Still there were problems. 'Hospitals were overcrowded, many patients were forgotten or neglected by family and friends, and patients were deteriorating,' wrote G. L. Fitzpatrick, Superintendent of Nursing, North Battleford. She went on to say:
To overcome this, and to help these people return to their rightful place in their community and society, we are trying with our trained staff to carry on patient assignment in nursing or caring for the mentally ill. The aim in patient assignment in hospitals is to make the patients feel the staff cared what happened to them, and would do everything to return them to normal or previous life and environment. Each staff was assigned a number of patients for whom he or she was responsible while routine duties were carried on as well.⁴⁰

This type of interaction with patients could be seen as a precursor of what was to come in terms of patient care. Up until the mid-1950s psychiatric nurses were little more than custodians, cleaning toilets, scrubbing windows and herding patients to and from meals,. By 1954, however, the introduction of psychotropic drugs revolutionized treatment. Phyllis McElroy reflected on the significant difference this new type of treatment made to her work as a psychiatric nurse:

. . . tranquilizers came in, and then came working with patients in groups, working with them as individuals. . . . we had many patients who responded to it, patients you would never think would be out of here. But month after month of steady group work . . . and making life more meaningful and interesting, gradually some of those patients were discharged. It was really rewarding because, although it was slow, even then, you could see it, and it was nice to work with the patient as a person for the first time.⁴¹

Other accomplishments in the early 1950s were the development of a pledge, a code of ethics and the adoption of the practice of wearing two maroon bands on caps and pockets as an insignia of the RPN. These steps occurred smoothly and without hitches. However, a more serious problem arose in 1953 when the SPNA received the contents of the Canadian Nursing Association's submission to the Sub-Committee on the Training of Nursing Personnel in Mental Institutions. The Sub-Committee had been appointed in 1952 by the Advisory Committee on Mental Health to the Department of National Health and Welfare.

At the time, the organization of psychiatric nursing education nationally was a confused one. The training and status of psychiatric nurses varied from province to province and from hospital to hospital. In British Columbia a graduate of the two-year psychiatric course became a licensed psychiatric nurse. In Manitoba, students in the mental hospital course who spent four months affiliating at a general hospital were eligible for licensing as practical nurses. In Saskatchewan, graduates of the three year psychiatric nursing course were eligible to register as psychiatric nurses after passing examinations set by the University of Saskatchewan Board of Examiners. Other provinces issued certificates or diplomas for the successful completion of courses in mental hospital nursing. Nationally, there was no uniformity in the courses or the status obtained upon their completion.

The Canadian Nursing Association's submission included a number of recommendations which helped to perpetuate the already strained relationship between the SPNA and the SRNA. Among these was a recommendation that RN's be in charge of all ward work in mental hospitals day and night for both male and female patients. The Canadian Nursing Association also claimed that because of a lack of affiliation programs for students in schools of nursing, RN's hesitated to accept positions in mental hospitals, and that in some communities nursing in psychiatric hospitals had less prestige than nursing in general hospitals.

The Sub-Committee noted that the CCPN was established to set up 'recognized standards of psychiatric nursing on a national basis which would enable trained psychiatric nurses to move freely from job to job in any of the provinces.' It felt also that a good working relationship between the CCPN and the Canadian Nursing Association was important.

The Sub-Committee recommended that there should be planning for training for auxiliary nursing personnel on a national basis and provision for experience in both fields of nursing for those who wished to transfer from psychiatric to general nursing and vice versa. Significantly, the Sub-Committee also recommended that the duties of the psychiatric nurse should be carried out under the direction of the attending physician and under the supervision of a registered nurse.⁴²

W. Vowles reacted strongly to the Sub-Committee's recommendations, The results of these plans will be that the majority of the successful candidates choose to remain in the general nursing field and those taking the psychiatric nursing course only have been classed inferior. That is why we have said we do not want the RN's classed inferior or superior to the PN's, or vice versa, but that each shall hold equal status in their separate professional nursing fields.⁴³

Relations between the SRNA and SPNA remained cool for the remainder of the 1950s. However, in 1955 the University of Saskatchewan School of Nursing began accepting psychiatric nurses in its Diploma course in Teaching and Supervision. That same year the Act Respecting Psychiatric Nurses was amended to stipulate that all future graduates had to pass SPNA examinations. Two years later, the educational standard for entry into the training programs was raised from Grade 10 to Grade 11.⁴⁴ In 1957 Vowles noted that, according to the SPNA register, 1,394 licenses had been issued since the inception of the Act, of which 1,006 were current and valid.⁴⁵

A landmark in the history of Saskatchewan psychiatry was the development of the Saskatchewan Plan. Mental health had always been a concern to the CCF, but by the mid-1950s it was becoming apparent that despite the advances of the previous decade the mental health program was under strain. As early as 1949 there were plans for the construction of a 1,100 patient mental hospital in Saskatoon. Although Dr. McKerracher, Director of Psychiatric Services, repeatedly tried to impress upon the government the urgency of this project, it was never constructed.⁴⁶

In July 1954, McKerracher presented three options for relieving the pressure on the two main mental institutions. The first was the construction of the 1,100 bed hospital in Saskatoon. The second option included the construction of a 600 bed institution in each of Saskatoon and Regina. The third called for the construction of smaller, regional institutions.47 It is important to note that by 1954, professional attitudes toward the treatment of mental illness were changing. H. Dickinson contends that much of the pressure from McKerracher was intentional. He believed that the best way to convince the government to accept these changes, which came to be known as the Saskatchewan Plan, was to publicly expose the deficiencies of the Weyburn and North Battleford mental hospitals.⁴⁸

The government did respond and as a result Dr. F. S. Lawson, who took over as Director of Psychiatric Services when McKerracher became a professor of Psychiatry at the University of Saskatchewan, reviewed the options and came up with a report which called for the development of small treatment centers which could be expanded as the need grew. This became known as the Saskatchewan Plan.⁴⁹