In 1961, when the new ICU was being discussed, it was already acknowledged that graduate nurses working in the unit would also require additional post-graduate specialized training in order to meet the demands of intensive care nursing.
In the Fall of 1965, Dr. Reuben Cherniack established a lecture series presented by physicians for nurses in intensive care. Dr. Cherniack, Dr. Cuddy, Dr. Downs, and Dr. Kirk presented lectures, and Monte Raber, the head of the Biomedical Engineering department, presented on the monitoring and treatment devices used in the ICU. This lecture series was combined with instruction at the patient’s bedside; nearly all nurses working in intensive care shared instruction duties, with more experienced nurses training the new nurses as they came into the Unit. The two instructors during this time were Heather Burchett and Amelia Lubinski, however these were not considered to be formal positions at this time. Because the intensive care space on E-2 was quite small with eight nursing staff, this kind of arrangement was possible. The nurses working on the E-2 unit at this time were Erna Schilder as Senior Head Nurse, and Gail Slessor, Eleanor Cramp, Kathy Toews, Marilyn Thomas, D. Toutant, Marlene Spencer, and Gwen Galbraith as junior nurses. All of these nurses, with the exception of Marlene Spencer, were involved with the first Intensive Care Nursing Program class in 1967. The nurses on E-2 were under the supervision on Mrs. Hassett.
As it became clear that the Intensive Care Unit would be expanded and formally opened on H-7, it was decided to design a permanent and more structured course for Registered Nurses and Licensed Practical Nurses in the ICU. Two instructors were hired in 1966: Gwen Galbraith was appointed clinical instructor for bedside teaching in May, and Judith Hindle was appointed as senior instructor in August. The instruction department within the ICU was formally established in September 1966 – the same month that the Unit opened.
The Intensive Care Nursing course (later the Adult Intensive Care Nursing Program) was the first structured course of its kind in Canada, and one of only a few throughout all of North America. The course was developed at the Winnipeg General Hospital in 1966, and the first class of twenty-four nurses graduated on 2 June 1967. The last class graduated in 2008. Between the years of 1966 and 2009, the course was continuously reviewed and revised to keep up with the demands of intensive care nursing.
It was acknowledged from the very beginning that the ICU would require specially trained nursing staff. Because it was the first course of its kind in Canada, it is likely that it served as an inspiration for other courses that were later developed across the country. By the early 1970s, nursing students came from all over Canada and all over the world to attend this specialized course. The 1976 Nurses’ Alumnae Journal describes Intensive Care Nursing and the need for designated training in the following way:
Intensive Care Nursing has become an increasingly specialized branch of the nursing profession over the past decade, and a high degree of special education and general competence is required of nurses in this area. The nurse in Intensive Care is involved in total care. She has knowledge of normal anatomy and physiology and is skillful in applying principles of patient assessment. She develops therapeutic nursing care plans in conjunction with the physician, and critically evaluates the patients’ response to their management, modifying plans as necessary. The primary qualities of an intensive care nurse are, therefore, those of astute observation and careful detailed patient care.
Provided here are some samples of the planning materials associated with the beginning of the Intensive Care Nursing Course. Click on a link below to view the documents.
- “Teaching Required for a Unit Designed to Handle the Critically Ill Patient.” Recommendations written by Dr. Reuben Cherniack and submitted to Dr. L. O. Bradley, Executive Director of the Winnipeg General Hospital, 1965
- “A Resumé of the Educational Program for Intensive Care Nursing Staff.” Prepared by Judith Hindle, 1967
It is evident from early documents that all aspects of patient care were considered and customs and course design were frequently revisited. In July 1967, a seminar entitled “On Determining Needs” was held and attended by graduates of the Intensive Care Nursing Program, current students, Licensed Practical Nurses, aids and orderlies, and guests from physiotherapy and Occupational therapy. Over five days, the attendees considered all aspects of patient care and discussed whether or not they were meeting expectations. These discussions ranged from feeding patients, to ensuring that they got enough rest, to wondering whether it would be appropriate to bring in shaving cream and cosmetic kits to boost morale among patients. This seminar offered nurses and student nurses involved with the ICU the opportunity to shape and have an active say in the kind of care provided in the Unit.
In 1967, the course was redesigned as the Advanced Course in Intensive Care Nursing under the leadership of Margaret Nugent, a former graduate from the Winnipeg General Hospital School of Nursing. Nugent became the Administrative Assistant to the 7th floor of the hospital and administered the new course, which provided didactic and practical training to graduate nurses and coordinated the teaching programs in the Intensive Care areas: Recovery Room, ICU, and the Kidney Dialysis Unit. The course consisted of a 4 week orientation, medical and nursing lectures, practical experience in the ICU and the Recovery Room, as well as a focus on the technology used in the ICU, particularly cardiac monitors. The ICU also hosted shorter courses based around periods of observation and instruction for nurses from outside of Winnipeg, including nurses from other Canadian provinces and from the US.
“I phoned the Grace Hospital, and they had no vacancies at the time. And the woman I was talking to said, ‘Oh! There’s an Intensive Care course at the Winnipeg General Hospital, why don’t you take that?’ So I phoned and said I was interested in their Intensive Care course, and she said – it started, I think, that week – ‘Well, the course had just started. When could you start?’ And I said, ‘This afternoon?’ So she said, ‘Okay, come on down.’ So I went down that afternoon and got into the course. That was in ’68. November, December ’68.”
– Hedie Epp, former ICU nurse
The first Intensive Care Nursing Course brochure, published around 1970, provides a thorough overview to the program:
One year later, two week workshops in Intensive Care and sponsored by the ICU and the University Department of Continuing Education were also introduced. Nurses from different hospitals and members of the Armed Service also attended these workshops, and the instructors—Margaret Nugent, Gail Slessor, and Glynn Murray—also provided training to Winnipeg Police Officers in resuscitation techniques in preparation for the police ambulances, which had recently acquired resuscitation equipment.
From the very beginning, the ICU also offered training in the principles of intensive care to residents from the University of Manitoba Department of Medicine, Surgery, and Anaesthesia. Resident staff consisted of one or more senior residents for a 6 – 12 month period, and up to three junior assistant residents, usually for a 3 month period. Weekly seminars in Respiratory Pathophysiology and Cardiac Arrhythmias were also held by the residents and staff of the ICU. The University of Manitoba Faculty of Medicine had developed a program to train physicians in critical care in the late 1960s, however it was not until the late 1970s that Critical Care became an official section within the Department of Internal Medicine, and Dr. Bryan Kirk served as the first section head.
ICU nurses were involved with education initiatives in other ways as well. In 1969, Winnipeg General Hospital Intensive Care Nursing Instructors organized the first Coronary Care Conference, which was attended by 34 nurses from 11 different hospitals. A Respiratory Care Conference was also organized and was attended by 52 nurses from 14 hospitals. These conferences were important ways for nurses to build and exchange knowledge with other nurses across the country, and were particularly useful when so few structured courses were available for intensive care training.
The preceptor program—or buddy program—was another form of education for student nurses interested in working in the ICU and was particularly important to provide student nurses with practical experience in an ICU to supplement their course-based knowledge and theory. By the end of the buddy program, it was expected that the student would be able to perform a thorough physical assessment and chart review to define patient problems; assist in the development of individualized nursing care plans based on the patient’s needs or problems; implement patient care with emphasis on the physical and emotional care of the patient and family; perform specific skills and procedures safely and correctly according to standard unit policies and procedures; and document data collected and/or any care performed by the student. The program was also designed to ensure that students become more comfortable in the Intensive Care Unit and with providing critical care.
The Adult Intensive Care Nursing Program (AICNP) replaced the Intensive Care Nursing program in 1988, with the first class of graduates on April 28, 1989. The AICNP was comprised of two components: collaborative courses and an advanced clinical practicum. The collaborative courses were developed by the University of Manitoba Faculty of Nursing, HSC, and St. Boniface General Hospital, and provided registered nurses with university credits for completed courses. The four courses were Principles of Disease Related to Adult Intensive Care, Adult Intensive Care Nursing I, Laboratory Practice in Adult Intensive Care Nursing, and Clinical Practice in Adult Intensive Care Nursing.
This coursework was then supplemented by the advanced clinical practicum, which consisted of a four-month practicum at HSC or St. Boniface General Hospital. The practicum aimed to integrate theoretical and clinical experiences so that the nurses could apply this knowledge in an intensive care setting. The clinical practicum consisted of a combination of classroom lectures, seminar sessions, and clinical experience which were during day shifts in the Medical Intensive Care Unit, the Coronary Care Unit, the Surgical Intensive Care Unit, and the Post Anaesthesia Care Unit.
The goal of the education program was to provide Intensive Care Units with a sufficient number of highly trained nurses. However, beginning in 1988, the program struggled to meet this goal as not enough nurses were enrolling in the program to meet the demand of the ICUs. A 1992 report – “Collaborative Adult Intensive Care Nursing Program Report” – explored some of the reasons why enrollment was dropping. One major reason was lack of financial incentive, both as a student as well as a professional nurse working in the ICU. However, the other primary reason was an overall negative perception of working in an Intensive Care Unit. Nurses interviewed for the report cited the following concerns as the primary inhibitors for working in the ICU:
- High Acuity
- Physical and mental strain
- Attitude preserve life at any cost
- Patients are sedated
- Confined space
- Do not like teaching
- ICU nurses too hyper and too keen, cannot relax
- ICU nurses do not associate with other nurses
- Need part-time
In response, the program actively recruited new students and tried to dispel these perceptions by highlighting the positive aspects of critical care nursing. The brochure provided below challenged these assumptions directly in an attempt to counter myths and boost enrollment.
In 1993, Brenda Stutsky was hired as Assistant Director of Special Programs on a one year term that turned into fifteen. As Assistant Director and later Director, Stutsky was responsible for the Adult Intensive Care Nursing Program and the Neonatal and Pediatric Critical Care Nursing Program. You can read more about her time as Director as well as the end of the AICNP here. The last AICNP class graduated on August 1, 2008.
The Winnipeg Regional Health Authority remains committed to offering a high quality education through the Winnipeg Critical Care Nursing Education Program, which is a 24-week training program offered twice a year. The 21st cohort of this program graduated in June 2016.
You can see more Education related photographs here.