[Sidenote: and of Medicine.]
10. Hours of administration of medicine, always except at night given
by head-nurse, to be fixed.
[Sidenote: Hours of Exercise, and Holidays.]
11. Hours of exercise of head-nurse and nurses to be fixed, and
arranged with reference to the ward-duties. A fixed occasional holiday
given in turn to the nurses is good. An annual longer holiday for them
and for the head-nurses is good; a fortnight is, I think, a good limit.
The holidays cause inconvenience, no doubt, but on the whole do, I
think, far more good than harm. The holidays should be distributed in
rotation during a fixed time of year, and comprehended in two or three
months, or four at the very outside; and no woman declining her holiday
at the proper time should be allowed it at any other.
[Sidenote: Permission of Matron for extra time out.]
12. No head-nurse or nurse should be out of the hospital before or
after the limit of her daily exercise time, two hours, without written
permission of the Matron. The Matron, I think, should put the cause
and amount of the extension in writing, and report the same to the
Treasurer or Chief Officer, at the next general meeting, whenever it
is called, of the Officers of the Hospital. She will find this a great
protection against petitions. There is not a doubt that the fewer
extraordinary absences, the better.
[Sidenote: Place of Exercise.]
13. Were it possible to have a small garden (in college gardens much
effect and much refreshment is produced by a green sward, a few
trees, some shrubs, a fountain, and some seats), in this, at strictly
separated hours, the men-patients, the women patients, the head-nurses
and nurses, the men-servants, if they choose, which perhaps is not
likely, could walk or sit down. This arrangement would little interfere
with its enjoyment by the dignitaries and their children, who require
it quite as much, and would be found in its results practically and
not poetically useful. Hospitals are, and perhaps must be, in or near
crowded thoroughfares. Streets are miserable places to walk in during
great part of the year. Nurses want and unconsciously crave for fresh
air, and often half-an-hour is better than more, given them close
to their work--and away from the streets, it would be often a great
preservative.
[Sidenote: Caution.]
14. I should, however, be very cautious as to introducing music or
anything of that sort. Hospitals are not tea-gardens, nor homes, nor
meant to be either. Great quiet and some severity of discipline are
necessary, and ought to be exacted.
[Sidenote: Dress.]
15. I think the head-nurses should wear a regulation dress, and the
nurses another; if we adopt the honest word livery, in use in the
hospitals, it will perhaps do no harm. Caps, dresses, aprons, should
be prescribed: whether or not out-of-door dress should be prescribed
is to be considered apart. Each should have three dresses yearly.
Better, I think, avoid washing stuffs; they require endless change to
look decent. Head-nurses and nurses might wear the same dress, and some
difference in the cap would be quite distinction enough.
[Sidenote: Wages.]
16. I incline towards giving the head-nurses £50 a-year, one or two
rooms (one room with an alcove and curtain would be best), fuel and
light. The nurses lodging; the night-nurse a room to herself, the
others together; entire board, fuel, light, and good wages to be
decided upon.
[Sidenote: Furniture.]
17. The nurses’ rooms should be supplied with plain comfortable
furniture. In the large Hospitals the head-nurse furnishes her own
room or rooms, which doubtless promotes her comfort and her care of
the furniture, both desirable things; yet the tendency of many to
accumulate decorations, which take time to clean, &c., is a drawback.
I should be inclined, as an experiment, to try the furnishing plan, or
at least to have some scale as to furniture allowed. A bed, arm-chair,
and sofa; a chest of drawers, wash-hand table or shelf; book-case
or shelves; a little table, and a larger one, a couple of chairs, a
footstool, and a cupboard with broad shelves, are the utmost that can
be required.
[Sidenote: Visitors.]
18. A difficult and important point to settle is the amount of liberty
allowed as to receiving visits. It is desirable on all accounts to make
head-nurses and nurses feel comfortable, and, as it were, at home:
it is also better they should not be unnecessarily out; also London
distances are great, and even omnibus-fare is a consideration; also
it is important to remember that these women are apt to feel and say:
“We are not in a nunnery,” nor should they be. Still upon the whole,
considering the nuisance of ordinary visitors, and the greater nuisance
of extraordinary (_e. g._, visitors to some head-nurses, kind friends
come to see how we are getting on, &c., &c., &c.), I think if it were
possible to make the rule that no visitors are allowed, it would be
a great gain. I am not sure, at present, whether it is possible or
not--still less whether it is possible to keep such a rule, if made.
But, at all events, nurses and head-nurses should only be permitted
to receive visitors on certain days and hours of the week; and those
hours and days should be strictly kept to. In Military Hospitals a
still more rigid rule will be necessary.
[Sidenote: Discharged Patients.]
19. No discharged patients, however previously well-conducted, should
be allowed to visit the wards.
[Sidenote: Graduated scale of Pensions.]
20. Apart from raising the wages of good nurses after every ten years’
service, I think it would well answer to establish a graduated scale
of pensions, for both head-nurses and nurses; beginning with a small
pension after ten years’ good service, increasing every five years
afterwards. Many women are quickly worn out in this life; and it is
equally undesirable to turn faithful worn-out servants adrift without
any provision, or to retain them in duties for which they are become
unfit. It is a question whether there should not be a compulsory
stoppage from wages, in order to entitle the nurses to pension under
conditions.
[Sidenote: No occasional Wards.]
21. Have no occasional wards, or wards for accidental and peculiar
patients.
[Sidenote: Head-Nurse to each Ward.]
22. Every ward, or set of wards, should be under a head-nurse.
Discipline is always defective under other arrangements.
[Sidenote: Religious Influence.]
23. This turns greatly upon a previous question. Every endeavour should
be used to bring the women under the influence of religion, God’s
instrument for saving, strengthening, and comforting souls. So far as
this work depends on rule, system, and superintendence, great things
may be done at any rate--so far as moral influence is concerned, it
can only be hoped for in the channels appointed by Him who turneth all
hearts whithersoever He will.