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g Changin , Chang to region from 1910arrative account o tment, and g Times n ea Changin rvices in the Waikaes a pictorial and tivity, care and tr . For those who hanging Times, C ental ry of M kanui ing To e histo llectiv es is a co to 2012, includ the f ing Plac Places d Se ac r amines h provi was fa atient Health , whic and p place es it ex ospital al, the au ing tim gs, staff as a h whan Hospit chang uildin e and kanui ent, b of the m m To o xt n h d at te ro as con envi y, it w ome an italised litical r man from h e hosp ers cio-po es. Fo away o wer the so memb l spac or wh ok them many physica re worked of the that to of its es ce ri lived, s closu la m o p su st wed it the ent a sad er llo an as iff fo th w d e it veral s, the hav more ion of es of se r other which ily. Fo the ey nities collect full m u h a e g fa m is u th r m o to es thro history new co close . This e stori d the pture family to over ity, an lls thes g to ca mmun rs, it te hopin e Waika te s, co th d ve ap at in ti io h ch ec of th ng per l healt irteen persp er a lo . In th menta eting lth comp ject ov ces of in 1997 tal Hea ch pro perien viding en ar ro ex M p se d , to or re to an writers e Waika ve maj onses rd of th borati of resp ns. cal reco f a colla range flectio sult o histori nal re The re perso d written a an time. ce ages im produ es to d e inclu of tim book , John es, the Poole rsued zette Servic has pu udes Su e team up incl Th ro e. G that born tory is le ve o H C ie h e el arin l Healt they b h and d Cath Menta ether, l Healt ert an r s. Tog aikato Lamb Menta h thei x year The W hanie Board st wit und si , Step ple tru Health for aro t eo ic es p ry tr e Graham to rvic histori e his to Dis se e iv a ka th ct ai as at lle plex r the W tation ope th e com this co e repu and h goal fo g of th rrent andin earn th timely, the cu t and ice To nderst u rv an er rt Se o h s p furt tion both im some Addic care is rovide ones’ will p book loved in this . ed re in e) ca ta h lt con o com tal hea ney (t f men of Syd past o ersity , Univ ls Po ans ssor H e Profe ssociat t by A emen rs o d En , s e m i T g n i g n Cha s e c a l P g n i g n Cha spital to Mental He0a1l2th nd borne a ne Cole tory Group Cathari is Edited by ental Health H ato M the Waik ne and Colebor ry Group e in r a Cath Histo Edited by ental Health M o t a he Waik t 3-8 3-2162 8-0-47 ISBN 97 nui Ho aikato, 1910-2 a k o T m W Fro s in the Service 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 Changing Times, Changing Places 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 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 73. 74. 75. 76. 77. 78. 79. 80. 86 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