Any Matron or Nurse who may receive permission to serve Her Majesty
without pay shall be, in all respects, bound by and amenable to the
Regulations on pain of dismissal from the service, without permission
of re-entering it.
If this cannot be done, money can easily be returned in one shape or
other; but it would have a good moral effect on the Nurses to allow of
the admixture of unpaid Nurses, provided they are strictly bound by the
same Regulations, and distinguished by no sort of peculiar designation.
The Surgeons will dislike these unpaid Nurses; but, in the long run
a firm, discreet woman, _who is an efficient Nurse_, can get on with
any Surgeon _who has his sick at heart_. The Matron also will not
at all like them, at first, but will find that she can rely upon
them and that they quietly and effectually help her with the other
Nurses: and, if she has her heart in her work, she will end by being
just, though, perhaps, always a little extra strict with and jealous
of them. The other Nurses will have, at the first, a strong little
touch of republicanism towards them, which will gradually wear off,
and, with God’s help, a higher and truer moral tone, and a simpler
and more useful kind of habits among them will prevail, than would
otherwise be the case. As for the patients, with all their faults,
trust them--trust the English soldier, and the peasantry from which he
springs. What these poor fellows are we know, and need not discuss.
They are worth suffering a good deal for; please God in the long run
good will be done. If only we can keep clear of the false, pernicious,
and derogatory system of puffery and fuss which others, for their own
purposes, and from vague, silly good-feeling have wound around this
work--a work essentially unpopular the moment we come to details! We
have learnt what reality is and what its presence or absence in this
business imports. As for the many and great other difficulties of the
work, they must be appreciated, they need not be dreaded. The purpose
is a good and noble one, and God grant it success! All we have to do
is, to do our utmost, and leave the event to Him.
[Sidenote: 9. Nurses--begin with few at first.]
9. As for the Nurses the material must be formed. If a few respectable
soldiers’ widows, including, and all the better, non-commissioned
officers’ widows, could be found, _cæteris paribus_, a preference
should be given to widows of the Service.
Except in emergencies Nurses should not be taken under thirty, or above
forty[11] years of age. These women are Head Nurses. Most of the Civil
Hospitals take no Head Nurse after forty.
One caution in engaging Nurses is perhaps not sufficiently attended
to. Certificates, without personal inquiry and answers to distinct
questions, are not worth the paper on which they are written.
As to engaging any Nurses out of the great Hospitals, for sundry
reasons, this should be done as little as may be.
Let us begin, for the sake of God and this His work, with few women.
Extension is easy--to occupy too much ground at first would be, I do in
my conscience believe, an irretrievable mistake.
No unnecessary Nurses should be suffered in Hospital; and no Nurse in
charge of wards should be required to do needlework for the Hospital.
There should be no superfluous hands; and the less a Nurse enters
another’s ward the better.
In case of suspension of a Nurse for misconduct, temporary assistance
must, however, be obtained; and this might be either appointing another
Nurse, to do, for the time, such duty in the suspended ward as she
could do in addition to her own, or putting in a temporary substitute.
All such dislocation of the Service, necessary and useful for
emergencies and holidays, should, nevertheless, be made to take place
as seldom as may be.
No Nurse, during her suspension, should be allowed to enter any ward of
the hospital.
Any Nurse asking or accepting a present, whether in money or in kind,
from any patient, or friend of any patient, whether during his illness
or after his death, recovery, or departure, must be at once suspended
from duty, her pay immediately cease, and the Superintendent-General be
apprised of it, who, if satisfied of the truth of the charge, should
immediately dismiss her.
Two hours daily for exercise or recreation should be allotted to the
Nurses, during which two hours they are to be considered relieved of
the responsibility of their wards. But I would not be too absolute in
requiring them to go out: sometimes to lie down or sit still for an
hour or two will do more good than a walk. Give them two hours for
optional exercise. Head-Nurses cannot have more of fixed leisure. They
must get time for private occupation as they can: very often not at
all; and no Nurse fit for her place will, of course, in emergent states
of her ward, leave it. Also the Matron must not worry herself or them,
if an anxious Nurse sits up part of a night or a whole night with bad
cases.
To a certain degree the Matron will find it better to allow a little
liberty and choice, in the matter of times and hours, (always excepting
after proper hours, _i. e._, after dark) to the Nurses, who are
Head-Nurses, than to attempt making them mere machines. An uniform
system, as far as possible, and a little range to each, will answer
best. But do not hurry the uniform system too much; take time: this is
very important.
The Nurse should, every morning, at an hour to be fixed by the Chaplain
or Matron, read aloud in the ward, the Confession, the Lord’s Prayer,
the Collect for the Week, the Collect for Grace, and the Benediction;
and every evening, at an hour to be fixed by the Chaplain or Matron,
she should read aloud in the ward the Confession, the Lord’s Prayer,
the Thanksgiving, the Collect for Aid, and the Benediction.[12] This
would Christianize things, instead of heathenizing them; and I believe
not a soldier would dream that his conscience was injured by it. The
Roman Catholics and Presbyterians might be allowed quite to refrain,
if they chose, which they would not. It would be necessary for the
Chaplain-General to approve of and direct in this, and best to wait a
year or two before beginning it.
The prayers should be very short, the whole not more than five or six
minutes each time, and the Nurse should read them, the men joining at
the proper times.
In some Civil Hospitals the prayers are far too long and are gabbled
over by some patient, perhaps the worst character and the best scholar
in the ward, or are stumbled through by some little boy, upon whom the
others cast the distasteful office, with circumstances of irreverence,
partly unintentional and partly shocking. At St. Bartholomew’s Hospital
the very short morning and the very short evening prayers are printed
clearly on each side of a card, which is affixed to each bed; and each
morning and evening the Head-Nurse reads them aloud: the difference is
very great.
[Sidenote: 10. Have the Diets sent hot and ready-divided from the
Kitchen.]
10. The Colney-Hatch Lunatic Asylum has a diet system worth inquiring
into; nothing is fetched by the Nurse, the Medical Officer writes the
diets on a large slate which is ready for him outside the ward.
The great advantage of this seems to be, that the Nurse’s time is
set free from a good deal of arithmetic and some writing; also that
each man’s portion is served him _hot_ from the kitchen, not cut up
laboriously by the Nurse. In most Hospitals the Nurse cuts and divides
the diets; in the London Hospital she moreover weighs them. All this
takes a great deal of time. If the patients can get the divided
portions _hot_ from the kitchen, it is far preferable.
At St. George’s Hospital the portions are sent hot and divided from the
kitchen.
[Sidenote: 11. The less any Patient is made into an Orderly by the
Surgeon the better. The Nurse should have Regulations to invoke to
allow her to do her duty.]
11. It should be distinctly settled by whom poulticing, fomenting,
and all minor dressings, applying leeches and blisters, and giving
enemas,[13] are to be done.
It would be advisable to consider whether the Nurse ought not to
instruct the Orderlies in some things. This, if it did not clash with
Orderlies’ Rules, would make these men, especially those ordered for
foreign service, much more useful than they are now, without such
teaching.
It will, however, be essential that there should be no clashing
between the Nurses’ Regulations and those already or to be issued to
the Orderlies. And for this, among other reasons, it is essential
to establish a direct channel of communication between the
Director-General and Superintendent-General of Nurses.
[Sidenote: Ward Medical Officer to give Directions to Nurse.]
I think, upon the whole and with reference to preventing, as far as
rules can do it, the obstruction of the Nurse’s duty, by adverse or
inexperienced Medical Officers giving orders to Ward or Assistant
Ward-Master, Orderlies, or patients, instead of to her, that it is
better to charge him to give the Nurse his orders as to the sick.
All the above-mentioned things should be done by the Nurse, _i. e._, by
her habitually and as a rule; occasionally letting an orderly do them,
under her own eye, in order that he may learn, as well by doing them
sometimes himself as by often seeing her.
The reasons why all these things must be clearly settled beforehand are
these:--