The Cessnock District Hospital opened on 14 June 1914, with the staff a modest eight people including the first Matron, Sister E Rutledge-Newton and three nurses.

There were no nurses quarters and no kitchen, with meals cooked on an ordinary household stove in a small room near one of the wards. One contemporary account describes the smell from the food permeating the ward and not at all advantageous to the health of some of the patients.

Nursing shifts were a gruelling 12 hours, but Cessnock Hospital was soon to be an innovator, in 1918 becoming the first NSW hospital to introduce straight eight-hour shifts.

The title nurse was used for enrolled nurses who were still studying; part of their uniform was a cap used to keep hair neat and tidy. Once qualified these trainees became registered nurses, who had the right to be called sister and wear the distinctive large white veil.

From the 1940s onwards worldwide nursing shortages became severe. In Cessnock the nursing situation was described by the Hospitals Secretary, John Brown, as desperate. It was so bad that in 1946 the mens surgical ward and part of the womens medical ward were closed due to a lack of staff.

The hospital board took action. Meeting the NSW Minister for Health, Gus Kelly, the board strongly expressed its view that the only way to encourage young women to enter nursing was to improve their wages. Not content with the governments response they turned to Australian Council of Trade Unions, asking the organisation to use its influence to obtain an increase in nurses salaries.

The critical situation continued, with the hospitals 1950 Annual Report calling for girls to be legally allowed to begin training at 17 years in order to alleviate the ongoing shortage. It also noted that the nurses quarters were so inadequate that many had to go home to sleep, rather than live-in as was preferred, because there simply were not enough beds for them.