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Chapter III.
Reciprocity of State Registration of Nurses.

In August, 1921, a letter was addressed to me by Miss Riddell, Registrar under the General Nursing Council for England and Wales, asking that I would through Kai Tiaki acquaint nurses in New Zealand that the State Register was now open and the Council prepared to receive applications for registration.

It will be remembered that the Bill for State registration of nurses in Great Britain had been passed in 1919. The intervening time before the register could be opened had been taken up with the preparation of regulations dealing with the many varieties of hospitals and their vested interests in Great Britain, a very different problem to what had to be faced in this new country where nearly 20 years before our registration Act had been passed.

Miss Riddell quoted rule 16 of the Act under which nurses registered elsewhere in His Majesty's Dominions could be accepted and asked me to place the facts before the nurses of New Zealand. I therefore published the whole letter.

Many nurses from the Old Country were in New Zealand, some holding hospital positions, others private nursing and the information thus concerned them very greatly, as, if they wished to return to their own country it would be to their great advantage to be placed upon the British register during the period of concession, as later it would be necessary to pass the State examination.

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About this time also, the Secretary of State for the Colonies, addressed a letter to the Governor-General of New Zealand regarding the terms of reciprocity of registration of nurses between the General Nursing Council and New Zealand. The late Dr. Frengley and I drafted the reply giving very fully the conditions of nurses training in New Zealand, pointing out that it was necessary here to allow small hospitals to train nurses, but that these had to comply with the regulations under the Registration Act, and that the uniform State examination had to be passed.

We laid down the terms on which we would accept nurses from Home, and said that only nurses holding a certificate of training from a recognised training school for three years, were eligible, as they had been since our Act was in force, for registration here. That nurses registered under the General Nursing Council on concession clauses would not be accepted.

We fully expected that our smaller hospitals would be cut out, but to our surprise, the reply came out in due course, that the General Nursing Council would accept without condition, nurses registered in New Zealand; and agreed to our conditions regarding nurses registered under concession clauses.

This, of course, was very gratifying and was a testimony no doubt to the efficiency shown by our nurses who from both large and small hospitals, were sent to serve during the War.

A prominent member of the General Nursing Council at that time, was Mrs. Bedford Fenwick and she, through her management of the French Flag Nursing Corps, had had experience of our nurses and had for years shown interest in New Zealand.

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For a long time New Zealand was the only one of the Dominions thus accepted for reciprocity, though several years later, arrangements were made with other parts of the Empire. At that time, however, New Zealand was the only one of the overseas Dominions which had a nurses' Registration Act, though South African nurses were provided for in a Medical Act. Since then, the Australian Acts have come into force; Victoria 1924, New South Wales 1925.

Writing of reciprocity with these other Dominions, the varying Acts of the Australian Commonwealth, each State unfortunately having a different Act, has made it difficult to establish it fully, and much correspondence has ensued, both before and since my retirement.

Since then too, my successor had a very hard task in endeavouring to preserve intact our reciprocity with the General Nursing Council for England and Wales. In 1929, a Bill was introduced into the House, near the end of session, for the registration of nurses trained in private hospitals. The Nurses' Association saw the danger of this to the status of the nursing profession, and the Hon. Secretary, by getting up a deputation to the Minister of Health, got the Bill deferred to the next session, and a promise that the Association would be given an opportunity of discussing the amendment. This gave some time for organisation against the Bill, which was brought in early in the next year. All the arguments against it which could be brought up were advanced—I was asked by the Association to write to the Press and my letters were published widely Many other opponents to the training in private hospitals, which most trained nurses consider would not be either satisfactory or fair to patients who are paying fees for qualified nursing care, or to page 29 private nurses who depend for their living on private patients and private hospitals, also gave their views.

An argument which was the one which appeared to carry most weight was the endangering of our reciprocity with Great Britain, where training in private hospitals is not recognised by the General Nursing Council. The Minister of Health promised that our standard would be upheld, and that any danger to our reciprocity would not be allowed. The result, though not quite all we wanted, which was no alteration of the Act of 1925, was that certain amendments were carried, which would allow of training in private hospitals with public wards attached. The conditions were to be laid down by the Registration Board. The Board ascertained from the General Nursing Council what allowances of time for a nurse's training in the public wards of a private hospital could be given in the private wards, and the reply was, three months only.

This condition practically limits any training of probationers in private hospitals to a degree, which will make it not the easy economic problem that the promoters of the amending Bill hoped.

As a matter of fact, it is extremely unlikely that more than one or two of the large Roman Catholic Church Hospitals will attempt any enlargement of their present capacity to admit many trainees.

While on the subject of State registration I must give some account of the new Act which was prepared partly during my last year of office.

The Nurses' Registration Act, of 1901, was then still in force, but it was felt that now that the profession of nursing was so well organised through its Association, that nurses should have some direct representation in its control. For some years I had advocated a Board on which page 30 nurses would sit. I myself, as Deputy Registrar, was the only member of the profession dealing with registration, and although in most cases this was a simple straight forward matter, which needed only occasional reference to the head of the department, there were times when a board to deal with questions in a more impersonal way would have more weight, and could lay down the law for the training schools with more authority.

Dr. Makgill was detailed to draw up a new Act with me to assist him. He thought it would be wise to incorporate the Midwives' Act in a general Act, and so to bring the midwives also under the same board. The part for nurses registration was very little altered:—

Part I. dealt with general matters and the constitution of a board. This had to be limited to a small number on account of expense, and it was to consist of Chairman, the Director-General of Health; a member of the B.M.A., nominated by that body; two members of the Nurses' Association, nominated by that body, one to represent general trained nurses, the other to represent midwives.

The Director, Division of Nursing, to be Registrar, and to sit as a member of the board.

We had many consultations over this Bill, and it was almost completed when my term of office came to an end.

I was away from New Zealand when the completed Bill was brought before Parliament, and when I returned I was sorry to find that in the midwifery part, two classes of midwife and maternity nurses had been provided for. I did not approve of the two standards, also as maternity nurses had not been registered before, this admitted to the register, under a concession clause, women who had practised without training.

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However, the desire was to bring such women under closer supervision than had been possible before, and may possibly have done some good.

When this new Act was passed and came into force, it was at the Annual Conference of the Nurses' Association, held in Christchurch in 1924, that the nominations of nurses for the first Registration Board were made. I was at the Conference, and was one of the two nominees to represent General Nurses. Miss Kohn, Matron of a private hospital in Wellington, the other.

I felt that having only so recently left the Department I would still be too much a Government official, and that it would be wise for the Association to have an entirely independent member. I therefore expressed my views to the meeting and Miss Kohn was elected. I regretted very much that I could not take this office, and possibly my view was mistaken, and I might have had the great interest and pleasure of being a part of the new Board without any detriment to the interests of the nurses.

Miss Inglis, late Matron of St. Helens Hospital, Wellington, was nominated as midwifery representative, and Dr. Young was nominated by the B.M.A., as the Medical representative.

A very busy time was ahead of the Board, in forming regulations under the Act; Miss Bicknell, of course, as Registrar was able to give valuable assistance.

Since this time, as the Board was elected for three years, there has been only one change when Miss Newman who had retired from the Matronship of St. Helens Hospital, Wellington, was nominated for the midwifery section, Miss Tennent, Matron of Dunedin Hospital, for the general nursing part.

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Under the Amended Act, 1930, two members were added to the Board, viz., another nurse representative nominated by the Association—Miss Muir, Matron of Christchurch Hospital—and a member of the Hospital Boards' Association—Mr. Wallace, the Chairman of the Auckland Hospital Board. No doubt the presence of a member of this body, will be an advantage to the Nurses' Board, Hospital Board members often do not realise the many problems connected with the training of nurses, necessary as they know nurses are to the existence of hospitals—year by year these problems come before the annual Conference of the Trained Nurses' Association and are discussed fully, and resolutions formed are sent to the Registration Board. The opportunity of their becoming acquainted with the views of the nurses generally is of great value to the Board.

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