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writer recognises and is fully conscious of the great good which the sisterhood of St. John's House, for example, has effected. To it we owe much improvement in the comfort, the circumstances, and the position of matrons and nurses alike. By its wise selection of competent ladies many hospital committees have been placed under great obligations. But when all has been fully allowed that can be allowed in favour of sisterhoods of this character, it cannot be doubted that the result attained is scarcely adequate when the cost is considered. An imperium in imperio is never a system to commend itself to the judgment of a wise administrator, and the unhappy conflicts which have been waged in the past justify the most prudent of hospital managers in their preference for other methods of attaining the desired result. Thus the Nightingale or common-sense system has great advantages. Given a competent matron, who understands her work, it places such a woman under proper control, and leaves her within reasonable limits and after consultation with the medical staff to effect the needful changes in the nursing department. This plan is sure to work well. To quote an instance. At the Royal Infirmary, Edinburgh, under the able guidance of the General-Superintendent, Mr. F. C. Fasson, such a system has revolutionised the whole nursing department, to the great credit of everyone concerned, without any disturbance or conflict of authority. Years ago Miss Jones, of Liverpool, built up a model school of English nursing on this system with success. At Winchester, at York, at Norwich, at the Queen's Hospital, Birmingham, and at many other places, the common-sense system has done wonders in a short time, and without causing bickerings or discomfort. The method adopted is almost everywhere the same. It is assumed at the outset that a nurse will attach herself to the school at which she is trained. Like a student at college, there is none in her estimation to equal, much less to rival, that at which she was trained. The system, the training, the arrangements, leave little, in her opinion, to be desired. Hence a constant supply of competent nurses is always available at the institutions where the common-sense system is at work. It is known to the more experienced hospital managers that a nurse who is really good all round will not be allowed to leave the hospital where she was trained for the sake of a few pounds a year in wages. Hence it usually happens that, when a trained nurse is advertised for, the applicants for such a post if really 'trained' in the right sense of the word, have been allowed to leave their alma mater because they possess some special vice. It may be temper, untruthfulness, flightiness, disobedience to orders, want of application, insobriety, or some other failing which has proved too much for the patience of the authorities at her first school. Whether it be one or several of these traits of character, experience proves that they are sure to be present. Hence, to advertise for a trained nurse is almost to tempt providence, as it often leads to the introduction of an element into the hospital world which had better have been left outside. Unless a hospital
trains its own staff of nurses, this part of its administrative work must always be in an unsatisfactory state. Those who question, this assertion can have had little practical experience in hospital manage
The following history of one year's work at an institution having an average of between 150 and 200 occupied beds will prove instructive and interesting. During twelve months ending April 30, 1880, 121 respectable young women-farmers' and tradesmen's daughters, milliners, upper servants, and others-applied to be taken on as probationer nurses. These young women came from all parts of the country, from the counties of Cornwall, York, Lancaster, Warwick, Norfolk, Sussex, Northumberland, Hampshire, and Kent, and many other places. It may therefore be concluded that they fairly represent the average type of the classes to which they belong. The results are not encouraging, but they will show the public that, although very many young women think themselves capable of becoming good nurses, very few can stand the preliminary test of one year's probation. Of the whole 121, 50 applicants were not written to, as they appeared on the surface to be unsuitable for the work. Of 71 to whom forms were sent, 58 did not continue their application, as they found the work too hard or to offer insufficient attractions to induce them to undertake it. Two others were rejected by the authorities as too young, and one proved unsuitable before entering on her duties. Of the whole number but ten remain to be accounted for. Of these but four have turned out really competent nurses. Of the remaining six, two broke down in health after a few months' trial, two left to be married, one had no capacity for the work, and the last, a young farmer's daughter, aged twenty-four, was found to be a confirmed drunkard. It will be seen from the above figures, that out of the whole number of applicants less than 3 per cent. proved efficient, and of those who were retained for twelve months only 40 per cent. stood the test.
The authorities of the Nightingale Fund find that about 60 per cent. of their probationers ultimately continue as trained nurses. The reason is not far to seek. Nursing is an arduous, a responsible, and a trying occupation. The confinement, the anxiety, and the disagreeables prove too much for the feelings, the health, and the patience of a great number of young women. Although a good income, a reasonable amount of independence, the prospect of a pension after long service, and fair chances of promotion are offered as inducements to remain, unless a woman really takes kindly to nursing all these will prove insufficient to retain her services. Anyone who considers the question fairly will at once perceive that hospital managers have great difficulties to overcome. For this reason, when once they have successfully trained a good nurse, as we have before said, they will take great pains to keep her in their service. Hence the trained nurses' who offer themselves for engagement are not usually in all respects desirable, and so some of the
nurses from the so-called Nurses' Homes, which are sent into private families, prove anything but satisfactory.
Of course, a hospital committee can avoid all the trouble incidental to training a number of nurses for their work by contracting with an association or a sisterhood to supply what they require. This method, however, costs at least a third more, and it necessitates-if King's College Hospital may be taken as a fair sample of the system-that the medical staff, and for that matter. the managers generally, shall allow the nursing to be put first in everything. Briefly, it means first the nursing, and then what you please, but nothing must interfere with the nurses or their superiors. Few hospitals will submit to such a system. Under it, the students and the resident medical officers suffer many injustices. The failings of previous holders of the resident appointments form a sort of accumulated list of vagaries, which the lady superior considers it her duty to guard against. In the case of a new comer he is warned that he must not commit any one of these offences; and as each little failing is carefully noted, the list soon assumes alarming proportions. On the other hand, the sisterhoods really nurse their patients most efficiently. The number of nurses, the system of training, and the class of women engaged all commend the system to imitation and approval. Its great fault is that it arrogates to itself an authority which it is not entitled to possess, and which it is desirable the nursing department should never assume in English hospitals. It further necessitates frequent changes in the personnel of the staff of each ward, a method of nursing which is fatal to the comfort of the patients and the medical staff. It, however, enables the lady superior to show her authority and to exercise it at pleasure, and so this last regulation forms a prominent feature in the nursing system of all sisterhoods. If any hospital managers desire to appreciate fully the evils of nursing sisterhoods, and the dangers of allowing them to take too prominent a place in the English system of hospital administration, let them visit the French hospitals, and make inquiries there. Anything more unsatisfactory can scarcely be conceived, and the cost is too great to render a general extension of the system probable or desirable.
In saying this much the writer wishes to declare his conviction that all systems should find a home on English soil. He rejoices that St. John's House, for instance, is prosperous and in vigorous health. It has done much for English nursing, and the opportunities it possesses, of showing what a sisterhood can do, are most desirable and satisfactory. It is efficient and expensive as a system of nursing, and its drawbacks have already been referred to. These drawbacks render a universal adoption of this system impossible; and the writer, whilst recognising fully its many merits, rejoices in the knowledge that this is necessarily the case.
On the other hand, the common-sense system, which Miss Nightingale recommended and instituted, is the one best adapted to
Ladies trained at St. John's House have found no difficulty in carrying such a system into practice. The reason is obvious. Given a gentlewoman possessed o. common sense, some administrative ability, and a good knowledge of nursing, and any hospital committee can easily and at small cost make its nursing arrangements as efficient as any in the country,-at small cost because the gradual training of nurses for the work enables a greater number to be engaged in the hospital wards without much increased expenditure. Such a system will commend itself to the approval of all connected with a medical charity, because the sole reason for its existence is not that it may train private nurses, but that the hospital patients may be efficiently nursed. For this reason everything is sacrificed to the good of the patients and to the interests of the hospital. All engaged in the work are animated by a feeling of pride in the prosperity of the institution with which they are connected. It is to them the one object to which their whole energies are devoted, and so nothing but good results from such a system. No divided allegiance is theirs. No sisterhood claims their first and best attention. On the contrary, from the highest to the lowest, one sentiment animates the whole staff—a desire to see their hospital take the first place for efficiency in all its departments. This is the grand end to be every where attained. Such being the case, knowing it can only be secured by the system here advocated, we commend it with confidence to the adoption of hospital authorities throughout the country.
The following brief details, as to the system of nursing actually pursued at Guy's Hospital and the London Hospital previous to November 1879, may interest many readers who have had their attention directed to the subject by the course of recent controversy, in which we have not felt it necessary to engage. We have preferred to give our own views and a statement of facts bearing on the wider question, the result of much experience:
Guy's Hospital.-For the past ten years each ward of twentyfour beds has been nursed by a sister, a day nurse, a night nurse, and an assistant nurse, commonly called a probationer. To these must be added a ward-maid to scrub the floors, and to do what is known as the menial work of the ward. All nurses, whether they have served in a similar capacity or not in other hospitals, must, before appointment as a trained nurse, have remained a given time on probation at reduced pay. The period of probation varied with the attainments of the probationer, but it was never less than six months. In the selection of probationers, preference was given to a good class of domestic servants, varying in age from twenty-two to forty, married women, where possible, being allotted to male wards. In training a probationer, great attention was always given to the necessity of securing as varied an experience as possible, and she was moved about from one part of the hospital to another to accustom her to medical and surgical work. In addition to the regular staff, twelve special nurses were retained for extra duty, half of which number were
trained nurses, the others being placed under the sisters in different wards. The sisters have always been selected from ladies in the middle class of life, who ave had previous opportunities of practical housekeeping, and who were required to serve for a time, six months or a year, under the regular sister before they were finally appointed. They were not engaged before the age of thirty, or after forty years of age. The duties were of a multifarious character, as the sister was the medium of communication between the medical officer and the patient, and she was constantly in communication with the executive of the hospital. Several widows and daughters of medical men and clergymen have held and still hold this office, and all have received an excellent education, and are respectably connected.
The London Hospital.-There is a regular training home and school for nurses in connection with this hospital, which is in charge of the matron. Each sister has charge of a ward under the direction of the matron. The nursing staff consists of day, night, and probation nurses, and no probationer is appointed a nurse until she has undergone a thorough training in all the duties of the office. Nearly all the present staff have been trained at the hospital. The majority were formerly domestic servants of the most respectable class. At the end of twelve months' training, if competent, the probationers were engaged as nurses, but their training was not considered complete until the expiration of three years' service, when they received a certificate of competency. No one was engaged as a night nurse unless she had been first trained as a probationer, and the night nurses received higher wages than the day nurses. There are, and have been for many years, two night sisters or superintendents, who inspect and visit the wards during the night, so that it is impossible that the night nurses should neglect their duties, or that the day sisters should be disturbed. The sisters are nearly all ladies, who have been thoroughly trained in nursing, and who are competent in all respects to discharge the duties devolving upon them. Five ladies were always in training for the office of sister, and by this means a good reserve in case of a vacancy was always available.
The foregoing brief statements of the actual condition of the nursing at the two great metropolitan hospitals attacked by Miss Lonsdale are taken from the Medical Times,' and have been verified by personal investigation. They sufficiently dispose of an article which has attracted far too much attention, and we purposely refrain from comment. A reference to the April number of the 'Nineteenth Century,' and a comparison between facts and fiction, will best dispose of the points at issue. Dr. Steele, the Superintendent of Guy's Hospital, so long ago as the year 1869, in an excellent and valuable paper on Hospital Nursing,' showed how groundless even at that period were many of the serious charges made by Miss Lonsdale. The nursing of twenty years ago has been made to do duty for the more modern system of to-day, and necessarily a very pretty quarrel