Salary—Increase of Salary—Carfare—Transportation—Telephone—Vacation—
Sick-Leave—Uniforms—Badges.
=Salary.= A good nurse should command a good salary—she is worth it.
There is a tendency to underpay nurses even at the present day, because
of the tradition handed down from the Middle Ages, that nursing service
should be given largely as a matter of love or charity. A woman who
gives up her whole time to district nursing, doing highly specialized
work, should at the very least receive a living wage. Associations are
often asked to supply nurses at a salary of forty or fifty dollars a
month, and surprise and indignation have been expressed because such a
woman was not forthcoming. Salaries should be large enough to attract
and retain efficient women; a small salary does not attract desirable
applicants, as a rule, and this limits the field of selection. Large
sums are appropriated for hospitals, sanatoriums, dispensaries, and
physicians’ services, but retrenchment takes place when it comes to the
nurse. Her work seems to be the one point where economy prevails.
In Baltimore, the staff nurses are paid seventy-five dollars a month,
and this is the very least that any woman should receive. A small town
or country community would doubtless have to pay more than this,
especially if it looks to the city for an experienced nurse. The reason
is simple enough—other things being equal and the character of work the
same, one would hardly expect a nurse to prefer an unknown locality,
away from home and friends, unless some extra inducement were offered. A
nurse might be willing to organize work in a small city, at a low
salary, for the sake of the experience. In that case, it is the
experience which offers the inducement. This once gained, however, she
would shortly be in a position to demand more salary or seek a wider
field of service.
=Increase of Salary.= The question constantly arises whether or not it
is well to increase the salary of the staff nurse from year to year. If
she enters the work at seventy-five dollars a month for the first year,
is it well to increase this to eighty dollars a month for the second
year, eighty-five dollars the third, and so on till a definite maximum
has been reached? To this question there are two answers.
Undoubtedly a nurse becomes more valuable as her experience ripens. Her
first six months on duty are largely spent merely in acquiring
rudimentary knowledge concerning her work. As she learns to know her
district, her patients, the doctors, the institutions, the social
workers, her value to the community increases. Each succeeding year,
therefore, which increases her knowledge of social conditions, should
make her in so far more valuable. It would seem but just, under these
conditions, that her remuneration should be raised accordingly. But at
this point there enters a factor which we must recognize. To specialize
in tuberculosis work makes peculiar demands upon one’s strength. Quite
apart from the physical strain, which is always great, it demands the
expenditure of a vast amount of nervous force, required in the constant
combat with opposition. For this reason it is peculiarly wearing and
exhausting. Also, by its nature, it tends to become monotonous. These
two factors—one of which tends to wear out the individual, the other to
make her indifferent and stale—make us hesitate to say that the nurse’s
value keeps increasing year after year. It undoubtedly does increase up
to a certain point, but after that point has been reached, it tends to
diminish. Such being the case, the obligation of raising the salary is
debatable.
Two kinds of nurses are usually found on the staff. One is the ambitious
nurse, who comes for the experience and training, to fit herself for an
executive position elsewhere. To such a woman, the routine of field work
will not be desirable for long—not for more than a year or two, or until
she has gained enough experience to prepare herself for a wider field of
service. That point being reached, her executive ability will seek an
outlet in work where she herself may become the organizing and directing
force. To such a nurse, salary increase will offer no inducement, since
she will seek that increase through work which provides greater
opportunities and responsibilities.
There is another sort of nurse on the staff however, who has no such
ambition; no executive ability, no desire to occupy any other than a
subordinate position. This one will never venture into a position of
responsibility, such as her experience might warrant, but prefers
instead the easier path, choosing to be guided rather than to guide. She
prefers to work under direction, rather than to direct others. To such,
an increase in salary would seem but a just reward for faithful service.
But, as we have said before, the monotony of tuberculosis work tends to
produce stale workers. There is danger, after a time, that the first
alertness and energy may wear off, the nurse may settle down into a rut,
and her daily task, though faithfully performed, tends to become one of
mechanical routine.
One of the chief duties of the superintendent is to train new nurses,
and she should renew the personnel of her staff whenever the welfare of
the work demands a change. Sometimes, when a nurse shows flagging energy
and interest, sufficient stimulus may be given by removing her to
another district, where she will encounter new patients and new
problems, and so regain her old keenness and ability. When one once
becomes thoroughly tired of this work, however, it is unwise and futile
to attempt to continue it. Therefore, in the interest both of the nurse
and of her work, it does not seem wise to offer inducements for
prolonged service, unless the individual characteristics of any given
nurse make this wholly desirable.
=Carfare.= In addition to salary, a reasonable sum of money should be
allowed for carfare. This allowance should vary in accordance with the
territory to be covered, those nurses who visit in smaller areas
naturally having a smaller allowance for the purpose. While economy in
this matter is always necessary, it must be remembered that undue
economy in carfare is wasteful of something still more important,—the
nurse’s time and strength. If she is obliged to walk long distances
between cases, this will greatly reduce the number of visits she can
make in a day. Moreover, she will spend so much energy in mere walking
that she will become too tired for effective teaching. Only fresh,
energetic people can teach; those who are physically tired are apt
unconsciously to let the obstinate patient have his own way.
=Transportation.= In small towns and country districts the problem of
transportation is often a difficult one. There are either no street
cars, or their service is very restricted and inadequate. Under such
circumstances it will be necessary to provide the nurse with a horse and
runabout, especially if she is expected to cover a large territory.
Unless there is proper provision for transportation, it will be
impossible for her to visit the patients often enough to make any
impression,—her teaching will be laid on too thin to have much value.
And to depend upon haphazard, volunteer offers of transportation is
almost as bad as to expect her to make her rounds on foot. She should be
given proper facilities for going from case to case, and should be able
to plan a day’s work unhampered by any considerations as to if or how
she can reach her patients.
=Telephone.= In making up the budget of necessary expenses, a reasonable
sum should be set aside for telephone calls. The nurse has constant
occasion to communicate with doctors, institutions, social workers, and
so forth, and this item of expense should not come out of her own
pocket. A careful weekly account of all expenditures, including
telephone calls and carfare should be rendered by her.
=Vacation.= A vacation of at least one month should be given during the
year. Less than a month is not sufficient time in which to recover the
physical and nervous energy expended during the rest of the year. This
holiday should be taken all at one time, rather than split up into
shorter vacations, taken at intervals throughout the year. We all know
that a week or two is not sufficient time in which to restore a
thoroughly tired person; at the end of such a short period, one is just
beginning to feel rested, and there has been no margin left over for
amusement, which is a necessary part of all holidays.
Strong emphasis must be laid on the fact that if a nurse expects to
return to her work and continue it successfully for another year, she
should use this vacation as a means of fitting herself for another
year’s close contact with an infectious disease. She should return to
work thoroughly rested, with her resistance increased by rest and
recreation, not lowered by injudicious use of this time off duty.
=Sick-Leave.= While a nurse is supposed to be sufficiently well and
strong to go on duty every day, in all weathers and at all seasons of
the year, a reasonable allowance for illness should nevertheless be
made. Two weeks’ annual sick-leave is a good allowance. If a woman is
off duty for longer time than that, needless to say her work must suffer
and her patients must be neglected. If a nurse is constantly off duty
for small ailments, this shows that she is not strong enough to
undertake this arduous work. A fixed allowance for sick-leave,
therefore, will tend to work automatically, and will eliminate the
unfit, whose burden of work is otherwise added to that of the steady
working members of the staff.
In the case of acute illness, such as typhoid fever or appendicitis, it
would be perfectly possible to appoint a substitute until the nurse was
able to resume her duties. If no time has been taken off for sick-leave
during the year, the two weeks should be added to the time granted for
vacation. If exceeded during the year, the salary for every day thus
lost should be deducted from the monthly salary. This procedure may seem
harsh, but with a large staff it is necessary. It places a double
incentive on keeping well, and nurses who would otherwise have been
thoughtless and careless as to their health, will take excellent care of
themselves, in order not to lose one day of their coveted vacation.
In Baltimore, the municipality gives two weeks’ vacation, and two weeks’
sick-leave. If the sick-leave is unused, a reasonable vacation is the
result.
=Uniforms.= The question as to whether or not a nurse shall wear a
uniform is one which usually excites much discussion. The one or two
disadvantages of such a dress are more than offset by the numerous
reasons in its favour. Two objections are usually raised to wearing it:
by the nurse, because it makes her conspicuous; and by the patient,
because the uniform makes him a target for neighbourly gossip.
Let us consider the first objection, that made by the nurse. A nurse
does not feel conspicuous when on duty in her district. Her busy, daily
routine, taking her in and out of homes where she is needed, soon causes
her to forget her personal appearance. A self-conscious woman is hardly
the right sort for this work. The only rub comes when she is off duty
and going to and from her district, but this cannot be held to
constitute a serious objection.
As for the patient’s objection—he would be equally conspicuous if
regularly visited by any woman unknown to the neighbourhood, no matter
how attired. Prying eyes would recognize her as an alien, and the
neighbours would speculate accordingly. We have often heard of patients
who for fear of what the neighbours would say objected to being visited
by agents of the Charity Organization Society. Yet the agents of that
Organization wear no sort of uniform. The truth is, it is usually really
the visit itself which is objected to, rather than the costume of the
visitor—the costume merely serving as an excuse. On analysing the
objections of a group of patients who disliked the uniform, they were
found to be, without exception, patients who strongly resented every
suggestion made to them. Their one desire was to be let alone, to be as
careless as they chose.
On the other hand, the advantages of the uniform are many. In the first
place, all effective care given to a consumptive has to include nursing
as well as teaching. Now, one can “educate” in a woollen dress, but one
certainly cannot give bed-baths in anything but a cotton dress, which
can be plunged into a tub and washed. And whether she enters the home to
give a bed-bath, or whether she goes in merely to distribute
prophylactic supplies, the fact remains that a nurse spends some eight
hours a day in contact with an infectious disease. Good technique
demands that she be dressed in washable material.
In summer, a dress of washable material is not conspicuous. In winter,
it may be covered with a long coat. And if we admit that such a dress is
necessary, what objection can there be to making it of simple and
uniform design? A single nurse so arrayed looks neat and business-like;
a staff of nurses looks equally so. Moreover, uniformity of dress
suggests uniformity of method, standard, and character of work, and
hence inspires confidence. A staff of nurses, each one dressed according
to the hazard of her own fancy, would hardly create the same impression.
In itself, the uniform is a protection to its wearer. It enables her to
go freely and without molestation into all kinds of tenements and
lodging houses, into side alleys and back streets. The well-known dress
surrounds her with recognition, affection, and respect.
The uniform is also of value to the patients and to their friends. It
enables them to recognize the nurse as she passes, and to call upon her
as she goes by.
The uniform worn in Baltimore consists of a plain shirtwaist suit, worn
with white linen collar and black necktie. The dress is made of blue
denim, such as is used for overalls. Denim of this sort has two sides, a
light and a dark; the dress is made up with the light side out, as in
washing it seems to “do up” better than the darker side. Black sailor
hats are worn, and in winter long, dark coats protect the dresses. This
uniform is not necessarily the last word as to what a uniform should be,
but it is simple and inexpensive, and the nurses look well in it.
=Badges.= The staff of a municipal nursing force is usually provided
with badges to denote that they are connected with the Health
Department. These badges should never be worn conspicuously, although
they should be readily accessible. They are only occasionally needed,
however, as when entering some lodging or rooming houses, or houses of
prostitution, or other places where there may be marked opposition. To
show them when entering a private home would be bad policy. A nurse
usually enters a private house as a friend, but a public house she is
sometimes obliged to enter in her official capacity. In dealing with all
her patients, however, no matter where they are situated, the less show
made of officialdom the better. By the time her patient finds out that
she is connected with the Health Department, she should be already
firmly established as his friend, and then the discovery will have no
terrors. Indeed, at that stage, it very often enhances her value, and
patients often feel intense pride at being visited by the “city nurse.”