Nursing as it is To-day
That nursing is a vocation in the religious sense is an assertion surprisingly still made to-day, as witness the film
“The Lamp Still Burns,” about which something will be said later. Nurses, like Nuns, are supposed to take up their work in response to a mysterious call, but many relinquish its mixed joys on closer acquaintance.
In early times, before the dissolution of the monasteries, the care of the sick was in the hands of the religious houses, remnants of which became the first voluntary hospitals. The Elizabethan Poor Law was the basis of what is now the municipal hospital, first under the Parish overseer, then the Board of Guardians, and lastly the Ministry of Health.
Of nurses and nursing in this country we know little before the nineteenth century, and training was unknown. In military hospitals there were no female nurses, and mortality was high. The lack of organisation went unnoticed until a major war occurred nearer the scale of modern war. War to the general public seemed far away when only a standing army was affected.
In the early nineteenth century there were voluntary hospitals and workhouse infirmaries for the sick poor, looked after by nurses who, if for nothing else, were known for their drunkenness. This was excused on the ground that hospital conditions were so terrible that some stimulant was necessary to enable nurses to carry on. Beds were packed close together, fresh air was practically nil, and surgical cases often died of the dreaded hospital gangrene. The rich were cared for in their own homes, by women of whom Dickens’
Sarah Gamp seems to have been a fair prototype; but at least they were not exposed to the infection of a hospital ward. Any poor ignorant woman who was fitted for nothing else could be a nurse. They worked long hours, did all the domestic work, and usually lived in the hospital, often in the wards themselves.
In the mid and late nineteenth century great reforms came about, mainly through the establishment of training centres, notably Florence Nightingale’s school of nursing and St.Thomas’s Hospital in 1860. Florence Nightingale may be called the founder of modern nursing. Though known sentimentally as the “Lady with the Lamp,” she instituted modern hospital planning and hygiene, and spread much knowledge of sanitation. It is interesting to notice a little of her career. Being of the propertied class, her wish to be a nurse was resisted by her parents on the ground that a gentlewoman could not associate on equal terms with working women, often drunken and immoral, and, even if chaste, still working women. After much resistance she obtained what training she could at Kaiserworth in Germany in 1851 and with the Sisters of Charity in Paris in 1853.
In 1853 the Crimean War commenced, and in this major campaign great perturbation was caused by the deaths of the wounded British from negligence. Nearly 50 per cent. died. People became incensed as they learned that preparations and precautions were practically nil. The French ally, by contrast, had reasonably well organised medical services, and had taken 50 Sisters of Charity to act as nurses.
Florence Nightingale was asked by the Government to take a party of nurses to remedy matters. We have seen that the British Army had no female nurses, and this intrusion was energetically resisted by many of the medical officers, who saw in it criticism of themselves. The medical profession to-day likewise resists any apparent encroachment on their privileges. We know by Florence Nightingale’s reorganisation of the hospitals at Scutari and in the Crimea that she did not lack energy and initiative.
Following the Crimean War, strenuous efforts were made to reorganise hospitals in this country, and trainees of Florence Nightingale started nursing schools at many hospitals, and the status of nursing became raised.
Just before the turn of the century, great improvement were made in this and other Western countries. Efforts were made to check infectious diseases by isolating and notifying. Great strides in medicine, such as the technique of antiseptic surgery, introduction of anaesthetics, discoveries of the causes of hitherto baffling diseases were made. County councils with medical officers of health were set up, and sanitation at last received some attention.
Florence Nightingale’s reforms in nursing had their way because all this was in the air. The discoveries in medicine made the more intelligent nursing of the sick essential. It was not something which just happened out of the blue by the goodness of one woman, but because at this time it became necessary to transform the Sarah Gamp into a trained knowledgeable worker in the art of nursing, into a woman who could carry out important observations, and many special treatments—in a word, to change the unskilled into the skilled worker.
In 1902 the Midwives Act was passed—”an Act secure the better training of midwives.” Efforts were made to secure as nurses girls of better education, at least secondary school standard. But the shortage of suitable recruits has usually been acute except at the best teaching hospitals —e.g., the London voluntary Hospitals. Girls of better education have wanted better rewards than nursing can give. The lure of the vocation, the life of satisfying work for suffering humanity, etc., ad nauseum, have all been tried. The bait has never been good conditions, reasonable hours and adequate pay for an efficient worker. But the dope has never been completely successful. The municipal hospitals and smaller voluntary hospitals have had to recruit from the elementary schools. This makes it difficult for the recruit, who has probably left school at 14 years and worked in a shop, office or factory, to go back to school again at 18 years. Particularly is this the case now that many high schools run pre-nursing courses, thus relieving the student nurse of much study in her first difficult year of hospital life.
A student has much to learn of a scientific character, and a knowledge of chemistry and mathematics is a great help to the prospective nurse. As always, the good background of education makes all the difference between taking a job in one’s stride or making it a very hard grind. Many fall by the wayside and never become State registered. They then become the assistant nurses, or, shall we say, the labourers of the present nursing world.
What has been the reward for the hard grind ? Until the Rushcliffe scale of salaries was introduced recently, the best salary paid to a student nurse was £20 in the first year, £30 in the second, and £40 in the third, together with board and lodging. The answer to complaints on this score has always been that training was being given free during this period, whilst other trainees—e.g. doctors, teachers, architects, etc.—have to pay for theirs. Such students, however, do not have to work 10-12 hours day or night, often at an exhausting pace, and then attend lectures afterwards. In the writer's experience of commencing training only 11 years ago night duty commenced at 7.30 p.m. and finished at 8 a.m. Often the entire night was worked without a break even for a meal, and then lectures had to be attended at either 9 a.m. or 6 p.m. At 9 a.m. the lecturer received scant attention. A hard school, indeed, and the one night off per week was often spent in sleeping the clock round. The Horder Committee report on nursing reconstruction, recently published, recommends that the nurse should be a student paying for her training, and not an hospital employee responsible for the work of the hospital. They suggest she should be helped by Government grants.
Conditions, however, are improving, in order to attract recruits of what are termed the better kind. Parents are not willing to allow their daughters to undergo an interesting but vigorous training at the cost of their health. “Hard work never killed anyone,” still say some members of the old school. Perhaps not, but health may be impaired, and vitality and energy for outside interests may be completely sapped. We do not, generally speaking, find nurses interested in political questions and world affairs. Why? Because the hospital is its own little world in which one may work and take no notice of the greater world. This may be thought a good thing. Florence Nightingale would have considered that completely absorbing work in the service of others was so. Facts belie it. A nurse so living becomes narrow and harsh, and finally is quite unable to understand the youngest recruits. Certain hospitals in this country now allow their trained staff to live out. This has, on the whole, been extremely successful, and these hospitals have had less difficulty in obtaining staff.
What are the nurse’s expectations when finally she is trained, passes her exams, and can put those long-coveted letters S.R.N. behind her name? She may remain in a general hospital as a staff nurse to do surgical or medical nursing, and after a few years of experience become a Sister and direct the ward. She may take further training in some other branch of. nursing—e.g., midwifery, fevers, children, district, public health or industrial nursing. Many fields of interest are now open to the trained nurse. The latest of these is that of industrial nursing.
The Government has recommended that factories employ a trained nurse and establish a first-aid and welfare department. This department was not established out of the kindness of the employer’s heart. Absenteeism through sickness is considerably reduced: prompt treatment of accidents saves weeks of disability, and reduces compensation;—the worker with a wound has his dressing done by the factory nurse, thus preventing him taking a day off to visit his local hospital or his panel doctor.
Public health and district work is popular, as here the nurse works with greater freedom than her hospital colleague, and she lives out. These nurses regard their work as important and socially useful; their hours are reasonable, and their scale of salary has just been raised through the recommendations of the Rushcliffe Committee. It is not, however, princely, as the maximum salary for a superintendent of health visitors, a post only reached after years of experience, is £55O per year.
The Rushcliffe yearly salaries for the trained nurse are £90, for the ward sister £130, and for a sister tutor £200 rising to £350. These are exclusive of emoluments. The student nurse is to be paid at the rate of £10 first year. £45 second year, £50 third year, and £60 fourth year. These are mentioned in detail as they were supposed to constitute a wonderful improvement.
Previous to the war nurses who married were expected to leave. Since the war they have been permitted—nay, implored—to remain. Florence Nightingale was harsh with nurses who married; she considered that they should devote their whole lives to their work.
The clock cannot be put back despite frantic efforts to do so. The production at this time of the film “The Lamp Still Burns” shows a desire to do so. The heroine, Hilary, foregoes her private life to serve her calling. Few would be willing to make such an unnatural sacrifice Why should such an anachronism be expected? Under modern conditions the nurse may work, for example, for eight hours efficiently and then leave hospital, district or clinic for her home or her own interests and relaxation. The nurse in training may live in for convenience, but should have her lectures in her “on duty” time.
Reorganisation is required and had to some small extent been carried out in England before the war, but more widely in America. Under better conditions nursing could be a most satisfying kind of work. Indeed, it provides an answer to those who state that workers must have bosses. Many nurses, working without supervision, voluntarily exceed their hours of duty for their patients’ welfare.
Efforts are required by nurses themselves to improve their conditions. Hitherto they have been too exhausted to do much in that direction, plus, of course, the play on the vocational side.
The nurse has now become a skilled worker, but do not whisper this to her, as she is taught to regard herself as belonging to the professional class, whom it would appear are a race apart. This snobbery has been a bar to trade-union activity, which has, generally speaking, been resisted by hospital matrons.
Apart from the apathetic state of nurses, three main obstructions to progress exist : The attitude of the working class, who ignorantly look on her as an angel of mercy or despise her as part of what they regard as the racket of medicine; the medical profession, who wish the nurse to be the Cinderella to their own great glory; lastly, from those who as nurses wish the vocational idea to continue.
Many of the diseases and accidents which can be directly traced to the needless hazards of industry or to the poverty of the workers, as well as the more dramatic casualties of war, will die with the death of capitalism. Only under a form of society in which the health and happiness of people, rather than the production of commodities, is the aim can nursing come into its own, with its infinite possibilities of satisfying work.
W. P.
