The Pediatric Cardiac Surgery Inquest Report




Nurses care for the sick and disabled, and promote, restore and maintain health. These services are usually co-ordinated with doctors and other health-care providers. By virtue of their education, experience and 24 hour-a-day presence with patients, registered nurses (RNs) play a unique and critical role in hospital care. Some of this care is in specialized areas, such as the operating room and intensive care unit, and nurses working in these areas are expected to develop the knowledge, skills and judgment essential for the management of complex patient problems. RNs are often the first to identify changes in a patient's condition, as well as trends in a patient's response to care. Nurses often act as a guide and interpreter for patients and their families trying to negotiate the complex and highly specialized environment of hospitals. RNs also provide the co-ordination of care and day-to-day management for both individual patients and patient care programs, ensuring that the right resources are in the right place at the right time to meet patient needs.

Scholars of the history of nursing in Canada stress the need to examine the role that gender stereotyping and discrimination has played in the history of nursing. Women dominate the profession of nursing. Approximately 98 per cent of nurses in Canada are female. Furthermore nurses, like most women who entered the Canadian labour market, were historically poorly paid and were expected to be completely obedient to male authority. In fact, the motto of Canada's first successful school of nursing, the General and Marine Hospital established in 1874 in St. Catharines, Ontario, was "I see and am silent." (Judy Coburn, "I See and Am Silent," in Women and Work, 1850-1930, Toronto: Women's Press, 1974, page 140)

For most of this century, Canadian nurses received their training in hospitals, where they served essentially as free labour to the hospitals as they apprenticed to their craft. Students were often required to live at their training hospital, where they regularly worked 12-hour days, 7 days a week. According to Katheryn MacPherson, author of a recent history of nursing in Canada:

Deferring to one's superiors was learned early on the job. Probationers entered the hospital at the bottom of the nursing hierarchy, subordinate to juniors, who in turn looked up to intermediates, who deferred to senior students. Seniors were expected to comply with the directives of supervisory graduate nurses, who themselves answered to the superintendent of nursing. Deference extended well beyond merely following orders to include physical demonstrations of differential rank. Nurses were instructed that, when in the presence of more senior nursing staff or any medical practitioners, they were to stand up 'at attention', surrender their place on elevators, and allow superiors to walk ahead. (Katheryn MacPherson, Bedside Matters: The Transformation of Canadian Nursing, 1900-1990, Don Mills, Oxford University Press, 1996, page 32)

While it has been possible to receive a Bachelor of Science in Nursing (B.Sc.N.) in Canada since 1919, the number of university training programs and the number of university-trained nurses in Canada remained low for most of the century.

Historically, nurses trained in hospitals for three years. During this period they constituted the main nursing labour force, while most graduate nurses provided supervision, not bedside care. When they graduated, nurses sought work in private care, public health or hospitals. While today approximately three out of every four nurses work in a hospital, for the first half of this century a very large percentage of nurses sought and found work in private practice. Graduating nurses took examinations that permitted them to be registered with local nursing registries, hence the designation Registered Nurse. These registries served as referral services and provided a variety of services to the nurses who were registered with them, including sick benefits and pension funds.

The focus of the diploma programs was to prepare nurses to provide care in hospitals and personal care homes, with the curricula focused on the nursing response to people suffering illness and disease. The baccalaureate curriculum still provides this focus, as well as requiring a broader foundation in the arts and sciences. Courses include anatomy, physiology, psychology, sociology, and both theory and clinical practice in nursing. In addition, there is an expectation that students learn scientific reasoning and how to apply current research to practice. The degree provides students with an in-depth knowledge of the determinants of health, which enables graduates to be effective in helping individuals, groups and populations prevent illness and lead healthier lives, as well as provide nursing care for those who are ill.

The last twenty years have also seen a dramatic expansion in nursing specialization-close to one-third of nurses are enrolled in post-RN training. Despite this expansion in training, formal recognition for specialized training has been slow in coming.

More recently, governments have closed hospitals and beds. Hospitals have moved toward reducing the length of time that patients spend in hospital, whether it be after having an operation, a baby or heart attack. This has resulted in an increase in the percentage of very ill patients in hospital, and markedly influenced the workload of the nurses who care for these patients.

During the last decade, hospitals across Canada have experienced difficulties attracting and retaining nurses. This is the result of several factors. Within Canada's health-care system, nurses occupy a unique and yet controversial position. Nurses have many of the responsibilities and obligations of professionals, and indeed, they are trained as professionals. However, they lack the control over working conditions that usually accompanies professional status. This, in combination with the increase in the workload and what is perceived as low pay for the care that nurses provide, has caused many to leave the profession. In addition, hospitals involved in cost-cutting efforts have looked for ways to reduce further their nursing costs-making greater use of part-time staff and having more tasks performed by non-nurses. Unintentionally, this has sent the message to current and potential nurses that the profession has a cloudy future. The Winnipeg HSC was participating in such an exercise in rationalization in 1993 and 1994.

The events in the pediatric cardiac surgery program in 1994 involved nurses who specialized in the nursing diagnosis and therapy of patients with cardiac problems, in cardiac surgery and in the intensive care treatment of young children in critical condition. All the nurses involved had a variety of educational backgrounds and different personal responses to the events of 1994. Those responses were shaped by their profession, its history and the place that it occupied in the broader health-care system.



Current Home - Table of Contents - Chapter 3 - Nursing
Next How a pediatric cardiac surgery case proceeded
Previous Pediatric subspecialties
Section 1 Chapter 1 - Introduction to the Issues
  Chapter 2 - Pediatric Cardiac Issues
  Chapter 3 - The Diagnosis of Pediatric Heart Defects and their Surgical Treatment
  Chapter 4 - The Health Sciences Centre
Section 2 Chapter 5 - Pediatric Cardiac Surgery in Winnipeg 1950-1993
  Chapter 6 - The Restart of Pediatric Cardiac Surgery in 1994
January 1, 1994 to May 17, 1994
  Chapter 7 - The Slowdown
May 17 to September 1994
  Chapter 8 - Events Leading to the Suspension of the Program
September 7, 1994 to December 23, 1994
  Chapter 9 - 1995 - The Aftermath of the Shutdown
January to March, 1995
Section 3 Chapter 10 - Findings and Recommendations
Appendix 1 - Glossary of terms used in this report
Appendix 2 - Parties to the Proceedings and counsel
Appendix 3 - List of witnesses and dates of testimony
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