The RBNA gradually went into decline following the Nurses Registration Act 1919; after six failed attempts between 1904 and 1918, the British parliament passed the bill allowing formal nurse registration. What resulted was the Royal College of Nursing (RCN), and the RBNA lost membership and dominance. Helena supported the proposed amalgamation of the RBNA with the new RCN, but that proved unsuccessful when the RBNA pulled out of the negotiations. However, she remained active in other nursing organisations, and was president of the Isle of Wight, Windsor and Great Western Railway branches of the Order of St. John. In this position, she personally signed and presented many thousands of certificates of proficiency in nursing.