Nursing was derived from religious orders and the military. Early nursing uniforms reflected this beginning with veils like nun’s coifs and the militaristic use of epaulettes and stripes on uniforms to demark hierarchy. Uniforms were often pale blue with white aprons and mob caps typical of English servant attire. White symbolised hygiene, blue symbolised purity.
In Britain Elizabeth Fry established an Institution of Nursing Sisters in 1840 and three-month hospital training, but it was under Florence Nightingale that a hospital training school was introduced after the Crimean War (1853-1856). In Queensland the Florence Nightingale system of training nurses was established and the Brisbane General Hospital became the first training centre in 1886. Regional hospitals followed suit, while religious and private hospitals also provided training. By the end of the 19th century there were a large number of trained nurses throughout Australia, prompting the establishment of the Australasian Trained Nurses Association in 1899, with membership offered only to those with hospital accreditation. The Queensland branch was formed in 1904 and began lobbying for registration of nurses. Success came in 1912 when Queensland established a Nurses Registration Board for general, midwifery and mental nurses — the first of its kind in Australia.
Under the Health Act 1911 general, midwifery and mental health nurses in Queensland were registered and were to be given preferential employment in hospitals covered by the Hospitals Acts. A state syllabus, examinations and a common period of training of three years in a hospital was introduced. Within 12 months 1401 nurses were registered in Queensland.
In 1921 nurses formed the union Queensland Nurses Association under the Industrial Arbitration Act 1916 to advocate for improved conditions and wages. Nurses worked long hours and were poorly paid, with a senior nurse earning £103 per annum and a teacher £195 and clerks £182. Senior nurses’ salaries were increased to £120-£160 in 1921. Hours worked were 112 per fortnight in 1921, reduced to 88 in 1925 and 80 in 1930.
Under the Hospitals Act 1923 hospitals were categorised into three-, four- and five-year training hospitals, largely dependent on their size. Sectional exams at the end of each year were introduced, rather than a final exam in the third year. The syllabus was changed to cater for the additional years.
World War II exposed a shortage of nurses both on the war front and home front. Despite a recruitment campaign and a temporary shortening of training from four to three years, the problem persisted and Red Cross and Voluntary Aid Detachment nurses had to fill the gaps in hospitals. In 1943 the Nurses Award was amended, but despite that first-year nurses earned £65 (an increase from £33) while a 16-year-old shop assistant earned £97. A first-year Sister earned £175.
Nursing education changed in the 1960s when the Queensland Branch of the College of Nursing introduced post-registration courses, most of which had been available only in Melbourne. The Australasian Trained Nurses Association lobbied to improve the educational standards of nurses, making completion of Junior (Year 10) a required minimum-entry level. A major curriculum change in 1970 increased the number of lecture hours to 840, with six weeks preliminary training. Depending on hospital size, training would be three or four years long. Lectures were now held in hospital time. Post-graduate training also expanded and the positions of nurses’ aides and enrolled nurses were introduced.
The move to separate nurse education from hospitals gained momentum in the 1970 when a college course started in Melbourne. Queensland was the last state to introduce tertiary nurse training when in 1978 the Queensland Institute of Technology offered post-registration courses, followed by the first undergraduate course in 1982. Many hospitals were reluctant to change. By 1993 all nurses in Queensland were trained at university.
Until the 1950s nursing had changed little. Nurses were responsible for patient care, as well a cleaning patients and wards, preparing meals, making bandages, sterilising and counting equipment, sharpening needles, sorting linen and making beds. Patients were treated in large, open Nightingale wards. Organised as a dormitory with the sickest patients closest to the Sister’s desk, the only privacy was afforded by heavy screens. The average patient stay was 10 days but many stayed weeks. The only monitoring of patients was done by nurses on their regular rounds. Hospitals did not have electric beds and hoists — patients were lifted by nurses, at the expense of their backs.
Nurses’ shifts were long and every minute was accounted for on-duty, and supervised and monitored when off-duty. Nurses lived on-site in nurses’ homes under the watchful eye of the Home Sister. Life was regimented with a 10 pm curfew rigidly and punitively enforced. Social lives were restricted and males could not visit. Most socialising was with fellow nurses and the bonds made between nurses created friends for life. All nurses were single as up until 1969 married women had to resign.
The 1970s brought significant changes. Hospital orderlies, enrolled nurses and nurses’ aides helped with patient care. Meals were made in kitchens and brought to the wards. Sterilising departments were introduced, only to be followed by the era of disposable bandages and equipment in the 1990s.
Nursing has evolved from the medical model where doctors dictated care and nurses subserviently followed. Since the 1990s it has been a more collegiate approach with doctors, nurses and allied health professionals such as physiotherapists and occupational therapists working together.
The nursing structure is still hierarchical, but less authoritarian. There are now more levels with endorsed enrolled nurses, enrolled nurses and assistant nurses junior to registered nurses and those above. However, nurses now take a more active role in patients’ care, performing the tasks once assigned to junior doctors or medical registrars.
Nursing is now also more specialised, with nurses working in intensive care, mental health and palliative care wards, postnatal and prenatal clinics and day surgery units, among others. The average hospital stay is less than 24 hours; patients recuperate at home. As a consequence, those in hospital wards require more intense nursing.