Nursing Education in the Northwest

by Maura Egan

After submitting my abstract and title, I completed more research; and, when I reviewed the Conference title, I was convinced that the title of this paper should be “From the chapel to CEO!” It is certainly descriptive of Mother Joseph of the Sacred Heart, a Sister of Providence, who made exactly that journey: from her religious community in Montreal to the leadership role she assumed in Washington Territory. She is recognized for opening five hospitals almost single-handedly, while Washington was still a new, very rough Territory.

It is not surprising to anyone who knows the story of Mother Joseph and the works of the Sisters of Providence in the Northwest, that she was honored in 1980, first with a statue in National Statuary Hall, in Washington, DC; and, another in our State Capital.

I am going to tell her story and that of several other religious women who influenced health care and nursing education at the turn of the last century. She was responsible for many of the building plans for 18 hospitals, schools or other institutions in Washington State alone; and, 11 more in bordering states and British Columbia. She did not administer those institutions directly, but was the Superior of the Providence Community in the Northwest for 10 years. In 1866, she was appointed bursar for the Sisters’ western missions (BRp202); and, in that administrative capacity, was responsible for fiscal management, recruitment, and fund-raising. Personnel issues had her working with demanding Missionary priests and directly with the local bishops, and, perhaps more than one Bishop back in Montreal. It must have taken a great deal of patience to deal with some very disillusioned young sisters, living in a primitive, foreign country; and, of course, with both honest and dishonest business men and politicians from different fledgling towns reachable only on horseback, Indian canoe or Columbia Riverboat steamer. Mother Joseph was one strong woman, like so many other self-sacrificing women who came West to serve. They were prayerful women that I am going to tell you about: and although they neither worked in a Boardroom, nor had the title, “CEO”---they all did the work of top-level executive officers.

By the beginning of the 20th Century, several communities of Catholic sisters, Methodist Deaconess Missionaries, and the wife of an Episcopal Bishop were planning or had founded hospitals in Bellingham, Tacoma, Aberdeen, and, Spokane. The rough and tumble towns of the new Washington State (in 1889) were beginning to grow and prosper.

The workers in small towns and, burgeoning, growing cities were overwhelmingly in high risk jobs: construction, building the new railroads, cutting timber, working in lumber mills, shipping, and mining. There were few doctors; and, there was some risk in finding doctors who were either competent or sober or both. Although there was a growing number of newly- Graduated Nurses on the East Coast, there were none in the Northwest!

It is difficult to say who the first “nurse” was in the area, now called Washington State. One might think it was a Native American or someone on an early sailing ship, but that would have been a shaman or someone filling an emergency “doctor-role. Once I thought Narcissa Whitman was the first nurse, working with her husband, Dr. Marcus Whitman at the Mission near Walla Walla, because she cared for many weary and sick immigrants, who stopped there to rest on the arduous trip out to Oregon Country. And, of course, I counted the many courage women as “nurses”, who came over the Oregon Trail with medicines in their bags or bundles, ready to care for their families or others who might be ill, injured or die on the long journey. But, none of those caregivers are really appropriate for the title “nurse.” Only when I began to investigate formal nursing education, I realized that it was “as recent” as the middle of the 19th Century that a new definition of “Nurse” emerged. Not only the definition, but the role and functions of a Nurse were about to change, as well.

Formal nursing education began in Germany and France in the mid-1800’s. After studying in Germany in 1851, Florence Nightingale brought strict, formal, nursing education to England, where the focus changed from a family member, servant or charity-caregiver to the individual Nurse who had received formal nursing education. There isn’t time to discuss the socio-economic context and ramifications of the changes in education and role for the nurse since 1850. But, I would like to describe some of the women in leadership roles who “came West” at about this same time, and founded hospitals, started nursing schools and made professional nursing an early reality and expectation in Washington State.

First to come to Washington Territory, were five Sisters of Providence in December of 1856: Mother Joseph of the Sacred Heart, Sister Praxedes, Sister Blandine, and one novice and a postulant (meaning, these latter were still in training to become sisters!). They were Sister Mary Norbert and Sister Vincent de Paul Thiebideax (sp?). The boat and carriage journey from Montreal to New York City, then, ship to Panama; on train over the Isthmus of Panama; by ship to San Francisco and finally, by steamer into Ft. Vancouver was at times adventuresome, dangerous, treacherous, sea- sickening and terrifying crossing the bar at the Columbia River. But, these were women who wanted to “serve the poor” and weren’t to be stopped, even as they arrived to find no living accommodations! In the Bishop’s absence, at the insistence of the Vicar who met them, they moved into the Bishop’s attic---with the priest, Fr. Rossi from France, with whom they had made the long journey. None of the travelers were ready for that situation! But, one must adapt as a Missionary!

During their first year of 1857, the Chronicles recorded that the five sisters, living in huts built by Mother Joseph, had taken in I2 boarding pupils, 2 Orphans, 10 day pupils and boarded 2 “College Boys” taught at the nearby school. Besides the work these children required, the sisters cared for 10 sick people in their homes, visited another 25 sick at home, and did 34 “night watchings” in homes.

The demands for their time and caring services never let up. In the second year, the Vancouver Ladies of Charity (good Catholics, Methodists, Episcopalians and Jews) begged the Sisters to turn one of Mother Joseph’s little buildings into a very small hospital. They were all very aware that most patients would not be able to pay. Patients were waiting before it was opened on June 7, 1868, and the hospital filled to capacity from the very beginning.

Often it was the local clergy who begged Mother Joseph for hospitals. And, so they were built in Walla Walla, Olympia, Port Townend and Spokane at great cost to the sisters, who had now spread out with missions & hospitals into Oregon and Montana. With a mounting debt of $20,000, at great physical and emotional sacrifice, the sisters made treacherous begging tours into the mining camps, crossing the Rocky Mountains by horseback and stagecoach. The first sisters assigned to care in these hospitals were not professional nurses; but, they took care of patients in the wilderness, for whom no one else would give care.

Now, let me tell you about another hospital built by Missionaries. The Fannie C. Paddock Memorial Hospital in Tacoma was established in 1882. That hospital was named in loving memory for Fannie Paddock, Bishop Paddock’s wife who died before she arrived in Washington Territory. She had survived the five week trip from East Coast to the West Coast by train, collecting contributions for the hospital before she left and all along the way. By the time their steamer reached Portland, Fannie Paddock was too ill to continue north. She died there of typhopneumonia, April 29, 1881 (HM,p4).

The Pierce County News on February 22, 1882, related: “An edifice (probably a former dance hall) has been transformed into what will hereafter be known as the ‘The Fannie C. Paddock Memorial Hospital’…her desire and purpose to found upon this far western coast a Protestant hospital, free to the unfortunate who might require the ministrations of Christian Charity…It will be opened April 29, 1882 with appropriate religious ceremonies for the beneficent work, one year having elapsed since the death of the lady whose memory the building and its work will consecrate afresh” (HMp5).

Strong church women tried to do the necessary ministrations that Fannie might have done in that primitive town: Initially, it was a Rev Miles and his wife who ministered with 1-2 doctors; but Mrs Miles “broke down” after the end of a year and they were obliged to leave for her health’s sake. Here is a description of what may have contributed to Mrs. Miles’ breakdown in 1882: “The initial cleansing of a man admitted from the logging camps required patience and diligence as well as understanding, perseverance, and a strong stomach. Many of the patients were too ill or too badly hurt to be bathed when admitted. Parasites wandered off to find another host. Not many who elected to do hospital work were stoic enough to abide these adversities.” (HMp9)

In 1895, the very first Nurses’ training school in Washington State began at Fannie Paddock Memorial Hospital, under the direction of manager and house physician, Dr. Charles McCutcheon (SJp84). There was a desperate need for nurses to care for patients, especially women patients. The hospital history for Fanny Paddock Memorial Hospital describes Dr. McCutcheon starting the nursing school “in self-defense.” There was a shortage of women in the West; and, there was a dire shortage of nurses at the end of the 1800’s.

It is well documented that student nurses provided care almost around the clock for hospital patients---that was their “on the job training.” There was no compensation for their work; and, besides nursing care, the student nurse was to keep wards clean, and, in some cases cook & serve meals for their patients. One nurse graduate of Fannie Paddock Memorial Hospital didn’t think that was “too much work!” Looking back, Mrs. Josephine Nicolai (whose husband was the pharmacist) said, “We were young and we could take it.” But, she described being responsible for care of 23 diphtheria cases at the Washington Children’s Home (in Tacoma): one nurse showed up to help, but lasted only that one day. “The rest of the six weeks I was there by myself. That was work!” (HMp.36)

Two Catholic sisters worthy of mention are Sister Dulcelino and Sister Benevenuta, Sisters of St. Francis, who left Philadelphia in 1890, to start a “state of the art” hospital for Tacoma. These sophisticated women had to live in the Tacoma Hotel when they first arrived; then a convent attached to a school, until space was available in the “laundry part of the Hospital building” several months later. The sisters proclaimed that they would accept patients regardless of race, creed, or color, and the record books show that they kept their word. Protestants outnumbered Catholics 3:2 (BL, p58,); there were four times more men than women; and, almost ½ of the patients were immigrants. But, from the start, the Sisters refused to take in patients suffering from “alcoholism”. A history of the hospital indicates that the few who were admitted with this diagnosis were discharged as “cured” after twenty-four hours.” (BL, p62)

The nursing care and Nursing School at St. Joseph’s Hospital focused on outstanding care. Sister Superior chronicled in 1897: that St. Joseph Hospital “is (not) merely an institution to nurse the poor…Our sisters are trained and experienced nurses, working incessantly...Anyone in our care receives the treatment best suited to the individual. Our wards are large and well-arranged in every particular for the comfort and health of our patients.” (BL p62)

At the other end of the spectrum in 1890, two Sisters of Peace from New Jersey came West to start a different St. Joseph Hospital in the fishing, lumbering town of Fairhaven (now part of Bellingham). In this case, the Sisters had to begin raising funds by selling annual hospital “tickets” for $10 each--- assuring the patrons of “pre-paid” care should they become ill or injured during that year. The Sisters gratefully accepted a donation of an acre of land from the Fairhaven Land Company.

By the next year, they opened a very modest, two-story frame building, with only 30 beds. But, they had a staff of seven Sisters and a layperson cook. In season, Patients had a diet of fresh vegetables from the Sisters’ garden, with other items donated by townspeople. There was generous community support, but even so two of the Sisters in their long, black habits joined the Klondike Gold Rush in 1897, trekking northward with “unabashed confidence in prayers and prospectors” in search of donations for a new, larger hospital. Many of the contributions they received were in gold dust in lieu of coins or currency. Their School of Nursing was established in 1904.

The Sisters of Providence were given the bid from King County Councilmen to run the County Poor House in Georgetown, just south of Seattle in 1877. Then, in 1878, they established Providence Hospital in a remodeled residence in Seattle. There was much rancor and prejudice in the city against the sisters, especially from the doctors who ran small private hospitals and charged fees. In 1895, a group of civic-minded women decided Seattle should have a Protestant Hospital. Thus, Seattle General started out non-sectarian and was run by volunteers. Their Nurse Training School started in 1900; they brought out Evelyn Hall, a graduate of the Methodist Episcopal Hospital School of Nursing in Brooklyn, who became the supervisor of nurses in 1901, and hospital superintendent the following year. She brought advanced Eastern nursing educational ideas and methods to Seattle and was a leader in Washington nursing.

Another factor at the end of the 1800’s, was the Spanish American War of 1898, which generated a critical need for nurses in the military “camps at home and in Cuba” (Sr. Mary, SP/RN, LLp8). That war led to epidemic typhoid being carried to coastal towns by ships, soldiers and sailors. Typhoid fever and smallpox raged in towns on Puget Sound at the turn of the last Century, when the causative agents of infectious disease were just being discovered and antibiotics were unknown.

Sacred Heart Hospital School of Nursing in Spokane started classes in 1898 with full support from the Mother General of the Sisters of Providence back in Montreal. However, unlike the best schools on the East Coast, for the first 10 years of the program, nurses’ training was limited to patient care and practical procedures. Science classes were not considered necessary for the nurses and generally were not taught by the physician instructors.

In another part of Spokane, three Methodist Deaconesses started caring for the poor and sick in a large, rented home in the late 1890’s. After Dr. Libby performed surgery on a patient on the kitchen table (supposedly to make him “feel more at home”), the women set about raising more money for a large hospital. Here is a partial listing of their activities by Clara Brown, a Deaconess and Superintendent, for the year1897, one year before the Hospital and Training School opened: 63 calls on the sick, 18 opportunities for prayer; 24 opportunities for bible reading; 60 days of nursing; 63 hours of nursing in homes of the sick, 17 baskets of food given away; 1 bible given away. At Deaconess Hospital the first class of four students, who graduated in 1901, had the advantage of six doctors with different medical specialties giving their lectures.

There was a tremendous growth of nurse training schools over the last decade of the 1800’s: less than forty schools in 1890 & fewer than 500 graduates in the US. By 1900, there were over 400 Schools of Nursing across the country (with four in Washington State) and well over 3,000 graduates (although it is doubtful, if even one tenth of 1% were in Washington). On the East Coast, by 1903, there was a beginning effort at standardization of Nursing Education and higher standards for Professional Nursing Practice mandated by the first few states that established Boards of Nursing.

Only 20 years a state, Washington was the 10th state and the first in the West to establish a State Board of Nursing [North Carolina was 1st in 1903]. The law--- called the Registration of Nurses, is recorded as Chapter 41, with 11 Sections and was printed on only three full pages of the 1909 Law Book. Marion Hay had just taken over as 7th Governor of Washington State and within a month appointed the first graduate nurses with two years of experience to the Board of Nurse Examiners: Miss Mary Keating, a graduate from the first class of Sacred Heart Hospital, Spokane was voted President at their first meeting; Miss Cora Smith, graduate of Rockford Hospital, Rockford, Illinois, was residing in Anacortes, WA; Miss Margaret Campbell, graduate of Mercy Hospital, Davenport , Iowa, came “West” to nurse in Tacoma; Miss Audrey Waymire, was a graduate of the first class of Deaconess Hospital, Spokane; and, Mrs. Mary Hawley of Seattle, was voted to be Secretary/Treasurer.

The Board of Nurse Examiners, as it was first called, was established to assure that graduate nurses had received adequate education and training to pass an examination to qualify as a “Registered Nurse.” The nurse applicant for registration had to “furnish satisfactory evidence that she is over twenty years of age, of good moral character, and free from habits liable to interfere with her services as a nurse, and further, that she holds a diploma from a training school for nurses of a reputable hospital…,” then, pay a fee of $5 and pass the examination. [The first exam was held Seattle in 1909.]

The early part of the 20th Century saw huge growth in numbers of nurses, improvements in their work settings, and incredible discoveries in science and medicine. National level reports were written calling for higher standards in medical and nursing education to meet new scientific standards. By 1930, Sister John Gabriel, a Sister of Providence, whom you will hear more about from another speaker, addressed the Washington State Graduate Nurses Association, stressing the need for higher educational requirements for nurses. Her clarion call was, “It is quality not quantity that we need.”

The University of Washington and Seattle College (later Seattle U) partnered with Harborview Hospital and Providence Hospital respectively to offer Baccalaureate education for nurses in the 1930’s. But, first the Great Depression, with large numbers of nurses out of work, created an “over-supply;” and then, with World War II, there was a huge demand to prepare more nurses “quickly” for overseas work. Political and economic factors put pressure on Nurse Training Schools, and then, Community Colleges to turn out “quantity” for Military services and hospitals at home. Quality Baccalaureate education was put on the back-burner for nurses---for women.

Let me close by lauding, those pioneering women over 100 -150 years ago, who did incredible things at a time when there was great need. Once again, we have need of more nurses for our aging population and for special populations around the world, given an increasing awareness of global health care needs. Washington State continues to have national leaders in Nursing Education, Research and Clinical Practice. But, our nursing education system has faltered over the last 60 years with multiple entries into “nursing practice.”

Perhaps most disconcerting to me is realizing that the “professional nurse” who emerged at the turn of the last Century isn’t so recognizable in the 21st Century: it’s not that the long, white starched dress and cap are gone---it’s that the individual who comes into the room in scrubs in the hospital or clinic office may not be a nurse---but, a “technician” or “nurse aide” or even the housekeeper. With the Training Schools and free help from Nursing Students long gone; hospitals have reorganized staffing patterns and resorted to hiring many different levels of care-givers.

The Board of Nurse Examiners, now called the Nursing Care Quality Assurance Commission, no longer reviews Education programs for Registered Nurses; that is done by National Accrediting bodies. Our State Nurse Practice Act no longer focuses primarily on education; it now deals extensively with Discipline, Revocation and Suspension of nurse licenses; and, defines the legal parameters of Practice for many kinds of patient “caregivers.” The Commission Members’ focus is on “Protection of the public.” “That’s a good thing,” says this retired Nurse--- who is sometimes back in her parlor, no longer at my classroom podium---but, when I’m really sick, “Please put me in any one of those now- up-to-date hospitals I mentioned earlier and give me a baccalaureate-educated Nurse or Nurse Practitioner in charge of my care.