[Sidenote: The Help Question]
When one considers the numbers of boxes of good brass pens, the quarts
of ink, and the reams of paper (to say nothing of such cheap things as
brains and time and vitality) that have been consumed within the last
score of years, in bringing forward “solutions of the servant problem;”
when one sees that self-same problem, still to the front, dangling
in the air as it were, refusing to settle itself or be settled, it
surely ought to be sufficient to deter all but the most audacious from
touching it. Instead of being solved, it is growing larger and more
difficult to deal with. It is not much wonder that men suggest that
women demonstrate their ability to manage their own domestic domain,
and get the servant question settled, before seeking to get into
politics and take a hand in the government of the state and nation.
However, a prominent member of the board of a certain hospital remarked
optimistically not long ago, that “since the Irish land question seemed
to be getting worked out,” she had some hope that somewhere, around
some unexpected corner, some bright man or woman would discover a means
of really solving “the servant problem.” But up to the present moment
that discovery has not been made, and let it be understood here and
now, that a solution of that problem is not attempted here. Neither is
any special claim made for originality, for the subject has been so
thoroughly gone over that it seems there is nothing new to be said.
But difficult as the subject may be to deal with, either theoretically
or practically, it cannot well be ignored in dealing with hospital
housekeeping, since it consumes no small portion of the time and energy
of the housekeeper, and is of vital importance to the institution.
[Sidenote: Numbers of Servants]
Perhaps the best place to attack the subject would be to calculate
how many servants are necessary to do the work in a certain hospital
of a certain capacity. But at the outset one is baffled at that
point because institutions differ so very greatly. Some buildings
are much more difficult to keep clean, more difficult to get work
done in because of mistakes in construction that entail more labor.
Servants also differ in their ability, standards of work vary, and the
organization of the working force varies. Some institutions require
nurses to do all the sweeping of wards and private rooms, others have
it all done by maids. Some hospitals require nurses to wash ward
dishes. In others nurses do none of that work. In a place where soft
coal is used more help will be required to maintain the same standard
of cleanliness throughout the building, than if that difficulty had not
to be contended with. Some institutions have no laundry work done on
the premises, others have it all done at home. Some hospitals bake all
their own bread, others bake none. All these and many other things have
to be considered in reckoning the number of servants required. Each
institution must be largely a law unto itself in this matter.
In a paper read at the Philadelphia meeting of hospital superintendents,
Mr. Lathrop threw out a suggestion about engaging servants that might
well be adopted by hospitals in general. In referring to the system
of hospital records and reports used in Roosevelt Hospital, he said:
“A book, entitled ‘A List of Officers and Employees,’ alphabetically
arranged, contains the signature of each to a contract at the head of
the page. The contract reads as follows:
[Sidenote: Contract]
“I, the undersigned, accept the terms herein mentioned, agree to do
faithfully the work assigned to me and to conform to all rules of the
hospital while in its employment; and it is distinctly understood and
agreed that whether I am paid by the day, week, month or year, my
engagement is to terminate upon notice by the superintendent that my
services are no longer required; and upon payment being made to me for
the actual time of service rendered, I agree to accept and receipt for
the same in full consideration for all demands against the institution.
The hospital reserves the right to deduct for absence from whatever
cause.”
This contract reduces to a minimum the difficulty in getting rid of
undesirable help without unpleasantness. The last clause is especially
important. The only possible way of making an impression on some
servants, and keeping them up to the mark in punctuality, is by
touching their pocket. When the absence or tardiness occurs from a
legitimate cause, as in illness, it may not be best, if the time lost
is trifling, to make any deduction, but at any rate the servant should
understand that part of the agreement, and when it is not enforced he
will be likely to have a due appreciation of the fact.
_Merit System_
When a hospital pays a fair rate of wages to its employees it is in
a position to insist on certain conditions, and to maintain certain
standards regarding work in all departments. If it pays the lowest
market price for such labor it must expect its servants to remain only
till something better is found. The merit system has been successfully
used in other lines of work, and ought to yield equally good results
in a hospital. If after giving a servant a fair trial, he is found
faithful and anxious to please and capable, he ought to be shown that
these qualities are appreciated. If he was engaged for fifteen dollars
a month, a raise of wages of one dollar every three or four months
until it has reached a certain point, would give him some inducement
to stay. The habit of expressing satisfaction with work well done is a
powerful incentive to continuance in well doing and better service in
the future. Servants are all human. They need reproof and correction,
but need quite as much the kind word of appreciation of their efforts.
There are but few people who will long continue to do their best if
they think nobody cares or notices it.
[Sidenote: Schedule of Work]
When servants enter the employ of the hospital, it is a good plan to
have some kind of schedule of the routine work ready to give them.
Certain duties will have to be performed every day, others on stated
days of the week. Usually the housekeeper is subject to demands of all
kinds. It is necessary for her to study how to get routine work done
well, with the least tax on her memory or vitality, and the schedule
will help in that direction. Proper instruction at the beginning is
always important. Many a servant has become discouraged in a few days
and left his place vacant, when a patient explanation of what to do,
and how to do what seemed to be expected of him, would have developed
a capable worker. It is never a good plan to have such fixed ideas
as to how a desired end should be reached that no other method will
be accepted. If servants have been accustomed to one certain way of
doing things, and their way yields as good results as some others, it
is well for the housekeeper to let them follow their own plans unless
it is found to entail a waste of time and material. In a hospital
where there is such a multiplicity of details to be attended to, no
housekeeper can afford to waste much time over non-essentials. The
point is to be able to recognize non-essentials and not to ignore
things of importance. If she sees that time and material can be saved
by doing things according to her methods, a suggestion and a little
teaching ought to effect the desired change. If it does not, if they do
not try to improve, and refuse to apply the instruction received, then
it is better to let them go and try to secure more tractable material.
There is seldom a time when all help is just what the housekeeper
wants, and it is safe to predict there never will be. Some will need
more supervision than others. Some will remember a thing if told
once, others will need to have it repeated again and again. One would
naturally expect that a thing that had to be done every day would
soon be done as a matter of habit, but this is by no means the case,
as every housekeeper knows. It is not enough to say: “This thing must
be done every day.” Somebody must be on the watch to see that it is
done. Some servants when they find a neglect passes unnoticed will be
very likely to repeat it, and the lack of proper supervision accounts
for the general slipshod condition of the domestic department of many
institutions. Usually there are enough hands to do the work if they
were kept up to the mark and properly supervised.
In the matter of cleanliness and neatness a great difference in
standards is observed in visiting institutions. Suffice it to say that
in a hospital, above all other places, there should not be a spot from
attic to basement that the superintendent would not wish to throw open
for inspection. Ice-boxes, kitchens, pantries, storerooms, basement,
laundry, all should be models in respect to cleanliness and good order.
Military rule, or organization based on it, is supposed to prevail to
a large extent in the training school, and it is equally important for
it to prevail throughout the other departments of the hospital. While
with nations, civil laws undergo changes as the spirit of the times
change, yet the fundamental principles of military organization remain
unchanged. There is a distinct gradation of officers, and every man is
recognized only in his station. If a private soldier has a grievance or
a report, he is expected to state it to the officer immediately above
him. The captain cannot officially approach a general and ignore the
intermediate officers. The general gives his orders to the officer next
to him in rank, and they pass down the line from rank to rank. Only
thus can a general hope to command the army of a nation successfully.
Each man is expected to be in his place and attend to the duties of
his position and not meddle with the affairs of others. Practically
the same system prevails in large business corporations, and no better
basis for organizing a working force of an institution has been
discovered.
[Sidenote: Rules]
Much as the average American dislikes rules, the fact remains that some
are necessary. The business is greatly overdone in some hospitals, in
others too much laxity exists, and this inevitably tends to lower the
tone of the institution. For the domestic department it is wise to have
cards with a set of general rules printed and framed and posted in
conspicuous places to serve as reminders. Each hospital superintendent
will have his own ideas of what general rules should be made for the
government of his hospital employees, but a specimen set of rules may
not be out of order.
1. All services are at certain rates per month or week for
time actually served. Employees desiring to leave shall give
one week’s notice to the superintendent. The superintendent
reserves the right to summarily discharge any employee for
any cause when his presence is detrimental to the interests
of the institution.
2. No reading or smoking in bed at night is allowed and
smoking or chewing of tobacco is forbidden during working
hours.
3. No duplicate keys for any part of the hospital shall
be made except for and by the hospital. All persons having
hospital keys shall deliver them to the superintendent if
absence over night is anticipated.
4. No employee shall enter the room of another at the
hospital without knocking and waiting for reply. Female
employees shall on no account visit men’s rooms nor male
employees women’s rooms.
5. No employee, unless duty requires it, shall enter the
wards without permission of the superintendent, nor shall
they enter departments where they have no duty except on
business.
6. Employees shall be prompt at meals. Those coming late
will be expected to explain the reason. No cooking, heating
or keeping of tea, coffee, or food shall be allowed on the
premises other than in places provided for them and by
persons employed for such duties.
7. All employees will, when practicable, be allowed two
half days off duty each month and when convenient a part of
each Sunday, subject to the needs of the institution and the
discretion of the superintendent.
8. Discharged employees are not entitled to the freedom of
the premises and must stop in the waiting-room, like other
visitors, while those discharged for cause are not admitted
except as patients or on business to the superintendent.
9. Employees shall attend to matters out of repair in
their departments, and report all articles broken or
injured to the head of their department. Nails shall not be
driven into the building or furniture without permission.
Scratching of matches on walls is forbidden.
10. The house will be closed at 10:30 p. m. Employees
desiring late leave must get permission from the matron or
superintendent. No employee shall go in or out any window,
except those used as doors, unless engaged in working about
the same.
11. Employees shall not keep in their possession nor have
on the premises, spirituous liquors, and the intoxication of
any employee shall be the cause of instant dismissal.
12. Loitering around the kitchen during working hours, or
at any time, by those not employed there is prohibited.
Kitchen employees are not allowed to linger around the
kitchen when off duty.
13. All persons connected with the hospital are expected
to be civil and polite at all times. Sleeping rooms,
wardrobes, dressers, closets, cupboards, etc., shall be
subject to inspection at any time. Rooms shall be in order
and beds made by 10 a. m. and shall at all times be kept
clean, orderly and free from vermin.
14. No one connected with the hospital shall remove the
property, however small, from one room or ward to another
without the permission of the superintendent.
15. Employees are expected by precept and example to
assist in keeping the hospital quiet and orderly and free
from dust, dirt and foul air. Boisterous or profane language
and whistling or singing cannot be permitted.
16. Cleanliness and neatness in appearance, habits and
work are imperative. All employees are expected to be
punctual in reporting for duty. Visitors to employees are
not allowed during working hours. In exceptional cases
permission may be obtained from the superintendent.
17. All articles broken or destroyed will be charged to
the person breaking them, at cost price.
Having made rules, it becomes necessary to see to their enforcement.
Exceptions should be few and far between. A rule that is not enforced
weakens the institutional government, and had better never have been
made. If it is good and necessary let it be enforced, if it is neither
good nor necessary let it be abolished.
The question of incompatibility of temper among servants is a common
perplexity. When it occurs it is just as well to plan for a separation,
letting the one who seems to be the strongest element of discord go.
In feeding help there should be always plenty provided—the quality
being about what is provided for ward patients. A separate bill of fare
for them would entail extra cost, both for material and labor, and they
would be none the better for it.
[Sidenote: Servants’ Dining Rooms]
Is it too much to hope, that, sometime, all hospitals will have
a servants’ dining room, where, apart from the heat and odor of
the kitchen, they can take their meals in comfort like respectable
people? Many of those who have labored on the servant problem seem
to have begun at the top for a solution, instead of getting down to
the foundations to build up a system. They have sought to establish
training schools and give diplomas, believing that was the one thing
needful to dignify the position of servants and make them happy and
contented in that kind of work. There is certainly no objection to
plans for training, providing they are not allowed to obscure other
features bearing on the problem. But one does not need to live more
than a day in some homes or institutions to find one reason for the
prevailing discontent among servants as a class. A hospital that
provides an attractive dining room for its help (which could also be
used as a reception room for their friends), that sees that they have
good bath rooms, lavatories, toilet rooms and sleeping rooms, may
expect to attract a superior class of servants, who will have some
inducement to remain where provision has been made for their comfort.
They will have more respect for themselves and for the institution and
better service can be expected.
[Sidenote: Sleeping Rooms]
There is a possibility of people becoming so charitable that they
forget to be just. Some are so intent on providing the most modern
equipment for the care of the unknown indigent patient that they
entirely overlook the necessity of proper living conditions for those
who must help in caring for the unknown indigent. How many hospital
managers would throw open with pride, for the inspection of a party
of visitors, the doors of their servants’ sleeping quarters, as they
do the doors to the free wards? While text-books and teachers are
emphasizing the necessity of pure air, the need of a certain number
of cubic feet of air-space for each occupant of every sleeping room,
hospital authorities are defying these self-same rules of hygiene, by
compelling their servants (and often nurses, too) to sleep in crowded
quarters without proper means of ventilation, and which sometimes the
direct rays of the sun can never penetrate. It is nothing uncommon
to find six or eight people crowded into one dormitory not larger
than 10x15, and that not only in a New York tenement but in a modern
hospital. Every intelligent person professes to believe that “Pure air
is as important as pure food in the production of vital energy of the
body and mind, but it is another case of not living according to one’s
belief. What we greatly need is a realization of the fact that hygiene
is not alone a science to be studied, but an art to be practiced, in
the hospital, in all its departments and elsewhere.”
[Sidenote: Attire]
The working attire of the servants may seem a trifling thing to
mention, but it too is an indication of the standards of the management
in that respect. A hospital is no place for a slovenly, untidy man or
woman. If they have not sufficient self respect to keep themselves
clean and neatly clad they certainly cannot be expected to cook and
serve food in a respectable, appetizing, healthful way or do their
work in a cleanly manner. “The apparel oft proclaims the man.” It oft
proclaims the institution, too. If the hospital is to make a desirable
reputation and maintain it, heads of departments must be on the alert
in minor as well as major matters. A chain is no stronger than its
weakest link, and each individual in the long human chain of hospital
employees is either helping to make or mar the good reputation of the
institution.
[Sidenote: Housekeeper’s Relation to Servants]
The housekeeper’s relation to the servants is too large a subject to
more than touch, but it is altogether too important to be left out
entirely. It is well to bear in mind the fact that laxity does not mean
kindness, nor does it always mean “good nature,” as some people appear
to believe. Neither does severity mean dignity. It is quite possible to
be dignified and approachable at the same time. It is quite possible to
be systematic about methods and work, and strict in the observance of
the rules of the institution, and at the same time thoroughly kind and
tender hearted and womanly. The housekeeper who lets her servants know
that she sympathizes with them in the trials and difficulties incident
to their life will have much less trouble in governing them than the
one who maintains a frigid air, shuts her eyes and ears to things that
are large to them, and treats them like machines. There are a hundred
ways in which she can touch their lives helpfully, and influence them
to higher ideals if she chooses. Questions of dress, health, morals
all suggest themselves at this point. The all too prevalent tendency
with the servant class to spend their hard-earned dollars in silks,
cheap feathers and tawdry finery, to follow the fashions, even if they
have to go in debt, is something that can be observed in the hospital
as elsewhere. This often has a bearing on health. Many who have spent
their all in jewelry or finery which they did not need, are obliged to
go without proper shoes, stockings, under-clothing and things that are
really essential for health and comfort. If the housekeeper has won
the respect and confidence of her help, she ought to have a decided
influence in checking this tendency among her maids and promoting
habits of thrift and wise expenditure.
Proper hours for retiring is another matter that will come in the
housekeeping province as it relates to servants, and one that no
institution can afford to neglect. Late hours are neither conducive to
good health nor good morals, and certainly do not help in getting good
work done. For all these reasons the housekeeper, where the help are
housed on the premises, should insist that the same hours that nurses
are obliged to observe in getting home, and getting lights turned out
should be observed in the servants’ quarters. Whether she wants the
responsibility or not, whether she thinks it or not, the influence
of the head of the domestic department is felt in the lives of her
servants. Characters are being molded and built up that will leave
their impress on future generations. The world of the average servant
is as a rule very small. They live on the surface of things. Trifles
seem large sometimes. At other times very serious and far-reaching
questions seem to them quite unimportant. Education of the conscience
and of the hand can go on, ought to go on, together.