From Nightingale nurses to modern profession: nursing in Australia

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Today Nurse Uncut has the first part of a recent ‘oration’ given by nursing educator Dr Georgina Willetts, which traces the history of nursing in Australia.

In 1889, the ‘Father of Federation’ Henry Parkes delivered the original Tenterfield Oration, a call for the Australian colonies to join together to become one nation. Since 2001, there has been an annual oration, with a distinguished speaker focusing on challenging social/political issues in Australian society.

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Dr Georgina Willetts delivering the Oration.

The Henry Parkes Oration for 2015 was presented by Dr Georgina Willetts, nursing educator and great great granddaughter of Henry Parkes, at the Sir Henry Parkes Memorial School of Arts in Tenterfield, western NSW, on 17 October. Dr Willetts spoke about the historical transition of nursing in Australia, from the Nightingale model to the contemporary profession.

In part one, Dr Willetts outlines the origins of how nurses came to Australia, at the behest of her great great grandfather, a prominent social reformer in the colony of NSW. Nurse Uncut will carry parts two and three of the Oration next week.

Introduction

In the 200th year since Sir Henry’s birth, I am honoured, as a descendent of Sir Henry, to have been given the privilege of presenting the 2015 Sir Henry Parkes oration. I am a professional nurse and my story is intertwined with the evolution of nursing as a profession. However, the story of nursing in Australia is also intertwined with my ancestor Sir Henry Parkes and his vision for both education and healthcare.

Nursing has always been seen as women’s work and this has created a troubled path that the profession has had to negotiate to legitimise itself. Today I am going to talk about the journey of nursing in Australia from its early days at the Sydney infirmary to its rightful recognition as a profession amongst the other healthcare professions in this country.

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Hospital nursing students in the 1980s.

In 1981, at the ripe old age of 17, I began my training in the old hospital apprenticeship system akin to the Nightingale training schools. From then I have worked continuously as a nurse and midwife and have travelled the journey to the professionalisation of nursing initially achieved in 1986 in Australia. I undertook midwifery and orthopaedic training in the old hospital certificate system and then went on to transition my qualifications to academic standing, undertaking a conversion degree, two graduate certificates, a graduate diploma, a Master of Education and then finally a Doctorate of Education.

Identifying always as a clinical nurse, I took a turn on my journey in 2010 and moved into academia. From here I have learnt there are many ways to influence the profession, particularly through the education of our new generation of nurses but also through research into the profession of nursing. My doctoral research studied social practice in ‘constructing the nurse’s professional identity’.

Some of you will know the story of the evolution of the nursing profession in Australia, especially those in the audience who are nurses. This oration provides a good opportunity to reflect on the caring profession, its challenges and its journey. I hope when you do come into contact with a nurse, that your experience is one of a professional carer who has taken the time to critically hone their craft, a professional that I would be proud of.

Sir Henry’s influence and Nightingale

Let us go back to the beginning. Sir Henry Parkes had a clear vision of social reform, public education and public healthcare, and he also held a strong commitment to women having public roles. In 1866 he wrote to Florence Nightingale about his requirement for Nightingale-trained nurses in the colony (Godden, 2006). Sir Henry became a pivotal character in establishing modern day nursing in Australia. As the political character he was, the arrival of the first nurses to the colony was the result of his ultimate discontent in the management of the Sydney infirmary: the government was putting money into the infirmary but had no say in its management. Sir Henry made moves to change this, through eliciting the support of the infirmary doctors, who were also unhappy with the happenings in the infirmary. Sir Henry was then able to cultivate their support. What both groups felt was needed were appropriately trained nurses to allow the doctors to practise the new ways of medicine.

The doctors’ petitions had actually begun back in 1857 but it was not until a particular patient in 1866 that the involvement of Sir Henry led to the opportunity to contact Florence. A young patient, David Gibson, was found to be “filthy and covered in vermin” (Godden, 2006). This was actually not uncommon for patients in the infirmary at this time; however, this poor patient died. This was the impetus, “with a letter of complaint from the doctors identifying his death was the result of the absence of efficient nursing” (Godden, 2006), that enabled Sir Henry to gain the authorisation to contact Florence Nightingale and discuss the need for nurses who had undertaken her training to come out to the colony and introduce a Florence Nightingale style of nursing.

Before I go on with Sir Henry’s story of introducing nursing into Australia, I must first articulate why Florence is so important to nursing.

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Since the Crimean War in the 1850s Florence had gained much recognition for her new ways of working as a nurse and regardless of whether you are a fan of hers or not, some of her ways have left an ongoing legacy. Her philosophy that you nurse the patient rather than the disease introduced the holistic philosophy of nursing that continues today. She believed that healing the patient required good nutrition, including ensuring that the mouth was clean and food was nutritional, and this remains centrally important today in patient care. Patients need sunlight and air to heal, and this was ensured by the design of her wards, which always included a balcony where patients if need be would be wheeled out in their beds. The Germ theory was a new discovery and she introduced rudimentary isolation techniques. Tenterfield Hospital shows the effects of Florence Nightingale’s reforms, with the building of a four-bed isolation ward in response to the potential for the 1918 Spanish flu epidemic to be brought back by returning WWI soldiers. Luckily this was only ever a potential.

Florence also identified that nurses should be calm, quiet and concise – difficult to achieve sometimes in our high-pressured environments today. She recognised pain and anxiety as obstacles to recovery, which was quite significant and new for nursing care in the 1850s. She also identified that there needed to be rules around sleep, and still today we have the afternoon rest period when visitors are restricted.

One of the most significant things she introduced into nursing practice was the recognition of nursing observations and nursing notes that were distinct and separate from medical observations and notes, and this, for nursing, was the beginning of evidence-based practice in our work. She went on to lead health reform in epidemiology and healthcare outcome statistics.

Overall, her legacy resulted in establishing a respected occupation for women and also the need for formal nursing education.

So Sir Henry was right at the cutting edge of healthcare reform back in the 1800s.

The letter from Sir Henry and the supporting head, Dr Roberts, took two months to reach Florence. This delay turned out to be timely as Florence had just received bad news that one of her proposals had been rejected by the Indian Government and there would not be the opportunity to train female nurses in India, so this opportunity to open a Nightingale training school in the colony was particularly welcomed.

Florence, however, did not just accept the request from Sir Henry; she made a significant change, rejecting the request of Dr Roberts for the nurses to be under the direct supervision of the doctors. Instead Florence insisted that a matron manage the hospital independent of the medicine. This was seen as a blow to Roberts, who wanted a doctor-led hospital, but Sir Henry supported Florence and it was a workforce not subordinate to the doctors. Hence the embryonic start to the profession of nursing in Australia.

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Lucy Osburn.

And so it was that Florence sent Lucy Osburn to the colony.

History of nursing in Australia: the legacy of Lucy Osburn

Opened in 1816, the Sydney infirmary was nicknamed the ‘rum hospital’ because Governor Macquarie paid the builders in spirits in exchange for building the hospital. The reputation of the hospital was that of a squalid environment not particularly conducive to health care. In 1868 Lucy Osburn arrived in the colony to take up the position of Lady Superintendent (Matron); with her were five probationary nurses, all trained in the Nightingale training system in London.

The story of Lucy Osburn is an interesting one and reflects in many ways the trials and tribulations of nursing in the early 1980s, when it was attempting to establish itself as a profession.

Throughout her time in Australia Lucy Osburn’s career was very much intertwined with Sir Henry and he was a strong advocate for her and the Nightingale style of nursing she was introducing. But this was controversial. At this time a middle-class woman always held the senior nursing position, regardless of her experience. Lucy was of middle-class breeding but she was also the most inexperienced in the group of nurses that were sent out. The other nurses were of the working class and therefore automatically became subordinate to Lucy, which caused some disharmony throughout her time at the infirmary. The colony was also not very accepting of a woman taking such a position in society – a single middle-class woman who had her own rightful vocation (I won’t call it a profession as yet). Sir Henry Parkes received much opposition from many in government and in medicine (Godden, 2006).

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Here it is important to note that the sisters of charity religious nuns were already functioning as trained nurses in the colony. What is significant to note is that these nurses were unpaid and under the direct authority of the medical staff. They were also, of course, of Roman Catholic persuasion and the colony was biased towards the protestant position (Godden, 2006).

However, what Sir Henry ensured was that the nurses under Lucy Osburn were paid and Osburn was also assured of her position of authority within the infirmary. This was challenged throughout her time in Sydney, but always supported by Sir Henry: he championed her position and was supportive of women in their own right. This was progressive for his time and laid the foundation for the potential development of the profession. Do not think that this was a happy ending: no indeed – much argy-bargy went on while Lucy Osburn was in Australia, between herself and the other nurses and also between herself and the doctors and the hospital board.

But the foundations were laid and eventually two of her nurses went on to bigger and better things. Haldane Turriff became the first matron of The Alfred Hospital in Melbourne and Annie Miller became head nurse at Brisbane. It is said that Lucy Osburn did not give a good reference for Turriff but needless to say the legacy of Lucy Osburn and Florence Nightingale and of course the vision of Sir Henry Parkes paved the way for the profession of nursing as we know it today.

Continue reading Georgina’s talk:

Thank you to the Henry Parkes Foundation and to Dr Georgina Willetts for permission to republish her Oration.

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