Kai Tiaki: Nursing in New Zealand

Nursing has a long and varied history around the world. Nurses offer essential skills and experience that help to supplement the work of doctors and physicians when it comes to the care for the sick or injured. The profession that we recognise today is not the way it has always been - there have been great changes in the practices, qualifications and expectations associated with nursing. As healthcare in general improved in the 19th and 20th centuries, the demands on nurses grew. This blog post will explore some of the changes in nursing throughout these time periods and will include early forms of nursing, state-registered nurses, the impact of WWI and WWII. Using images from the Auckland Libraries Heritage Collections, we can get a sense of the expectations these nurses had to live up to, where they worked and even what they wore.

In mid-19th century New Zealand, the sick or injured were nursed by family members or members of their community. There was no formal training available, or required, to care for the sick or injured. In 1847, the first public hospital in Auckland opened. The 50-bed building was located on the site of the current Auckland city hospital, presumably so it was slightly removed from the squalid conditions of Auckland city. The staff consisted of a medical officer, a dispenser, one male nurse, a male cook, a servant and a messenger. By 1865, the capacity of the hospital had been extended to 78 beds and the annual admissions were 695 patients. In the same year, the hospital employed a provincial surgeon, a house surgeon, four male nurses, a matron and a cook.

Image: James D Richardson, Auckland Public Hospital, 1850s?, Auckland Libraries Heritage Collections, 4-305.

1877 saw the opening of a new Auckland hospital to replace the original, which was considered inadequate by that stage. The new hospital operated for some years in a reportedly dreadful state. There were vermin infestations, poor cleanliness, bad layout which resulted in the inability to isolate fever patients and a general lack of care. Most nursing duties were carried out by convalescing patients, under supervision of one matron at best. According to W.E. Henley, after a tumultuous few years, an 1883 report from the new board of management stated that a “preponderance of evidence established fully the fact that trained female nurses were the most efficient”. Miss Crisp, a trained nurse from Southampton, was appointed lady superintendent and the first trained nurse at Auckland Hospital. Once Miss Crisp was on staff, she began a nurse training programme to raise the standards of care. By 1888, nurses were required to pass an examination after 12 months of practical hospital training.

Image: Frederick George Radcliffe, The Hospital Auckland, 1915?, Auckland Libraries Heritage Collections, 35-R74.

Perhaps the most significant change in nursing in New Zealand came in 1901 with the Nurses Registration Act which was passed on September 12 1901. It came into effect in January 1902 and meant that nurses had to “hold a certificate of three consecutive years' training as a nurse registered in a hospital, and proves to the satisfaction of the Registrar that during her training she received systematic instruction in theoretical and practical nursing from the medical officer and matron”. This Act was advocated for by Grace Neill, who was Assistant Inspector in the Department of Asylums and Hospitals from 1895 to 1906. Grace was instrumental in the campaigning and drafting of this bill. As a result, the world’s first state-registered nurse was made official on January 10 1902. That nurse was Palmerston North resident Ellen Dougherty.

Image: Auckland Weekly News, Dr Alice Woodward and the two nurses who volunteered for duty in the supposed plague case at Auckland Hospital, 11 May 1900, Auckland Libraries Heritage Collections, AWNS-19000511-10-1.

Image: Herman John Schmidt, Gallagher Group of Nurses 1910, 1910, Auckland Libraries Heritage Collections, 31-59029.

The First World War had a large impact on nursing in New Zealand. After the South African conflict, the need for trained nurses in wartime became apparent. In 1908 the New Zealand Medical Corps Nursing Reserve was formed with the goal of consisting of “qualified nurses willing to undertake the nursing of the sick in time of war in hospitals under the control of medical officers of the New Zealand Medical Corps”, as Anna Rogers has written. The Corps failed to gain interest from trained nurses and faced political challenges and in 1910 the matron Janet Gillies was forced to step down. A few months later, Hester McLean was appointed matron-in-chief of what would become the New Zealand Army Nursing Service (NZANS). In April 1915, the first contingent of 50 nurses were selected to serve overseas. By the end of the war, some 550 New Zealand nurses had served in a range of countries and faced overwhelming challenges throughout. Some of those challenges included the heat, poor sanitary conditions, resistance from others regarding their rank, long work hours, illness and restrictive uniforms.

Image: Herman John Schmidt, Nurse Nobbs soldiers group, 5 October 1916, Auckland Libraries Heritage Collections 31-WP8025.

Image: Herman John Schmidt, Nurse Gumbley and an unidentified nurse, 1911, Auckland Libraries Heritage Collections 31-63859.

Upon their return to New Zealand, many army nurses continued to work in military hospitals around the country or in greatly understaffed civilian hospitals. Little did they know, one of the greatest threats to well-being was not the war they had just returned from. The influenza pandemic struck New Zealand between October and December 1918 and claimed a staggering 9000 lives. Patients were being admitted to hospital at rates that rivaled those during wartime, which stretched resources and skills. The outbreak of the Second World War saw another surge in wartime nursing services. By May 1940, 1200 suitable trained nurses had volunteered to serve overseas. Between 1939 and 1945, 602 nurses belonging to the NZANS served outside of New Zealand. They faced many of the same challenges faced by New Zealand nurses serving overseas in WWI. Trying weather conditions, lack of resources, poor pay and long hours were once again rife.

Image: Clifton Firth. 1/2 Portrait of Nurse, Miss Nona Rice, 29 August 1941, Auckland Libraries Heritage Collections 34-R54.

Image: Auckland Weekly News, The Nurse Herself, 1 May 1940, Auckland Libraries Heritage Collections AWNS-19400501-36-4.

Nursing in New Zealand was constantly evolving. The World Wars helped identify gaps in nurses’ training, and general global trends helped influence the future of nursing. By the 1960s, nursing was still predominantly hospital-based training, supplemented by lectures and demonstrations on site. The 1970s saw a move toward university and other tertiary-based training. By the 1990s, nurses were required to undertake a three-year nursing degree which was the early form of the current Bachelor of Nursing that is offered today. Improvements in science and healthcare practices in general have changed the way we think about nursing. Nurses make up an essential component of our healthcare system and while their uniforms and qualifications have changed, there are still challenges relating to workload, pay and working conditions that are yet to be fully remedied.