[Sidenote: Isolation of each Head Nurse and her Nurses.]
1. The isolation of each head-nurse and her nurses appears to me very
important. The head-nurse should be within reach and view of her
ward both day and night. Associating the nurses in large dormitories
tends to corrupt the good, and make the bad worse. Small airy rooms
contiguous to the ward are best. The ward should have but one entrance,
and the head-nurse’s room should be close to it, so that neither
nurse nor patient can leave, nor any one enter the ward, without her
knowledge.
[Sidenote: All to Rank and be Paid alike, with Progressive Increase of
Wages.]
2. All the nurses should rank and be paid alike, with progressive
increase of wages after each ten years’ good service, or a slow annual
rise, which is better.
[Sidenote: Night Nurses.]
3. The night-nurses should be on duty 12 hours, with instant dismissal
if found asleep; 8 hours should be allowed for sleep, and 4 hours for
daily exercise, private occupation, or recreation. If they have no time
to themselves for their mending, making, &c., they do it at night,
sometimes innocently, sometimes to the injury of the patients. I would
not however prohibit occupation at night; as sometimes the ward-duty is
slight; and doing something is far better and more awakening than doing
nothing. This is one of the matters the head-nurse should constantly
look to. I do not fancy, but at present am not positive about, cleaning
or scrubbing at night. The night-nurse should have a reversible lamp,
or something that without disturbing the patient, gives her light,
brighter than the dim fire or gas-light properly maintained in the
wards at night. She should have a room to herself.
[Sidenote: Day Nurses.]
4. The day-nurses should have eight hours’ sleep, and if it be
possible, 4 hours daily for exercise, private occupation or recreation.
They may have one room.
[Sidenote: Nurses to fetch nothing.]
5. All provisions, &c., &c., should be as much as possible brought into
the wards, or to the ward-doors, by lifts. Nothing should be fetched
by the nurses. This would save much time; would enable the nurses to
do more work, and yet have more leisure; and above all, would obviate
the great demoralization consequent on the nurses, patients, and
men-servants congregating in numbers several times daily.
[Sidenote: Patients to fetch nothing.]
6. The patients should be made as useful as possible, consistently with
their capacities, inside the ward; but should be permitted to fetch
nothing to it.
[Sidenote: Scrubbing.]
7. I strongly incline to have the scrubbing done in each ward, by a
nurse assigned for that purpose, and for general attendance when the
scrubbing is done. There should be hours for the scrubbing, before and
after which it should not be done. This whole matter is one on which I
am not positive at present.
[Sidenote: Distribution of Ward Work.]
8. At present, I incline to something of the following scale. Two
wards, single are best, but it might be one double ward, with 40 beds,
served by 1 head-nurse and 3 nurses. The head-nurse to superintend all
things, and to do the dressings not done by the surgeons and dressers,
assisted mainly by one nurse, whom she thus instructs in nursing.
Another nurse to do the scrubbing, and mainly the cleaning, and when
these are over to mind the ward during the remaining hours in turn or
in conjunction with the first nurse. The third to be night-nurse. In
the morning, before dressing begins, and before the night-nurse goes
off duty, all three nurses to clean the ward, make the beds, wash the
helpless patients, &c.
[Sidenote: Hours of Dressing and Poulticing,]