Issue #24: Summer 2009

No Handmaiden of Medicine

by lissa cowan

Ethel Johns helped establish the UBC nursing program in 1919. Her vision – to transform the role of nurses from physicians’ assistants to professional caregivers – would become a reality.

The young girl who came with her family to Canada from England in 1892 couldn’t have known the challenges that faced her or the impact she would have on Canadian society. But the seeds were there already: as an English schoolgirl, she used her garden plot in the schoolyard as a burial ground for dead birds and mice instead of growing and tending flowers like the other little girls. An early sign, perhaps, of the independent mind and unique spirit that would lead her to spearhead a turn-of-the-century revolution in nursing.

The family lived at the Wabigoon native reserve in Ontario, where Ethel Johns’ father was a missionary and teacher. According to Margaret Street, who wrote Watch-fires on the Mountains: The Life and Writings of Ethel Johns, he was an atypical missionary in that, unlike many God-fearing colonists who came to Canada in the late 1800s, he didn’t quash Ojibway customs and traditions. After he established his school, the indigenous community continued to follow traditional rites such as the mid-summer medawin or medicine dance. Those on the reserve accepted the Johns family into the community and the Ojibway chief even referred to Johns’ mother, Amy, as “a good medicine woman.” By age 16, Ethel Johns was fluent in Ojibway, and was an interpreter between the Wabigoon Chief and the federal government.

A defining moment for Johns came in her early twenties when freelance journalist Cora Hind visited the Wabigoon reserve. “This vivid young woman lived in a world of which I knew nothing and was free to come and go as she pleased,” Johns wrote in her diary. “I had never seen anyone like her.” Her encounter with the free-spirited journalist taught Johns that she could feed her hunger for learning and that it was possible even then for women to be free of the dictates of culture and upbringing. So, at age 21, she set off for Winnipeg to become a nurse.

“When Ethel Johns entered the profession, nursing wasn’t perceived as something that required much knowledge or training,” says Sally Thorne, MSN’83, PhD, director of UBC’s school of Nursing. In the early years, Johns saw tremendous irregularities and shortcomings in how nursing was taught in Canada, and became aware of the profession’s low standing. No legislation existed in Manitoba to govern nurse training and registration, and trained nurses vied for jobs with those who had little training and charged lower fees. Nursing was perceived as a woman’s labour of love rather than a professional occupation.

Johns’ first brush with struggles in Canada’s rural hospitals came in 1902 following her graduation from the Winnipeg General Hospital Training School for Nurses. She received a temporary appointment as superintendent of a small hospital in Prince Albert during a severe outbreak of typhoid. The experience brought her into intimate contact with a resource-poor hospital and illustrated the importance of well-trained student nurses. Johns referred to the untrained nurses as “deplorably ignorant” pointing to the “crying need” for a serviceable nursing workforce based on more than just a womanly need to serve.

Between 1905 and 1911 she worked at the Winnipeg General Hospital as a teacher and head nurse in charge of the x-ray department. She became involved in fledgling nursing organizations and publications, links that created a solid footing for her to pursue the political task of making sure that nursing was regulated.

Major challenges stood in the way of passing a bill. Many nurses, for example, did not recognize the significance of a State Registration for Nurses. In a September 1907 issue of the Nurses’ Alumnae Journal, Johns referred to the “difficulty of banding women together for concerted action.” Then there was the age-old idea that nursing was a special privilege. Adding to that was legislative opposition among rural constituencies with small hospitals and feeble nursing schools. In speeches and articles, she repeatedly defended her position of having a legal standard instituted for the nursing profession just as it was in medicine, dentistry, pharmacy, law and teaching.

In 1913 the government of Manitoba finally passed a Registration Act, which Johns initially referred to as a “total wreck,” then later accepted as she realized that “a bad bill is better than none.”

After the First World War, returning Canadian soldiers caused an epidemic of the Spanish flu. As the flu spread, trained nurses were in short supply. Thousands of women volunteered for nursing service, yet lacked the training to contribute in a meaningful way. Johns was superintendent of the Children’s Hospital of Winnipeg during the epidemic when two-thirds of her trained staff became ill and had to attend to the sick as soon as they recovered. “Under the most difficult circumstances they rendered us a service we shall not soon forget,” she said.

During the epidemic that killed 50,000 in Canada and from 50 to 100 million people worldwide, the need for trained nurses became clear. But John’s vision for the nursing profession had progressed. She understood that the higher education of nurses was the only way forward. Years later, reflecting on
the period of the epidemic, she wrote, “I had acquired a rooted conviction, based on my personal experience, that it was in the university and in the university alone that nurses could hope to find the broader educational opportunities without which they could never meet the increasing demands being made upon them.” Her belief in the critical role that higher education needed to play in forming a knowledgeable nursing workforce was soon to nudge her toward a new career in Vancouver.

In Vancouver, discussions were taking place about how to improve nursing education in the province. Malcolm MacEachern, medical superintendent for the Vancouver General Hospital, was part of the hospital standardization movement to improve the quality of hospitals. While many in the medical establishment disapproved of the higher education of nurses, MacEachern understood that a high nursing standard required it. In a letter addressed to the UBC Senate, he asked the university to take over from the Vancouver General Hospital Training School for Nurses. The Senate appointed a three-member committee to look into the issue. A search began to find a director, and Johns was hired. Although the wheels were in motion for the new school, the debate on the program’s value and what faculty it would fall under had only just begun. Johns was perfectly placed to aid the development of the statement of criteria. She was present at the executive meeting to consider and approve the submission and was there when the Senate referred nursing to the faculty of Applied Science.

In spite of persistent criticism, Johns had two key allies in MacEachern and Reginald Brook, dean of the faculty of Applied Science.

“It was an interesting tweak of history to combine nursing with engineering because the idea of nursing having a scientific basis wasn’t really accepted until the 1950s,” Thorne says. “It exists as the only such configuration anywhere in the world and it has retained that history. We’re still in the faculty of Applied Science.”

A photograph of Johns taken in 1919, the year the department of Nursing at UBC was established, shows a slender, fair-haired woman wearing a white cap and a black uniform. A graduate of that opening year described her as “very clever and a wonderful lecturer.” Johns referred to UBC as a “young, western, great big striding university, without too many traditions.”

When the school opened its doors, Canada became the first country in the Commonwealth to offer a baccalaureate degree program in nursing. Addressing staff and students at VGH, she called the university’s new program an “experiment,” saying that its success or failure depended on collective effort. “We must expect in the future to be able to develop the faculties of nursing in our universities,” she said.

“Ethel Johns moved nursing away from the handmaiden of medicine image, articulating it and identifying it in the university and the larger community as a distinct discipline in its own right,” remarks Thorne. “In 1919, this was a very revolutionary message.”

So revolutionary that in 1920 even the College of Physicians and Surgeons expressed open opposition to the new degree program, remarking that “overtraining of nurses is not desireable and results largely in the losing of their usefulness,” and “theoretical branches of nursing are of very little use in the sick room.”

Nevertheless, patient numbers were increasing and there continued to be an overwhelming need for highly trained nurses. Johns addressed an assembly of physicians, entreating them to support the program. “You have taken us for granted, as men always take their women folk for granted,” she said. “Surely we can enlist your sympathy in support of a movement which has as its object the development of a nursing force worthy of a cause to which it and you alike are dedicated: the prevention of disease and the conversation of life lived to the full, active, healthy, and happy.”

Fortunately, for us, Johns enlisted that sympathy and went on to help improve Canadian public health for the better part of a century.

Lissa Cowan is a writer living in Vancouver. She is working on a book related to women’s health.