Chapter 14 - Becoming a Registered Nurse in Canada
New qualifications, and unpleasant surprises
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When Trish arrived in Canada, she was hired as a “graduate nurse,” a position with lower pay than a Registered Nurse (RN). Determined to advance, Trish prepared to take the registration exams required to become a Registered Nurse. These exams were held every spring at the University of British Columbia (UBC) in Vancouver, coinciding with the graduation of new nursing students. Trish and other internationally trained nurses took the exams alongside the UBC nursing graduates.
In the spring of 1971, after nearly a year in Namu and then Bella Bella, Trish returned to Vancouver. She booked passage on the freight boat that traveled along the west coast delivering supplies to remote communities. The boat also took a few passengers on each trip. Shortly after the journey began, Trish struggled with seasickness. To help her, the crew gave her a job. While underway, the deck crew was doing light maintenance on the vessel. That included painting areas above deck, and they gave Trish the task of painting the ship’s funnel to help distract her from her seasickness. The distraction worked, turning an unpleasant experience into a fun and memorable one.
Once in Vancouver, she focused on preparing for her registration exams—four in total, spread over three days. She was pleased to learn the pediatrics exam would be the first one she would write. Pediatrics was her specialty; she thought it would be a good way to ease into the process.
On the morning of the exams, Trish sat nervously at a desk in the UBC School of Nursing exam hall. Her usual “exam day” nerves quickly turned to dismay when she opened the exam booklet and discovered the questions were in a multiple-choice format, a style she had never encountered before. In England, exams were always written in longhand.
As she tried to process the unfamiliar format, the sound of a chair scraping across the floor caught her attention. Trish looked up to see a fellow candidate gathering up her exam papers and marching to the front of the room. Everyone watching in stunned silence as the woman tore the papers in half and dropped them on the adjudicator’s desk.
“This is an insult to English intelligence,” she declared in a crisp English accent, before striding out of the exam hall.
Trish stared after her, amazed. She shared similar frustration, but knew she needed the qualification. Obviously, the other woman didn’t, whatever her reasons. Resolving to stay, Trish turned her attention back to the exam. The multiple-choice format was confusing—sometimes more than one answer seemed correct, depending on the context—but she pushed through. Over the three days, Trish completed the pediatrics exam, followed by the medical, surgical, and midwifery exams.
Upon returning to Bella Bella, Trish went back to working her shifts, enjoying the companionship of her colleagues, and occasionally getting out to explore the areas around the village. There was a water reservoir up in the hills behind the village, and an access road, barely more than a trail, really, that led to it. Trish enjoyed walking in that area. Most days, a big fluffy dog from the village who had befriended Trish, joined her. One day, Trish and the dog were walking the perimeter of the walled reservoir. As they rounded a corner, they came face to face with a brown bear! They turned and ran—Trish in one direction, back down the trail, while the dog sprinted into the forest in another direction. After running a distance, Trish stopped, breathless, and looked back. She could still see the bear, it was lumbering away in yet another direction. As Trish caught her breath and the thumping in her chest slowed, she thought, so much for my “guardian” dog, he’s probably already back at the village!
Throughout the summer, another interesting distraction arrived from time to time, in the form of two fishermen living aboard their abalone boat. The young men were harvesting abalone in the area, spending the entire season on their boat. They confided in a nurse they met, while stopping in Bella Bella for fuel, that they ate only abalone. That disclosure secured them an invitation to dinner at the nurses’ residence. The lads arrived with a gunnysack of abalone, in exchange for a roast beef dinner. They even graciously showed the women how to cook the abalone so that it would become tender, and less like eating shoe-leather. Abalone was a delicacy, but it needed to be cooked properly to be truly enjoyable. The consensus was everyone won in the exchange—the young fishermen had a break from a diet of straight abalone, and the nurses had a brief break from the ever-present salmon that was regularly donated to the hospital and the nurses’ residence.
Finally, when Trish received her exam results later that summer, she first confirmed that she had passed them all, then she noticed her marks improved with each test she took. Although pediatrics was her specialty, it was her lowest-scoring exam since she wrote it first. She suspected her marks on subsequent exams showed her improving ability to navigate a multiple-choice exam, rather than her knowledge of nursing. Regardless, she had officially become a Registered Nurse in Canada, though the registration certificate wouldn’t arrive until September. Her new RN designation came with a substantial pay increase and offered more job opportunities.
With a better salary, Trish began thinking about traveling back to Liverpool to visit her family and friends. She had decided to stay in Canada long term, and she wanted to tell her parents in person. Though she and her mum frequently exchanged letters, important conversations were difficult to have this way, as the back-and-forth made discussions feel disjointed. Trish wrote to her mum to share her plans for a visit, she also reached out to her friend Jean and a few other friends.
As she considered her travel plans, she mentioned her upcoming trip to her colleagues, and to Ben, one of the pilots who flew into Bella Bella from time to time. Ben was younger than Trish but always very friendly whenever they saw each other. When she told him about her upcoming vacation, he looked surprised, then a grinned, like he had an idea. He told her he had vacation planned at the same time, and had already booked a flight to visit his grandparents in Holland. When Trish said she hadn’t booked her travel yet, he invited her to meet him in Amsterdam for a few days, before continuing to Liverpool. He said his grandparents would be delighted to have one more guest. Trish had never been to Holland, so she eagerly accepted his spontaneous offer, and booked her flights to include an extended stop in Amsterdam.
With her vacation still some weeks off, Trish faced an unexpected issue at work. Each shift, she was paired with a nurse’s aide. Most of the aides were skilled and hardworking, and seemed to enjoy the job; most, but not all. One aide stood out from the others—the daughter of the hereditary chief. The woman was well-known and respected in the community. She and her husband owned the local store, where she worked during the day, while also caring for their children. On top of this, she worked night shifts as a nurse’s aide at the hospital. Trish thought she must have been given the job for political reasons, not because she needed or wanted the work.
When assigned to work with Trish, the aide began the shift with the usual tasks—such as feeding the babies. However, she then retreated into the office, curled up in a chair and slept for most of the night. This left Trish to handle the entire night shift on her own, including cleaning and preparing everything for the in-coming day shift—tasks that were usually shared with the aide.
One morning, near the end of the shift, the aide woke up later than usual and asked Trish to help her feed the babies. Trish, who had spent the night doing both her own work and the aide’s, was behind on her duties and couldn’t assist. The aide had to rush to feed the infants herself before the day shift arrived and was unhappy about it. She later filed a complaint with the hospital administrator, claiming that Trish wasn’t helping her enough on the night shifts.
The administrator discussed the complaint with the Matron and Dr. Henderson, and Trish was called in for a meeting to explain her side of the story. To Trish, the issue was straight-forward—the aide hadn't been hired to sleep through the night, and providing proper care to patients was more important than local politics. She argued that the night nurse couldn’t be expected to handle all the cleaning and other basic tasks on her own; she needed to be available for new patients and managing existing patients as needs arose. That was why aides were part of the team. Trish firmly told the administrator that if they believed otherwise, they should fire her.
The administrator, Matron, and doctor had a brief discussion before announcing their decision—she was fired. Trish was dismayed but remained defiant. She believed the job should go to someone who valued it, especially since many of the women in the village would take pride in the work and benefit from the extra income. To her, it was unfair for someone who already had a job and a role in the community to take the opportunity from someone else, particularly if they didn’t take the role seriously.
Trish chose not to appeal the decision and instead began preparing to leave Bella Bella. She had already been planning a trip to England to visit her family, so she booked her ticket and arranged her travel to Vancouver.
She also began looking for a new job. Trish wasn’t interested in working in a large hospital, as that felt too similar to the roles she could have taken back in England. Her experience in remote locations had challenged her in ways that went beyond nursing, and she wanted more of those opportunities.
Trish found a job posting for a public health nurse in the remote village of Telegraph Creek, in northern British Columbia, near the Alaskan border. The position was through the Federal Government and focused on health promotion rather than direct nursing care. Still, both the job and the location intrigued her, so she applied.
To interview for the position, Trish flew to Prince Rupert, where the Department of Health, Medical Services had its office. During the application process, she explained why she left her previous position in Bella Bella—she had been fired. To her surprise, the interviewer simply nodded and moved on to the next question, signalling that it wouldn’t be an issue. After the interview, Trish returned to Bella Bella to pack her belongings and prepare for her journey back to England, with a brief stop in Amsterdam.
Although the circumstances of her departure were unsettling, she recognized how valuable her time in Bella Bella had been. She had made friends, applied her nursing skills in new ways, and gained insight into a way of life completely different from what she had known before.
On the day Trish left Bella Bella for the last time in late 1971, Dr. Henderson walked with her to the wharf where she would board the float plane for the last time, helping her carry her belongings. He had become a good friend in the time they had known each other. Trish felt a sadness as she boarded the plane. It helped that she knew the pilot, and others on the flight. They helped her feel like it was just another flight out of the village.
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Author’s Notes
N.B.1: In 1970, as Trish was introduced to the people of Namu, Bella Bella, and other communities where she worked, the language of the time, “Natives”, was used. Today, the people living on the lands where Trish worked, have reclaimed their traditional identities, leaving behind the nomenclature assigned them during colonization.
Namu and Bella Bella sit on the traditional territories of the Heiltsuk Nation. If you would like to read more about the identity and culture of First Nations people in Canada, including insights from Indigenous authors and advisors, here is a resource from the “First Nations & Indigenous Studies” program at the University of British Columbia.
N.B.2: We often see our parents through the lens of their roles in our lives— caregivers, disciplinarians, cheerleaders. Perhaps they are our role models or mentors, but who were they before they became these things to us?"
To better understand who my parents were before they were, well, my parents, I set about interviewing them about their lives before marriage and kids. I started with my mom.
Trish Lewis was 18 years old and desperate to escape a mind-numbing administrative job at a factory in Liverpool in the 1950’s. She made the impulsive decision to join a friend to interview for nurse’s aide training at Alder Hey Children’s Hospital. That decision changed the trajectory of her life and launched her into an interesting and rewarding career as a nurse.
Trish is my mom, and this is her story, as told to me in a series of interviews in 2024. The story is pieced together from Mom’s memory, photos, and documents. As we all know, memory is fallible. In the telling of this story, some names have been changed, either because they could not be recalled, or to protect the privacy of the person. The Journey is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
N.B.3: If you are enjoying this story, you may also enjoy reading my memoir, “Resilience in the Rubble: A True Tale of Aid and Survival in Kashmir”. The book shares my experience as a first-time medical aid worker in Azad Kashmir, Pakistan, after an earthquake devastated the region in 2005. It also tells the story of Nadeem Malik, a local teenager who lived through the earthquake, and his struggle to provide for his family in the aftermath.