| Author: Karen Flynn, University of Illinois, Urbana-Champaign |
The UKAHN Bulletin |
| Volume 9 (1) 2021 | |
This article is reproduced with permission from Women’s History Magazine (Summer, 2012), 26-35. Copyright remains with Women’s History Network. See https://womenshistorynetwork.org/womens-history-journal/ for more information about Women’s History, the journal of the Women’s History Network.
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‘I’m not your typical nurse’: Caribbean nurses in Britain and Canada
Introduction
In 1966, at the age of eighteen, Trinidadian-born Ancilla migrated to Britain. Her childhood aspiration had been to become a physician, but her parents were unable financially to pay for her education. Motivated by people migrating to Britain from her area, Ancilla decided to follow to pursue nurse training. To finance the trip, a friend of her father loaned him the money on the premise that his daughter ‘would send the money from England to [her] dad, to help pay back’ his friend.[1] Ancilla was among the masses of Caribbean people who left their individual islands for the ‘motherland’ after the Second World War. Many were encouraged to migrate by family members and friends who had already made Britain home. Others were recruited to work in a variety of industries as a result of the labour shortage, and some took the trip as a form of adventure. By the time Ancilla arrived in Britain, the Caribbean migrant population had reached about 330,000.[2]
Teenagers, such as Ancilla, who left the Caribbean constituted a unique group in that they migrated alone, and did not always have support systems, familial or otherwise, in place. While Caribbean migration to Britain has received ample attention, the narratives of teenagers such as Ancilla remain virtually absent from scholarly literature.[3] Drawn from a larger project conducted with Caribbean and Black Canadian-born nurses on themes that included childhood, nurse education and training, family, work and community,[4] and using semi-structured interviews, this paper explores the migratory subjectivities of young women such as Ancilla. These young women, sixteen in total, left the Caribbean between the years 1949-1968, trained primarily as state-registered nurses (SRN) in Britain, and then migrated to Canada.
In discussing how Black women were situated within British and Canadian society following the Second World War, the tendency has been to underscore their subjectivity as workers. Writing about Black women in these geographic locations, the scholarly consensus is that they were victims of the racist, sexist, and classist ideologies that structured capitalist relations of production. Easily exploitable, Black women were often concentrated in service: that is, in semi- and unskilled work where they were poorly remunerated. For example, in The Heart of the Race: Black Women’s Lives in Britain, Beverly Bryan, Stella Dadzie, and Suzanne Scafe argued that, ‘Service work was little more than institutionalised housework, as night and daytime cleaners, canteen workers, laundry workers and chambermaids – an extension of the work we had done under Colonialism in the Caribbean’.[5] Writing specifically about nursing, Carol Baxter noted that Black nurses in Britain ‘were over-represented in the less prestigious specialties and lower echelons of nursing to which they tend to be recruited (geriatrics, psychiatry, and mental handicap)’.[6] This analysis was extended to Canada as well.[7] Indeed, those researches are an excellent starting place for understanding how institutionalised forms of oppression impacted on Caribbean nurses. At the same time, such generalisations about Caribbean nurses as an undifferentiated category ignore differences related to the time of migration, age, education, training, and work experience.
My objective in this article is to elucidate a more embodied portrait of Black nurses’ subjectivity beyond that of mere workers and embattled victims of capitalism and White racism. This is not to deny the pernicious impact of systemic and institutional forms of oppression that rendered Black nurses suitable for certain positions or how they were treated by various medical personnel and patients.[8] Rather, the goal is to provide a more holistic portrait of these young women who consciously made choices about their material lived reality even in the face of racist and sexist hostility in and outside of nursing. To do this, I begin by providing some brief biographical information about the interviewees. Who were these young women who made the sojourn to Great Britain? What were their reactions to Britain? And, what prompted them to choose nursing as an occupation? I juxtapose their recollections with the dominant discourses and images of Black women circulating in Britain during that time. From there, I move to discuss the women’s reactions to nursing in Canada. Finally, having had careers that spanned decades, the last section of the article explores the interviewees’ revelations about their occupation, and the lessons they wish to pass on to their successors. Here, I focus specifically on the women’s involvement in and responses to organisations that represent their interest. In addition to delineating the multiple dimensions of Black nurses’ lives, this article fills a gap in the scholarly literature that, according to Julia Hallam, ‘continues to deny Black nurses voices of their own and a secure place in nursing history in spite of their large numbers in the workforce’.[9]
Growing up in the Caribbean
The English-speaking Caribbean was under colonial rule when the young women in this study were growing up. Both Jamaica and Trinidad gained independence from Britain in 1962, and the other islands (Dominica, Antigua, Grenada, Barbados, and Guyana) remained under British control until the 1970s and early 1980s. In fact, the majority of the interviewees were British subjects when they migrated. While the unequal distribution of wealth and resources in the islands meant that poverty dominated many of the Black inhabitants’ lives, there were exceptions. Some families were able to move into the middle class by farming, entrepreneurial activities or skilled trades. Being lower- to middle-class made a huge difference in how the majority of interviewees lived while growing up.
Most of the women described their socio-economic status as lower-middle to middle class. For these women, their family’s economic status was determined not necessarily by their father’s occupation, but by land, cattle, and home ownership. Unlike their working-class or poorer counterparts, access to resources was not an issue. Besides having their basic needs met, such as food, shelter, and clothing, the children of middle-class families had toys, such as dolls. How one dressed further indicated a person’s class status, which meant for middle-class children wearing shoes as opposed to going barefooted.
The availability, quality, and quantity of certain foods, such as roast beef, plus a wife’s status, and the responsibilities assigned to children in households were also indicative of class background. Middle-class families were able to hire extra help, often from their working or poorer counterparts, to assist with household and yard duties, which spared children from assuming these tasks. Jamaican-born Daphne B., whose mother was a popular seamstress, explained that,
When we were very small she [mother] employed somebody to look after us until we grew to a stage where we could help ourselves so she let that person go. And then we had somebody to wash and iron for us. And when I went to England at nineteen, we still had somebody to wash our clothes.[10]
Having household assistance meant Daphne B.’s mother had time to devote to the Women’s Guild and the Parent Teachers Association. As a child of middle-class parents, Daphne B. participated in extracurricular activities, such as the 4-Club, and attended chaperoned dances. Middle-class children also learned how to play musical instruments, such as the organ. Equally important, these parents were able to send their children to some of the islands’ best secondary and high schools. In so doing, their children could enter middle-class occupations to maintain their class status.
Besides providing a formal education, the schools in which some of these women enrolled served other purposes as well. Bridget Brereton noted that ‘they would also acquire with their schooling a command of good English or French and some familiarity with European literary culture, both essential requirements for successful upward mobility’.[11] This meant avoiding, for example, the speaking of patois, the language of the masses. Daphne B. maintained that growing up she was taught ‘middle-class values’, including how to be a lady, the proper use of cutlery, and speaking proper English. Middle-class Caribbean families attempted to replicate European norms and sensibilities, which the educational system reinforced. Thus, Daphne B. pointed out that if the teachers ‘heard us speaking what they called poor English’, students would endure some form of humiliation as punishment.
Of course, not all of the Caribbean interviewees grew up middle class. In this group, Ancilla admitted that her family was poor. Unlike Daphne B., who had household help and other assistance, this was not Ancilla’s reality. Growing up, Ancilla experienced the burden of housework and paid work. She explained,
Other than trying to help in the fields in order to get money to go to school, I would have to help with the cooking and the washing. I hated ironing, so I only did it when I was forced to. I cleaned the house, do all those things. I had to do the work as if I was an adult. And then, when my mom would have babies, I would have to take care of the babies and do all the extra diapers and all that kind of stuff.[12]
Still, according to Ancilla, her father wanted a different life for his children, and subsequently encouraged them to pursue a formal education. She was awarded a scholarship to attend Naparima Girls’ High School, which, she boasted, ‘was very prestigious in those days’. Once they completed high school, the young women found migration to be a more attractive option than staying on their respective islands.
Migration to Britain
The general consensus among migration scholars is that economic factors historically drove Caribbean people to cross borders and, once they arrived, the primarily unskilled labourers occupied the lowest echelons of the industries where they were employed.[13] The reality, as Caribbean scholar Elizabeth Thomas-Hope pointed out, is that ‘at times working class, skilled or unskilled labour movements have predominated, at other times, middle-class and high-level occupational groups have been the majority’.[14] She further added that, ‘for each social class, the movement has been characterized by different patterns, different purposes, and different meaning’. Thomas-Hope’s latter point is especially relevant when taking into account the reasons young Caribbean women migrated. None of the interviewees migrated as workers; in fact, some mentioned that they already had employment prospects once they completed the appropriate examinations.
While a few of the women mentioned the lack of opportunities available on their respective islands, they were the exception rather than the norm. Dorette cited mothers’ fears of their daughters getting pregnant, and their use of migration as a preventative measure. Several of the women mentioned invitations from family members and friends to migrate. Two of the interviewees were granted scholarships to study nursing in Britain as long as they agreed to return home at the completion of their studies. At least two of the women, aware of the demand for nurses, contacted hospitals in Britain that welcomed them as a way to relieve the shortage of nursing personnel.
In addition to their individual rationale for migration, the women all saw migration to Britain as a form of adventure. A glimpse into several of their recollections regarding migration provides insight into their motivations. Barbadian-born Muriel, who migrated in 1955, had this to say: ‘It was the first time for me going out in the world, literally on my own. And everything was exciting for me. That’s one of the things that I liked about it. Everything was so exciting’.[15] Jamaican-born Daphne C., who migrated in 1958, likened the migration of Jamaicans overall to a ‘fever’ – which was infectious. Here, she explained what prompted her to migrate:
So, you get the fever that you wanted to go. And so, my aunt had a daughter, and we were brought up like sisters. And she sent for her daughter. And after Elaine went, then I wanted to go! Because once she got there, she started telling her mother that I have to come. So, I got to go to England.[16]
Similarly, Barbadian-born Joan, who migrated to Britain in 1954, explained,
I had just left school, and even though my parents more or less wanted me to stay on the island, some of my friends went to England, and I thought, oh, I’d love to go to England. I applied to Netherne Hospital, and they accepted me, and then I left Barbados to go England.[17]
Chris Weedon argued that this ‘history of major migration, which helped to change the face of Britain, remains largely unknown to Britain’s White population’.[18] If the varied reasons for Caribbean migration had been incorporated into the larger public discourse and made available to the British people, perhaps their perception of these migrants might have been different.
The ease with which these young women discussed moving to Britain reflected the relationship between the imperial metropole and its colonies. As Winston James pointed out, ‘At home, especially in the Caribbean, which had endured 300 years of British Colonialism, Black people had been taught that they were British and came to think of themselves as such’.[19] Consequently Muriel, Daphne C., Joan, and the other young women who entered Britain after the Second World War, according to James, were not immigrants; they ‘were simply moving from one part of the British Empire to another as British citizens’.[20] Unfortunately, White British society in general did not welcome or view Caribbean people as British subjects. This was reflected not only in parliamentary debates aimed at stemming migration from the colonies, but also in terms of the racism that was present in employment, housing, education, and other aspects of society.
The interviewees who made the sojourn to Britain were vivacious, intelligent, and confident. Regardless of how these young women saw themselves, gendered racism coloured how they were viewed by wider British society. On the whole, Black people were viewed as ‘strangers who lacked the qualities assumed to be central to the character of white Britons’.[21] Furthermore, how Black womanhood was constructed revealed a specific racialised view of femininity that stood in stark contrast to middle-class White womanhood as the epitome of beauty and domesticity.
The image of Caribbean female migrants as hypersexual breeders unable to control themselves was reflected in letters to the editors in the Nursing Times following the Notting Hill and Nottingham riots in 1958. In one letter, the writer complained, ‘The illegitimacy rate is high; and that many of the women arrive in this country at various stages of pregnancy, and often live on National assistance.’[22] ‘Primitiveness, savagery, violence, sexuality, general lack of control, sloth, irresponsibility’, were assumed to be the defining characteristics of Caribbean people, which were in direct opposition to British values and norms.[23]
The interviewees did not fit the condescending image circulating in Britain. They did not migrate to Britain to be a burden on the state as was suggested by the above-referenced correspondence, or by political figures.[24] In fact, as discussed earlier, these women mostly grew up in middle-class families and attended schools where they were inculcated with British moral values. Indeed, the majority believed that the only way to procreate was within the confines of marriage and that children fared better in nuclear families. Interestingly enough, one interviewee, nineteen at the time, was pregnant upon arrival to Britain but resumed working immediately after the baby was born. She placed him in a residential nursery with the aid of a social worker, where, according to her, ‘he was well looked after’.[25] Due to the absence of familial support in Britain, this interviewee sent her son back to Jamaica to live with her mother and aunt. So concerned were they that Caribbean people would disrupt the panorama of ‘their’ country, it appeared that Whites rarely took the opportunity to get to know the so-called strangers, relying instead on a nexus of racist, classist, and sexist stereotypes to render them as outsiders.
A closer look at why young Caribbean women chose nursing as an occupation actually reveals how similar their aspirations and dreams were to their White counterparts.[26] While Caribbean migrants who entered nurse training felt that living in residence protected them from the virulent forms of racism in mainstream British society, nursing schools and hospitals did not always welcome prospective Black students. ‘Until 1966, it remained legal to discriminate in all areas of life on the grounds of race, and Blacks … often found themselves excluded not only from acceptable housing, but also from skilled employment.’[27] Such exclusionary and discriminatory practices were tied to fears of the impact of Black people generally on Britain’s national character, fears that led White nurses to ignore or downplay shared similarities with Black women. Acute labour shortages, however, had a way of tempering racist attitudes, even if momentarily.
The interviewees reported no single reason why they chose the nursing profession. The influence of family members who were nurses, limited career opportunities available to women at the time, knowledge of the nursing shortage, and recruitment of nurses by hospital administrators were some of the explanations. A few offered a more altruistic reason that they wanted to ‘do nursing and serve others’.[28] Two of the interviewees were awarded government scholarships to train as nurses with the stipulation that they return to the Caribbean once they completed their studies. Regardless of their rationale, it was patently clear that the interviewees were ambitious, motivated, and that they envisaged a future that included a secure, full-time, stable and respectable career.
As they reflected on how they came to be nurses, the majority of interviewees presented themselves as autonomous subjects who thoughtfully exercised the power to choose their careers. Guyanese-born Jean was attracted to teaching, nursing, and missionary work because she had ‘always wanted to help people’.[29] In each of these roles, she surmised, ‘[I could] help kids get a better education, as a missionary I could go to different parts of the world to help people, and as a nurse, I could [help] with their healing’. In 1958, at the age of eighteen, Jean migrated to England to pursue nurse training. After graduating from grade eleven and completing her Second Grade Cambridge Examination, Dominican-born Nancy was undecided about a vocation. She began to think about nursing when a Canadian nurse visited her high school as part of a program to help students decide about their future profession. Following the presentation, Nancy went to the library and read the book Hospital Careers for Girls. ‘After the way she portrayed nursing to us, I decided that’s what I wanted to do’, she declared.[30] A cousin already living in Britain further solidified the decision to migrate.
Jamaican-born Dorette was the youngest of the migrants and the only one to attend and complete high school in Britain. She left Jamaica at the age of fifteen-and-a-half to join her father and stepmother. Over a period of several years, Dorette worked at General Electric, Raleigh Industries, and British Railways as a stenographer. She also attended night school. Discouraged and disillusioned, she called in sick one day and went for a nursing interview. ‘Out of the blue, I went into nursing, just out of the blue, I just got fed up’, she recalled.[31] Dorette’s frustration was a result of the gendered racism she encountered which marked her as other, first in high school, and then in wider British society. Moreover, she resented working in environments where her male superiors invalidated her expertise and knowledge. Decades later, Dorette concluded, ‘I still feel that because of discrimination I went into nursing, I’m still convinced that’s what drove me into nursing; it was safe’.
Dorette’s apparently spontaneous decision to pursue nurse training was a result of dynamics other than her work experience. From her point of view, nursing appeared less discriminatory, as none of the nurses who frequented her stepmother’s hair salon had complained about differential treatment in the occupation. Dorette also had a cousin who was a nurse. In addition, her relationship with her stepmother was strained and she felt stifled by an over-protective father. She weighed the options available and chose to be in a more hospitable environment. Besides the opportunity to pursue a career, nursing provided certain benefits for young women who were discovering who they were. Dorette insisted that, ‘nursing gave me freedom’, a freedom which she had not experienced living at home.
In contrast, Grenadian-born Dorothy J. assumed that she would automatically join the young women from ‘back home’ who were employed in various factories throughout London, earning about five pounds a week. Considering that the majority of interviewees had never worked for remuneration, the opportunity to earn any income signified independence, which meant a great deal to them. Nick, Dorothy J.’s brother, had his own ideas about his younger sister’s future. Dorothy J. recalled:
My brother said to me, ‘You will go into nursing.’ It wasn’t my [choice]; I didn’t say ‘I’m going into nursing.’ He said to me ‘You are going into nursing – you are not going to work in no factory.’ So that was it. My sister-in-law got the application, and I went into nursing. I got to England in June, and I think I started nursing in August of that year.[32]
Nick apparently recognised that nursing offered far more possibilities for his younger sister. Indeed, it offered guaranteed stability, a steady income, and more respect than factory employment.
To be sure, choosing nursing as a career was also connected to other factors such as the women’s culture, religion, and early socialisation.[33] Together, the church, family, and school, albeit with various intensity, were critical in the socialisation of Caribbean girls and boys.[34] In these institutions, characteristics deemed as feminine and masculine, though socially constructed, were propagated as natural. These discourses about gender roles undoubtedly influenced young women’s occupational preferences even if unconsciously. The interviewees believed in the seemingly universal and innate characteristics, such as healing, caring, and nurturing, that women supposedly possess. The church reinforced these ideals as women’s greatest gifts to be used in caring for others and in their households; gender dictated what was considered girls’ and boys’ work. Equally important, the educational system was designed to sustain the status quo by promoting a gender ideology in which girls were prepared to work in particular areas suited for their sex.
As mentioned earlier, the prevailing scholarship on Black nurses tends to explore Black women’s subjectivities as mainly workers, with a focus on how their experiences are mitigated by institutional racism in its various manifestations. Thus, in the crucible of a hierarchical occupation, the vectors of race, gender, and class operated to shape and define Black women’s experience. Indeed, the interviewees related multiple examples of systemic, institutionalised, and everyday forms of racism. Yet, gendered racism was only one aspect of Caribbean women’s narratives regarding what it meant to train, live, and work in Britain. Similar to Whites and other nurses, Caribbean practitioners used nursing as an opportunity to become skilled workers developing a professional identity that was partly rooted in the notion of caring – a characteristic which was believed to be intrinsic to womanhood. This commonality, however essentialist and contrived, could have served as one of the bases for forging a powerful bond of sisterhood. Nursing, however, was anchored in a White, middle-class identity, which came to be representative of its ideals and practices.[35] These ideals and practices were embedded in the organisation and structure of the occupation influencing not only how Black nurses were viewed generally as workers, but their social relationships with White nurses. Instead of challenging stereotypes, White nurses generally colluded in the distorted perceptions about their Black counterparts.
Training and working in Britain
To explain the differential positions of Black women, and subsequently their oppression in the National Health Service (NHS), some writers have focused on the low status of state-enrolled nurses (SEN) whose responsibilities mirrored those of domestics. Only two of the nurses interviewed for this study were SEN; the majority trained as state-registered nurses (SRN) with midwifery. Of the aforementioned group, a few had additional training in health-related fields such as neonatal. One of the interviewees trained as a registered mental nurse (RMN), and one SRN sought further training in psychiatry. In describing how well they performed academically, the women, defying the notion that they were somehow intellectually inferior, inadvertently challenged mainstream discourses about citizenship and belonging.
In summarising her training, Daphne C. stated, ‘I was good. I studied hard and I won lot awards for my hard work’.[36] Joan echoed Daphne C., adding, ‘In my first year, I excelled in anatomy and physiology, and I remember getting a certificate because if you did well you get a certificate and a book. I got both certificate and the book’.[37] Likewise, Trinidadian-born Carmencita, who migrated to Britain in 1968 at the age of twenty and trained at Providence Hospital, also commented on how academically astute she was by stressing how she excelled on all the exams. ‘I was a really good student’, she maintained. How these interviewees represented themselves as nursing students is hardly surprising given their educational background, acumen, and drive to succeed.
Similar to their non-nursing counterparts, Caribbean women had a range of experiences training, working, and living in Britain. Despite the fact that colourism, a manifestation of slavery and colonialism, which created social hierarchies based on skin tone, was deeply embedded in Caribbean society, it was in Britain that most of the young women came to realise how social meanings were attached to their skin colour. In addition to dealing with institutionalised and systemic forms of oppression within the NHS, as students and workers, the interviewees experienced hegemonic domination at the hands of White nurses, patients, and physicians. For some, it was the racist stereotypes British nurses held about Black people generally. For others, it was the isolation they felt through being ignored at work, while others mentioned the patronising attitudes directed towards them. In her interviews with Barbadian nurses, Julia Hallam noted that they too ‘found “managing” their White nursing peers and hospital management teams far more difficult than managing racist reactions from their patients’.[38]
It bears repeating that a narrative that explores the practitioners’ victimisation in nursing is only partial. It does not account for how nursing training itself allowed probationers to forge bonds that crossed culture, class, and race lines. In other words, affiliations and friendships that were meaningful, memorable, and lasting are obfuscated when the emphasis is primarily on the interface between Black women’s exploitation and contemporary capitalism. Trained under the apprenticeship system as a cheap supply of labour for hospitals, trainees endured long hours, monotonous, tedious, and sometimes laborious assignments. They were also subjected to authoritarian Sisters, disciplined for certain infractions, and expected to defer to physicians and senior nursing staff.[39] Antiguan-born Jennette, who migrated in 1958, in describing her first year of nurse training, pointed out how uniforms were used to differentiate between probationers and the more senior students. She further added that, ‘You got to do all the dirty work; you do the bedpans, the sluice and all that stuff. It was a very hierarchical system’. Yet, Jennette maintained, ‘It was fun. It was hard work, but it was teamwork’.[40] Besides the kinds of teamwork mentioned by Jennette, residence led to the creation of friendships that might not have been possible in other spaces. Attention to these relationships revealed a more rounded portrait of how these young women navigated life in Britain.
Notwithstanding that they missed their families, found the climate unbearable, and had difficulties adjusting to the exigencies of nurse training, the interviewees also had fond memories. They matured and felt their horizons expanded in ways that might not have been possible had they remained in the Caribbean. For Barbadian-born Muriel, training at the Epsom District Hospital meant being exposed to a diverse group of nurses. She explained,
There were a whole lot of other nurses from every part of the globe … I think that was interesting. Our school was so diverse, so I tried to learn a little bit of other people’s cultures. A lot of Irish girls were there. You know somebody from Iraq, a friend is from Tehran. And so, I met a lot of really nice people. We got along really well. I didn’t really have any problems with those students.[41]
Carmencita mentioned making friends with and socialising with nurses from different geographical locations. Commenting on her experience, she stated, ‘I was very multicultural so I had friends from China, Spain, and we used to have an evening where we cooked all different foods. I’ll cook a Trinidadian dish; an African dish … we all intermingled in our class’.[42]
Daphne B. also maintained that living in residence was ‘lots of fun’ because of the heterogeneity of the nursing population. Dorette, too, felt that living in residence and interacting with others was a meaningful experience especially since her father ‘prevented her from mixing with people’ upon her arrival in Britain because he was trying to protect her.[43] Associations also extended beyond the classroom, wards, and residences as a few Caribbean nurses visited the homes of some of their new-found friends. According to Joan, ‘I went to Glasgow with one of the nurses. I went to her home and I always had a wonderful time’.[44] In articulating their ability to forge friendships that transcended divisions based on culture and race in particular, these migrants painted themselves as more sophisticated and progressive than those British people (including medical and nursing personnel) who defined them as the hyper-visible, sexual others.
The interviewees who worked in Britain were generally pleased with their work experience overall. Indeed, there is a tacit recognition of their indispensability to the NHS even if it was not apparent to them at the time. As she reflected back on the eight years she spent in England, Daphne C. vividly recalled the details of her first delivery:
The first baby I delivered by myself was on St. Patrick’s Day. The mother wanted to have a boy so she could call the baby Patrick. She got a girl, so she called the baby Patricia. I have a picture with me and the baby somewhere. I saw it not too long ago. It was a wonderful experience delivering these babies, especially going into these homes to deliver the baby in the mother’s bed, and you cannot afford to mess up anywhere.[45]
Daphne C. was not only a midwife; she served in the capacity of a Sister, a supervisory role, until she migrated to Canada in 1970. Despite difficulty in procuring employment and housing, only to discover that ‘it was because of the colour of your skin’, Daphne C. was able to say, ‘England was beautiful in terms of a lot of things’.[46] The interviewees’ experiences in Britain would be reconfigured when their professional qualifications and identity was called into question upon migration to Canada.
Migrating to Canada
Migration allows for the reconstitution of subjectivities as migrants negotiate and inhabit new spaces and places. In addition, migration provides an opportunity for an exploration of the self in a way that is not always possible in the places left behind. In other words, crossing borders, moving from one place to another, allows for comparisons, assessments, and conclusions regarding certain experiences.[47] This was evident when British-trained Caribbean migrants discussed how their credentials were assessed in Canada. It is in the evaluation of the various nursing systems that one can see Black nurses’ recognition of their value and worth, but also a keen analysis of how patriarchy structures the medical field.
The women gave similar reasons for migrating to Canada as they did for Britain. Again, for some, the decision to travel to Canada was rather spontaneous. Upon completing her SRN and midwifery training, Jennette returned to Antigua in 1963; approximately one year later, she migrated to Canada. She explained why she chose Canada:
I had a couple of old English nursing magazines and I looked up and found a hospital. I didn’t even know there was a London, Ontario until I looked. I found this hospital in London, Ontario looking for nurses, and I wrote, got offered the job. They told me to write to Immigration to get my landed (permanent resident status).[48]
Jennette felt she had outgrown her hometown and the people she had left behind, and wanted to leave. Returning to England was not an option because, according Jennette, ‘I couldn’t stand the English due to their arrogance’.[49]
A trained SRN and midwife, Barbadian-born Eileen explained that she had been in England for six years and ‘thought that at the time I needed to go somewhere else. Canada at the time was looking for nurses, so I applied and got a job at a hospital in Sudbury’.[50] She migrated to Canada in 1960. Elaine, on the other hand, admitted that she had gone to England with the ‘intention of becoming a nurse, but diverted from my plans and got married instead’.[51] She eventually trained as a state-enrolled nurse (SEN), and migrated to Canada in 1969 with her husband and one child. As in the case of Britain, reuniting with, or migrating because of family members was another common motivation.
Judging from the nurses’ reactions when they arrived in Canada, it is obvious that they made certain suppositions about their new work environment. They assumed that the Canadian nursing system was similar to Britain, which was not entirely accurate. The first issue Caribbean migrant nurses confronted upon migration was in relation to accreditation – that is, how their foreign qualifications were evaluated in Canada. State-enrolled nurses (SEN) found that there was no equivalent in Canada. Both Dorothy R. and Elaine fell into this category. Dorothy R., however, had begun her general training but migrated to Canada prior to writing her SRN exams. Both nurses were stunned by how their qualifications were evaluated. For Elaine, the discrepancy between the information provided by the school where she inquired about upgrading and the College of Nurses, which is responsible for adjudicating migrant nurses’ qualifications, intensified her frustration. Elaine explained that the College of Nurses told her that her pediatric background was limited, and as a result she needed an additional twenty-one hours of training. When she inquired at the school where the course was being offered, she was told that she needed to redo the entire program. Elaine was incensed: ‘They didn’t think it was up to their standard having done two years [in England] when theirs [Canada] is just a ten-month program’.[52]
To intensify an already tense situation, the nurses were also amazed at how limited their scope of responsibilities was in Canada compared to Britain. Dorothy J. provided the following example:
When I came here [Canada] I was working as an RNA (Registered Nursing Assistant), but I was already like a staff nurse in England because I had already graduated from my school of nursing. I found things here to be much different. I couldn’t do meds, I couldn’t do certain dressings, and there certain things such as taking out sutures, clips, and things you did automatically like suctioning. Working as an RNA, I couldn’t do those things because they were left to the RN — that was the RN’s job.[53]
The women used terminology such as ‘degrading’ and ‘second-class citizen’ to describe what it was like working in Canada during the early years of migration. Eventually, Elaine and Dorothy J. upgraded and subsequently met licensing requirements to practice as RNs.
Trained as a Registered Mental Nurse (RMN) in Britain, Myrna also worked as a RNA because, like Elaine, her specialised training had no Canadian equivalent. She too was told by the College of Nurses to upgrade, but refused to do so, and confidently pointed out that, ‘there was nothing for me to learn, I had learned everything in England’.[54] In comparing her experience in Canada and Britain, Myrna said,
Nursing in England, you were a nurse, and you were taught everything, whereas here [Canada] you learn some things, and the things you do learn, you cannot really work with it because the doctors do most of it. That is what nursing here is all about; you are not really a nurse.[55]
In reporting what felt like an attack on their education and, by extension, their professional identity, Britain emerged for the interviewees as the quintessential geographic location where nursing knowledge and practice were considered superior compared to Canada.
In addition to grappling with how their skills were adjudicated once in Canada, the nurses were further shocked at the physicians’ omnipresence in the hospitals, which they felt placed Canadian nursing practitioners in a subservient role. In comparing the two systems, Eileen had this to say:
There were a lot of things in England that you were not allowed to do here. They were certain procedures that the doctors did and you went along with it. I heard that when the thermometer first came out the doctors walked around with it as if it was a precious thing. In time they too will have to learn that they will have to give up some procedures to nurses and accept it.[56]
Some of these procedures included, but were not limited to, doctors being responsible for writing prescriptions, checking patients’ temperatures, and inserting nasogastric tubes.[57] Perhaps the greatest disappointment was felt by nurse midwives who discovered upon migrating to Canada that they were prohibited from delivering babies. By the time the interviewees had arrived in Canada, practicing midwives were virtually eliminated in most provinces as physicians controlled the birthing process.[58]
Daphne C., another SRN and nurse-midwife, explained how she found out about the role of midwives in Canada: ‘I started in the nursery, and it was at the time I learned that you are not allowed to deliver babies, even if you are working in the case room, you’re just there to assist, to take the baby from the doctor’.[59] Daphne C. was not only disturbed by the common practice of using forceps by physicians, she also found it unusual that midwives were unavailable for ‘people who do not want to have babies in hospitals’. She continued, ‘It really did something to me’.[60] For these nurses, it was difficult and painful to be left out of the birthing process. Working in the pediatrics department was the closest that nurse-midwives such as Eileen and Daphne C. came to babies.
While they too struggled with the reality that their midwifery skills would never be utilised in Canada, Daphne B. and Jamaican-born Lillie, the only nurse to train in Scotland in 1954, refused to work in the hospital. Under no circumstances would these nurse-midwives assist male doctors in an area that they fervently protested should be a woman’s enclave. Daphne B. compared physicians in both countries, ‘Doctors [in Canada] were like little gods, and the nurses seemed afraid of them. In England, the doctors relied on you. They taught you a lot more so that you could be their eyes and ears and you could do things when they were not there to do it’.[61] She continued, ‘I never work in the case room delivering babies. I didn’t want to be a glorified maid for any doctor mopping up after they make a mess’.[62] Also, in reference to Canada, Lillie argued, ‘They give you no responsibility. The doctor has to order everything. Although it seems to be getting better, it seems all they [doctors] want is a handmaiden. There are so many British-trained nurses who have their midwifery training, and none of them are accredited for it here’.[63] British-trained nurse midwives were cognisant of the positions of dominance that existed in the hospitals which privileged and legitimised physicians’ expertise and knowledge, and which subsequently structured the relationship between them and the physicians.[64] Clearly, these women in their critique of physicians’ hegemony were contributing to feminist analysis about patriarchal power within the medical arena. To avoid being a ‘glorified maid’ or ‘handmaiden’, Lillie and Daphne B. enrolled in the University of Toronto School of Nursing where they earned the requisite qualifications to work as public health nurses.
Already retired or near retirement at the time of the interviews, the women have had time to reflect on their nursing careers as well as their lives. All of the nurses admitted to having enjoyed and found their nursing career fulfilling, yet there was a sense that they were unhappy with the direction of the occupation. This dissatisfaction stemmed from transformations that were connected to the restructuring of the Canadian health care system which started earlier, but intensified in the 1990s. This encompassed, for example, the introduction of technology and divisions among rank-and-file nurses, that is, university graduates versus those trained in the apprenticeship system. Tensions between nurses and management were also a concern. Moreover, the women maintained that these changes in the health care system led to an environment where caring was no longer intrinsic to nurses’ professional identity. I have discussed these issues in detail elsewhere;[65] as such, the rest of this article is devoted to highlighting a few pressing issues the interviewees identified. The objective here is to legitimise Black nurses as knowledge producers who can offer valuable insights that nurses across geographical boundaries, regardless of their multiple social identities, may use as a basis for solidarity.
A disproportionate number of the interviewees expressed concern about what they perceived to be a lack of support for rank-and-file nurses especially among nurse-managers and organisations that claimed to represent nurses’ interests. The interviewees emphasised that nurses’ well-being, broadly conceived, must always be a priority. While Daphne C. worried about the profession in terms of ‘efficiency, accountability, and responsibility’, she pointed to the plight nurses face daily while working. For her and other nurses, the Registered Nurses Association of Ontario (RNAO) and those in supervisory positions are abdicating their responsibility to nurses. Regarding the RNAO, Daphne C. made the following observation:
They are not representing them half as much, there are a lot of things that were happening to nurses, and you have no one to take your side. Even if a patient spits at you, it’s like, okay, it’s the patient’s job to spit at you. There’s nobody you could really complain to about something that a patient has done to you or is doing to you. So, it’s like whatever the patient did, the patient was right. Even if the patient was lying, there’s nobody to say, ‘Okay, the patient was lying and the nurse was right.’ … We need somebody to take our sides.[66]
Similarly, Dorothy J. related an incident where the son of a politician had been extremely abusive to her and other nurses. She complained to management but was virtually ignored. In a conversation with the nurse-supervisor, Dorothy J. stated, ‘I told the charge nurse that we have no rights … because nobody would stand up for us’.[67] Dorothy J. made it clear that she would not be subjected to the patient’s abusive behavior. Although nurses are instructed to document cases of abuse, Dorothy J. found the policy ineffective inasmuch as there is often no resolution to nurses’ complaints, which she finds disheartening. The message the interviewees wanted to emphasise was that when organisations and those in positions of authority refuse to advocate on nurses’ behalf, it sends a negative message to them regarding their value and significance.
As the largest group of health care workers in Canada and Britain, the interviewees insisted that nurses should not only be informed about their unions, but that they must choose conscientious leaders whose mission it is to defend and protect their interests. Muriel was in management for most of her career, yet she pointed out,
You need to have a union that has the people’s interests at heart, but they also need to be able to work with administration. And they need to know their purpose, they need to educate the nurses around what the union can and cannot do for them, rather than, ‘Elect me because, I’ll represent you’.[68]
Muriel insisted that leaders should not be elected on a whim, but must demonstrate their commitment to those they represent. She further underscored that the relationship between the union and administration must be amicable in order to avoid, for example, strikes that can have a detrimental impact on patients and on nurses’ morale. While the majority of nurses felt they benefited from collective bargaining, some were concerned about the union’s inability to address inequality in the occupation.
Given the diversity in nursing, attention must be paid to how institutional forms of oppression are reproduced and maintained in ways that disadvantage nurses of colour. To address this issue, the interviewees recognised that all nurses have a role to play, however minimal. To create a more inclusive nursing environment, gendered racism must be taken seriously. In order for this to occur, nurses must be at the forefront and be willing to risk being censured. Ancilla worked at the same hospital for thirty-six years in a variety of capacities, and in 1980 became president of the nurses’ union. Ancilla recognised that as a Black woman she not only occupied a position that historically had been the preserve of Whites; she was also dealing ‘with a predominantly White workforce’, where racism was a taboo issue.[69] Not to be deterred, Ancilla pointed out, ‘I brought it forward, the Ontario Nurses’ Association flagged that as something that they would have to eventually deal with in the collective agreement’.[70] For Ancilla (whose activism began as a nursing student in Britain when she organised a protest that led to a change in the menus and the redecoration of the residence), ignoring any form of injustice was not an option. She declared:
If you want to make changes, then you have to get involved … You can’t just sit and gripe about it. So, I am not your typical woman. I am not your typical nurse, sitting in the background. I do everything that would help to improve the situation. So, if I can’t help to make it better, then I don’t talk about it.
Practitioners such as Ancilla know from experience that racism and other forms of discrimination poison the work environment, and suggest a multi-pronged solution to eradicate inequality. They urge implementing policies to ensure that all nurses regardless of their social location receive fair treatment. At the same time, policies are ineffective if they do not translate into practice. The interviewees also insist that White nurses, especially those in management, play an active role in addressing gendered racism. Too often Caribbean nurses have been the objects of, or have witnessed, differential treatment at the hands of their White colleagues, patients, and their families. Often White nurses’ answer to the problem has been to keep silent. Finally, all nurses (especially those from the dominant group) must commit to understanding how power relations are constituted and play out in nursing. Nurses must avoid being complicit in the victimisation of others who are less powerful.
Conclusion
The narratives presented here are not intended to represent all Black nurses. The aim was to provide a more nuanced examination of Black nurses’ lives that moves beyond their portrayal as mere victims of capitalism, patriarchy, and gendered racism. Including information on the interviewees’ background and reasons for migrating, challenges the idea that all migrants were from unskilled and working-class backgrounds and migrated for economic reasons. Furthermore, these young women migrated alone and not as appendages to men, as is often assumed by migration scholars. Whether in Canada or Britain, these women were pioneers on many levels, and have by their very presence contributed to the nursing profession and the societies in which they lived.
References
[1] Ancilla Ho-Young, interview, Burlington, Ont., 15 Aug. 2007.
[2] See Ceri Peach’s authoritative book on the subject, West Indian Migration to Britain: a Social Geography (London, Oxford University Press, 1968). These statistics must be used with caution. Peach pointed out that prior to the 1961 Census and the implementation of the Commonwealth Immigration Act of 1962, the only official statistics on migration were compiled by the Board of Trade, and some migrants were excluded from the official count.
[3] For one exception to this trajectory, see Mary Chamberlain, Narratives of Exile and Return (London and Warwick, Caribbean Studies, 1997); Karen Fog Olwig, Caribbean Journeys: An Ethnography of Migration and Home in Three Family Networks (Durham and London, Duke University Press, 2007).
[4] See Karen Flynn, Moving beyond Borders: Black Canadian and Caribbean Women in the African Diaspora (Toronto, University of Toronto Press, 2011). The interviewees signed consent forms and were also given the option of using pseudonyms; four of the women chose this option. The tapes are currently in the possession of the author.
[5] Beverly Bryan, Stella Dadzie, and Suzanne Scafe, The Heart of the Race: Black Women’s Lives in Britain (London, Virago Press, 1985), 25.
[6] Carol Baxter, The Black Nurse: an Endangered Species: a Case for Equal Opportunities in Nursing (Cambridge, National Extension College, 1988), 16. See Gail Lewis, ‘Black Women’s Employment and the British Economy’, in Inside Babylon: the Caribbean Diaspora in Britain, ed. Winston James and Clive Harris (New York, Verso, 1993), 73–96. For a general overview on Black workers in Britain, see Clive Harris, ‘Post-War Migration and the Industrial Reserve Army’, in James and Harris, Inside Babylon: the Caribbean Diaspora in Britain, 9-54.
[7] Agnes Calliste, ‘Women of “Exceptional Merit”: Immigration of Caribbean Nurses to Canada’, Journal of Canadian Women and the Law, 6 (1993), 85-103.
[8] My research on Black Canadian and Caribbean nurses explores the exclusionary policies of the Canadian state. See Karen Flynn, ‘Race, the State and Caribbean Immigrant Nurses, 1950-1965’, in Women, Health and Nation: Canada and the United States since 1945, ed. Georgina Feldberg et al. (Montreal, McGill-Queen’s University Press, 2003), 247-63.
[9] Julia Hallam, Nursing the Image: Media, Culture and Professional Identity (London, Routledge, 2000), 158.
[10] Daphne Bailey, interview, Toronto, Ont., 29 May 1995.
[11] Bridget Brereton, ‘Society and Culture in the Caribbean: the British and French West Indies, 1870-1980’, in The Modern Caribbean, ed. Franklin W. Knight and Colin A. Palmer (Chapel Hill, University of North Carolina Press, 1989), 90.
[12] Ancilla Ho-Young, interview, Burlington, Ont., 15 Aug. 2007.
[13] In the case of Caribbean women see, for example, Amina Mama, ‘Black Women, the Economic Crisis and the British State’, in Black British Feminism: a Reader, ed. Heidi Safia Mirza (London, Routledge, 1997), 36-41.
[14] Elizabeth Thomas-Hope, Caribbean Migration (Kingston, University of the West Indies Press, 2002), 2.
[15] Muriel Knight, interview, Scarborough, Ont., 12 Sep. 2006.
[16] Daphne Veronica Clarke, interview, Windsor, Ont., 27 Apr. 2006.
[17] Joan Virtue, interview, Scarborough, Ont., 12 Sep. 2006.
[18] Chris Weedon, Identity and Culture: Narratives of Difference and Belonging (London, Open University Press, 2004), 63.
[19] Winston James, ‘The Black Experience in Twentieth Century Britain’, in Black Experience and the Empire, ed. Philip D. Morgan and Sean Hawkins (London, Oxford University Press, 2004), 377.
[20] James, ‘The Black Experience in Twentieth Century Britain’, 349, emphasis original.
[21] Chris Waters, ‘Dark Strangers in Our Midst: Discourses of Race and Nation in Britain, 1947–1963’, Journal of British Studies, 36 (1997), 224.
[22] Nursing Times, 5 Dec. 1958.
[23] Sheila Patterson, Dark Strangers: A Sociological Study of the Absorption of a Recent West Indian Migrant Group in Brixton, South London (London, Tavistock, 1963; abridged ed. 1965) as quoted in, Waters, ‘Dark Strangers in Our Midst’, 277.
[24] See, for example, Enoch Powell’s infamous ‘River of Blood’ speech. Extracts can be found at www.sterlingtimes.co.uk/powell_press.htm.
[25] Daphne Bailey, interview, Toronto, Ont., 29 May 1995.
[26] Hallam, Nursing the Image, 161.
[27] Weedon, Identity and Culture, 68.
[28] Lillie Johnson, interview, Scarborough, Ont., 9 Aug. 1999. http://www.movinghere.org.uk/galleries/histories/caribbean/working_lives/nhs.htm#
[29] Jean Harry, interview, Scarborough, Ont., 9 Aug. 2000.
[30] Nancy Ward [pseudonym], interview , Toronto, Ont., 5 Jan. 2000.
[31] Dorette Thompson [pseudonym], interview, Mississauga, Ont., 17 Aug. 1999.
[32] Dorothy Jones [pseudonym], interview, Rexdale, Ont., 29 Feb. 2000.
[33] Margaret Shkimba and Karen Flynn, ‘In England We Did Nursing: Caribbean and British Nurses in Great Britain and Canada, 1950–1970’, in New Directions in Nursing History: International Perspectives, ed. Susan McGann and Barbara Mortimer (New York, Routledge, 2004), 143.
[34] For an excellent discussion on gender socialisation in the Caribbean, see Olive Senior, Working Miracles: Women’s Lives in the English-Speaking Caribbean (Bloomington, Indiana University Press, 1991).
[35] Hallam, Nursing the Image, 8.
[36] Daphne Veronica Clarke, interview, Windsor, Ont., 27 Apr. 2006.
[37] Joan Virtue, interview, Scarborough, Ont., 12 Sep. 2006.
[38] Hallam, Nursing the Image, 159. See also Linda Ali, ‘West Indian Nurses and the National Health Service in Britain 1950 – 1968’ (Unpublished PhD thesis, University of York, 2001).
[39] The following scholars discuss aspects of the apprenticeship system in their respective research: Monica E. Baly, Nursing and Social Change (London, Routledge, 1995); Hallam, Nursing the Image.
[40] Jennette Prince, interview, Toronto, Ont., 8 Oct. 1999.
[41] Muriel Knight, interview, Scarborough, Ont., 12 Sep. 2006.
[42] Carmencita Gomez [pseudonym], interview, Toronto, Ont., 14 Oct. 1999.
[43] Dorette Thompson [pseudonym], interview, Mississauga, Ont., 17 Aug. 1999.
[44] Joan Virtue, interview, Scarborough, Ont., 12 Sep. 2006.
[45] Daphne Veronica Clarke, interview, Windsor, Ont., 27 Apr. 2006.
[46] Daphne Veronica Clarke, interview, Windsor, Ont., 27 Apr. 2006.
[47] Flynn, Moving Beyond Borders.
[48] Jennette Prince, interview, Toronto, Ont., 8 Oct 1999. Landed means permanent resident status. See also Shkimba and Flynn, ‘In England We Did Nursing’, 147.
[49] Jennette Prince, interview, Toronto, Ont., 8 Oct. 1999.
[50] Eileen Jacobson, interview, Burlington, Ont., 6 Jan. 1995.
[51] Elaine McLeod, interview, Toronto, Ont., 5 May 1995.
[52] Dorothy J. [pseudonym], interview, Rexdale, Ont., 29 Feb. 2000. See also Karen Flynn, ‘Experience and Identity: Black Immigrant Nurses to Canada, 1950–1980’, in Sisters or Strangers: Immigrant, Ethnic, and Racialized Women in Canadian History, ed. Marlene Epp, Franca Iacovetta, and Frances Swyripa (Toronto, University of Toronto Press, 2004), 387.
[53] Dorothy Jones [pseudonym], interview, Rexdale, Ont., 29 Feb. 2000.
[54] Myrna Blackman, interview, Brampton, Ont., 29 May 1995. See also Shkimba and Flynn, ‘In England We Did Nursing’, 150.
[55] Myrna Blackman, interview, Brampton, Ont., 29 May 1995.
[56] Eileen Jacobson, interview, Burlington, Ont., 6 Jan. 1995. See also Karen Flynn, ‘Proletarianization, professionalization, and Caribbean immigrant nurses’, Canadian Woman Studies, 18/1 (1998), 57-60.
[57] Cynthia Toman pointed out that the issue of delegating certain tasks that were once the purview of physicians was a contested issue as nurse leaders grappled with the legal ramifications. In some hospitals nurses did assume certain tasks while in others it took longer. See, e.g., Cynthia Toman, ‘“Body Work”: Nurses and the Delegation of Medical Technology at the Ottawa Civic Hospital, 1947–1972’, Scientia Canadensis, 29/2 (2006), 155–75.
[58] Dianne Dodd, ‘Helen MacMurchy: Popular Midwifery and Maternity Services for Canadian Pioneer Women’, in Caring and Curing: Historical Perspectives on Women and Healing in Canada, ed. Dianne Dodd and Doborah Gorham (Ottawa, University of Ottawa Press, 1994), 135.
[59] Daphne Veronica Clarke, interview, Windsor, Ont., 27 Apr. 2006.
[60] Ibid.
[61] Daphne Bailey, interview, Toronto, Ont., 29 May 1995.
[62] Ibid.
[63] Lillie Johnson, interview, Toronto, Ont., 9 Aug. 1999. See also Flynn and Shikmba, ‘In England We Did Nursing’, 152.
[64] Eva Gamarnikov, ‘Sexual Division of Labour: The Case of the Nursing’, in Feminism and Materialism: Women and Modes of Production, ed. Annette Kuhn and AnneMarie Wolpe (Boston, Routledge, 1978), 96-123; Pauline Leonard, ‘Playing Doctors and Nurses: Competing Discourses of Gender, Power and Identity in the British National Health Service’, Sociological Review, 51/2 (2003), 218-37.
[65] Karen Flynn, ‘Black Canadian Nurses and Technology’, in Nursing Interventions Through Time: History as Evidence, ed. Pat D’Antonio and Sandra B. Lewenson (New York, Springer Publishing, 2010), 153-69.
[66] Daphne Veronica Clarke, interview, Windsor, Ont., 27 Apr. 2006.
[67] Dorothy J., [pseudonym], interview, Rexdale, Ont., 29 Feb. 2000.
[68] Muriel Knight, interview, Scarborough, Ont., 12 Sep. 2006.
[69] Ancilla Ho-Young, interview, Burlington, Ont., 15 Aug. 2007.
[70] Ibid
