The Nurse’s Training—Health—Hours off Duty—Afternoons off—Character.
=Training.= One of the first qualifications of the nurse should be
proper training. She should be a graduate of a first-class general
hospital, which gives a three-years’ course. In States where
registration is established, she should be a registered nurse as well.
This means that she has passed the examinations set by the State Board
of Examiners for Nurses, and has attained at least the minimum degree of
efficiency prescribed by that body. Of course, it is well if she far
exceeds this minimum, but she must not fall below it in any case.
It is sometimes said that a woman trained in a sanatorium or special
tuberculosis hospital will make as good a tuberculosis nurse as one who
has been trained in all branches of nursing work. This claim is often
made by those sanatoriums which seek to find positions for their
ex-patients, to whom they have given a more or less sketchy training and
a diploma. Needless to say, if a community undertakes to support a
nurse, it should procure the best that can be found. There is no economy
in employing a half-trained woman. In social work the nurse occupies a
unique position in the patient’s household—she must be able not only to
gain but to retain the family’s confidence, and this cannot be done by a
half-educated woman, not sure of herself and unable to carry conviction
to her hearers.
=Health.= Next to thorough training, the health of the nurse is of
utmost importance. All nurses should be examined before they undertake
tuberculosis work. This should be done for two reasons: first, for the
obvious reason of protecting the nurse herself; secondly, for the
protection of the work. There is already sufficient prejudice against
tuberculosis work, and it is well not to increase it by having a nurse
break down soon after going on duty. In Baltimore, all applicants are
examined by a specialist before they are accepted. Note that this is
done by a specialist, and that the applicant is not permitted to go to
her own “family physician” who may or may not be able to make a proper
examination. The candidate is given a choice of several specialists, to
any one of whom she may go. The report of her physical condition, mailed
to the superintendent, determines her eligibility from the standpoint of
health. In this way, the responsibility is assumed by those most capable
of assuming it, and neither the health of the nurse nor the prestige of
the work is jeopardized.
After the preliminary examination, it is well for the nurse on duty to
be re-examined every six months. If suspicious symptoms present
themselves, this should be done oftener. Part of the superintendent’s
duties are to watch the health of her workers, and keep a sharp look-out
for suspicious symptoms—symptoms which the nurse herself may be unaware
of or afraid to acknowledge. Each nurse, however, should assume the
responsibility for her own health; she should remember that she is
dealing with a highly infectious disease, and that it behooves her to
keep in as good physical condition as possible. Nurses with a
predisposition to tuberculosis should not undertake this work.
The question often arises as to whether this visiting work is suitable
employment for arrested cases—for nurses who have had tuberculosis and
recovered. It is not suitable. It is far too hard and trying, for it
must be done day in and day out, at all seasons and in all weathers, and
involves severe physical strain. For that reason it is not proper
occupation for one whose health is in any way precarious. The danger of
relapse is too great. Nor should this work be done by those who are
afraid of tuberculosis. If fear of tuberculosis develops after a nurse
goes on duty, she should be released at once. Under such circumstances
she cannot do good work, while to persuade her to remain on duty,
contrary to her instincts, is a responsibility too grave for any one to
assume.
=Hours off Duty.= At this point we should like to speak of the nurse’s
hours off duty, though strictly speaking they are not within our scope.
As a rule, the hours on duty are eight—from 9 a.m. till 5 p.m., with an
hour in the middle of the day for lunch. This is a long day, and at the
end of it, any woman is in a condition of mental and physical fatigue.
The constant nervous strain occasioned by contending with the ignorance
and stubbornness which a nurse must encounter, is particularly wearing.
The hours off duty are for recuperation from the day’s toil, and if this
recuperation is insufficient, it will manifest itself in various ways. A
tired nurse is of no use as a teacher—she cannot cope successfully with
the obstinate wills of her patients, nor with the trying demands of the
daily routine. Moreover, a physically tired person is one who offers
ready soil for the development of tuberculosis. These two facts must be
constantly borne in mind. Therefore we should like to impress upon all
nurses who undertake this work that they must take excellent care of
themselves. Rest, sleep, and food are the three essentials to good
health, and any scheme of life which reduces these below a certain level
is bound to lead to disaster.
No one condemns reasonable pleasures, and in no other work is relaxation
and recreation so much required, but one must be careful not to burn the
candle at both ends. It is no part of the superintendent’s duties to
regulate the life of her nurses outside of working hours, but when their
life off duty diminishes their working ability, she is then called upon
to interfere. Tuberculosis work is trying, serious, and difficult, and
demands a high degree of mental and physical strength and freshness. If
a nurse is not willing to give this, she should not undertake public
health work.
=Afternoons Off.= Each nurse should be given one afternoon a week off
duty. It is more satisfactory to give this half-day in the middle of the
week, on Wednesday or Thursday, rather than on Saturday, at the week’s
end. In this way, the rest period breaks the long stretch of days, and
the nurse is enabled to rest before she becomes too tired. Sundays, of
course, should always be free. Under no consideration should the nurse
be subject to night calls and it is well to have this fact understood at
the outset of the work. A nurse cannot be on duty night and day both,
and certain rules should be established, regarding her hours on duty,
and be rigidly adhered to.
=Character.= The questions of training and of health having been
satisfactorily answered, there remains a third great essential to be
considered—the question of personality. Social nursing differs from all
other branches of nursing, since in this specialty there is a wider
departure from the routine and mechanical duties which form so large a
part of nursing work. Those qualities which make a good institutional,
or a good private nurse, do not necessarily make a good social or public
health nurse. Something more is demanded.
Broadly speaking, apart from professional training, the more highly
educated and cultivated the woman, the better will she be qualified.
This, one may say, would apply to all branches of the profession, but we
believe these qualities are more necessary in the tuberculosis nurse
than in the operating-room nurse, for example. The latter does work
which demands mechanical quickness and coolness; the former requires a
personality capable of dealing with human beings in all stages of
refractoriness, over whom she has no authority, but from whom she is
expected to obtain results. As every one knows, it is far easier to deal
with things than with people.
The qualities of a teacher are requisite. No matter how well one may
know a subject, if one cannot present it clearly and impressively, small
progress will be made. Nor is it the patient alone that the nurse is
called upon to deal with. Her activities bring her into close relations
with physicians, social workers, politicians, boards of directors, and
“benevolent individuals” of all classes, whose interest and good-will it
is necessary to secure. She must be as well able to meet people of this
sort, as to teach the humblest patient in her district.
Since this is social work, the so-called social virtues are a
necessity—and these exclude a bad temper or a quarrelsome disposition.
It is as essential to work in harmony with other social workers as with
the patients themselves—the two relationships are interdependent.
Needless to say, a nurse who cannot get on with her patients is a
failure. No matter how experienced she may be, or how well trained, if
she cannot gain the confidence and friendship of her families she is
unfitted to deal with them. It frequently happens that for the first few
visits a family may be uncordial and suspicious, but within a short time
a well trained, sympathetic nurse should be able to change this attitude
into one of confidence and appreciation. A few, a very few families
remain unchangeable of course, but their number is so small that they
form a negligible quantity.
Neither should a nurse fraternize with her patients. Through familiarity
she loses the personal dignity which means so much to her authority.
Authority is a term somewhat subtle in its definition—it means that hint
of power, of sureness, of knowledge, which enables one to speak with a
confidence which transmits itself to others, and compels them to accept
one’s point of view. A strong personality easily conveys this sense of
authority, but it may also be conveyed by a personality less strong,
when the nurse is well assured of her facts and cannot be caught
tripping. It is the hall-mark of the successful teacher—this ability to
impress her points upon others, and to make them see that what she
proposes is right, reasonable, and advantageous.
It seems hardly necessary to speak of the qualities of honesty, loyalty,
and conscientiousness. When they are lacking, all or any one of them,
the nurse is useless. The nurse is alone in her district all day long,
from early morning till late in the afternoon, and she must be a woman
with a high sense of responsibility and worthy of her trust. Patience,
that despised virtue, is also an essential part of the nurse’s
equipment, for she must listen to long details of illness, and must be
willing to reiterate, over and over again, without show of annoyance,
the rules which have been needlessly and exasperatingly ignored. No one
knows better than the nurse the awful hiatus that exists between
preaching and practising—the glib promise and the broken pledge—but she
must never show her irritation. We have known many excellent nurses who
gave up this work because they could not stand discouragement of this
sort, and who had not vision enough to look into the future for results.
This standard of requirements may seem high, but it is not impossible.
In fact, it is the minimum from which successful work can be expected. A
superintendent who has a choice of nurses will of course approximate it
as nearly as possible, in choosing her staff. The higher and finer the
type of woman, the more valuable she will be—probably in no other field
do fine instincts and fine feeling tell so strongly.