The Second “Great Transformation”: Renegotiating Nursing Practice in Ontario, 1945–70

Abstract

In the period following the Second World War, hospitals in Ontario faced a shortage of nurses that prompted the renegotiation of nursing practice. This article examines the introduction of “certified” nursing assistants, a new category of worker who became the fastest-growing segment of the nursing labour force. Nursing assistants occupied an important position in the reorganization of nursing labour in these years, intentionally positioned between registered nurses and a pool of other support workers, such as practical nurses and ward aides. Nursing assistant training programs were established throughout Ontario and helped to create a credentialed community of practice. From 1946 to 1959, 4,840 nursing assistants were registered in Ontario. Between 1960 and 1966, more than 12,000 nursing assistants were registered, increasing to 17,723 in the final three years of the 1960s. The rapid growth of nursing assistants reveals the extent by which nursing labour in Ontario was reorganized in these years. Importantly, registered nurses were not mere bystanders in this transformation but, rather, effectively managed the critical issue of encroachment, at least for the short term. The system of registration created in Ontario effectively legitimated the participation of registered nurses in the regulation of nursing assistants. Registered nurses also participated in important ways in the governance of nursing assistants, in overseeing education programs, and in supervising the clinical work done by nursing assistants. Finally, the shift toward recognizing “registered nursing assistants” acknowledged that nursing labour was undergoing segmentation, with tasks being divided among different kinds of workers.