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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
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 have 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
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
who enter as lady probationers may be roughly grouped in two divisions :
1. Those ladies who take up nursing from religious motives.
2. From preference for the work, and with the view of earning a livelihood.
There are those who undertake nursing for a time from more or less personal motives, but we need not concern ourselves with them here.
The two classes we have mentioned are practically united in aim, and are the backbone upon which hospital committees have mainly to rely for the superintendents of nursing. It often happens, however, that a severe conscientiousness prevents members of the first class from ever doing the full amount of efficient work for which they are specially fitted. To give one example out of many known to the writer. A lady by birth and education, who had to earn her own living, chose nursing by preference, and on religious grounds as the means to that end. She was thoroughly trained, and became one of the most competent nurses in the country. Capable as an administrator, conciliatory in manner, tender as a nurse, and possessing the power of winning the affections of her patients and of the nurses under her, she never became the head of a large institution. Why? Because she was so punctiliously conscientious, that is to say, she stood always in her own light. She was ever troubled about trifles. Thus, when she was selected as one of two for a post of responsibility, she invariably appeared in garments resembling those of a religious order, although she held herself aloof from all such organisations. When remonstrated with by her friends, she would claim the right of independent judgment, and declare that as long as she was a nurse, she would wear a distinctive uniform. If asked by one of the electing body if she was a member of a sisterhood, she would resent such inquiries, and would by her manner excite a prejudice against her. If a cause was unpopular, and should any of her friends be associated with it, she would often join them, especially if there had been any little disagreement between them recently. Her reason for this course was that it humbled her, and if she brought discredit upon herself thereby, she held that she deserved to suffer for her former fault. Actuated by the highest principles she lacked common sense, and when eventually appointed lady superintendent of nursing to a large hospital, her conscientious discharge of duty rendered her administration a failure, because her zeal was not tempered by discretion. There are many such characters in the nursing world. It is to be regretted that so much that is admirable should be rendered absolutely useless because religious enthusiasm seems in such cases to remove all adequate appreciation of the necessarily practical character of our dealings with others.
The second class stands out by itself. It includes the majority of lady probationers, and it is being rapidly recruited as to numbers
each year. Nevertheless, it must be remembered that as one swallow does not make a summer, so a year, two, nay, five years' training in nursing will not necessarily produce a competent matron or lady superintendent. To the qualities of a skilled nurse several other most important qualifications must be added. To wit, a knowledge of the world and of character, the power to organise without friction but with efficiency, firmness, tact, discretion, and unselfish adherence to duty. All these and many more qualities will be necessary before a lady can hope to be a success in such an office. It is not surprising that it is found more difficult in practice in the present day to secure the services of a really competent woman for the head of the nursing department than to introduce a new and efficient system of nursing. It follows likewise that where efficient nursing has found a home, it has often only remained efficient so long as a competent lady has been in charge of the department. Change your superintendent, and no matter how efficient the system, it will become a dead letter in twelve months unless the new comer is up to her work. The field is a large one, the remuneration is fairly liberal, but the labourers are at present few. Some four hundred posts, varying in value from 351. to 150l. per annum, exclusive of board, residence, &c., are now open in the United Kingdom in connection with the medical charities alone. Yet so few, comparatively speaking, are the candidates available, that there is little, if any, choice. Everyone regrets the fact, and no one who has a knowledge of such matters fails to recognise that the absence of competent gentlewomen for such posts is much to be regretted. Knowing this, all who are actively engaged in the practical details of hospital administration have read Miss Lonsdale's article with pain, because she has (unwittingly no doubt, but none the less certainly) lessened the chances of a sufficient supply of competent ladies for these posts in the future. The chief of the nursing department of a hospital has great responsibility, her duties are onerous, and her competency is a necessity if the new system is to be successful anywhere. For these reasons, her position, prospects, and training form probably the most important factor in successful hospital nursing in the present day.
Lastly, what position do the nurses occupy in the new system? Necessarily an important one. Without their aid, and unless they are efficient, good hospital nursing must be conspicuous by its absence. At the outset, the writer's preference for a common-sense system of nursing, in preference to a sisterhood or other outside organisation, was declared. His experience convinces him that any institution can, to say the least, secure as good a system of nursing within its walls, by placing the department under the direction of a competent lady selected by the committee, as it can by calling in the aid of an outside authority, which, like all outsiders, will not only cost a great deal of money, but will also demand large privileges. A nursing sisterhood or training school is too apt to use the hospital wards as a means to the particular end of such bodies-private nursing. The