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metropolitan and national associations, training schools, and other high-sounding organisations for the promotion of high-class nursing --and have, as a rule, signally failed to meet the wants of these busy times in which we live. Why? Because they have fought for the triumph of personal influence, and not solely for the steadily developed progress of right principles of nursing. Hence it is not surprising that whereas a simple matron of the Nightingale class was enabled to gradually make the nursing of a workhouse hospital like the Highgate Infirmary as efficient as any in the kingdom, without any conflict whatever, the ladies superior and superintendents-general have all more or less failed to accomplish even moderate reforms without many bitter conflicts, often ending in numerous resignations, bringing serious monetary losses to the institutions concerned.

All that is really required for nursing reform anywhere is money, a little patience, and the services of a gentlewoman possessed of some experience and much common-sense. Such a woman, with tact, discreet action, and a regard for the rights and feelings of others, will effect the needful changes in two years' time to the satisfaction of everyone, and to the great advantage and comfort of the hospital patients, who, after all, are, or ought to be, the chief consideration. This much Miss Nightingale has proved to demonstration by training a numerous body of ladies who have introduced good nursing into English hospitals in all parts of the country, without bitterness and without strife. Yet it is unfortunately too common an experience nowadays that a lady who is deputed to introduce some particular and doubly warranted system of nursing into an English hospital where there is cause for complaint, signals her advent by some radical and specially aggressive changes which she is pleased to say it is necessary to carry through at once in order to assert her lawful authority, and to take up a just position in the institution. It will be noticed in all such cases that the objectionable step has always been taken to assert the authority and to assure the right position of the individual. It is not to introduce good or even betier nursing, it is not to enable the patients to be better taken care of, but it is invariably to assert a principle of personal government. The writer's experience leads him to believe that hospital committees or treasurers will do well to regard the manifestation of this symptom at the outset as deserving of grave suspicion, as indeed is every system which does not sink the personal identity of the individual in the good of the cause it nominally professes to advance.

It is now twenty years since attention was first attracted to the reform of Hospital Nursing. At that time people were beginning to feel that the days of “Sairey Gamp'ought to be numbered. The writer well remembers how frequently the doctor on entering the ward failed to observe a nurse in readiness to receive and attend him. Whilst hesitating as to his course, a figure would rise from the floor at the end of the ward, would drop a scrubbing-brush into the bucket beside her, and would unroll her apron. Then, coming No. 607 (NO. CXXVII. N. s.)


forth from her corner, she would address the physician, whilst still smoothing down her apron, with the words, “Yes, doctor!' The scrubber and the nurse were in those days one and the same person in the majority of English hospitals. Of course there were exceptions, but as a rule the two offices were combined. Of the night nurses it may be said that they were for the most part non-resident, that they came on duty at 8 P.M., and that they left at 9 in the morning. Having been engaged for the greater part of the day in domestic duties at home, and being allowed no food by the hospital authorities, it is not surprising that this class of nurse was paid half-a-guinea a week for consenting to sleep in the hospital ward instead of in her own bed at home. The writer has known instances where it has been seriously argued that it was not necessary to have a smart nurse for night duty, because, forsooth, there was so little nursing to do at night. And yet it is when darkness approaches that patients become, as a rule, worse, and in bad cases life itself may

be sacrificed because the skilful hand is not ready to apply the needful relief. Nevertheless, the above sentiment as to night nurses was a popular axiom twenty years ago, and hence the non-resident night nurse was the rule in our hospitals and not the exception.

In Scotland the nursing has always until quite recent years been worse than in England. Ten years ago the nursing at the Edinburgh Royal Infirmary, for example, was in all respects unsatisfactory. But an excellent system is now in force there, as we shall see later on.

In Ireland even now hospital nursing needs great improvement. Four years ago the writer paid his first visit to Ireland. Accustomed to the filth of many of the lower quarters of English cities, he was yet quite unprepared for the horrible uncleanness of Dublin. The hospitals, with the exception of the Mater, were abominably dirty ; the floors, the bedding, everything disgusted and pained him greatly. Had some of them been situated in Russia or Siberia, the condition of affairs could scarcely have been worse. Since then, however, thanks to Dr. Grimshaw and the Dublin Hospital Sunday Committee, hospital management has greatly improved, and, judging by the experience of a second inspection last winter, the writer believes that ultimately the filthy will be made clean even in that dear but dirty city. In Dublin at the present time better nursing and better nurses are everywhere being sought for and secured. Briefly, then, nursing reform has actively progressed in England since 1860, in Scotland since 1870, and in Ireland during the past four or five years. Everywhere there are encouraging signs of a needful awakening, and the best results may, therefore, be speedily anticipated.

What, then, are the merits claimed for the modern system of nursing, and in what does it consist? Briefly, that every woman, before she assumes any position of responsibility in the nursing department of a hospital, shall be properly trained for the work. No matter how high or how humble the duties connected with her office, there is a right and a wrong way to discharge those duties, and she must first be trained in the right. Training necessitates intelligence in the trained, and hence the raw material has been necessarily improved, and younger women are selected than of yore.

The new system may be considered from three aspects: the superintendents, the nurses, and the circumstances under which both are employed. Let us examine the last first. It cannot be too widely known that there are hospitals and hospitals. That is to say, there are hospitals having medical schools, and others where no medical instruction is given. At the former there will be a large body of medical students, who will require the utmost facilities for using the raw material, which the wards can alone supply. Here, then, the duties and responsibilities of the nurses will be much lessened. No dressing or other minor surgical or medical work will be required from the sisters and nurses. All such privileges for practice belong exclusively to the dressers and students who have to gain all their practical knowledge of a surgeon's work in the hospital wards. It can easily be understood, therefore, that much work of an interesting kind is necessarily taken from the nurses at those hospitals, called clinical, where there are medical schools.

At the county and other hospitals, where there are no students, all this is changed. There a nurse is of little use unless she can undertake much of the dressing, the taking of temperatures, the testing of various matters, and much of the minor medical work which elsewhere devolves upon the student. The nurse under these altered circumstances has much more to do, and her work is, on the whole, of a more responsible and interesting character. It happens, therefore, that a nurse trained wholly at a clinical hospital, where she has few opportunities of learning dressing, &c., is of little use in an institution where there are no students and few skilled assistants. On the other hand, a nurse who has been trained at a county hospital, where she has, to use a popular phrase, done everything,' is likely to become discontented and disheartened should she find herself suddenly placed in the large ward of a clinical hospital. The results of such a transition may be witnessed at Guy's Hospital at the present time. At Guy's a lady was brought from the Leicester Infirmary, a large county hospital having no medical school, to take charge of the nursing. She brought with her a staff of nurses, trained on the non-medical school model. She heard and she believed that the whole system of nursing at Guy's Hospital must be sent to the rightabouts bag and baggage. Imbued with these opinions, her first impressions were confirmed by the reports she received from day to day from her staff of nurses, who, finding the most interesting portion of their work taken from them, were firmly impressed with the belief that the old system of nursing at Guy's Hospital was rotten to the core. It is needless to dwell upon the result. The conflict which is raging at Guy's Hospital is only the effect of a want of experience of nursing in all its branches. Had the treasurer had

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the wit to realise the position of affairs at the outset, all the lamentable uproar which has since arisen would have been avoided. Had the medical staff been called in consultation on, or better still before, Miss Burt's arrival, no disturbance would bave occurred. As it was, the position of affairs was not realised by the one-sided or only half-experienced nurses of the county hospital, who agitated for their rights, as they considered them; while they failed to see that if they got their way, it would be impossible to have a medical school at all. In a word, at a clinical hospital the nurse must be content to perform the ordinary duties appertaining to her position, and to leave to the student the dressing, the testing, and the temperatures which, in other institutions, it may have been her privilege to undertake. Nursing is a many-sided profession, and no one should attempt to introduce a new system into a large hospital unless they are fully familiar with all sides. Had Miss Burt and her nurses realised this, had they been more patient, conciliatory, and discreet, they might have done much good at Guy's Hospital. As it is, they have not only brought discord into that establishment, but they have discredited good nursing to a degree which can scarcely be realised at present. No one has a greater respect for Miss Burt, or a firmer belief in her ability, than the writer of this paper; but the conduct of the controversy at Guy's points to an absence of capacity all round to realise the exact position of affairs which is almost inexplicable.

English people are growing less and less in love with despotism, and recent experience shows that hospital government by treasurers is at best a doubtful experiment. For years the system may answer well ; but, sooner or later, when so much power is left in the hands of one individual, a serious blunder will be made, which will probably be followed by others, as the blunderer tries in vain to make good a false position which he ought never to have assumed. Hence all who have watched the controversy at Guy's Hospital are convinced, that although at the present time much evil has resulted, still in the end it will prove a fatal blow to the most prominent evils in a system of government which is rapidly falling into discredit. No great public institution ought in fact to be left to the control of one individual, and the sooner such an anachronism is modernised the better for the welfare of the charity. No more striking proof of its failure exists than that afforded by the knowledge that inmates of the institution have been permitted to remain on duty within its walls after they have wantonly endeavoured to injure its fair fame by unworthy and false statements out of doors. A house divided against itself is sure to fall. A system which allows any part of its organisation to prey upon the remainder deserves to, and will most assuredly, fall to pieces. Of the many sad instances of weakness which the Guy's Hospital controversy has brought to light, that which permitted Miss Lonsdale to remain a member of the staff after the publication of the article in the Nineteenth Century,' is

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surely the worst. In no other institution in the country would a member of the staff be allowed, without remonstrance, to publicly challenge the conduct of all concerned in its management, from the president to the humblest official. That there should be an exception to this rule shows that the undue heat which a prolonged controversy has aroused has blinded the judgment of the head of its administration to the importance of remembering that, after all, self-preservation is the first law of nature.

And yet the article on · The Nursing Crisis at Guy's,' if severe in its strictures on the staff, was certainly far more condemnatory of the feeble and incompetent supervision of the treasurer and governors. The writer cannot help feeling that, uncontradicted, the article was one of the severest censures ever passed upon the treasurer and governors of a charitable institution. Yet no steps were, or have been, spontaneously taken by these gentlemen to protect their own or the institution's honour. The knowledge of this fact is a startling proof of the personal character of the controversy which is still raging at Guy's Hospital.

In passing on to the consideration of the first aspect under which it is proposed to examine the new system of nursing, it becomes necessary to say at the outset that the following remarks are based upon considerable personal experience, and that the facts can be verified if necessary. In considering a large question like hospital nursing, the truth ought fearlessly to be stated, or the evils of the new system will never be remedied. What, then, is the first aspect we have to consider?—the superintendent or head of the nursing department. How is this official trained for her work? She is, first of all, admitted as a lady, or as an ordinary probationer, and she receives at least twelve months' training in nursing. This course of preliminary instruction is both desirable and necessary. It is desirable, because to control others in any station of life, we should have an accurate knowledge of the details of the work entrusted to each person under our charge. It is necessary, because unless a matron or lady superintendent has an accurate knowledge of nursing in all its branches, she will never make a competent chief of department. It is found, however, in practice that although the remuneration offered by hospital committees grows increasingly liberal, there is often a dearth of good and competent candidates for these appointments. Probably this statement will cause surprise, because it is known that of late years an increasing number of ladies have offered themselves as lady probationers. This is doubtless true, but it must be remembered that a multitude of weakness does not make strength. That a larger number of ladies come forward to offer themselves for training every year cannot be denied, but the writer's experience leads him to believe that if the candidates have increased in number, the proportion of those who ultimately grow into competent nurses is less than formerly. Indeed, it may be well to state that the applicants

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