Abstract

Margaret Mary Hunter (1918-1991) was Chief Nursing Officer for the St.John Ambulance Association from 1965-1981. She vigorously promoted the Association's Home Nursing course believing every Canadian household should have some one trained in home nursing. Her greatest achievement came in 1976 when, at her initiative, the Department of National Health and Welfare awarded $1,000,000 jointly to the Association and the Canadian Red Cross Society to develop the multi-media program "There's No Place Like Home for Health Care". Unfortunately this award-winning instructional program was never widely implemented and, following her retirement, home health care training in the Association declined in importance. Margaret Hunter's efforts to effect change illuminate the complex challenges facing nursing leaders of all generations.

"With the present shortage of nurses...we need to conserve hospital beds for the acutely ill, and teach the public to be able to look after themselves and know what to do when sickness strikes in a home" ("Encourages youth," 1966). "Our plan is to teach people to help themselves and to intelligently use public services such as the Victorian Order of Nurses and emergency services at a hospital" ("Chief nurse visits city," 1966). Margaret Hunter spoke these words almost 35 years ago as she travelled the country, visiting provincial branches of the St. John Ambulance Association (SJAA), promoting training in home nursing. Hunter was at the beginning of her 16 year career with SJAA, a career marked by a passionate commitment to the role of home nursing in fulfilling the mission of this voluntary health organization. At the time of her appointment, SJAA was (and remains) highly regarded for First Aid training and service (through the St. John Ambulance Brigade), and training in Home Nursing .

In 1965, the year she joined SJAA, over 7000 classes were held in all provinces and in several major industries and government departments. Over 70,000 awards were earned in First Aid and over 3000 in Home Nursing (St. John Ambulance Association, 1965). Hunter wanted to correct the disparity in participation between these two programs believing that every household in Canada should have someone trained in home nursing ("St. John Ambulance wants aware public," 1966). Hunter experienced both success and disappointment at SJAA. It was her effort that led to the procurement of a $1,000,000 grant from the federal government to develop a new home health care training program, and it was her fate to watch the program founder on the shoals of organizational rivalry and indifference in the context of an institutionally-focussed health care system.

Margaret Hunter was born in Winnipeg in 1918 but grew up in Ninette, Manitoba, the eldest of 5 children. She graduated from the School of Nursing, Brandon General Hospital in 1939 and worked there as a staff nurse until she joined the Canadian Army in 1943. She was commissioned a Second-Lieutenant (Nursing Sister) in the Royal Canadian Army Medical Corps and a year later posted overseas where she served as a triage nurse in field hospitals and a casualty clearing station in Northwestern Europe in the final 18 months of World War II. Hunter was decorated for her war service.

Following the war, and for the remainder of her military career, she served in military hospitals across Canada, including a two year posting from 1961-1963 in Ottawa at the newly opened National Defence Medical Centre (NDMC). During this time she had the honour of standing sentinelle during a wreath laying at the National War Memorial by Her Majesty, Queen Elizabeth, the Queen Mother in June, 1962 (see GWL Nicholson, 1975, photograph #72). A year later Hunter left her position as Deputy Director of NDMC to become Director of Nursing at the Canadian Forces Hospital, Kingston. In 1965 she retired with the rank of major, at the time the most senior rank open to women in the Canadian Army.

Hunter was recruited to the position of Chief Nursing Officer immediately following her retirement. In joining SJAA she followed in the footsteps of other retiring army officers who were recruited into staff positions in the Association. Ex-military found a familiar environment in St. John with its clear delineation of authority by rank, and in the Brigade, the wearing of uniforms, annual inspections, competitions, promotions and awards. And, as in the armed services , they found an explicit gender division in organizational function between First Aid and Home Nursing.

Hunter wore the uniform of Chief Nursing Officer of the Brigade (a position she held until 1977) as she made her first cross-country tour in 1966, and more than one reporter commented on the stylish figure she presented ("St. John Ambulance wants aware public,"1966, "Chief nurse visits city," 1966). Hunter was tall and slim, with large dark eyes, and was immaculately groomed whether in uniform or civilian dress. Her physical attractiveness and friendly manner made her a welcome visitor to provincial Councils of SJAA . Typical of the response to her visits are these words from the June, 1967 minutes of the Annual Meeting of the Nova Scotia Council: "In October we were favoured with an official visit from Major Margaret M Hunter, CD, RN, the Chief Nursing Officer of the Priory in Canada. ....The Home Nursing program in Nova Scotia was given a very welcome boost by the visit of so charming and prominent a nursing officer." (Nova Scotia Council, St. John Ambulance Association, 1967).

Hunter's interest in increasing the profile of the Home Nursing course was both a matter of personal conviction and role responsibility. She promoted home nursing as an essential skill for Canadian women ("Nursing class lauded," 1968) and as a measure to conserve hospital beds for the acutely ill. The costs of health care concerned Hunter and she saw care in the home as an underused alternative to expensive hospital care. In this regard, she was clearly ahead of her time.

When Hunter joined SJAA, the Home Nursing course was taught by volunteer Registered Nurses (RNs) using the manual, "Patient Care in the Home", and whatever sick room equipment was available or could be improvised in local branches. The manual, newly published in 1965, was the latest in a long line of SJAA manuals teaching practical nursing skills to the general public. Hunter was fully in support of the new text and promoted it as she toured the provinces in 1966. Developments in First Aid training , however, soon caused her to consider a different approach to teaching the Home Nursing course. In the early 1970s the Workman's Compensation Boards of Canada gave $90,000.00 to SJAA to refashion the First Aid course as an 8-hour multimedia presentation of films and workbooks. Hunter clearly felt Home Nursing would benefit from a similar treatment and began to search for ways to make it happen.

It was an ambitious undertaking for several reasons. Home Nursing did not enjoy the same support or resources within SJAA as did First Aid. Indeed, Hunter was a department of one, in contrast to the well staffed First Aid department. According to a former staff member employed during Hunter's tenure, the First Aid course always had greater public appeal, was allocated a larger budget, was a more important source of revenue for the organization and was more consistent with the military culture of St. John, than was Home Nursing (Interview, J. Allen, May 9, 1999). A further, and significant, challenge to Hunter's vision was the country-wide expansion of hospitals and hospital care that took place in the 1960s, the result of government policies to provide hospital and medical insurance for Canadians, and to build more hospitals (Crichton & Hsu, 1990). To make-up for the lack of inhouse help, and determined to see the Home Nursing program grow, Hunter turned to nursing colleagues in Ottawa for assistance in pursuing her vision. She enlisted the help of Helen Mussallem, ( then Executive Director, Canadian Nurses Association), Evelyn Pepper, ( then Nursing Consultant, Emergency Health Services, Department of National Health and Welfare)), and Irene McPhail, (then Chief Nursing Officer, Federal District, SJAA). These women were her friends, were linked to SJAA through volunteer service and, in the case of Mussallem and Pepper, shared a common military nursing history. By virtue of their nursing positions they were well placed to advise her on how to proceed. On behalf of a consortium of SJAA and the Canadian Red Cross Society(CRCS), Hunter made application to the Research Programmes Directorate, Department of National Health and Welfare and in 1974 obtained funds for a feasibility study of a multimedia course in home nursing. This was followed in 1976 by a $1,000,000 grant to develop a multimedia program to teach basic nursing skills to the general public. The award of this large grant suggests the relevance of Hunter's ideas for a new health care framework then being proposed by the federal government in the Lalonde Report(Department of National Health and Welfare, 1974). It speaks also of the growing recognition in government of the need to foster alternatives to expensive hospital care.

By 1978 the program "There's No Place Like Home for Health Care" was prepared . It consisted of 12 films and accompanying self-instructional manuals. The aims of the program reflected Hunter's vision for home nursing training:

  • to present lay persons with the knowledge, attitude and skills necessary to develop positive health practices in caring for sick individuals with skill and confidence.
  • to more effectively and efficiently use community health resources while providing home care.
  • to increase the precision of observations of health problems and the effectiveness of reporting the observations to health professionals.

The program was made available to provincial Councils whose role it was to implement nationally developed programs. It received an Honourable Mention award in 1980 at the John Muir Medical Film Festival in California, and appeared set for a bright future. But then it faltered. According to a senior volunteer at the time, the program was not popular with the provincial Councils. (interview with V. Allen, May 9, 1999). It was expensive to operate and the Councils were chronically short of funds. In comparison to First Aid training programs, they did not view it as an important revenue source, and there was little reason to promote it, given the availability of hospital beds and prolonged hospital stays. Coupled with an unenthusiastic response by provincial Councils was the historically difficult relationship between SJAA and the CRCS. Longstanding competitors in the field of first aid and home nursing training, they could not agree on how the program should be distributed. The final blow was dealt in 1982 when, following protracted discussions over several years by executive officers of both organizations (discussions which generally did not include Hunter), SJAA was told by the CRCS ( on advice from the International Red Cross) that the red cross of the CRCS and the black 8-pointed cross of SJAA could not appear together on any materials distributed to the public. Tragically, the program was withdrawn from circulation.

Hunter retired in 1981, her vision of an alternate to expensive hospital care caught in a contest between two organizations unable to 'share the pie' of home health care training, at a time when hospital care dominated health care. For her services to her country she was awarded the Order of Canada in 1984. In the years immediately following her retirement various other health care training programs (directed mainly to seniors) were initiated with federal funds in SJAA but none endured. In 1991, after a prolonged period of ill health she died in the NDMC. In the year 2000 the St. John Ambulance Association is chiefly recognized as a provider of First Aid training; training in Home Nursing is no longer offered.

Remembering Hunter, Mussallem said " She was the most gracious visionary person that I have ever known....She saw her goals and she worked towards them. " (interview, November 20, 1999).

Time has proved the legitimacy of Hunter's concerns for health care in Canada. The transfer of care to family members that has taken place through health care restructuring reveals the wisdom of her vision for home nursing. Her ultimate lack of success in implementing that vision speaks to the enormous challenges nurses face in making change in health care organizations. Disadvantaged by gender and frequently constrained through hierarchical structures, nursing leaders must be sustained by their vision of health care.

About the Author

Frances M. Gregor, PhD, RN, is Associate Professor, School of Nursing, Dalhousie University, Halifax, NS.

Acknowledgment

The author wishes to acknowledge the helpfulness of Elizabeth Hubley, and Joan Wills, Secretary to the Order, St. John Ambulance Association in the preparation of this article.

References

Allen, J. (1999). Interview.

Allen, V. (1999). Interview.

Canada. Department of National Health and Welfare (1974). A new perspective on the health of Canadians. Ottawa: Author.

Chief nurse visits city. (1966, March 26). The Calgary Herald, p.24.

Crichton, A., & Hsu, D. (1990). Canada's health care system: It's funding and organization. Ottawa:

Canadian Hospital Association. Encourages youth in child care. (1966, October 11). The Mail Star, p.27.

Mussallem, H. (1999). Interview.

Nicholson, GWL. (1975). Canada's nursing sisters. Toronto: AM Hakkert.

Nova Scotia Council, St. John Ambulance Association (1967). Minutes of the Annual Meeting, Halifax, NS: Author.

Nursing class lauded. (1968, March 7). The Vancouver Sun, p.22.

St. John Ambulance Association (1965). Annual report. Ottawa: Author.

St. John Ambulance wants aware public. (1966, March 31). The Vancouver Sun, p.15.