Nursing staff

“ The duties of nurses ought also to be distinctly confined to attendance on the sick, and no menial work, such as scrubbing floors and the like, should be demanded of them; a proper staff of servants ought to be employed for such purposes. It is also desirable that a separate pavilion for lodging the nurses should be set apart, and that fair and reasonable time for rest and recreation should be allowed. Some discussion has taken place as to the advisability of placing the nursing of a hospital in the hands of a sisterhood or a separate corporation. ”

“ 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 completion of their training they must be prepared to take employment on the nursing staff of some public hospital or infirmary wherever offered to them by the Committee, and to continue in similar employment for a period of three years at least, this period being limited to one year in the case only of those who have paid at the higher rate. ”

“ The more it is considered, the more essential it appears, to train Nurses, from the first, to do efficiently a great deal of work. A small staff of respectable, laborious, and thoroughly efficient women seems the thing to be aimed at; whether considering Military Hospitals by themselves, or as a training-school for Hospital war-service.
5. It would be better to give each Nurse one great ward; but wards above a certain size are inadmissible for sanitary reasons.
6. The care of 24 to 30 patients is not sufficient duty, by a great deal, for a Nurse. ”

“ Guy’s had the same provision with, however, the drawback that there was not a Sister in charge, but a Nurse over other Nurses, with higher pay, but not a Sister or Head Nurse. However excellent such a Nurse may be, every ward must be under the same regular government as is general in the Hospital, if discipline and order are not to suffer. Every ward or set of wards should be under a completely appointed staff. ”

“ A recent study from the Department of Health and Human Services reports that more than half of America's nursing homes don't have the minimum staffing levels necessary to guarantee quality care. And too often the staff that is there isn't properly trained. ”

“ All these reports bear emphatic testimony to the merits and devotion of the Lady Superintendent and her staff. The medical men, it is noteworthy, speak strongly of the better discipline and far greater obedience to their orders observable where the trained nurses are employed—a point the more important because it is that on which, before experience has reassured them, medical and other authorities have often been most doubtful. ”

“ Still it would be ad [91] vantageous if we could from the first include in the staff of Nurses for the larger Hospitals, one or two places which could be filled by efficient persons who yet were unfitted for the ward work, which calling will be, and ought to be, laborious and wearing enough. Many a woman would never do to look after a Pavilion and seventy-five men; who yet, in charge of linen or stores, would be most valuable, and influence most beneficially the Nurses, whom yet she might be unfit to govern. ”

“ 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. ”

“ These organizations may be visiting nurse associations, prenatal clinics, health centers or dispensaries. As the doctors are assisted by nursing staffs they are able to offer protection, through these channels, to a very large number of mothers and babies.
Among the women who are cared for by such organizations, or by doctors in their private practice, there is an enormous reduction in the occurrence of convulsions, for example, abortions, miscarriages, stillbirths, infections (childbed fever) , and prolonged and difficult labors. ”

“ It may be conceded that a nurse, possessing a preliminary graded school education, who has been carefully taught for two or three years in an accredited hospital, is able to give nursing care, under medical supervision, to the sick bed patient. ”

“ Nobody ever contemplated giving to a Nurse the entire charge of a number of sick in a Military General Hospital. It is no part of good Hospital nursing to do so. With proper Orderlies, a Nurse can very well attend to sixty or seventy sick. We were prevented, indeed, by the authorities, and by circumstances, from organizing a proper system of nursing, and were obliged to do all the good possible in the best possible way. But Sir John Hall’s method of estimating the efficiency of nursing, by dividing the number of sick by the number of Nurses, is simply absurd. ”

“ Now well-appointed hospital trains move backwards and forwards from the clearing hospitals to the base. For the first time we enter the nurse's sphere. Everything changes when the nurse appears upon the scene. She loves order. Cleanliness is her life. She is trained in all the little arts of nursing which bring comfort and peace. She can do what no man can do. The doctor is splendid at his own special work, the stretcher-bearer, the ambulance man, and the hospital orderly at his. ”

“ Sometimes they employ a head-nurse, become too old for her work, as an extra and inferior nurse. Sometimes they grant a worn-out head-nurse an asylum in the incurable ward of the hospital. I believe the pensions to old nurses are still fewer than the few to head-nurses. ”

“ The aim of the Nursing Department of the Public Health Service is to give as efficient nursing care to the patients in these hospitals as can be given, to see that the nurses cooperate in every possible way with those responsible for the care of the patients—that is, the Medical Officers in Charge,—to recruit a sufficient number of qualified nurses to meet the needs of the Service, and to recommend the establishment of such policies in the Nursing Department as will increase the efficiency of the nursing corps. ”

“ Very often there are fifteen beds in each ward (not by over crowding) , and these Head Nurses are often to be seen in charge of seventy-five patients each, including many serious, and some urgent cases. The two lobbies, the small wards, and the duty of some daily writing and arithmetic in settling the diets, with some daily loss of time in fetching and waiting for medicine, render a Head-Nurse’s service, as regards “manual” labour, less efficient than it might be; even where she is most efficient. ”

“ No thoughtful man who has watched her in the character of nurse, even when she is uneducated, will entertain a doubt about her happy qualifications for the management of the sick.
The most important responsibilities of a physician have reference to ventilation, cleanliness, bathing, feeding,—in brief, to nursing; and no one but a stupid, obstinate man would suggest her inferiority for such services.
I have no doubt that, finally, the medical profession will fall almost exclusively into the hands of women, as its most important part, nursing, already has. ”

“ Time, strength, and this modicum of comfort, enter much into a Nurse’s health—and health is essential both for efficiency and economy.
Where the Nurse sleeps at a distance from her ward, her efficiency, both as to superintendence and work, especially at night, in dangerous cases, is seriously impaired.
If she sleeps at a distance from her ward, her comfort, also, such as it is, is destroyed. Whatever a Nurse does for herself, she must do by fits and starts. ”

“ No less so, that the time during which a hospital nurse can work and lay by, is short, compared with the average duration of other kinds of service. Apart from all excess of their own, their work and its concomitants wear out hospital nurses fast. In every large hospital you will see many women of 40, whom you would suppose 60, and strength often decays as prematurely as appearance. Well-ventilated bed-rooms, more sleep, and better food, would be materially in their favour; but the work can never be other than one which wears out most constitutions fast. ”

“ Many of these are still strong and well, but need special consideration in particular ways. Many others are not ill, but delicate, and in need not of full-time nursing care but of occasional good offices of trained helpers. One nurse, a "practical nurse" or a trained nurse past in age and strength full service of her profession, could easily give occasional service needed for twenty or more elderly persons in usual health or for ten or more aged, in greater need of care but not helpless, if all were under the same roof. ”

“ I would not, however, expressly exempt the patients from being made useful in nursing the sick. A lazy or ill-conditioned patient might make it a handle to refuse to do or grumble at doing things which he ought to do, such as (a thing frequently required) giving and emptying a bed-pan to an ordinary patient who cannot leave his bed, while the Nurse and Orderlies are doing other things in the ward; assisting to move a helpless patient, if all the Orderlies are not at hand; sometimes watching or attending for an hour or so a critical case, &c., &c., &c. ”

“ District Nursing Care of the sick in hospitals, as everyone knows, depends almost as much upon efficient nursing as upon the skill of the physician—in many cases, far more. Of the labors of nurses for humanity, it is not necessary to speak here. But in our present public health campaign, a new type of nurse has appeared, “the visiting nurse,” who watches homes to guard against disease as well as to cure, and she is now regarded by competent observers as the strategic point in the battle for improved health in our cities and towns. ”

“ At least four important training-schools for nurses are now working under the direction of universities, and other provision has been made to give education supplementary to the hospital training.
Nurses themselves have taken the initiative in securing the means for equipping women in their profession to meet the new requirements. They are providing helpful literature and finding stimulating associations with others enlisted in similar efforts for human welfare. I had the honor to be elected first president of the National Organization for Public Health Nursing. ”

“ A patient who cannot touch his dinner at two, will often accept it gladly, if brought to him at seven. But somehow nurses never "think of these things." One would imagine they did not consider themselves bound to exercise their judgment; they leave it to the patient. Now I am quite sure that it is better for a patient rather to suffer these neglects than to try to teach his nurse to nurse him, if she does not know how. It ruffles him, and if he is ill he is in no condition to teach, especially upon himself. The above remarks apply much more to private nursing than to hospitals. ”

“ Additional visits should be made if the patient is still in bed and there is no intelligent adult to give care, or if the baby’s condition is not satisfactory.
A SUGGESTION FROM MONTREAL Ingenuity, resourcefulness, and quick wit on the part of an intelligent nurse can almost always apply hospital ideals to circumstances which would at first seem hopeless. It is the nurse’s knowledge of obstetrical nursing and principles, rather than her equipment, that counts in saving lives. ”

“ Every woman, or at least almost every woman, in England has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid,—in other words, every woman is a nurse. Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. ”

“ Do not attempt a full nursing visit unless the patient meets you more than half way. Every patient is to be encouraged to come to the Center for as much of the nursing care as is possible for that individual woman. In the care of all patients it is the nurse’s responsibility to make every effort to solve (by working 424with every existing agency) such home problems as might effect the health of the mother or baby or disturb the mother’s peace of mind. ”

“ Sometimes, when a vacancy finally occurs, the patient may be contented with home treatment and refuse to enter the institution, or his family may refuse to let him go. The nurse must do her utmost to persuade them. She must explain that in the hospital he will receive constant, not intermittent care, and that her work will only permit her to render nursing service to those who cannot otherwise be provided for. Should he still refuse, she must continue her visits of supervision, but must stop all nursing care. ”

“ How can the nurse know that the other is truly open to nursing—can the nurse impose self into the world of the other? What about an unrepentant child rapist or a person responsible for genocide, can we say that person is caring, and if not, can we nurse them? Does the nurse have to like the person being nursed? Does the nurse seek enhancement of personhood in the nursing situation? ”