages.

What was CNA Headquarters like? Friendly … after at time. But Helen had grown up in a different professional milieu. Since she was from B.C. – a leader in Canada in the Union movement of professionals — she was thought to be painted pink or red, or at the very least to be a Union sympathizer. The word “union” was unacceptable in the professions but all knew that the last meeting Helen had attended as an RNABC Board Member was held to decide if the nurses in one of the inland hospitals should go on strike when the hospital would not honour the decision of the government arbitrator. Helen remembers discussing the situation until 3 AM, until it was decided that nurses would withdraw their services in all but essential areas. This was a first for nurses in Canada. She remembers leaving the meeting in downtown Vancouver, in the early morning hours, so exhausted that she walked straight into a puddle up to her ankles and felt nothing until she returned to her suite to find water and mud oozing from her boots.

Helen’s first months at CNA were hectically busy, but she did not mind as she had few social engagements in the evenings. Occasionally, she would sneak across the river to Hull for a change of milieu. What was on her plate as Director of the Pilot Project for Evaluation of Schools of Nursing?

– development of criteria for the evaluation of the schools

– preparation of preliminary information schedule

– role of National Office in the survey

– preparation of list of data required at the time of the survey

– preparation guide for the survey week

– preparation of a format for writing the report in both English and French

Most daunting of all, was the schedule prepared by National Office to: first, visit all officials in national and provincial health departments as well as a one-day visit to each of the 25 schools to acquaint them with the project and to show that Helen Mussallem did not have “two heads”. There was much anxiety across the country as this project was, incorrectly, viewed as an accreditation program; and, second, to prepare a cross schedule.

Travel in the ‘50s was more difficult than it is in the 90s and hotel accommodation in smaller communities left much to be desired. On the first series of one-day visits, there were many surprises. Helen remembers getting off the train in a small Ontario town in mid winter. Emerging from the train, there was only one taxi to be had so all four travellers squeezed in. Helen told the driver she would like to go to the “X” Arms Hotel. Silence. All other passengers left –one by one. When the driver began to drive into the outskirts of town, Helen became suspicious and asked if the “X” Arms was a good hotel. “Yes,” said the driver. When he stopped, a startled Helen saw, through the dark night, a two-story, run-down building with a huge dog out front. Again she asked if this was a good hotel and again the driver replied in the affirmative. The Project Director will never forget the scene that greeted her as she walked into the hotel: a densely smoke-filled room with drunken men chasing women around the room. She was asked to sign an ancient book and then was pointed to her room. Unbelievable! Panel in door ripped off, etc. She recalled her orientation at the Nursing League for Nursing and their advice that, in such a situation, one should go to the phone and call another hotel. She ventured into the main room again only to be told there was no phone in the hotel and that the nearest phone was two blocks away. Nothing to do, but to place the half clean towel over the bedspread, covered with dog hairs, and lie down. What a night! Women screaming and men running up and down the halls ALL night. She stayed fully clothed on the bed and, as dawn broke, splashed water on her face, paid for her room, and set out on foot to find the nearest phone. A gas station about two blocks away permitted her to phone “the best hotel” in “X”; a cab was dispatched and she arrived at a lovely, modern hotel and made for the dining room. All white linen, flowers and well dressed people. Life was real again. Across the dining room, Helen spotted a VON nurse she had met in Ottawa. When she told her story, the nurse said” Wait a minute. A student of yours is a VON nurse here and I want you to tell her about last night.” Helen did. The former student opened her big, brown eyes and said, “Miss Mussallem, did you stay there ALL night?” “Yes,” Helen replied. “Tell me what kind of hotel is it?” “Well,” said the VON nurse, ”we hold a clinic there from time to time.” Enough said.

Then there was the time when Helen’s plane to St. John’s, Newfoundland arrived very late. Ten men and Miss Mussallem lined up at the Hotel Newfoundland for their rooms. Helen was at the end of the line as her luggage slowed her down ascending the stairs. There was great shouting at the front desk when the reception clerk announced that they would all have to share rooms. They all shrieked about “confirmed reservations” but there were no rooms to be had as there had been no flight out for departing guests. Almost as a person, they turned and looked at the lone female. Helen just stood there and waited only a few minutes. A porter came and whisked her to a lovely single room overlooking the harbour.

Those were also the days when, leaving an elevator, you made sure you had your keys in hand as there was usually someone following. Strange were those days when few females travelled on business. At another school of nursing, on a one-day visit, the director of the school arranged for a corn roast in the evening. All the teachers and local members of the professional association were present. Corn was passed around. Helen decided that, instead of presenting a speech, she would ask for questions. The audience sat quietly as someone asked a question, then as Helen paused before replying, all simultaneously chewed across a row of corn. What a sight –speaking to 20 cobs of corn! So, while the audience was formulating questions, Helen joined in the chewing of the corn.

The North Bay visit will always be remembered by the Director for the sleepless night spent at her hotel. A convention of salesmen had decided to spend the night on the main floor, drinking the hours away. Despite Helen’s frequent pleas to the management, it was 6 A.M. before the noise ceased. Although in no condition to conduct a proper orientation visit the next day, the Director did her best.

Having completed one-day visits to the 25 large, medium and small size schools of nursing, located in all provinces, the Director selected the various types of diploma programs to be surveyed –the three-year diploma hospital program, the two year plus one year internship program, and programs with close university affiliation. The goal of the survey, “To determine if Canadian schools of nursing are ready for a program of accreditation and if it is feasible at this time to initiate such a program”, seemed more daunting than ever.

The achievement of this goal was, of course, not the Director’s sole responsibility. There was, as always, a committee structure set up to assist the Pilot Project Director. This “democratic process” was meant to ensure that CNA members felt involved and would be able to claim some ownership of the finished product.

The first committee struck was the Special Committee which the Executive Committee of the CNA Board of Directors charged with initiating work on the project until a director was appointed. Although little preliminary work had been done when Helen arrived in September of 1959, the Executive Committee continued to Special Committee “…to advise the Director of the Pilot Project, upon her request, on matters of administration and policy”. Members of this committee were leaders in nursing education in Canada: Sister Denise Lefebvre, Rae Chittick, Sister Mary Felicitas, Margaret Street, Katherine MacLaggan, and six more. They were all eminently knowledgeable and well-recognized in the Canadian nursing community and they scared the new Director to death! Helen says, “Even though they treated me as a competent person, I’m not sure I was. I said many times that I may not be an expert in the field but I had a strong sense of commitment to achieving the goals of any work I undertook. This trait was acquired from my parents. We learned that we must work hard and only play after the job was done”.

The Special Committee soon determined that there was, and would continue to be, a need for interpretation of the project to allied professional agencies. Hence, a Liaison Committee was appointed. Members came from the Canadian Joint Committee on Nursing (equal representation from Canadian Medical Association (CMA), Canadian Hospital Association (CHA) and CNA, plus a representative from the Canadian Public Health Association, the Canadian Association for Adult Education and two members of the Special Committee on the Pilot Project. Meetings were infrequent and often held at CMA headquarters in Toronto. Helen remembers entering the CMA building by a side door and meeting in a room with inadequate heating and no air conditioning, which was considered a luxury in those days. She has a clear recollection of being “allowed in” the side door of CMA headquarters but, in 1962, when she had completed her doctorate, the front door suddenly swung open and, from that moment on, the Director was allowed to use the front door.

The times being what they were, it was difficult to assess how well this committee succeeded in interpreting such a “massive project on Canadian nursing education” to the seven national organizations.

The nature of the pilot project required that a qualified Board of Review study the survey reports, written by the Project Director, and pass judgment on the educational programs of the schools survey, i.e., using present criteria, if a program of national, voluntary accreditation were in place, would the school be accredited?

This was an incredibly hard-working committee. Each member of the Board of received a copy of each completed report as soon as it was duplicated at national office. They then studied the reports before the committee’s final meeting in May of 1959. To prevent any possible bias, schools were identified only by a code number.

Although not a committee, Regional Visitors were an integral part of the surveys. Following the National League for Nursing pattern, two regional visitor surveyors were selected for each school of nursing. This was intended to ensure that the report would provide a balanced judgment of each school. On each visit, the Director acted as senior visitor and the regional visitor as second visitor. For French-language schools of nursing, a third person –the senior bilingual visitor –played an integral role. She, with the assistance of a second bilingual visitor, was responsible for conducting surveys in the five French-language schools. The Director also participated on this team. Not only did she have overall administrative responsibility for surveys in these schools, but she translated the French language reports into English.

Little did Helen realize, when she agreed to be Director of the project, that she would be faced with such a formidable task of planning, organizing and directing the Pilot Project as well as coordinating all activities related to it. Her responsibilities included:

– Travelling to all 25 schools across the country on a preliminary visit; interpreting the Project to directors of the schools, and orienting them to the process of the survey;

– Conducting orientation workshops for regional visitors and an orientation program for the Board of Review;

– Taking overall responsibility for the surveys of the schools by:

– organizing each field survey trip;

– writing the survey report with the regional visitor

– validating, clarifying and supplementing information;

– setting up an organizational structure;

– providing guidance to schools within the field of her competence; and

– interpreting the project to hospital personnel;

– Establishing all procedures and organizing meetings of the Special and Liaison Committees;

– Interpreting the purpose and scope of the Project to deputy ministers of health, education, allied professional groups and the general public, via press, radio and television media.

How the new Director gained the skills necessary to conduct such a massive survey is a story in and of itself. As CNA had decided that a Canadian nurse should direct this Project, after one short week in Ottawa, Montreal and Toronto, Helen was sent to National League for Nursing headquarters in New York to become a competent surveyor. The time allotted for this training was four months!

This intense orientation program was invaluable to the fledgling Director’s future work. To make the indoctrination to the accreditation process as thorough as possible, no effort was spared by National League for Nursing staff. Helen was asked to serve as one of two accreditation visitors on six full-fledged accreditation visits in various geographical areas in the United States. Each of

these six surveys was carried out with a different National League for Nursing visitor to enable the new Canadian Director to study variations in survey techniques as well as the personal, philosophical variations of National League for Nursing staff. Surprisingly, Helen’s problems as a National League for Nursing visitor were unrelated to her expertise. She had a Canadian accent! Should the school being surveyed learn that one of the visitors was a Canadian and if perchance, the school did not receive accreditation, the whole process might have been condemned. Helen was continually reminded to say “OWT” and “ABOWT”, etc. and, luckily, as she had obtained her master’s degree at Teachers College, Columbia University, she was aware of the required accents. Frequently, the staff of the schools surveyed asked where she came from and Helen always replied “the Pacific Northwest” which was true as Vancouver was home. At each school, she always asked, immediately, some personal question like, “Where did you receive your basic education?” or “Have you always lived here?” She had quickly learned that most people are always happy to talk about themselves. Only once did she find herself being grilled and, thankfully, the senior National League for Nursing visitor saw her predicament and called on her for advice. Whew! She had another tense moment when some nurses in Duluth, Minn. took the National League for Nursing visitors for a drive and wanted to take them across the Canadian border. What to do? It would be a bit hard to explain Helen’s Canadian passport! Some miles from the border, the senior visitor again came to the rescue by advising that they really didn’t have time for such a long drive. Saved again!

The novice Director soon became accustomed to the pressures involved in conducting a survey. Each survey was one week in duration: five and a half days were spent on the survey with the remaining time being allocated for travel to the next school to be visited. One full day and evening (Monday) was spent at the hotel studying all written materials describing the program. Three days (Tuesday, Wednesday, and Thursday) they were at the school, visiting and each night and all day Friday was spent writing the report. Helen vowed, there and then, that she would develop a tool to assist in writing the reports as she found that, by ten or eleven P.M., their minds were so numb that they could hardly think of one decent descriptive noun or even the correct verb. Eventually, her “tool”, used in Canada, was so successful that it was adopted, with revisions, by her National League for Nursing mentors. The report was read to the school and hospital staff on Saturday morning, with opportunity allowed for correction of errors. The completed report was shipped to National League for Nursing headquarters and then it was on to the next survey. At National League for Nursing, after six surveys, the visitors took one week off. This luxury was not possible in Canada as staff was very limited and the entire project was conducted over such a short period.

Helen’s first stop as an National League for Nursing visitor was in the hot, humid Delaware city well known for being the Dupont headquarters. She recalls leaving Delaware on a stiflingly hot day and standing on the platform waiting for the train to her next post. The platform was level with the train entrance but, as she entered the train carrying bags in both hands, her shoe got wedged between the station platform and the train. Not knowing what else to do, she stepped on board, dropped her bags, and then turned to retrieve her shoe. Unfortunately, the train had started and her shoe was swept away. So, there she was, sitting in the back seat, one shoe on and one shoe off contemplating how to get a pair of shoes out of her luggage. The train stopped at the next station but the aisles were full so, off the train and into Penn station she limped –an unusual sight in 1957, but no one stopped or even stared. In the Ladies Room, she retrieved another pair of shoes from her suitcase and discarded the lone shoe in a wastebasket.

Each town –like DuPont in Delaware –seemed to have some special claim to fame. When Helen was posted to Little Falls, Minn., she was sure there would be nothing there. In fact, she even had difficulty finding it on the map. Imagine her surprise when she met with the faculty, and guess what? They proudly pointed out that Little Falls was the birthplace of Charles Lindbergh!

On Helen’s return to New York, work at National League for Nursing headquarters was intense. She formed many warm, rewarding relationships with National League for Nursing staff during stressful times spent preparing for the Board of Review and reporting to committees, etc. When it was time to return to Canada in early January 1958, she was sad. After such warm camaraderie at National League for Nursing, she was again on her own.

The new Director’s orientation was complete. The next step: the long awaited survey of 25 Canadian 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”.

Writing of the report in Ottawa and Maple Ridge (5.1.5)

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.

Presentation of Final Report to Executive Committee and Board of Directors (5.1.6)

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.

Halifax June 1960  (5.1.7)

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 “Ellea 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!

Now the study was completed, the report presented to membership at the 1960 Biennial meeting, and three of the four recommendations were approved by the Executive Committee at their post convention meeting. I was asked to stay on CNA staff for one more year to implement the three recommendations of the Pilot Project.

I advised the Executive of my plans to return to Teachers College to complete my doctorate. I knew my financial resources were very slim but I was determined to complete the remainder of the two year doctoral study. They agreed that I should return to Teachers College for one semester and, when needed, fly to CNA for meetings to implement the three projects. This I did.

The amount paid for those days at CNA assisted greatly in buying books and food. My return trip to Teachers College was made with the now president Helen Carpenter, also a student at Teachers College.

The 1960 biennial meeting was over and an exhilarated Helen started on her return to Teachers College for the fall semester. She decided that the two Helens should go by bus to see the Acadian country and visit her relatives in Yarmouth. On their arrival, however, Helen Carpenter developed a serious chest condition and her uncle, a physician, ordered her to stay in bed. The doctor, a delightful gentleman of 91 years, was still practicing medicine and administering anaesthetics too. He told Helen Mussallem that he still used chloroform by the drip method. She was duly impressed –and amazed. Helen stayed with the Carpenters for an extra day but, as her friend was not improving, decided to try and figure out a way to get from Yarmouth to New York in time for registration and classes. She took the ferry to Portland Maine, getting incredibly seasick on the voyage, and eventually, via bus and train, made it to Whittier Hall in New York.

Whittier Hall was strictly a women’s residence, but Helen chose to live there so she would not be distracted by the many social activities at International House, and besides, she was closer to the library. Studying at the doctoral level was going to be a full-time job –especially as Dr. Anderson had mapped out a plan “to get her through” as quickly as possible. Helen was aware of her many commitments in Canada. She had completed one semester and was now returning for the second. She would then return to Canada for one year to collect data for her dissertation and carry out her new responsibilities as Director of Special Studies tor CNA, including implementation of three of the four recommendations of the Pilot Project.

Development of Plan to Implement 3 of 4 recommendations of Pilot Project  (5.2.2)

On her return to Canada, project directors were recruited. Dr. Kaspar Naegle was engaged as Project Director for;

– Recommendation 1: “That a re-examination and study of the whole field of nursing education be undertaken”.

– Recommendation 2: “That a school improvement program be initiated to assist schools in upgrading their educational programs.”

Helen recruited Glenna Rowsell, already on CNA staff. Lillian Campion was persuaded to assume the position of Project Director to implement

– Recommendation 3: “That a program be established for evaluating the quality of nursing service in areas where students in schools of nursing receive their clinical experience”. As Director of Special Studies, Helen was responsible for the overall supervision of these projects.

– Recommendation 4: “That a program of accreditation for schools of nursing be developed by the Canadian Nurses Association” was held in abeyance pending completion of the other three projects.

Royal Commission  on Health Services (5.3)

CNA Project and RCHS project on Nursing Education combined  (5.3.1)

At this time, there was also general concern about the whole health care system. In 1961, a Royal Commission on Health Services was established with Justice Emmett Hall as Chair. It was the Commission’s intention to include an examination of the whole field of nursing and nursing education. It seemed logical, therefore, that Recommendation 1 on the whole field of nursing education be assumed by the person carrying out the examination for the Royal Commission. Dr. Naegle was a superb sociologist and scholar and Helen was delighted that he would be directing the project on nursing education for both CNA and the RCHS.

Royal Commission on Health Services Project Director (5.3.2)

The study for the Royal Commission on Health Services in Canada was an exciting and rewarding experience for Helen. The territory was familiar, but greatly expanded, from the report of the Pilot Project. It included not only diploma schools of nursing but university schools, nursing assistant programs, psychiatric nurse programs, operating room technician programs and midwifery courses. She especially enjoyed the field work which required many trips across Canada and her working relationship with researchers and RCHS staff, to whom she was responsible. Helen had been seconded to the RCHS by CNA from the summer of 1962 to May of 1963. The final report was published in 1964.

During the summer of 1962, CNA received a grant from Kellogg to create a Foundation and award fellowships. Applications were received from students and immediate awards needed to be made or the money for the current year would be lost. Katherine McLaggan, the prime mover in obtaining the grant, was responsible for forming a Selections Committee and, as it was August and no one else was readily available to meet with a committee, Helen was recruited.

She met with Katherine in her room at the Chateau Laurier in Ottawa where all the student applicant files were piled on the bed. While they were developing selection criteria for the awards, Helen was called to the Daly Building to meet with the Director of Research for the Royal Commission on Health Services and sign the contract for her study. While there, she met Mr. B. Blishen, Director of Research and Dr. Malcolm Taylor, Research Consultant. Dr. Taylor wished to speak with her at length and seemed slightly annoyed when Helen told him of her other responsibilities with Katherine McLaggan. When she related her encounter with Dr. Taylor to Katherine, she was told to phone him immediately and invite him to dinner. As he was already booked for dinner, Helen invited him to the Jasper Lounge for cocktails, where Katherine McLaggan used the encounter to great advantage, immersing him in the grave problems of nursing education. Helen’s role was to see that drinks were served without question and to be discreet about paying the bill. This being the pre-credit card era, she gave the waiter a $10 bill –ample for drinks in those days. She instructed the waiter carefully to serve as many drinks as requested. He did –but only one each –and, before Helen could get up to retrieve her change, minus tip, he brought the change to their table and plunked it down in front of her.

Helen was so embarrassed and Dr. Taylor was not amused. In those days, men always looked after the bill. After the drinks fiasco and dinner, Helen and Katherine went for a walk through the quiet Ottawa streets. Helen asked if Katherine had ever seen the face of the nurse at the back of the War Memorial. She hadn’t, so they scrunched around to get a better view. Just as Helen was pushing Katherine up the monument for a better look, the loud voice of a policeman shouted, “You ladies get down immediately or I will turn you in!” They both slid down ignominiously and vanished into the night. Up to the time she died, Katherine would recall this incident with great glee. During this period, and on into the 70s, Helen received many offers to assume the deanship of a university school of nursing or to become director of nursing at several large hospitals. She found only one offer tempting –to be director of the School of Nursing at the University of British Columbia. Even though CNA was planning to host the 1969 International Council of Nurses Congress in Montreal, Helen was assured CNA would wait for her. Negotiations continued.

As the School of Nursing had been on the UBC campus since 1916 and as two other health science faculties had been created at the university, the faculties of medicine and pharmacy, one of Helen’s requirements, an important one, was that the UBC School of Nursing also become a faculty. The negotiator sadly advised her that no change could be made as there already were too many faculties on campus. Finally, he arrived with what he termed “good news”. The Board of Governors had agreed that if Helen returned to UBC, the School of Nursing would become a faculty. Helen was delighted and asked to have the promise in writing.

This was impossible as the Board of Governors did not write such letters relating to the hiring of faculty! So Helen never accepted the UBC position and often wonders, if she had, what a different life she might have led. But that’s skipping way ahead of 1962. Let’s back up.