Early nurses were untrained and combined health work with domestic and childcare work. From the 1880s hospitals offered training programmes, which signalled the formalisation of nursing as a profession. Supervised nurses’ homes were opened on hospital grounds to encourage young and respectable middle-class women to enter the profession. Male nurses were less common and tended to work in psychiatric hospitals.
The formalising process was completed by the Nurses Registration Act 1901, the first legislation of its kind in the world. Nurses were trained through a three-year apprenticeship scheme at hospitals, and sat an examination at the end. Successful candidates were registered.
Nursing became more specialised. Nurses could train as a general nurse, an obstetric nurse (or both), a psychiatric nurse or a psychopaedic nurse (who specialised in intellectual disabilities).
In 1971 the Carpenter Report recommended that nursing education occur in educational institutions rather than in hospitals. Student attrition rates were high and some nurses argued that the apprenticeship scheme in hospital was exploitative. The transition was completed in 1989 when the last hospital school of nursing closed. Initially, undergraduate training occurred at polytechnics, and postgraduate courses were available at universities. In the 21st century both were offered at polytechnics, institutes of technology and universities.
Until nurses were trained in educational institutes and developed more autonomy in learning and practice, they were seen as subordinate to doctors. This attitude was expressed by Nurse Sibylla Maude in 1908: ‘To hear a nurse answer “Yes, Sir” is surely more professional than “Yes, Doctor”, and to stand to receive orders … is equally important. Another point of etiquette too often violated is the questioning of doctor’s orders, after he has left the patient. Whatever a nurse may think, her duty is to obey without expression of opinion, as after all the patient is in the doctor’s charge, the nurse being required simply to carry out his instructions faithfully.’1
In the 21st century there were three categories of nurses: nurse practitioner, registered nurse and enrolled nurse.
The nurse practitioner role was introduced in 2001 and allows for autonomous practice for expert registered nurses with masters degrees. In 2015 there were 145 nurse practitioners in New Zealand.
Registered nurses have a nursing degree and are registered with the Nursing Council of New Zealand. They are qualified to work independently in all health-care settings.
Enrolled and assistant nurses have lesser qualifications and work alongside registered nurses in a support role.
The nursing workforce comprises over half of the total health workforce. In 2015 there were 52,729 nurses holding annual practising certificates.
Until 1904 most midwives received no formal training and learned on the job. Government concern about high maternal and infant mortality rates led to the Midwives Registration Act 1904. Midwives were trained at seven St Helens hospitals throughout the country. After this, registered midwives managed most births.
Jill of all trades
A newspaper advertisement from 1860 shows the different tasks midwives undertook in the 19th century: ‘Mrs. M. Haughay, Midwife and Nurse. References as to the above can be given. Also WASHING and DRESSING Done in the Best Style at very Moderate Charges.’2
The Nurses and Midwives Registration Act 1925 created maternity nurses, who worked with a doctor. Midwives worked alone. However, from this time most graduates were maternity nurses so midwifery services were increasingly controlled by doctors. From 1957 midwives had to be registered nurses, and from 1971 could not deliver a baby without a doctor present.
The Nurses Amendment Act 1990 reintroduced autonomous midwifery practice. The act separated midwifery and nursing, which were established as separate and distinct professions. Educational institutes could offer direct-entry midwifery training – a nursing qualification was no longer necessary.
Since 1990 midwives have been increasingly responsible for managing normal births. About 75% of women choose a midwife as their lead maternity carer. Almost all GPs have ceased their involvement in normal birth, so women choose between a midwife or a medical specialist (an obstetrician).
In 2015 there were 3,068 midwives holding annual practising certificates in New Zealand. Over half worked at public hospitals, and almost one-third were self-employed independent midwives.