Pilot Project for Evaluation of Schools of Nursing

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.

5.1.2 Arrival in Ottawa

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!

5.1.3 Initial Planning

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.