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This is a corrected version of Kate Prebble’s chapter in Changing Times,
Changing Places (ISBN 978-0-473-21623-8). Unfortunately, during production
of the book, some errors including the omission of some references were
introduced into this chapter. This version has been amended to correct
those errors. Sincere apologies to Dr Prebble.
CHAPTER 5
Mental Health Nursing Education in
the Waikato, 1912 – 2010
Kate Prebble
The education of mental health/psychiatric nurses1 in the Waikato changed enormously during the
twentieth century and beyond. The changes reflect a transformation in the role and status of the nurses
and the environment in which they worked. In the early years, male attendants and female mental
nurses were working class labourers who provided the nursing care and most of the physical labour,
along with patients, for the Tokanui hospital, a rural, largely self-sufficient, custodial institution. By
the beginning of the twenty-first century, mental health nurses were registered health professionals
practising in a wide range of hospital and community settings. Movement towards professionalisation
was influenced by national and international trends. It was also accompanied by certain tensions.
During the hospital years, the most enduring tension was between the educational needs of nurses
as students and the labour demands on the nurses as workers. Other tensions came to the fore as
professionalisation brought psychiatric/mental health nurses into a closer relationship with the wider
nursing profession. While this relationship potentially brought higher status and standards to the
discipline, it also threatened its specialist nature and identity. In the final decade of the twentieth
century, national policy and funding decisions to improve mental health services had a profound
impact on this nursing specialty. By 2010, mental health nursing education in the Waikato was in
reasonably good shape, largely because of the growth in clinical support and postgraduate education for
registered nurses.
Training in the basics - serving the needs of the institution: 1912-1929
During the early years at Tokanui, training of male attendants and female nurses was not a high
priority: breaking in the land and providing sufficient shelter, food and water overrode questions of staff
training and examination. Like most other mental hospitals, Tokanui relied on a largely uneducated,
67
rural, working class workforce. The goal of training was not to educate and professionalise. Rather, it
was to provide basic knowledge and skills so that the workers could safely carry out the directions of
medical staff and seniors. The training system also provided a structure for promotion and an incentive
for workers to remain on staff. Little is mentioned about training in Tokanui’s annual reports until the
1920s when the names of successful candidates in the annual examinations began to be recorded. This
delay can be partially explained by the disruption caused during World War One when the hospital
experienced severe staff shortages, and most male attendants’ employment was interrupted. The lack of
attention to training in the reports and the meagre resources allocated to it, however, indicate that it
was not of significant priority to the medical superintendent or staff.
A three-year system of training, examination and registration for mental attendants and nurses
had been established by the Department of Mental Hospitals in 1905. It aimed to provide a basic
and nationally consistent level of knowledge and skills to ensure safe custodial care for patients. All
probationer attendants and nurses were required to attend lectures on basic anatomy and physiology,
first aid and emergency procedures. Lectures were given by the Medical Superintendent and were
based on the Handbook for Attendance on the Insane, known as the ‘Red Book‘, a textbook published
by the Medico-Psychological Association of Great Britain and Ireland (MPA). There was no classroom
or training school: classes took place on the wards and were fitted around the attendants’ and nurses’
duties.
The training system provided a structure for grading, promotion and salary increments. At the end
of their first year, after passing the ‘Junior Examination’, the staff members were promoted to the rank
of ‘junior attendant’ or ‘junior nurse’. After a further two years of service and attendance at a more
advanced series of lectures in the practice of mental nursing, nurses and attendants were entitled to sit
the ‘Senior Examination’. Successful candidates’ names were added to the Register of Mental Nurses
(held by the Department) and they were immediately promoted to ‘senior attendant’ or ‘senior nurse’.
However, those who chose not to sit the exam or did not pass could still be promoted to senior after
another year’s employment. The first recorded successful Tokanui candidates in the Senior Examination
were Margaret Farrell, Lena Kenny and Maude Kenny, who passed the exam in December 1923.
FIG 5.1 Nurses outside the Nurses Home at the time of their ‘Finals’ (Senior Examination), 1939.
Photo Courtesy of Judy Besley
68
Changing Times, Changing Places
After this, a handful of nurses and attendants passed the exam and had their names added to the
Department’s Register of Mental Nurses each year. Although mental nurses and attendants gained from
their achievements in hospital examinations, their ‘registration’ had limited use beyond the network of
mental hospitals. Their qualifications were not recognised at other New Zealand hospitals or overseas.
Female mental nurses, although nominally recognised as nurses, were excluded from the professional
privileges and recognition afforded to general nurses whose registration was controlled by a statutory
body, the Nurses and Midwives Board (N&MB). Attendants, being male, were not recognised by the
nursing profession as nurses. Because of the limitations of the training and the lack of recognition,
training at Tokanui served the needs of the institution but did little to promote the status of its mental
nurses and attendants.
Tutor-sisters and the drive for closer alignment with general nursing: 1930-1949
Closer alignment with general nursing came to be seen as the way to improve mental hospital
nursing during the 1930s and 1940s. To this end, substantial reforms, including the introduction of
general-trained tutor-sisters, were instigated in mental nursing education. Reforms, however, were
not necessarily the main force behind changing mental nursing standards during this time. Other
events, such as an economic depression and World War Two, as well as conditions within the hospitals,
influenced educational standards both positively and negatively. Attitudes about gender and nursing
also drove the direction of reform. Nursing and medical leaders assumed that male attendants were
not suited to being nurses. Laurie (Monty) Mills, who began work as an attendant at Tokanui in 1936,
clearly recalled that, ‘Male staff were not nurses’. His memory of training was of attending a lecture
approximately once a week. On the day of class, he would be told, ‘You can’t go out on the [farm]
gang today - you have to go to a lecture’.2 Joff Nolan concurred with the view that training was not a
high priority for attendants. He was surprised when he gained 89 per cent in the Junior Examination
in 1939, because he and his colleagues, ‘...didn’t apply ourselves too greatly in those days’.3 For male
attendants, the training programme was a useful adjunct to their primary role as farm and hospital
workers, rather than a route to professionalisation.
Theodore Gray, the Inspector-General of Mental Hospitals from 1927 to 1947 was keen to improve
the standard and status of mental nursing, which he firmly believed to be a woman’s occupation. The
aptitudes of male attendants, he thought, were, ‘...not directed towards nursing, with a few brilliant
exceptions, but rather towards outside work on the farm’.4 Gray expected that mental nursing reform
could be achieved through a closer alignment of mental nursing with general nursing. In the early
years of his office, Gray acted quickly to break down barriers between general and mental nursing. He
offered state (general) registered nurses (NZRNs) one year’s dispensation off mental hospital training,
encouraged female mental nurses to undertake general nurse training, and directed mental hospitals
to employ NZRNs as tutor-sisters where possible.5 These changes were to have an effect on Tokanui
during the 1930s when, in the context of an economic depression, conditions were ripe for the
recruitment and retention of qualified general nurses.
Full staffing during the 1930s economic depression helped Tokanui meet some of Gray’s goals for
training of mental nurses. In the absence of other employment, women and men of higher than usual
calibre applied to mental hospitals for work. May Puch, who started at Tokanui in 1935, remembers
that her classmates were ‘a cut above average’.6 With a low turnover of staff, the number of successful
candidates for the senior examination increased. Many of the ‘depression recruits’ at Tokanui made a
career out of mental nursing and continued to influence life at the hospital for the next 30-40 years.
Donald Graham was one such man who admitted that his decision to start his 42 year career in
mental health was based ‘purely on economics’.7 Among the depression recruits were several NZRNs
who completed the mental nurse training and stayed on for several years, some as nurse tutors. Louie
Agnes Reed was the first of the NZRNs employed at this time. She joined as a junior nurse in 1931,
completed her training in two years and remained on staff for another year as a senior nurse. Reed is
remembered by some as Tokanui’s first tutor-sister. However, official documents show Robina Kelly,
another NZRN who was employed in 1938, as the first tutor-sister.8 Four other registered nurses
Mental Health Nursing Education in the Waikato 1912-201069
followed in Reed’s path during the mid-1930s. Although these nurses were not officially employed as
tutor-sisters, they were called on to assist with teaching and demonstrations of practical nursing skills.
Another double-trained Tokanui nurse made a significant contribution locally and nationally during
this period. Margaret McRae, a deputy-matron from 1934 to 1940, was one of the country’s earliest
double-trained nurses. McRae trained as a mental nurse at Sunnyside Hospital in Christchurch then
completed her general training at Wellington Hospital, registering in 1932. As Deputy Matron, McRae
was responsible for much of the teaching at Tokanui.
McRae was a member of the Mental Hygiene Committee of the New Zealand Trained Nurses
Association (NZTNA), an organisation that represented the professional interests of registered nurses.
During the 1930s, the NZTNA, under the direction of the International Council of Nurses, sought
ways to incorporate mental health concepts into registered nurse training. McRae, as a member of the
working group, maintained a staunch view on the value and uniqueness of mental nursing. Rather
than simply agreeing to changes in the general nursing curriculum, she called for reciprocity (equal
recognition) between mental and general hospital nursing. She believed that not all general nurses
would have the temperament suitable for the role of mental nursing.9
Despite the increase in numbers of double-trained sister-tutors in mental hospitals, Gray was still
not satisfied with the state of mental nurse training. His major concern was that the Mental Nurse
qualification was not recognised in other hospitals or overseas. His first achievement in this regard
occurred in 1939 when an amendment was passed to the Nurses and Midwives Registration Act. This
allowed female mental nurses to sit the nurses State Preliminary Examination after one year’s training.
Successful candidates who completed three years of mental nurse training were granted 12 months’
concession towards their general training.10 Tokanui was gazetted as a B-grade training hospital under
the N&MB regulations in order to prepare nurses for the preliminary examination. Unfortunately,
like other mental hospitals, it was poorly equipped to provide training in general nursing skills. There
were few teaching resources, and the pressure for nurses to fulfil their duties on the wards seriously
undermined teaching and learning. Tokanui was one of the few hospitals that had an allocated room set
aside for teaching, but the hospital’s only tutor sister, Robina Kelly, left in the early 1940s.11 Kelly was
not replaced until Muriel Dandy was appointed in 1946. In the meantime, Tokanui nurses were not
able to prepare for the state preliminary exam.
FIG 5.2 Robert Henry Gray, Head Attendant
Tokanui Hospital early 1940’s
Photo Courtesy of Jeanette Chynoweth, grand
daughter
70
Changing Times, Changing Places
Over the next six years, Gray’s efforts to improve mental nursing education occurred against the
backdrop of war-time conditions. As soon as New Zealand joined the war in September 1939,
staffing at mental hospitals deteriorated. Men enlisted for active service and women took up various
occupations left vacant by the men’s absence. Mental hospitals, which had never been an attractive
workplace for women, suffered serious shortages despite the instigation of ‘manpowering’ from 1942.
Severe shortages of staff, accommodation and resources affected mental hospitals during and after the
war.12 It became clear to Gray that something more was needed to address the status of mental hospital
nursing. Gray wanted to create a training system that would give female mental nurses a stronger
foundation in nursing skills and greater recognition amongst the nursing profession. He planned
to create a parallel, in-house career structure for male attendants. After further negotiation with
national nursing leaders, a decision was made to establish state registration for mental nurses. Under
pressure from the Public Service Association, who lobbied on behalf of returning servicemen, a last
minute decision was made to include male attendants in the provisions of the Nurses and Midwives
Registration Act.
Psychiatric Nursing Registration
In September 1944, Parliament passed the Nurses and Midwives Amendment Act thus establishing
a New Zealand Register of Psychiatric Nurses. This was the most significant change in New Zealand
mental hospital nurse training since it was established in 1905. Under the new provisions, training,
examination and registration were brought under the authority of the N&MB. When the new system
was introduced, nurses and attendants could gain the title of ‘registered psychiatric nurse’ (NZRPN)
either by passing the new final (state) qualifying examination after three years training, or by applying
for recognition of their Mental Nursing Certificate. By
1947, three Tokanui staff members held the NZRPN
title: Senior Attendant, JA Steele, Sister J Seymour, and
Training in 1950s
Staff Nurse MPA Power.13 By the early 1950s, most
Training in those days was different, like you did two
of the senior nurses at Tokanui had become registered
hours in the morning and two hours in the afternoon.
Maybe it might be one day this week, or it might be
psychiatric nurses.
two days next week or something like that. But in
between you were actually working on the ward, like
Despite the introduction of state registration, there
you started on the ward at seven o’clock in the morning
continued to be serious deficiencies in the training
or earlier ... And you did your morning’s work and gave
system at Tokanui. Nancy Jamieson, who was a pupil
the patients their breakfast and their baths, and got
nurse at the hospital during this period, remembers
them dressed and then you went to education for
two hours, and then you came back and you gave the
that there were not enough tutors, a ‘minimum of
patients their lunch, and did the rest of the things that
lectures’ and a reluctance to leave the wards for class
they needed to until the afternoon, and then you did
because of the nursing shortage.14 Small improvements
two hours [class] in the afternoon.
were attempted. In early 1946, for example, Cabinet
Interview with Barbara Johnson, 9 Feb. 2011.
approved the purchase of 16mm film projectors to be
used for ‘...the training and instruction of staff and
the entertainment of patients’. Unfortunately, when
a projector finally arrived at Tokanui in 1948, the hospital no longer had a tutor sister who could be
trained to use it.15 After Sister Dandy left in 1947, there was a gap of six years with no sister tutor
except for a brief period in 1949, when JE Kedge held the position. By the end of the 1940s, hopes for
nursing education reform had not translated into practical changes on the ground at Tokanui.
In-between Years: 1950 - 1960s
Standards of training at Tokanui gradually improved during the 1950s and 1960s as the psychiatric
nursing curriculum was developed to reflect modern nursing theory and hospital systems were brought
into line with the registration requirements. Several nurses made their mark in their roles as tutors
or senior nurses, and male staff members were finally recognised as nurses, rather than as attendants.
Progress, however, was seriously constrained by the conditions within the hospital and intractable
Mental Health Nursing Education in the Waikato 1912-201071
institutional practices. Growth in the patient population, shortages of staff, and systems that supported
nurses as ‘workers’ rather than as ‘students’, limited the effectiveness of the training programme. These
decades were the ‘in-between years’, in which aspirations for reform of nursing education were generally
unfulfilled.
One of the main obstacles to educational improvements was the pressure to fill rosters. The growth
in patient population, which reached a peak of 1,050 in 1964, was not matched by a similar increase in
numbers of nursing staff.16 Shortages of staff remained critical, particularly throughout the 1950s. As a
result, new staff members were employed as and when they applied, with little consideration for their
educational qualifications or orientation needs. George Searancke, who started work at the hospital
in the early 1950s, commented that the nursing programme was ‘heavy going’ for someone ‘straight
off the street’, particularly since he was only spared off the ward for an hour or so each week to attend
class.17
Nurses and attendants provided most of the farm and domestic work alongside worker patients.
Searancke recalled:
You would have a gang that would come out and work on the farm doing hay,
helping the fencer, rounding up stock, whatever, anything that the farm required
doing... and we would go out and help supervise and we were sort of expected to
work alongside of them... we actually got our hands dirty.18
Shortages of tutors were a problem during the 1950s and 1960s. FL McKendry held the position of
Tutor Sister from 1953 to 1954, but after she left, the position was unfilled for another three years.
Teaching and other duties that the tutor sisters performed, such as dispensing medication and looking
after sick nurses, fell to the matrons during this time. Medical staff still gave many of the lectures.
The hospital was fortunate to have Rita McEwan as Assistant Matron from 1953 to 1956. McEwan
was one of the most qualified psychiatric nurses in the country. She was double-trained and was one
of the first two psychiatric nurses to complete the Post Graduate Diploma of Nursing, a qualification
she achieved in 1952. During the 1950s, she represented psychiatric training schools on the Florence
FIG 5.3 Sister Irene Netto was a tutor sister at Tokanui from 1959 to 1969. Born in Rangoon, Burma (1905), Netto served in the
Auxiliary Nursing Service during World War One before training as a general nurse in London. In mid-1950s, she moved to New
Zealand and completed psychiatric nurse training at Ngawhatu Hospital in Nelson and midwifery at Grey Hospital on the West
Coast. During most of her time at Tokanui, she held the position of Senior Tutor and took primary responsibility for teaching
anatomy, physiology and physical nursing skills. A devout Catholic, with manners reminiscent of an earlier era, Netto has been
remembered as a ‘lovely gentle soul’ who ‘possessed qualities that were as a breath of fresh air in the hurly-burly of a busy
mental hospital’.
Adrienne Netto correspondence, 9 June 2007, Waikato District Health Board
Photo Courtesy of Waikato District Health Board.
72
Changing Times, Changing Places
Nightingale (education) Committee of the New Zealand Nurses Association (NZNA), was a member
of the N&MB, and took a significant role in setting and marking psychiatric state examinations.
During McEwan’s time at Tokanui, one of the pupil nurses, Rovina TK Maniapoto, won an essay
competition run by the NZNA. McEwan, no doubt, was influential in encouraging Maniapoto to enter
the competition.19
A new curriculum
By the late 1950s, it had become clear that changes were needed in psychiatric nursing education in
New Zealand. International leaders in the field had for some time been advocating for a psychiatric
nursing role based on ‘therapeutic relationship’.20 Such ideas began to seem possible as somatic
treatments and medications were introduced into New Zealand mental hospitals, and an expectation
grew that nurses would engage in therapeutic roles, rather than merely custodial care. Such expectations
were reinforced by the introduction of policies such as rehabilitation and ‘open-door’. Tokanui, for
example, prided itself on ‘giving every patient as much liberty as possible’. By 1959, 14 of its 18
wards were open all day and patients were ‘free to move about the hospital’.21 Harold Turbott, the
Deputy-Director of Health, suggested that the role of a psychiatric nurse should be to supervise the
‘community life of a ward’, by ‘teaching patients to be socially and morally conscious, to understand
the responsibility and consequences of their actions and regain a purpose in life’.22 In 1958, the N&MB
introduced a new psychiatric nursing curriculum that aimed to increase the theoretical teaching and
place greater focus on public health, social sciences and nursing sciences and arts.23
A central component of the new curriculum was the preliminary school, where new pupil nurses
learned the basic principles of nursing over several weeks of uninterrupted class time. Such systems
were common practice in general hospitals but had been inconsistently applied within mental hospitals.
Tokanui’s new Medical Superintendent, Kenneth Stallworthy, a staunch advocate for psychiatric
nursing reform, was quick to act on the requirement. He announced that a preliminary school would
be offered every three months during which normal duties would be suspended for four weeks and
classes would be offered Monday to Friday for 40 hours per week.24 Unfortunately, establishing a block
system proved more difficult than he had expected. Nurses complained that they were losing money
and charge nurses demanded their workers back. Within a year the plan had to be revised to allow
nurses to work one ‘long day’ each weekend so they would not be disadvantaged financially.25 The
weekday classroom timetable was also adapted so that nurses could be available to assist in the wards
before and after class, and at lunchtime.26
Although the introduction of block classes had not gone well, Stallworthy’s time as Medical
Superintendent (1958-1964) promised hope for reform of psychiatric nursing practice both at Tokanui
and further afield. His Manual of Psychiatry, published in 1950, was the main text used in mental
hospital nursing schools well into the 1960s.27 Under his leadership, wards were unlocked and nurses
were encouraged to support patients in their rehabilitation. Margaret Bazley, who was appointed
Charge Nurse of Villa 7 in 1961, established one of the first ‘therapeutic communities’ in the country.
Patients were allowed to wear their own clothes and have a say in their treatment. Bazley instigated
ward meetings, a radical departure from practice in psychiatric wards at that time.28
During the 1960s, male nurses began to find a place professionally. Stallworthy suggested that it was
time for them to think of themselves as nurses, rather than attendants.29 As a consequence, the word,
‘attendant’ was dropped from common usage and men were allowed to take up tutoring positions.
Initially, the decision to employ men in the Division’s schools of nursing was to fill a gap created by
the implementation of the new curriculum which demanded more teaching hours. Des Anderson was
temporarily appointed as a Junior Tutor at Tokanui in 1963. He was followed a few years later by Bert
Whittaker who became a tutor in 1967, a position he retained until 1972. BR Skinner also tutored
briefly from 1968.30
Despite Stallworthy’s reforming influence, all was not well within nursing education at Tokanui
during the 1960s. Work demands such as domestic and farm labour continued to undermine teaching
Mental Health Nursing Education in the Waikato 1912-201073
FIG 5.4 Nurse looking towards D Ward
Photo Courtesy of Judy Besley
and learning. Shortages of tutors and poor classroom facilities also affected the training programme.
An external review at the end of the decade exposed a multitude of problems. It pointed to a hospital
administration that had not adapted its systems to the needs of nursing education. Priority was
still being given to filling rosters on wards. Clashes with shifts, days off, and leave, interfered with
nurses’ attendance in class, and students were often expected to work a night shift before going to
class. Attendance rates were poor and tutors had been unable to fully implement a recent increase in
theoretical hours in the curriculum. The school buildings were deemed inadequate. Housed in three
wooden buildings, one of the classrooms was considered ‘adequate in size but has a gloomy, sombre air’;
the other was next to a busy road and was only used when absolutely necessary.31 There was no room
for a library, so books were stored in a locked cupboard which rendered them virtually inaccessible to
tutors or students.32
Problems within the School came to a head in the late 1960s because of gaps in nursing leadership.
Tutor sister Irene Netto was absent because of ill-health for a long period before her retirement in 1969.
During this time, Bert Whittaker filled the gap as the Senior Tutor, but was hampered by insufficient
numbers of tutors to cover the teaching and a lack of authority to instigate new ideas. The Matron,
Joan Berry, also took extensive leave during this time to attend the Postgraduate Nursing School in
Wellington. She resigned soon after returning to the hospital in February 1970. During her absence
the acting Matron, Marie Whittaker, was frustrated in her attempts to make changes to the training or
roster systems. By the end of the decade, despite national and local reforms, Tokanui was struggling to
provide the systems and content of education expected of nursing education in that period.
The Nursing School in its heyday: 1970s & 1980s
‘a more complete and embracing training than had previously been the case’
The 1970s began on a hopeful note for the Training School. Following the critical review of 1970,
Bert Whittaker was promoted to Senior Tutor and given permission to reorganise the classroom
timetable to fit better with rostered ward duties. Tokanui finally implemented a full block system in
which student nurses attended week-long classroom sessions approximately four times per year. JG
Williams, the acting Medical Superintendent, claimed that the new system gave student nurses, ‘a
more complete and embracing training than had previously been the case’.33 The hospital addressed the
shortage of tutors by seconding nurses from the wards for various lengths of time. Brian Thomas, Bob
74
Changing Times, Changing Places
Left FIG 5.5 The old School of Nursing
classroom
Photo Courtesy of Waikato District Health
Board
Below FIG 5.6 The new Department of
Nursing Education (D.O.N.E.) building
constructed 1972, later known as the
Service and Staff Development Unit
(SSDU)
Photo Courtesy of Waikato District Health
Board
Elliott, Anne Watts and Pat Imeson all contributed around this time. These relatively young nurses
brought new ideas and energy into the classroom. The greatest boost for morale, however, came in
1972 with the opening of a new Nursing School. Nurse tutors and students, who had put up with substandard accommodation for many years, were delighted to move to the new purpose-built building.
In many respects, nursing education at Tokanui was at its strongest during the 1970s and 1980s.
With a purpose-built school, more dedicated classroom time and greater numbers of nurse-tutors,
it was possible to provide a more solid education. The hospital environment was changing; student
nurses were relieved of many of their labouring tasks and were given greater opportunities for learning
therapeutic skills. Qualified nurses were also exposed to a wide range of educational opportunities
through the hospitals’ newly developed In-service Education Department and through external nursing
and university programmes. Integration of the male and female wards in the early 1970s enhanced the
clinical learning environment by challenging entrenched practices, particularly from the male side. It
also gave male nurses more opportunities to assume leadership roles in nursing practice and education.
After the hospital farm closed in 1967, there was much less call on nurses to provide agricultural
labour. Nurses were also relieved of many of the domestic tasks following industrial action against ‘nonnursing duties’.34 The transformation in the student nurses’ role, however, was by no means complete.
As Suzette Poole, who started her training in the early 1980s recalled, working on the garden gangs was
still a big part of the student nurse’s role, ‘you actually had to prove yourself … you actually had to be
able to garden’.35 Student nurses also provided a great deal of the physical nursing care, particularly in
the psychopaedic and geriatric wards. Poole recalled, ‘... you know the kind of things that you did were
basically around their ADLs [activities of daily living], like feeding, and bathing them [children with
intellectual disability], and also the tractor rides around the hospital, like taking them out for a walk,
you know.’ The hospital was not gazetted to provide training in psychopaedic nursing, so although the
students gained considerable experience in caring for people with intellectual disability, they did not
register in this specialty.36
Mental Health Nursing Education in the Waikato 1912-201075
FIG 5.7 The 16mm film projector played a significant role in New Zealand mental hospitals during the twentieth century. Introduced
immediately after World War Two, the projectors were used to entertain patients and educate staff. This photo shows a nursing
tutor loading a film to show Tokanui nursing students, circa early 1970s.
Photo Courtesy of Waikato District Health Board.
FIG 5.8 Library in D.O.N.E/SSDU building
Photo Courtesy of Waikato District Health Board
In contrast to the ‘garden gang culture’, innovative practices such as group and family therapies,
rehabilitation and therapeutic community were introduced in a few wards during the 1970s and
1980s. In a workforce that had relatively few qualified nurses, senior student nurses took a great deal
of responsibility for introducing change on the wards. Rodger McLaren who trained at Tokanui during
the early 1970s, commented that the student body was ‘relatively radical, you know. It was not exactly
politicised, but certainly liberal’.37 He recalled that ‘in a lot of ways I think the students ... drove a lot
of that [clinical changes] ..... Several of the units, when they undertook major restructuring, used either
senior students or very newly registered nurses ... as part of the driving of it’.38 Nurses such as John
Old and Chris Townley are remembered for their visionary leadership as students and newly registered
nurses.
76
Changing Times, Changing Places
Both students and tutors were better qualified than their predecessors. In 1972, School Certificate
became the minimum qualification for entry, a move that brought psychiatric nursing into line with
general nursing.39 Tutors were offered opportunities to undertake further education. Some completed
general nurse training, others did university papers, and many went to short courses and conferences.
Barbara Johnson recalled her experience at this time, ‘I went up to Auckland and did a course on
alcoholism, and a forensic course, and that sort of thing. I did those courses, and lots of conferences’.40
Opportunities for male psychiatric nurses were also rapidly expanding. Brian Thomas was the first
Tokanui nurse to do his general training when this was made available for men at Waikato Hospital in
1968.41 He was also the first to attend the Post-Graduate School in Wellington 1972. Like others who
were given these opportunities, he taught in the School of Nursing when he returned to Tokanui.42
Nursing-specific education was not the only development. During the late 1970s, Tokanui opened
an In-service Education Department. Developed by Chris Townley with the support of the Principal
Nurse, Larry Clarke, the Department became a major driver within the hospital. It provided core
training such as ‘physical handling’ and CPR, and developmental programmes such as medication
endorsement for enrolled nurses. It was also responsible for developing policy manuals, a new
phenomenon for Tokanui. Most notably, the Department became a vibrant centre for training in
new therapeutic modalities such as psychodrama and family therapy. Workshops were offered in the
weekends with trainers brought from Australia and other parts of New Zealand. McLaren, who worked
in the Department during the 1980s, remembers the positive energy of this period:
It was a real bit of a halcyon really, in a lot of ways and there seemed to be a lot
going on, there was reasonable funding available. And there were a lot of staff
who were actually willing to spend a reasonable amount of their own money on
training, you know particularly in the whole sort of interpersonal side of things.43
Integration with the hospital board and introduction of comprehensive nursing education
Despite the strength of nursing education during this period, other forces were at play that heralded
the end of hospital-based psychiatric nursing programmes. Two national policies had a significant
impact on the School of Nursing during this period. First, the transfer of mental hospitals to local
hospital board control in 1972 and second, a government decision later that year to introduce pilot
comprehensive nursing programmes in polytechnics.
The transfer to the Waikato Hospital Board control in 1972 was not altogether welcomed by Tokanui
staff. As Marie Whittaker, the Matron recalled, ‘…there was quite a bit of resentment at first because
you’ve got to be fair about it, they didn’t understand us and we didn’t understand them, you know,
they hadn’t a clue on how to run a psych hospital, not a clue’.44 Fortunately for the nurses, the process
of change was made easier because of the personalities involved. From 1975 to 1978, Margaret Bazley
held the position of Chief Nurse for the Board. Bazley’s experience in psychiatric nursing and her
knowledge of national nursing politics proved to be a boon for nursing education at Tokanui. One
of Bazley’s priorities was to introduce in-service education across the Hospital Board. In 1977 she
appointed Nancy Neilson, a general nurse from Rotorua, to lead the project. A year later, Neilson
replaced Bazley as Chief Nurse. Although she was not a psychiatric nurse, Neilson felt accepted by
Tokanui staff, initially, she believes, because of the ‘flow on from Margaret Bazley’s influence’.45
Neilson became passionate about mental health and devoted a considerable portion of her time to the
development of nursing education and practice at Tokanui.
Under Bazley and Neilson’s leadership, Tokanui nurses were drawn out of their professional
isolation.46 Psychiatric nursing students undertook month-long placements at Waikato Hospital and
likewise, general nursing students arrived in batches at Tokanui to gain experience in psychiatric
nursing. There was often friction on the wards, as the psychiatric nurses reacted to perceived superior
attitudes from the general nursing students. As Johnson recalled, ‘I used to think it was so silly, because
after all we’re trying to do the same job, and we’re all trying to learn’.47 Tokanui tutors began to meet
regularly with tutors from other hospitals to discuss how they could support each other’s students when
Mental Health Nursing Education in the Waikato 1912-201077
they were on placement, and to exchange ideas about nursing education. Johnson recalled, ‘the whole
group of tutors from Waikato and Rotorua and wherever else, linked up and …we wrote up [exam]
papers, we helped the general staff write up papers, and they helped us write up our papers’.48 The
Waikato Hospital Board extended its recognition of achievement to the psychiatric nursing students. In
1976, Anne Oosterman and Val Milne each received the infrequently awarded Waikato Hospital Board
Silver Medal for ‘all round nursing excellence’.49
Major changes in nursing education also brought psychiatric nursing into closer relationship with
general nursing. Following the recommendations of the 1971 ‘Carpenter Report’, a decision was
made to move pre-registration nursing education from the hospital based apprenticeship model
to a generalist model within the education sector.50 The consequent 1972 announcement of pilot
comprehensive nursing education programmes in polytechnics heralded the end of specialist, hospitalbased programmes. Initially, this had little impact on Tokanui, but gradually it became apparent
that specialist psychiatric nursing training was about to end and the hospital would lose its student
workforce. In 1978, approval was granted for a comprehensive nursing programme at Waikato
Polytechnic, the sixth programme established around the country.51 As the programme grew, Tokanui
nurses and managers were faced with a number of challenges. Neilson recalled the tensions of this
period:
The nursing education one was a huge change for people… That whole kind
of tension of “we like what we’ve got and we don’t want to change it and you’re
trying to take that away from us and yet at the same time you actually want us to
have these alien bodies coming in here ... with a totally different approach to the
traditional way ... and you expect us to support them and teach them”.52
Demand for places on ‘bridging’ courses rose. Funding was released for one year programmes for
psychiatric and psychopaedic nurses to bridge into general nursing and vice versa.53 Initially, these
were offered by hospital boards, but later by polytechnics. From 1980, Tokanui nurses attend 40-week
bridging programmes at Waikato Polytechnic.54 By 1984, four of the original seven psychiatric hospital
training schools had closed and the Ministry of Health increased funding on bridging programmes.55
At this time, nursing policy dictated that the nursing workforce of the future would be fully-qualified.
The hope was that hospitals would no longer need to use student nurses or nurse aides. To achieve
this goal, funding was made available for psychiatric assistants to upgrade their qualifications by
undertaking enrolled nurse (second-level, one year) training.56
On 13 August 1984, the inevitable happened: Waikato Hospital Board decided that there would
be only one more intake at Tokanui School of Nursing. To soften the blow, it was agreed that the last
cohort of 20 students would be recruited from amongst the hospital staff. Five to six places would
also be reserved on the Board’s enrolled nurse programme for Tokanui staff members. John Saxby, the
Medical Superintendent, assured the Tokanui community that the next three years would give the
hospital time to draw up plans for replacement of students in the workforce.57 In the event, the hospital
supported 40 psychiatric assistants to train as nurses in this last group.58
The Tokanui Nursing School closed its doors in December 1988. For some tutors and students, the
loss of a specialist programme was mourned for a very long time. As Jamieson reflected, ‘I think that
really, hospital based nursing training for psychiatry has produced a much better product than present
training at technical institutes and universities provide’.59 For others, comprehensive programmes in a
tertiary educational institution brought exciting possibilities for progressive teaching of mental health
nursing unencumbered by institutional practices. Whatever the educational strengths or weaknesses,
when the School of Nursing closed, a central part of Tokanui’s communal life came to an end.
Mental Health Nursing Education – beyond the institution
‘Holding onto the visibility of mental health nursing took some doing for a time’
Education of mental health nurses changed significantly during the two decades that straddled the
end of the twentieth and beginning of the twenty-first century. In the early 1990s, the future of
78
Changing Times, Changing Places
psychiatric nursing appeared uncertain: specialty pre-registration training had finished, there were
few opportunities for post-registration education, and nurses faced the challenge of moving from the
security of familiar institutions to new, largely unknown roles within the community or inpatient
units at general hospitals. Negativity and uncertainty surrounded mental health services: inquiries into
incidents related to psychiatric patients fuelled public debate about the adequacy of post-institutional
care. The next two decades were characterised by national efforts to rebuild mental health services
and to staff them with workers equipped to provide socially-conscious care in a post-institutional
environment. Mental health nursing benefitted from these developments and was influenced by
national efforts to develop nursing leadership and advanced practice through professional development
programmes, post-graduate education, and changes to Nursing Council of New Zealand (NCNZ)
regulations. Influenced by these national developments, mental health nurses in the Waikato fought to
create specialist educational pathways, developed new professional support structures, engaged in postgraduate education, and produced the country’s first mental health nurse practitioner. By 2010, mental
health nursing was in a reasonably good condition in this region.
Pre-registration education
With the closure of the Tokanui School of Nursing, Waikato Polytechnic became the sole provider
of pre-registration nursing education in the region. The relative status of mental health within
the comprehensive curriculum varied. At times, it was marginalised and individual mental health
teachers fought to maintain its visibility. Forging links between the classroom and the wards was not
easy, particularly with the physical distance between the polytechnic and Tokanui Hospital. Robyn
Boladeras, a mental health nurse who later became a senior lecturer at the School of Nursing, recalled
her experience when first asked to supervise students in the early 1990s:
I was rung up on a Sunday night, and they said, “We are desperate for someone
to go to Tokanui. Will you go?”… I didn’t know who the students were. I didn’t
know what their theoretical preparation was. It was a very ad hoc way of providing
clinical supervision.
One area of contention in comprehensive programmes was the expectation that nursing tutors could
teach across all specialties. Tokanui staff nurses were less than happy to discover that some clinical
tutors had no experience in mental health.60 Psychiatric nurses also had to adjust to a new type of
student who visited for short periods and worked in a supernumerary capacity. Poole described a sense
of disconnection. ‘It was quite a different relationship, because these students were there to observe and
learn… whereas before [as a nursing student] you were labour, you know, because you were part of the
team’.61 On the whole the students did not become part of the hospital community.
A small number of nurse graduates joined the Tokanui workforce during the 1980s and 1990s.
Transition from comprehensive student to mental health nurse was difficult. McLaren recalled
‘[comprehensive graduates] weren’t particularly well viewed… probably quite unreasonably. But
they were viewed with suspicion by the hospital trained staff. You know, they really had to come in
and prove themselves, when they arrived’. With no orientation programmes, the new graduates were
thrown in at the deep end. ‘We had a whole hospital full of staff that had sort of eased into their roles
over time. And these poor sods just had to arrive and hit the ground running’.62 One comprehensive
nurse later described her experience at Tokanui as traumatic, not just because she felt unsupported
but also because the nursing practices at the hospital were at odds with what she had learned in her
undergraduate programme.63 As reported elsewhere in New Zealand, the ideals of holistic, individuated
care taught within the comprehensive programmes was not always a good fit with institutional
practices.64
Comprehensive nursing education faced challenges during this time. Not the least was the
introduction of cultural safety, a term coined at a Māori student nurses’ hui in 1988. Cultural safety,
a model that emerged as a response to poor Māori health status, was adopted as policy by NCNZ
in 1992 and became a central component of nursing education.65 It required nurses to engage in a
Mental Health Nursing Education in the Waikato 1912-201079
process of self-reflection, to understand the effects of colonisation, and to engage in power-sharing
with patients and their communities. Implementation of cultural safety in nursing curricula caused
controversy at several polytechnics. At Waikato, the issues became entangled with one teacher’s
outspoken criticism of the standard of mental health teaching.66 In an unfortunate series of events, two
minority groups within nursing, Māori and mental health, were pitted against each other.
Despite the challenges of the early 1990s, the decade proved to be a turning point for mental
health in New Zealand. In response to grave concerns about the size and quality of mental health
services, a myriad of reports and strategy documents outlined plans for growth and development of
the services and the workforce. The pivot for change came with the release of the ‘Mason Report’ in
199667 and the subsequent establishment of the Mental Health Commission to act as a watchdog over
the implementation of the National Mental Health Strategy.68 The Commission’s Blueprint for Mental
Health Services in New Zealand published in 1998 quantified the size of services to meet population
needs and described the philosophical changes needed to improve services. A new ‘recovery’ approach
would require mental health professionals to empower consumers, fight discrimination and instil hope.
These developments profoundly affected mental health nursing education at all levels.
A quiet renaissance amongst psychiatric/mental health nurses also contributed to the change. In a
bid to resist the effects of marginalisation, psychiatric nurses held a conference, Te Ao Maramatanga in
Porirua in 1988 and formed the New Zealand Branch of the Australian and New Zealand College of
Mental Health Nurses (ANZCMHN) in 1994.69 The next year, the College published the Standards
of Practice for Mental Health Nursing in New Zealand. These events provided a vehicle for nurses to
form a collective professional identity and allowed individual nurses to gain exposure to international
trends. Waikato nurses participated in the College, joining in relatively large numbers and hosting
local seminars. In 2003, the local sub-branch hosted an international conference in Rotorua that was
FIG 5.9 Closer relationships developed between Wintec and the DHB during the 2000s. As Clinical Nurse Director for Mental Health
Suzette Gisler (Poole) represented WDHB on the Bachelor of Nursing Advisory Board and secured funding for a student award for
mental health and addictions. Here, she presents the award to Chi Li Qi.
Suzette Poole email, 9 April 2011
Photo courtesy of Suzette Poole
80
Changing Times, Changing Places
memorable for its representation of Māori kaupapa within its artwork and programme. A year later,
in a bid to reclaim national sovereignty, New Zealand withdrew from ANZCMHN and formed Te Ao
Maramatanga, New Zealand College of Mental Health Nurses Inc.70 The new Waikato Branch was
again at the forefront, hosting the College’s inaugural conference in Hamilton in July 2007.
Nurse educators at Waikato Polytechnic, re-named Waikato Institute of Technology in 2001 and
Wintec in 2003, readily engaged with the new philosophies and used the raised profile of mental health
to expand their teaching and to pioneer the involvement of ‘consumers as teachers’.71 With mental
health services now easily accessed in central Hamilton, they were also able to work closely with their
clinical counterparts at Health Waikato. In the early 2000s, Robyn Boladeras, Jacquie Kidd and others,
negotiated a ‘Mental Health Pathway’ within the new curriculum. Students could choose to focus on
mental health during the last two years of their programme. The aim was to recruit at least 16 new
graduates into mental health at the end of their course. Although the programme was successful for a
time, interest waned as soon as the champions of the programme left. As Boladeras commented, ‘…
that was purely about people having a vision, but it dissipated as soon as we left, which showed that it
was person-dependent as opposed to a philosophical shift, which was a real shame’.72 By the late 2000s,
the distinct pathway had been discontinued and the number of new graduates entering mental health
from Waikato had reduced to a mere handful.
New graduate programmes
Assisting new graduates with transition to practice became a priority for health services during
the 1990s. Health Waikato established a programme whereby new graduates worked with preceptor
(clinical mentor) support in two six-month placements and attended classes on a variety of subjects.
Some nurses chose mental health as one of their placements, although there was sparse attention to the
specialty in the education sessions. As mental health nurse educator positions were established, people
such as Catherine Faville, Jude Constable, Helene Stoles and Suzette Gisler (Poole) developed training
sessions that better suited the needs of the nurses in mental health. The classes were open to other
registered nurses who used them to update their skills and knowledge.
New graduate programmes soon became the linchpin of mental health nursing education in
New Zealand. Following a successful pilot programme by Capital Coast Health Ltd and Whitireia
Community Polytechnic in Wellington, and spurred on by the recommendations of the Mason
Report, funding was released by the Clinical Training Agency (CTA) for new graduate mental health
nursing programmes.73 In each location, courses were offered by Crown Health Enterprises (public
health services) in conjunction with tertiary educational institutions. The 6-10 month programmes
comprised supported clinical practice, postgraduate education and clinical supervision. A CTA funded
programme, administered by Lakeland Health, started in the Waikato in 1997. Initially, the new
requirements were grafted onto the existing new graduate structure, with Otago University providing
one post-graduate paper. Over time, the programme developed. Major changes occurred in the mid2000s when the programme was extended to nurses employed by non-government organisations; the
academic programme was taken over by the University of Auckland, and a new graduate co-ordinator
was employed to manage a much larger cohort of 22 new graduates.74
Post-registration and specialty practice education
Education for registered nurses took on greater significance towards the end of the twentieth
century in response to several issues. First, the clinical settings in which registered nurses practised
were increasingly specialist, technical and complex. Even within mental health, sub-specialties had
emerged such as forensic, child and adolescent, and addictions. Second, evidence of health workforce
competence had become a public issue since the rise of advocacy initiatives of the 1990s.75 It was no
longer acceptable for health professionals to rely on their initial training as evidence of proficiency.
Workforce retention was also an issue: the profession sought ways to reward nurses for remaining in
Mental Health Nursing Education in the Waikato 1912-201081
clinical practice and advancing their skills. Third, moves were afoot to expand the scope of nursing
practice to fill a shortfall in the health workforce and address unmet needs in the community.76 In
summary, these developments led to specialist postgraduate education, career pathways, and the
introduction of the Nurse Practitioner role.
In the Waikato, specialty mental health nursing education took several forms. The new graduate
programmes discussed earlier became the entry point to specialty practice. CTA funding was also made
available for postgraduate programmes in advanced mental health nursing. Waikato nurses accessed
these postgraduate certificates and diplomas at the University of Auckland. Nurses could also apply
for financial support for education from several funds administered by Waikato District Health Board.
These included grants from the Public Service Association and the New Zealand Nurses Organisation.
The availability of financial support and access to educational programmes led to a growing number
of nurses completing their Masters, and some going on to complete doctoral studies. CTA funding for
sub-specialty mental health courses reflected the perceived need within the workforce. Forensic courses,
for example, were developed in the mid-1990s when a network of forensic psychiatric services was
established throughout the country. Such courses became an important support for staff development
at Tokanui, and later at the Henry Rongomau Bennett Centre. During the 2000s, postgraduate
programmes were also offered in child and adolescent mental health, and alcohol and other drugs.
Career pathways
Mental health nurses started to engage with clinical career pathways during the 1990s. Nurses on
the Waikato Hospital site had access to the general nursing support systems for the Professional
Development and Recognition Programme (PDRP), a framework that contained three levels of
practice; ‘competent’, ‘proficient’ and ‘expert’. Boladeras was the first mental health nurse to achieve
recognition as an ‘Expert’. She later assisted other nurses with their portfolios and became an academic
assessor for the Waikato PDRP. At Tokanui, Rodger McLaren, the Professional Nurse Advisor, worked
with other senior nurses to develop competencies for mental health. The levels of practice would, he
hoped, contribute to supporting a fully-qualified nursing workforce at the new Henry Rongomau
Bennett Centre.77 In the event, this was not possible to achieve because of workforce shortages. The
PDRP continued throughout the 2000s. Further developments included a Māori development
pathway.78
Nurse Practitioner
A new advanced nursing role established in 2002 linked closely with clinical career pathways and
postgraduate education. The Nurse Practitioner (NP) was established by NCNZ to enable experienced
and highly educated nurses to provide a wide range of assessment and treatment interventions in an
independent manner with or without prescribing rights. It was anticipated that NPs would most often
practise within the primary care setting. To become a NP, a nurse must have had a clinically focussed
Masters degree, met NCNZ competencies and have completed four to five year’s experience at an
advanced level in a specific scope of practice.79 Nurses in the Waikato were quick off the mark to take
up this new opportunity. Waikato produced the first nurse practitioner, a neonatal nurse, Deborah
Harris in 2002. A few months later Mark Smith became the first mental health nurse practitioner.
Smith developed a joint academic and clinical role in adult mental health.80 Jeff Symonds, who had
taken a lead role in establishing forensic services in the Waikato, became a NP in 2007.
By 2010, education for post-registration mental health nurses was on a much firmer foundation than
it had been twenty years earlier. New graduate and postgraduate programmes were in place, and nurses
within the clinical setting had access to professional development programmes. For a few nurses, the
Nurse Practitioner option was available. Although the Mental Health Pathway was no longer available
in the undergraduate programme, there was ample evidence that it had been successful in attracting
nurses into the field.
82
Changing Times, Changing Places
Conclusion
In 1912 when Tokanui opened, training of attendants was a secondary concern to the need for
labour to build the hospital and establish a farm. Although a training system was quickly established
at Tokanui, work commitments often overrode the call to study. This tension between education
and labour continued throughout most of the century. There were, however, efforts to improve the
standard of mental hospital nurse training at Tokanui and elsewhere. Significant events included the
introduction of a psychiatric nurse registration in 1945; curriculum review in the late 1950s; inclusion
of male tutors during the 1960s, and the opening of a new School of Nursing building in 1972.
Although it became clear in the 1970s and 1980s that the psychiatric nursing programme would soon
end, these decades were arguably the strongest for Tokanui School of Nursing. At this time, classes
were taught by a team of tutors, many of whom had gained extra qualifications and had opportunities
to interact with nurse tutors from other schools. This period finished with the closure of the School of
Nursing in 1988.
Two significant events transformed psychiatric/mental health nursing education in the Waikato in
the latter part of the twentieth century; the introduction of comprehensive nursing education and
deinstitutionalisation of psychiatric services. Initially, comprehensive education sat uncomfortably in
relation to the hospital as students, instilled with ideals of holism and progress visited Tokanui Hospital
as learners rather than workers, and later joined the workforce with little orientation to registered
nurse responsibilities in this setting. Hospital staff struggled to accommodate to this new breed of
nurses. With the closure of the hospital, and shift of services into Hamilton, the relationship between
polytechnic and mental health services became easier to sustain, but with no specialist education in
place, the future of the mental health/psychiatric nursing discipline seemed uncertain. During the
1990s and 2000s, ‘holding onto the visibility of mental health’ within nursing education became
important. Several national policy developments made this possible: funding for new graduate and
post-graduate education, the development of clinical career pathways, and the instigation of the nurse
practitioner role. By 2010, education for mental health nurses in the Waikato was in reasonably good
shape. The university-based, postgraduate specialty programmes, however, would be unrecognisable to
the attendants and nurses of the past who snatched an hour or two for class from their duties as fencebuilders, laundry-hands and bathroom supervisors.
Notes
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Various titles were used during this 90 year period. When discussing the overall period, I use ‘psychiatric/
mental health nurse’. When discussing a specific period, I use the terms most commonly used at that time.
Interview with Laurie (Monty) Mills and Laura Condon, 13 June 1996. Interviewed by John Graham and
Bub Libline, held at Waikato District Health Board (WDHB).
Interview with James (Joffre) Nolan, 3 November 1983. Interviewed by Lois Wilson, OHInt 0014/124,
New Zealand Nursing Education and Research Foundation Oral History Project (NERF-OHP). Held at
Alexander Turnbull Library (ATL), Wellington.
Theodore Gray to Public Service Commissioner, 26 January 1937, H-MHD, 1, 8/125, Archives New
Zealand (ANZ), Wellington.
The first tutor sister employed in the Department was at Porirua Hospital in 1928.
Interview with May Puch, 13 July 1984. Interviewed by Yvonne Shadbolt, OHInt 0014/135, NERFOHP. Held at ATL, Wellington.
Interview with Donald Graham, 15 December 1983. Interviewed by Lois Wilson, OHInt-0014/061,
NERF-OHP. Held at ATL, Wellington.
New Zealand Public Service List, supplement to the New Zealand Gazette (NZG), 1940, Vol. 3, p.3289.
Margaret MacRae, ‘Better Training of the Mental Nurse’, notes of the New Zealand Registered Nurses
Association Mental Hygiene Committee, 17 January 1936, H, 1, 22719, 12, ANZ, Wellington.
Kate Prebble, ‘Ordinary Men and Uncommon Women: A History of Psychiatric Nursing in New Zealand
Mental Hospitals, 1939-1972’ (unpublished PhD thesis: University of Auckland, 2007, p.142.
Miss Bridges, a nurse inspector with the Department of Health visited Tokanui in November 1941 to
Mental Health Nursing Education in the Waikato 1912-201083
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
84
inspect the hospital. See H,1,22719, 12, ANZ, Wellington.
Prebble, 2007, pp.58-70.
New Zealand Public Service List, supplement to NZG, 1947, Vol. 3, p.1550.
Nancy Jamieson nee Bolton, ‘Reflections on Two Years of Training at Tokanui as a Registered Psychiatric
Nurse’, held at Te Awamutu Museum, Te Awamutu, p.5.
John Russell, Director of Mental Hygiene to Medical Superintendants, 2 February 1948, H-MHD-1,
8/94/8, part 2, ANZ, Wellington.
Tokanui Newsletter, January 1964, held at WDHB, p.1.
Interview with George Searancke, 5 February 2004. Interviewed by Jenny Robertson, Tokanui Oral
History Project (TOHP). Held at Te Awamutu Museum, Te Awamutu.
George Searancke interview.
‘Results of Essay Competition’, Kai Tiaki, New Zealand Nurses Journal (KT), 47, 6, 1954, p.215.
Hildegard Peplau, Interpersonal Relations in Nursing. A Conceptual Frame of Reference for Psychodynamic
Nursing (New York, Springer Pub. Co., 1952); Helena Willis Render and M.Olga Weiss, Nurse-Patient
Relationships in Psychiatry, 2nd edn. (New York, McGraw-Hill, 1947).
Report of the Department of Health for the year ended 31st March 1960, Appendices to the Journal of the
House of Representatives (AJHR), 1960, H31, p.82.
Harold Turbott, ‘Nurses - their Education and their Role in Health Programmes’, KT, 50, 3, 1957, p.110.
The N&MB introduced new curricula for general nurses at the same time.
Stallworthy to Director of Mental Hygiene, 22 August 1958, H-MHD, 1, 8/94/0, vol. 2, ANZ,
Wellington.
Stallworthy to Director of Mental Hygiene, 13 May 1959, H-MHD, 1, 8/94/0, vol. 2, ANZ, Wellington;
A ‘long day’ was the 13 hour shift that nurses regularly worked at least twice a week. On other days, they
worked a ‘short day’ or 10.5 hours.
Tokanui Newsletter, February 1961, held at WDHB, p.1.
Kenneth Stallworthy, A Manual of Psychiatry, 6th. edn., Christchurch, New Zealand, Perryer, 1963.
Interview with Margaret Bazley, 17 September 2007. Interviewed by Suzette Poole. Held at WDHB.
Laurie Mills interview.
B.R. Skinner was transferred to the School in 1968 because of a physical injury that prevented him from
working on the wards.
Nurses and Midwives Board, ‘Nursing Education Review’, 23 November 1970, YCBG, 5929/14a, ANZ,
Auckland, p.10.
Nurses and Midwives Board, ‘Nursing Education Review’, 23 November 1970, YCBG, 5929/14a, ANZ,
Auckland, p.10.
‘Block Training is Comprehensive’, KT, July 1971, p.26.
Prebble, 2007, pp. 299-231.
Interview with Suzette Poole (previously Gisler and Te Huia), 9 April, 2011, interviewed by Kate Prebble.
Held in personal collection.
‘Psychopaedic’ was a term coined in New Zealand in 1960 when a decision was made to establish a
network of hospitals and training schools for children with intellectual disability under the management
of the Division of Mental Health. Psychopaedic nursing education and registration was established at the
same time.
Interview with Rodger McLaren, 24 March 2011, interviewed by Kate Prebble. Held in personal
collection.
Rodger McLaren interview.
In 1971, only 54 per cent of psychiatric nursing recruits held School Certificate. Under the Nurses Act
1971, School Certificate became the minimum qualification for entry to psychiatric and psychopaedic
nursing programmes. This had been the case in general nursing since 1966.
Interview with Barbara Johnson, 9 February 2011, interviewed by Kate Prebble. Held in personal
collection.
A Register of Male Nurses had been in place since 1945 but few psychiatric nurses had undertaken the
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training because of the cost of transferring to a general hospital at a significantly lower salary and the
few benefits to be gained from the extra qualification. In the late 1960s, funding was made available for
selected male nurses to retain their RPN salaries while they trained at general hospitals.
‘Tutors of Tokanui’, compiled by Brian Thomas, November 2006. Held at WDHB.
Rodger McLaren interview.
Interview with Marie Whittaker, 12 February 2004, interviewed by Jenny Robertson, TOHP. Held at Te
Awamutu Museum, Te Awamutu.
Interview with Nancy Neilson, 1 March 2004, TOHP. Held at Te Awamutu Museum, Te Awamutu.
Marie Whittaker interview.
Barbara Johnson interview.
Barbara Johnson interview.
‘A History of Tokanui Hospital: Te Awamutu 1912-1997’, ed., by Rodger McLaren, ([n.p.]: [n.pub.],
1997). Copy held at Te Awamutu Museum, Te Awamutu, p.15.
Helen Carpenter, An Improved System of Nursing Education in New Zealand (Wellington, Department of
Health, 1971).
Report of the Nursing Council of New Zealand for the year ended 31st March 1978, AJHR, 1978, E18,
p.4.
Neilson interview.
Report of the Department of Health for the year ended 31st March 1973, AJHR, 1973, E10, p.105.
Report of the Department of Health for the year ended 31st March 1980, AJHR, 1980, E10, p.49.
Increased to 70 places nationally: Tokanui Newsletter, 3 October 1984. Held at WDHB, p.1.
Report of the Department of Health for the year ended 31st March 1984, AJHR, 1984/5, E10, p.51.
Tokanui Hospital Newsletter, 27 August 1984. Held at WDHB, pp.1-2.
Tokanui Newsletter, February 1985.
Interview with Ken Jamieson, 24 March 2004, interviewed by Jenny Robertson, TOHP. Held at Te
Awamutu Museum, Te Awamutu
Interview with Robyn Boladeras, 23 January 2012, interviewed by Kate Prebble. Held in personal
collection.
Suzette Poole interview.
Rodger McLaren interview.
Debra Wilson, ‘Transforming Nursing Education: A legitimacy of difference’ (unpublished PhD thesis:
University of Canterbury, 2001), pp.1-4.
Kate Prebble and Barbara McDonald, ‘Adaptation to the mental health setting: The lived experience of
comprehensive nurse graduates’, Australian and New Zealand Journal of Mental Health Nursing, 6 (1997),
pp.30-36.
Elaine Papps and Irihapiti Ramsden, ‘Cultural safety in nursing: The New Zealand experience’,
International Journal for Quality in Health Care, 8, 5 (1996), pp.491-497.
Brian Stabb, ‘How I became “culturally unsafe”, KT, (May 1995), pp.24-26.
Ministry of Health, Report of the Inquiry under Section 47 of the Health and Disability Services Act 1993 in
Respect of Certain Mental Health Services (Wellington: Ministry of Health, 1996).
Looking Forward: Strategic Directions for Mental Health Services (Wellington, Ministry of Health, June
1994); Moving Forward: The National Mental Health Plan (Wellington, Ministry of Health, June 1997).
The name ‘Te Ao Maramatanga’ was gifted to New Zealand mental health nurses by Ralph Love, a
kaumatua of Poneke, Wellington. For a brief time following the 1988 conference, there was a national
mental health nurses’ organisation by that name: Psych Nurse 88, Te Ao Maramatanga (Wellington, 1992),
preface.
Anthony J. O’Brien and Erina Morrison-Ngatai, ‘Te Ao Maramatanga, The New Zealand College of
Mental Health Nurses’, Guest Editorial, International Journal of Mental Health Nursing, 13 (2004), pp.7576.
Robyn Boladeras, “Reflections on Practice by Student Nurses’, Incite, 1, 1(2001), pp.27-31.
Robyn Boladeras interview.
Mental Health Nursing Education in the Waikato 1912-201085
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Ngaire Cook, ‘Quality improvements for psychiatric mental health services’, Whitireia Nursing Journal, 5
(1998), pp.25-31.
Personal communication: Anthony O’Brien, University of Auckland.
For example, the formation of the Health and Disability Commission in 1994.
Report of the Ministerial Taskforce on Nursing: Releasing the potential of nursing (Wellington, Ministry of
Health, 1998), p.20.
Rodger McLaren interview; Suzette Poole interview.
‘New PDRP offered to Māori nurses’, Nursing Review, 10, 11, (March 2010), p.5.
Nurse Practitioners in New Zealand (Wellington, Ministry of Health, 2002).
Mark Smith, ‘Reviewing the role of mental health nurse practitioner’, KT, 14, 3, (March 2008), pp. 2021.
Changing Times, Changing Places