Filling the Gap between Metropoles and Peripheries: Insights about Hospital Standardization from the British Columbia Hospital Association Conferences, 1918–30

Abstract

In this study, we examine British Columbia’s Hospital Association conference records (1918–31) to understand how place, gender, and profession shaped debates about hospital standardization during the interwar period. The conference records reveal that hospital standardization was conceptualized as the conformity of smaller, peripheral hospitals to larger metropolitan ones. Arguments about how to best address the gaps in small hospitals were often directed to elite nursing leaders, who suggested improved nursing education as a solution. Hospital affiliation was recommended to ensure adequate training for rural nurses by moving trainee nurses from rural to urban hospitals during the last year of their education. Yet the way that affiliation was conceived was more aligned with the professional goals of the nursing elite, rather than the needs of rank-and-file nurses in small hospitals. These ideas ultimately worked to support the goals of standardization, but obscured the divergent needs of small community hospitals.

Help Wanted, Experience Preferred, Stamina a Must: A Narrative Review of the Contextual Factors Influencing Nursing Recruitment and Retention in Rural and Remote Western Canada from the Early Twentieth Century to 2023

“…At the same time, governments expected nurses to function in an expanded role that could fulfill most healthcare needs of the population at a much lower cost than physician services (Gilbert, 2003;Vandenberg & Johnson, 2022). Many mid-century outpost nurses were young, female, European-Canadian, English-speaking, middle-class, and university-educated with little preparation for the cultural diversity they experienced in practice (Drees & McBain, 2001;Elliott, 2008).…”

“…The contextual background information provided in this review alluded to the health and socioeconomic disparities experienced across rural areas of Western Canada. Ten papers conducting historical inquiry discussed how policymakers overlooked the needs of rural communities and how rural regions often received inequitable proportions of government funding and physical resources, such as medications (Drees, 2010;Drees & McBain, 2001;Elliot, 2010, Elliott, 2008Gilbert, 2003;McBain, 2010McBain, , 2012Quiney, 2008;Rutherdale, 2008;Vandenberg & Johnson, 2022). The sparsely distributed populations, diffuse poverty, poor access to education, and precarious work meant that most rural communities could not afford to sustain a nursing outpost or fund improvements to existing infrastructure (McBain, 2010(McBain, , 2012Quiney, 2008).…”

“…The intrinsic connection of politics and healthcare gives democratic policy-making power to densely populated urban areas. As a result, organizational designs, public policy, and education systems often fail to meet the needs of diverse rural and remote populations (Drees & McBain, 2001;McBain, 2010McBain, , 2012Montour et al, 2009;Pitblado et al, 2005;Vandenberg & Johnson, 2022). For example, during the interwar period in British Columbia, healthcare leaders promoted hospital standardization to bring rural hospitals 'up to' urban standards (Vandenberg & Johnson, 2022).…”

“…As a result, organizational designs, public policy, and education systems often fail to meet the needs of diverse rural and remote populations (Drees & McBain, 2001;McBain, 2010McBain, , 2012Montour et al, 2009;Pitblado et al, 2005;Vandenberg & Johnson, 2022). For example, during the interwar period in British Columbia, healthcare leaders promoted hospital standardization to bring rural hospitals 'up to' urban standards (Vandenberg & Johnson, 2022). The idealization of urban hospital standards highlighted the power imbalances that existed between medical leaders, the nursing elite, and the rank-and-file nurses operating rural hospitals on the periphery (Vandenberg & Johnson, 2022).…”

“…For example, during the interwar period in British Columbia, healthcare leaders promoted hospital standardization to bring rural hospitals 'up to' urban standards (Vandenberg & Johnson, 2022). The idealization of urban hospital standards highlighted the power imbalances that existed between medical leaders, the nursing elite, and the rank-and-file nurses operating rural hospitals on the periphery (Vandenberg & Johnson, 2022). Male physicians dominated the discussion at the British Columbia Hospital Association conventions, where frontline nurses' requests for increased education and resources to support their expanded scope of practice in rural settings were dismissed in favor of nursing leaders' goals of professional advancement and medical leaders' goals of standardization (Vandenberg & Johnson, 2022).…”