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hundred years ago, being a nurse meant sterilizing equipment, doing laundry, giving baths and dressing wounds. Much has changed during the past century; nurses now have many more options available in terms of the roles they choose to play in the health care system. And then, there are the things that haven’t changed and never will—including the need for nurses 24 hours a day, every day of the year.

"There are four demands of nursing practice," explains Joni Boyd, senior consultant on nursing policy for the Canadian Nurses Association and manager of the Canadian Nurses Portal Project. "Education, research, administration and clinical practice. The public mostly perceives clinical practice as the ‘true’ nurse but the profession actually is much broader than that. " Boyd adds that nurses are increasingly involved in public policy at all levels of government—and are instrumental in effecting change. One example, she says, is that nurses worked hard to get smoking laws changed in the Ottawa area and other regions of the country so that bars, clubs and restaurants could become healthier workplaces.

According to the most recent statistics, there were 258,393 registered nurses in Canada in 2003. We talked to two of them—a mother and daughter—about their experiences and some of the ways nursing has changed from one generation to the next.

Heather Turner, 55, went into nursing in 1969. Thirty-two years later, her daughter, Meaghan followed in her footsteps.

If Heather had a calling, it definitely wasn’t nursing. In fact, what she really wanted was to be a hairdresser. But in 1969, she recalls, as a woman "you were a teacher, a nurse or a secretary" and her mother strongly steered her in the direction of nursing, promising to pay for everything. Everything for Heather included a three-year diploma from the Mack School of Nursing in St. Catharines, Ontario (a prestigious school and one of the first training schools for nurses in North America). "We had classes, we had practicum on the floor," she recalls. "We worked all shifts. We were there to help staff—I remember emptying bedpans—not as independent students. When my daughter went, she was there to learn."

Task-oriented

Heather's graduation picture

At the time, nursing was very task-oriented—giving medication, bed baths, looking after an intravenous, taking out sutures and so on. Of the different areas—including obstetrics, pediatric, medical and surgical nursing—Heather opted for psychiatric nursing. "It was more communication and interpersonal skills that were the focus," she says. "There were still the illnesses you had to know and if we got patients who had overdosed and they didn’t go to a medical floor, you would look after them too."

Part of her job involved getting the patients to talk about how they were feeling and what was depressing them or trying to determine whether someone was suicidal. Patient advocacy was becoming more well-known; new medications with far fewer side effects were coming out. And mental health laws, with which Heather had to be familiar, were just becoming more prevalent. "Nurses were treated a little bit more as a partner in psychiatry than they were on other floors," says Heather. "You could more easily tell the psychiatrist what you thought was wrong with the patients." Now, generally, she adds, all nurses are treated with more respect by younger doctors. "They see us more in a collaborative position."

Working shifts

For years, Heather worked 12-hour shifts. "With a family it was very difficult," she says. "You got home at 7:30 at night and there was no time or energy to do anything." But that was the way it was - at least until she became head nurse in psychiatry and her hours settled down. In 1990, Heather moved into part-time work at a 75-bed nursing home attached to the Welland Hospital where she can basically set her own work day.

The new environment

Over the years, Heather has seen huge changes in her field and in those who choose to become nurses. For one thing, Heather worked in the same hospital for 35 years. These days nurses often work for more than one employer.

Then again, she adds, the environment has changed too. The past thirty years have seen massive changes to healthcare in Canada, including cost-cutting measures and restructuring. "We have fewer resources—less equipment and less staff, " she says. All that plus a consumer who is expecting more from health care. "It’s a very responsible position. I guess it’s just like every other job only you’re dealing with human lives. If you make a mistake, it could have very, very serious consequences."

Meaghan Turner remembers her mother’s shift work, her being asleep at odd hours and her rarely being around to make breakfast. She also remembers, as a child, wanting to be a nurse herself but then as she grew up she never really thought about it again. In the end, Meaghan got her bachelor’s degree in English but couldn’t find any work with it. What she did discover, on poring over classified ads, were a lot of job openings for nurses.

At the age of 25 Meaghan started her nursing degree at McMaster.

The feeling of making a difference

Meaghan's graduation picture

Because she had already completed another degree, Meaghan was able to do the nursing program in two and a half years before she moved into her first job. Now 28 and a public health nurse in the Peel region east of Toronto, Meaghan provides supportive counselling to single mothers. "It’s what I pictured myself doing," she says. "I always liked psychiatry—I might have picked that up from my mum. I like talking to people and feel that I’m making a difference and supporting them and helping them make choices."

A variety of opportunities

The diverse employment opportunities available to nurses today appealed to Meaghan. "I went into nursing school knowing there were other things nurses could do than work on medical wards," she explains. "There are a variety of opportunities that weren’t previously available—occupational health and safety, research, pharmaceutical marketing and sales, and consulting work." Some nursing jobs allow for more flexible scheduling. Meaghan’s job, for instance, does not require shift or weekend work.

As far as Meaghan is concerned, there are definite benefits to having another nurse in the family. "Just having someone else to talk to who understands, who has been there, is really helpful," she says. And she and her mother enjoy talking about how the role of nurse has changed over the years. "My mother and her class learned about bed baths, injections and making hospital corners," says Meaghan. "Today, nurses get not only a solid education in basic skills but also learn critical thinking. We’ve been encouraged to talk to the doctors whereas in my mother’s day you just did as you were told. The nurses were not given the same amount of freedom and respect." Her mother agrees. "Today they go where they can fulfil their own dreams and their own goals," she says. "They’re much more assertive."

Some things haven’t changed

Whatever the changes in nursing have been over the past three decades, what hasn’t changed is that nurses still put much of the caring into health care. And that is something that patients and their families, whether in hospitals or community settings, know well.