A History of Nursing in Ontario

• A “nurse” was a woman who gave care in the home, usually to members of her own family who were ill, or giving birth
• Kingston’s Female Benevolent Society provided the only hospital care available to the sick poor
• 1795 : First Medical Act introduced in Upper Canada made it virtually illegal to practice midwifery without a license
• 1806 : Upper Canada Medical Act repealed as impractical

• Victorian reformer Florence Nightingale established nursing as a profession in England, setting the pattern for the future of nursing in Ontario
• 1866 : Ontario restricted midwifery practice exclusively to physicians

• 1871: Mrs. Catherine Cole of Toronto was enumerated as being a “monthly nurse”, an individual who cared for a new mother and infant for one month following the birth, caring for a new infant in a barrister’s home – probably the most frequently hired caregiver of the mid-19th century
• 1874 : Given the Victorian values of the times, nurses were trained and socialized to be passive and subservient to their superiors
• The low-paying, heavy-duty work and unpleasant working conditions meant the majority of nurses came from working and lower-class homes
• Two nurses from Florence Nightingale’s U.K. school, St. Thomas, and a doctor establish the first successful training school for nurses in Canada at the St. Catharines Marine and General Hospital. Named the Mack Training School for Nurses, it offered a two-year program based on practical nursing experience in the hospital. Six nurses comprise first graduating class in 1878

• 1883: Toronto Medical Society set up a “Directory for Nurses” listing private nurses available to be hired, however many of these nurses were untrained
• 1884 : Mary Agnes Snively, the first Ontario nurse trained according to the principles of Florence Nightingale, assumed the position of Lady Superintendent of the Toronto General Hospital’s School of Nursing. She made a profound difference at Toronto General, including establishing the first nursing student residence as well as a proper curriculum. Snively later co-founded the International Council of Nurses, and played a large role in the establishment of The Graduate Nurses Association of Ontario and the Canadian Nurses Association

• 1892 : Victoria General Hospital School of Nursing had two male graduates in their first graduating class. At that time, male nursing students were generally given a higher status in the nursing school with special privileges
• 1892 : Ontario’s second nursing school (Canada’s first Catholic nursing school) founded at Toronto’s St. Michael’s Hospital School by the Sisters of Saint Joseph
• 1897 : With encouragement from the National Council of Women of Canada, Lady Ishbel Aberdeen (wife of Canada’s then Governor General) founded the Victorian Order of Nurses (VON). In response to the lack of medical and nursing services for pioneer women, the VON immediately sought to provide pre- and post-natal care for expectant mothers by establishing small cottage hospitals in communities throughout western and northern Ontario
• 1880s-1914: Institutionalization of health care in Ontario: movement of medical services into hospitals, 96 new hospitals built in Ontario

• 1902: New York City Board of Education hired Toronto native and Hospital for Sick Children graduate Lina Rogers Struthers R.N. as North America’s first school nurse. Within one month, Struthers’ efforts dramatically reduced school absenteeism due to communicable diseases, improved attendance and quickly led to the employment of school nurses in New York City and across North America
• 1904 : The former Graduate Nurses Association of Ontario (GNAO) is founded, later to become the Registered Nurses Association of Ontario (RNAO).
• 1905 : Ottawa’s Anti-Tuberculosis League hired Canada’s first tuberculosis (TB) nurse – a public health role – to visit the homes of TB patients
• 1907 : Toronto Health Department became the first municipal health department in Canada to hire a TB nurse, Christina Mitchell
• 1908 : Canadian National Association of Trained Nurses (CNATN) formed to elevate the educational standards of the profession (pre-cursor of Canadian Nurses’ Association)
• 1909 : Provincial responsibility for public health nursing began with medical inspection programs under the Department of Education to counteract high levels of school absenteeism due to widespread childhood disease. Free of the hierarchy of hospitals, public health nurses were the most independent nurses of this period
  
  Hospitals realized the advantages of forming nursing schools as a source of free, skilled labour and by 1909, 57 of Canada’s 70 nursing schools had extended their nursing education program to three years

• 1910: Lina Rogers Struthers returns to Toronto from New York City to become the city’s first school nurse and, thereafter, becomes Superintendent of School Nurses in Toronto.
• 1912 : Ontario’s Hospitals Act was passed and included the right to use the title “Registered Nurse”
• 1914 : University of Toronto committee on nursing education was first in a series of academic and governmental bodies that found that continual physical and mental strain on the students was reducing enrolment and effective training

• Efforts made to take nursing training out of the hospital and place it in a university setting. This was difficult, as strong opposition still existed to women receiving university education in preparation for professional careers
• Red Cross established nursing outposts in Ontario
• 1920 : The Ontario Red Cross Society funded a one-year university program for public health nurses at the University of Toronto
• 1922 : Nursing was officially recognized as a regulated profession when the provincial government passed a Nurses Registration Act in Ontario
• 1925 : The Registered Nurses’ Association of Ontario (RNAO) is incorporated
• 1926 : National War Memorial dedicated to the Nursing Sisters, Ottawa

• The Great Depression required many nurses to combine nursing with non-nursing employment to survive.
• 1935 : Standards for nursing education and practice were established and the title "registered nurse" was protected by making registration mandatory for its use
• 1938 : CNATN committee formed to campaign for an eight-hour work day

• Nursing programs began accepting African-Canadian and First Nations applicants, possibly in response to the lack of nurses partially related to the Second World War
• Penicillin required injection every three hours; overwhelmed medical interns turned to nurses who adopted intramuscular injections as a standard nursing skill
• 1941 : Registered Practical Nursing Association of Ontario (RPNAO) founded
• 1942 : After being refused degree status by the University of Toronto, Kathleen Russell pioneered Canada’s first nursing program at the university by developing a program integrating nursing theory and practice that would meet all standards of a university degree
• 1946 : The first training centres for nursing assistants, offering a nine-month training program, were opened in Toronto, Kingston and Hamilton under the joint sponsorship of the Ontario Department of Health and the Department of Education
• 1947 : Ontario hospitals established intravenous and blood infusions as the first act delegated to nurses from doctors
• The Nurses' Act was amended to provide for the title "Certified Nursing Assistant"

• Auxiliary personnel such as nursing aids and orderlies expanded, along with the active recruitment of men and immigrant nurses to fill vacancies in hospital staff nursing positions
• 1951 : After decades of effort from nurses, legislation passed giving the Registered Nurses Association of Ontario (RNAO) full power over admission to nursing schools and nurse certification – 82 years after the medical profession in Ontario had been granted similar powers over its profession
• 1959 : University of Western Ontario established a Master’s program in nursing

• 1963: College of Nurses of Ontario (CNO) became the regulatory body for Ontario’s nurses
• 1963 : The title of the Certified Nursing Assistant was changed to "Registered Nursing Assistant"

• 1973: Ontario Nurses’ Association (ONA) founded as the trade union that represents registered nurses and allied health professionals working in hospitals, long-term care facilities, public health, community agencies and industry throughout Ontario

• Discrimination based on race, ethnicity, sex or sexuality was being openly challenged as most practitioners recognized that diversity among nurses made the occupation stronger

• 1993 : The Regulated Health Professionals Act (RHPA) is proclaimed. A key principle underlying this legislation included recognition that professional expertise rests in the minds and knowledge of the professions.
• 1993 : Registered Nursing Assistants (RNA) are given the right to use the title “nurse” and adopt the title of Registered Practical Nurse (RPN)

• 2005: As of January 1, 2005 the requirement for RPN entry to practice was increased from a certificate to a diploma from a College of Applied Arts and Technology
• 2005 : As of January 1, 2005 the minimum requirement for RN entry to practice was increased from a diploma from a College of Applied Arts and Technology to a four-year baccalaureate degree in nursing or equivalent
• 2006 : The Ontario Government launches the HealthForceOntario (ForceSantéOntario) strategy to create new and innovative health care roles and to recruit and retain the best and brightest health care workers, ensuring Ontario has the right supply and mix of health care professionals when and where they are needed

Compiled from :

“I See and am Silent”: A Short History of Nursing in Ontario by Judi Coburn in Women at Work: Ontario, 1850-1930, edited by Janice Acton, Penny Goldsmith and Bonnie Shepard (Canadian Women’s Educational Press, 1974).

On All Frontiers: Four Centuries of Canadian Nursing, edited by Christina Bates, Dianne Dodd and Nicole Rousseau (University of Ottawa Press, 2005).

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