1. Economy of hands, combined with efficiency of service, is an urgent
thing in all Hospitals; most of all in Military Hospitals,
On the score of expense;
On that of efficiency of inspection;
From the nature of Military Hospitals, where the aim should be
throughout to combine great simplicity with thorough efficiency;
From the importance of training the staff, male and female, of
Military Hospitals, for service in War Hospitals, where every man
or woman who can be spared is better away.
2. Yet economy of hands, carried too far, becomes, like all other such
economies, penny wise and pound foolish.
3. Without doubt, large wards can be efficiently served by fewer hands
than small or moderate wards. But, as sanitary considerations limit the
size of wards to from 24 to 30 patients, let us make this the basis of
all calculation.
4. The more it is considered, the more essential it appears, to train
Nurses, from the first, to do efficiently a great deal of work. A small
staff of respectable, laborious, and thoroughly efficient women seems
the thing to be aimed at; whether considering Military Hospitals by
themselves, or as a training-school for Hospital war-service.
5. It would be better to give each Nurse one great ward; but wards
above a certain size are inadmissible for sanitary reasons.
6. The care of 24 to 30 patients is not sufficient duty, by a great
deal, for a Nurse.
7. Therefore, upon the whole, and as decidedly the lesser of two evils,
I recommend assigning to each Nurse two wards.
8. It is less difficult, and less objectionable, that she should have
charge of two wards on one floor, than of two wards on two floors.
9. As regards the Nurse, I recommend therefore, upon the whole, to
give each Nurse the charge of two wards of 30 men each; the wards to
be on the same floor; but, except as being under the same Head Nurse,
entirely separate.
10. It is important to repeat that the Nurse (who is Head Nurse), will
be set free of two things, which consume much of a Civil Head Nurse’s
time.
(1). “Settling the diets,” and fetching, besides waiting for, portions
of those diets (_e. g._ wine) and medicine.
(2). Distribution of Diets.--It is quite possible that, in no long
time, it may be found desirable to assign this duty to the Nurse.
But it would be better to try to have it efficiently, which implies
honestly, discharged by the Ward-Master. It will relieve the Nurse
daily of considerable time; and it charges the Ward-Master with a
definite duty which he can perform. The more he has defined duties, the
less he will be inclined to fidget and disturb the Nurse. He is pretty
certain to do this; but definite duties will diminish the tendency.
I should avoid giving the Ward-Masters too few wards. Otherwise they
will make themselves insufferable obstructions, one way or another, to
the Nurses. I should say that each Ward-Master, in charge of a Pavilion
of six wards of 30 each, besides the small wards for one, would not
have at all too much to do. Where there are no Nurses, the Ward-Master
should have Assistant Ward-Masters in their place.
N.B. Wine might be treated as medicine, and, as such, delivered by the
Nurse. Wine and medicine are usually, in the Civil Hospitals, given
from the Apothecary’s shop at the same time. Or it might be considered
desirable to leave this duty to the Ward-Master. In either case, it
will never do to serve a bad case at once with all his wine, and either
to let him stupify himself by swallowing it at once to make sure that
he has it; or to set it by his bed-side for the flies to spoil it, or
for a dishonest comrade, or here and there an Orderly, to drink it. The
Nurse should receive, whether directly or from the Ward-Master, the
wine of such patients, and should administer it in successive small
fresh portions. The intelligent administration of wine ordered to bad
cases is one of those momentous _minutiæ_ by which, I do believe, and
believe more and more, many lives are, by God’s blessing, annually
saved in English Hospitals which would be lost elsewhere. Of course the
only Regulation about wine should be to specify whether the Ward-Master
or the Nurse should administer it.
11. Relieved of the loss of time incurred by fetching and waiting, and
relieved at starting, at all events, and we will hope permanently, of
the time consumed in distributing the diets, I certainly consider that
a Nurse of the class of which, please God, Her Majesty’s must all be,
(strong, laborious, active, and conscientious women,) can efficiently
serve two wards of 30 men each.
_Orderlies._