The sanctification of suffering: How the ideal of the selfless nurse created a culture of exploitation

“ Now unfortunately the more “noble” a profession is considered, the greater is the tendency to neglect the material [29] well-being of those concerned in it; and nurses have reason to feel the full force of this misplaced sentiment. The policy followed in their regard is as foolish as it is unjust. The inevitable fatigues of a nurse’s life require to be counteracted by the most careful provisions for her comfort, if full efficiency is to be kept up; and Hospital Boards would do well to remember that more professions are now open to women than there were when nursing first became popular. ”

“ Self-denial.—The business of taking care of the sick, if rightly attended to, requires a devotion to the interests and wants of the patient, which can only be given by the good nurse, who can willingly, and from her heart, practise the heavenly precepts of doing as she would be done by, and denying herself any indulgences that interfere with her duties. ”

“ But a temper fed from hidden springs, and full of austerity and detachment, must ever look to the mass of men like an alien thing, the outcome of hypocrisy or sheer foolishness. Nothing but an outward and visible career passed in nursing the sick in hospitals can, to this day, redeem it. ”

“ But is it a matter of no importance that a sufferer should condemn his attendants to a prolonged drain on their health and strength, in order to cling to a life which is useless to others, and a burden to himself? The nurse who tends, perhaps for weeks, a bed of agony, for which there is no cure but death—whose senses are strained by intense watchfulness—whose nerves are racked by witnessing torture which she is powerless to alleviate—is, by her self-devotion, sowing in her own constitution the seeds of ill-health—that is to say, she is deliberately shortening her own life. ”

“ If you have not learned or are not determined to learn to endure the caprices and demands of unreasonable men and women in the most unreasonable hour of their lives, you have mistaken your calling; as without Christian patience, I do not believe it possible for a nurse to succeed for any length of time. The trials and vexations of a nurse’s life are so numerous and so constant, that it is a wonder to me that there are so many who are ready to enter this calling in life. There is no need since the revival of professional nursing for women to torture themselves or do penance. ”

“ So much has from time to time been said of the untrustworthiness of pauper nurses, of the evils resulting to those patients who are placed exclusively under them, of the mischievous consequences upon the discipline of the Workhouse of a large number of petty offices being filled by able-bodied women, that your Committee believe they rightly interpret the feeling of the Select Vestry, as they undoubtedly do that of the general public, in supposing that the actual nursing of the sick in the Liverpool Workhouse can no longer be left in the hands of pauper nurses. ”

“ Her gracious and winning dignity was far indeed from the blindness of a weak amiability, and it can hardly be doubted that what she saw of the so-called “nurses” in our hospitals of those days, went far to deepen her resolve to devote herself to a calling then in dire neglect and disrepute. Dirt, disorder, drunkenness—these are the words used by a trustworthy biographer in describing the ways of English nurses in those days—of whom, indeed, we are told that they were of a very coarse order—ill-trained, hard-hearted, immoral. ”

“ This will show that it is no imaginary picture of either a hospital or a workhouse nurse that we are giving, but one which is strictly true and taken from the life. We could tell too many stories of cruelties practised and deaths hastened by these women in workhouse wards, where they have nearly unlimited power, the one visit of the matron daily having but little power to check, or even discover, such evils as we are describing'. ”

“ The proposal now made to the Committee, means that the paid staff shall be increased, so that the sick shall be cared for by responsible officers only, and not left, even partially, to the care of pauper nurses.
There is no doubt that pauper nurses are unreliable, inefficient, and many of them very worthless; and it is only by careful watching, and the utmost stringency of regulations, that they can be made serviceable in the hospital. ”

“ On the whole, the testimony brought before us is sickening. Drunkenness, profligacy, violence of temper, horribly coarse and brutal language—these are common, albeit the reverse of the picture is generally true. The toil is great, the duties disgusting, the pecuniary remuneration small, so that there is nothing to invite the co-operation of a better class of nurses but the highest motives which can influence a true Christian. At one moment the selfishness and irritability of the sufferers require a strong control ”

“ In less than three years she had reduced one of the most disorderly hospital populations in the world to something like Christian discipline, and had converted a vestry to the conviction of the economy as well as humanity of nursing pauper sick by trained nurses.”
And it was in introducing a book about the Liverpool Home and School for Nurses that she wrote:—
“Nursing, especially that most important of all its branches—nursing of the sick poor at home—is no amateur work. ”

“ It seems a commonly received idea among men and even among women themselves that it requires nothing but a disappointment in love, the want of an object, a general disgust, or incapacity for other things, to turn a woman into a good nurse.
This reminds one of the parish where a stupid old man was set to be schoolmaster because he was "past keeping the pigs." ”

“ We have seen that we have a right to shorten life in obedience to a call of duty, and it will at once be said that the nurse is obeying such a call. But has the nurse a right to sacrifice her own life—and an injury to health is a sacrifice of life—for an obviously unequivalent advantage? We are apt to forget, because the injury is partially veiled to us, that we touch the sacredness of life whenever we touch health: every case of over-work, of over-strain, of over-exertion, is, so to speak, a modified case of euthanasia. ”

“ Nurses cannot avoid exercising a moral influence. They exercise it by their characters, and no point can ever be reached at which a woman can say, “Now my character is perfect.” “Nurses are not chaplains”; “it is what a nurse is in herself, and what comes out of herself, out of what she is (almost without knowing it herself) that exercises a moral or religious influence over her patients. No set form of words is of any use. And patients are so quick to see whether a Nurse is consistent always in herself—whether she is what she says to them. ”

“ Herschel’s argument which is, that nursing is neither an order, a trade, nor a means of earning a livelihood; but that it must ultimate in a profession filled almost exclusively by women. Our American hospitals, though second only to those of England in point of equipment for the training of nurses, are still imperfect. From a small beginning actuated by humane motives, of necessity, nursing has assumed vast proportions. Like all other avenues of human activity, the bad crops out with the good and many a conscientious nurse suffers for the261 sins of one who has crept in. ”

“ It conclusively established two facts: that such women are utterly unfit to be trusted as nurses; and that their employment in that capacity does not effect all the saving that might be supposed. It might be thought that the choice lay between such employment and maintaining the pauper in idleness, while paying a nurse in her stead. But it was found—as the Governor had always predicted—that when sent back from the hospital to the able-bodied wards, nearly the whole of these women left the Workhouse, and relieved the parish from the charge of their maintenance. ”

“ This applies not only to the state of the wards, the care of the sick, but is particularly observable in the demeanour of the patients, upon whom the humanizing influences of a body of women of character, devotedly discharging their duties, has produced evident fruits.
The question has often been asked whether the "new system is likely to succeed?" The "old system" meant nothing more than this, that old, ignorant, and unreliable pauper women, many of whom were of doubtful character, were entrusted with the discharge, without pay, of responsible duties. ”

“ When once she has taken to drink, one of two things invariably follows (dishonesty may be presumed to ensue upon, though it often does not precede habits of drink) ; she is or becomes unguarded, and is soon found out, and sinks into the miserable second and far too numerous class of characterless hospital nurses, unless drink shortly finishes her; or, in the other case, she is cautious and guarded—she then becomes sly, dishonest, and thoroughly venal; she extorts gifts and takes bribes from her patients and their friends—and the friends of hospital patients, like others, are of various kinds ”

“ It is unfortunately impossible to repeat in any detail the complaints made by nurses without indicating the institutions to which they refer; but most persons with acquaintances among hospital nurses know that abundant dissatisfaction exists in the profession. Examples could of course be given of institutions that are well managed in this respect, but they are, it is to be feared, the exception rather than the rule. Boards of Management are under constant pressure to increase their accommodation, and, funds being seldom abundant, they are tempted to work with an insufficient staff. ”

“ To displace these pauper women, however, involves a complete change in all the hospital arrangements, and suggests the difficulty of finding and keeping up a supply of suitable nurses to undertake the work at, as it would no doubt often happen, short notice. The Committee are aware, too, that owing to the fact that the paupers have hitherto been required to attend upon the sick, the accommodation for paid officers is very limited, and that the adoption of the proposal would render it necessary at once to provide additional rooms for the additional staff. ”

“ The position of a medical man dependent for the execution of his instructions upon nurses who are neither intelligent nor trustworthy, is very painful, and tends to deteriorate his own character, both as a man and as a practitioner, by rendering him callous to preventible suffering which he is denied the proper means of relieving, and by compelling him to forego the use of remedies which require intelligence and conscientious care in administering them. ”

“ Miriam’s restive anger would not allow her to attend fully to the long story. She wandered off with the dreadful idea of nursing a “semi-mental” sitting in a deck-chair in a country garden, the hopeless patient, the nurse half intent on a healthy life and fees for herself, and recalled the sprinkling of uniformed figures amongst the women crowded at the table, all in this dilemma, all eagerly intent; all overworked by associations claiming part of their fees or taking the risks of private nursing, all getting older; all anyhow as long as they went on nursing bound to live on illness ”

“ It’s so hard for nurses to live in a constant atmosphere of depression and sickness. When one is ill for a long time, as you were, one gets so bored and wearied by the monotony of the sick-room, and it’s such bliss to be free again, and speak at the pitch of your voice, and be done with medicines, and pulses, and temperatures, and tiresome rules and regulations, but the nurse never gets free. Just when things are beginning to get cheerful, she goes away to another darkened room and another anxious household, and the whole programme begins over again. ”

“ A very large proportion of nurses are mothers, often widows, with large families, whom they support and put to service out of their wages, too often eked out by improper means, i. e., bribes and petty dishonesty. Many of these women are moral, sober, industrious, and doubly anxious to retain their places, on account of their children; still there are serious embarrassments in employing them. The wages of hospital nurses are not and never can be enough to supply a proper support for children, in addition to the support the mothers ought themselves to have. ”

“ At present, when every one is struggling for employment in an overstocked market, the lowest rate of payment is readily accepted; and when work is only done to eke out a maintenance chiefly provided by other members of the family, this is comparatively unimportant; but when it is the sole provision and means of subsistence, it becomes a fearful evil, and drives persons to yield to the saddest temptations in order to avoid starvation.
In conclusion, let me mention where it is that nurses for the sick are chiefly wanted, and also where they can be taught their profession. ”

“ A certain proportion of nurses are all the above, excepting drink; for though, almost without exception, every nurse who drinks takes bribes, some take bribes and do not drink.
Of course widows and unmarried women who are not mothers do the above things; but there cannot be a doubt of the additional and terrible temptation [12] to women burdened with children, to make money in various ways out of their patients. Even in the most favourable cases (and it is to be feared they are few) where the real good principle of the mother restrains her from venality, there are still serious objections. ”

“ The beginning has been made, the first crusade has been fought and won, to bring—a truly 'national' undertaking—real nursing, trained nursing—to the bedsides of cases wanting real nursing among the London sick poor, in the only way in which real nurses can be so brought to the sick poor; and this is by providing a real home, within reach of their work, for the nurses to live in—a home which gives what real family homes are supposed to give—materially, a bedroom for each, dining and sitting-rooms in common, all meals prepared and eaten in the home ”

“ Nay, as the old hospital nurse did thirty years ago, she may even come to prey upon what is provided for her patients.
There is a third alternative: that she breaks her heart.
But the thing which always does happen is, that no woman really fit for the work will do it, or ought to do it.
To have a person fit to live in a home—and who would have any other?—and to create homes for the poor, for it is nothing less, you must have a home fit for her to live in.
If you give nurses a bad home, or no home at all, you will have only nurses who will live in a bad home, or no home at all. ”

“ It is tragic that the gallant women who have volunteered for service as nurses should be so overworked. It is tragic that our wounded men should ever want for the best possible nursing care.
The inability to get the needed nurses for the Army is not due to any shortage of nurses; 280,000 registered nurses are now practicing in this country. It has been estimated by the War Manpower Commission that 27,000 additional nurses could be made available to the armed forces without interfering too seriously with the needs of the civilian population for nurses. ”

“ The present shortage of Army nurses is reflected in undue strain on the existing force. More than a thousand nurses are now hospitalized, and part of this is due to overwork. The shortage is also indicated by the fact that 11 Army hospital units have been sent overseas without their complement of nurses. At Army hospitals in the United States there is only 1 nurse to 26 beds, instead of the recommended 1 to 15 beds. ”

“ Such a limited view, in fact, is a dehumanizing denial of man's potentials. As a human transaction, the phenomenon of nursing contains all the human potentials and limitations of each unique participant. For instance, frustration, discouragement, anger, rejection, withdrawal, loneliness, aggression, impatience, envy, grief, despair, pain, and suffering are constituents of nursing, as well as tenderness, caring, courage, trust, joy, hope. In other words, since nursing is lived by humans, the "stuff" of nursing includes all possible responses of man—man needing and man helping—in his situation. ”

“ I know that men's lives have been shortened by these brutal assaults. And that is only a polite way of saying that murder has been committed here." Turning next to the matter of the women's wards, I said: "A patient in this ward—a man in his right mind, who leaves here on Tuesday next—told me that a woman patient told him that she had seen many a helpless woman dragged along the floor by her hair, and had also seen them choked by attendants who used a wet towel as a sort of garrote. I have been through the mill and believe every word of the abuse. ”

“ To turn now to the second class of workhouse Lunatic Inmates, the demented from age, accident, or disease: these, we do not hesitate to say, are not suitably accommodated in workhouses, for, like the paralytic, they require careful supervision, good diet and kind nursing; they are full-grown children, unable to help or protect themselves, to control their habits and tendencies; often feeble and tottering, irritable and foolish, and, without the protection and kindness of others, the helpless subjects of many ills. ”

“ She would sometimes be seized with fits of violence during which it was with great difficulty that she could be controlled. Several times she threatened the lives of her nurses, and even on one occasion attempted to execute her threat, the person's life being saved by mere accident. ”

“ Care must always be used not to injure a patient while exercising necessary control. In the violence of a patient innocent injuries are sometimes received. The attendant is excusable if he can show that he used necessary force only, without malice.
A violent patient should never be struggled with alone, and on a well-managed ward help will always be within call. It may be necessary, however, to break this rule in order to prevent homicide or suicide, or serious injury to another patient, or setting the house on fire. ”

“ That big, broken-arm case on the ward cursed you yesterday because you would not loosen his splints. And you rushed from the room angry and humiliated, wishing you could quit nursing forever, and asked to be moved because you had been insulted. But that man cannot harm you. He has never known a real lady in his life before. His training from childhood has been to regard women as chattels to do man’s bidding; his experience in life is that they usually do what he asks—women of his kind. Moreover, he has never had a serious pain before, and it is not to be endured. ”

“ It is possible for a nurse to spend time and strength lavishly in day and night vigils, to be the best of poultice-makers, and the most careful administrator of food and medicine, and yet to fail utterly in helping the patient back to health and strength. Over and over again I have found patients sorrowful, perhaps crying, over the sense of being ‘such a burden;’ this, too, where there has been real affection on the part of nurses, but where the first duties of self-control and cheerfulness have been neither understood nor practised. ”

“ On the other hand, if a nurse denies her own struggling humanness, she self-righteously will be apt to accuse either self or her other. This way of being denies, suppresses, and represses one's own and the other's ability to be, to be as much as potentially possible. ”

“ The humiliation to our nurses in placing them below the orderlies in the hospitals is not only a blow to their esprit de corps, but a definite handicap to their efficiency. A nurse who was at the head of the nursing staff in a state hospital wrote from the front: "There is one thing the Nursing Committee needs to work for, and work hard, too, and that is, to make for nurses the rank of lieutenant. The Canadians have it, why not the Americans? You will find that it will make a tremendous difference. You see, there are no officers in our nursing personnel. ”

“ It is thought by some persons that all advice on nursing should be written by nurses. But here we object. Surely the physician is entitled to say what he requires?
We certainly consider that we have a right to have our say in a matter which concerns us more than anyone else save the patient. We physicians are responsible for the well-being of the sick. We are to blame, and we are blamed, when the results are disastrous. If we employ a careless nurse, and she, by her bungling, thwarts recovery, we are to blame. It is upon us, not upon the nurses, that retribution falls. ”