Hospital housekeeping

by Charlotte A. Aikens

CHAPTER XII.

The Help Question

When one considers the numbers of boxes of good brass pens, the quarts of ink, and the reams of paper (to say nothing of such cheap things as brains and time and vitality) that have been consumed within the last score of years, in bringing forward “solutions of the servant problem;” when one sees that self-same problem, still to the front, dangling in the air as it were, refusing to settle itself or be settled, it surely ought to be sufficient to deter all but the most audacious from touching it. Instead of being solved, it is growing larger and more difficult to deal with. It is not much wonder that men suggest that women demonstrate their ability to manage their own domestic domain, and get the servant question settled, before seeking to get into politics and take a hand in the government of the state and nation. However, a prominent member of the board of a certain hospital remarked optimistically not long ago, that “since the Irish land question seemed to be getting worked out,” she had some hope that somewhere, around some unexpected corner, some bright man or woman would discover a means of really solving “the servant problem.” But up to the present moment that discovery has not been made, and let it be understood here and now, that a solution of that problem is not attempted here. Neither is any special claim made for originality, for the subject has been so thoroughly gone over that it seems there is nothing new to be said. But difficult as the subject may be to deal with, either theoretically or practically, it cannot well be ignored in dealing with hospital housekeeping, since it consumes no small portion of the time and energy of the housekeeper, and is of vital importance to the institution.

Numbers of Servants

Perhaps the best place to attack the subject would be to calculate how many servants are necessary to do the work in a certain hospital of a certain capacity. But at the outset one is baffled at that point because institutions differ so very greatly. Some buildings are much more difficult to keep clean, more difficult to get work done in because of mistakes in construction that entail more labor. Servants also differ in their ability, standards of work vary, and the organization of the working force varies. Some institutions require nurses to do all the sweeping of wards and private rooms, others have it all done by maids. Some hospitals require nurses to wash ward dishes. In others nurses do none of that work. In a place where soft coal is used more help will be required to maintain the same standard of cleanliness throughout the building, than if that difficulty had not to be contended with. Some institutions have no laundry work done on the premises, others have it all done at home. Some hospitals bake all their own bread, others bake none. All these and many other things have to be considered in reckoning the number of servants required. Each institution must be largely a law unto itself in this matter.

In a paper read at the Philadelphia meeting of hospital superintendents, Mr. Lathrop threw out a suggestion about engaging servants that might well be adopted by hospitals in general. In referring to the system of hospital records and reports used in Roosevelt Hospital, he said: “A book, entitled ‘A List of Officers and Employees,’ alphabetically arranged, contains the signature of each to a contract at the head of the page. The contract reads as follows:

Contract

“I, the undersigned, accept the terms herein mentioned, agree to do faithfully the work assigned to me and to conform to all rules of the hospital while in its employment; and it is distinctly understood and agreed that whether I am paid by the day, week, month or year, my engagement is to terminate upon notice by the superintendent that my services are no longer required; and upon payment being made to me for the actual time of service rendered, I agree to accept and receipt for the same in full consideration for all demands against the institution. The hospital reserves the right to deduct for absence from whatever cause.”

This contract reduces to a minimum the difficulty in getting rid of undesirable help without unpleasantness. The last clause is especially important. The only possible way of making an impression on some servants, and keeping them up to the mark in punctuality, is by touching their pocket. When the absence or tardiness occurs from a legitimate cause, as in illness, it may not be best, if the time lost is trifling, to make any deduction, but at any rate the servant should understand that part of the agreement, and when it is not enforced he will be likely to have a due appreciation of the fact.

Merit System

When a hospital pays a fair rate of wages to its employees it is in a position to insist on certain conditions, and to maintain certain standards regarding work in all departments. If it pays the lowest market price for such labor it must expect its servants to remain only till something better is found. The merit system has been successfully used in other lines of work, and ought to yield equally good results in a hospital. If after giving a servant a fair trial, he is found faithful and anxious to please and capable, he ought to be shown that these qualities are appreciated. If he was engaged for fifteen dollars a month, a raise of wages of one dollar every three or four months until it has reached a certain point, would give him some inducement to stay. The habit of expressing satisfaction with work well done is a powerful incentive to continuance in well doing and better service in the future. Servants are all human. They need reproof and correction, but need quite as much the kind word of appreciation of their efforts. There are but few people who will long continue to do their best if they think nobody cares or notices it.

Schedule of Work

When servants enter the employ of the hospital, it is a good plan to have some kind of schedule of the routine work ready to give them. Certain duties will have to be performed every day, others on stated days of the week. Usually the housekeeper is subject to demands of all kinds. It is necessary for her to study how to get routine work done well, with the least tax on her memory or vitality, and the schedule will help in that direction. Proper instruction at the beginning is always important. Many a servant has become discouraged in a few days and left his place vacant, when a patient explanation of what to do, and how to do what seemed to be expected of him, would have developed a capable worker. It is never a good plan to have such fixed ideas as to how a desired end should be reached that no other method will be accepted. If servants have been accustomed to one certain way of doing things, and their way yields as good results as some others, it is well for the housekeeper to let them follow their own plans unless it is found to entail a waste of time and material. In a hospital where there is such a multiplicity of details to be attended to, no housekeeper can afford to waste much time over non-essentials. The point is to be able to recognize non-essentials and not to ignore things of importance. If she sees that time and material can be saved by doing things according to her methods, a suggestion and a little teaching ought to effect the desired change. If it does not, if they do not try to improve, and refuse to apply the instruction received, then it is better to let them go and try to secure more tractable material.

There is seldom a time when all help is just what the housekeeper wants, and it is safe to predict there never will be. Some will need more supervision than others. Some will remember a thing if told once, others will need to have it repeated again and again. One would naturally expect that a thing that had to be done every day would soon be done as a matter of habit, but this is by no means the case, as every housekeeper knows. It is not enough to say: “This thing must be done every day.” Somebody must be on the watch to see that it is done. Some servants when they find a neglect passes unnoticed will be very likely to repeat it, and the lack of proper supervision accounts for the general slipshod condition of the domestic department of many institutions. Usually there are enough hands to do the work if they were kept up to the mark and properly supervised.

In the matter of cleanliness and neatness a great difference in standards is observed in visiting institutions. Suffice it to say that in a hospital, above all other places, there should not be a spot from attic to basement that the superintendent would not wish to throw open for inspection. Ice-boxes, kitchens, pantries, storerooms, basement, laundry, all should be models in respect to cleanliness and good order.

Military rule, or organization based on it, is supposed to prevail to a large extent in the training school, and it is equally important for it to prevail throughout the other departments of the hospital. While with nations, civil laws undergo changes as the spirit of the times change, yet the fundamental principles of military organization remain unchanged. There is a distinct gradation of officers, and every man is recognized only in his station. If a private soldier has a grievance or a report, he is expected to state it to the officer immediately above him. The captain cannot officially approach a general and ignore the intermediate officers. The general gives his orders to the officer next to him in rank, and they pass down the line from rank to rank. Only thus can a general hope to command the army of a nation successfully. Each man is expected to be in his place and attend to the duties of his position and not meddle with the affairs of others. Practically the same system prevails in large business corporations, and no better basis for organizing a working force of an institution has been discovered.

Rules

Much as the average American dislikes rules, the fact remains that some are necessary. The business is greatly overdone in some hospitals, in others too much laxity exists, and this inevitably tends to lower the tone of the institution. For the domestic department it is wise to have cards with a set of general rules printed and framed and posted in conspicuous places to serve as reminders. Each hospital superintendent will have his own ideas of what general rules should be made for the government of his hospital employees, but a specimen set of rules may not be out of order.

1. All services are at certain rates per month or week for time actually served. Employees desiring to leave shall give one week’s notice to the superintendent. The superintendent reserves the right to summarily discharge any employee for any cause when his presence is detrimental to the interests of the institution.

2. No reading or smoking in bed at night is allowed and smoking or chewing of tobacco is forbidden during working hours.

3. No duplicate keys for any part of the hospital shall be made except for and by the hospital. All persons having hospital keys shall deliver them to the superintendent if absence over night is anticipated.

4. No employee shall enter the room of another at the hospital without knocking and waiting for reply. Female employees shall on no account visit men’s rooms nor male employees women’s rooms.

5. No employee, unless duty requires it, shall enter the wards without permission of the superintendent, nor shall they enter departments where they have no duty except on business.

6. Employees shall be prompt at meals. Those coming late will be expected to explain the reason. No cooking, heating or keeping of tea, coffee, or food shall be allowed on the premises other than in places provided for them and by persons employed for such duties.

7. All employees will, when practicable, be allowed two half days off duty each month and when convenient a part of each Sunday, subject to the needs of the institution and the discretion of the superintendent.

8. Discharged employees are not entitled to the freedom of the premises and must stop in the waiting-room, like other visitors, while those discharged for cause are not admitted except as patients or on business to the superintendent.

9. Employees shall attend to matters out of repair in their departments, and report all articles broken or injured to the head of their department. Nails shall not be driven into the building or furniture without permission. Scratching of matches on walls is forbidden.

10. The house will be closed at 10:30 p. m. Employees desiring late leave must get permission from the matron or superintendent. No employee shall go in or out any window, except those used as doors, unless engaged in working about the same.

11. Employees shall not keep in their possession nor have on the premises, spirituous liquors, and the intoxication of any employee shall be the cause of instant dismissal.

12. Loitering around the kitchen during working hours, or at any time, by those not employed there is prohibited. Kitchen employees are not allowed to linger around the kitchen when off duty.

13. All persons connected with the hospital are expected to be civil and polite at all times. Sleeping rooms, wardrobes, dressers, closets, cupboards, etc., shall be subject to inspection at any time. Rooms shall be in order and beds made by 10 a. m. and shall at all times be kept clean, orderly and free from vermin.

14. No one connected with the hospital shall remove the property, however small, from one room or ward to another without the permission of the superintendent.

15. Employees are expected by precept and example to assist in keeping the hospital quiet and orderly and free from dust, dirt and foul air. Boisterous or profane language and whistling or singing cannot be permitted.

16. Cleanliness and neatness in appearance, habits and work are imperative. All employees are expected to be punctual in reporting for duty. Visitors to employees are not allowed during working hours. In exceptional cases permission may be obtained from the superintendent.

17. All articles broken or destroyed will be charged to the person breaking them, at cost price.

Having made rules, it becomes necessary to see to their enforcement. Exceptions should be few and far between. A rule that is not enforced weakens the institutional government, and had better never have been made. If it is good and necessary let it be enforced, if it is neither good nor necessary let it be abolished.

The question of incompatibility of temper among servants is a common perplexity. When it occurs it is just as well to plan for a separation, letting the one who seems to be the strongest element of discord go.

In feeding help there should be always plenty provided—the quality being about what is provided for ward patients. A separate bill of fare for them would entail extra cost, both for material and labor, and they would be none the better for it.

Servants’ Dining Rooms

Is it too much to hope, that, sometime, all hospitals will have a servants’ dining room, where, apart from the heat and odor of the kitchen, they can take their meals in comfort like respectable people? Many of those who have labored on the servant problem seem to have begun at the top for a solution, instead of getting down to the foundations to build up a system. They have sought to establish training schools and give diplomas, believing that was the one thing needful to dignify the position of servants and make them happy and contented in that kind of work. There is certainly no objection to plans for training, providing they are not allowed to obscure other features bearing on the problem. But one does not need to live more than a day in some homes or institutions to find one reason for the prevailing discontent among servants as a class. A hospital that provides an attractive dining room for its help (which could also be used as a reception room for their friends), that sees that they have good bath rooms, lavatories, toilet rooms and sleeping rooms, may expect to attract a superior class of servants, who will have some inducement to remain where provision has been made for their comfort. They will have more respect for themselves and for the institution and better service can be expected.

Sleeping Rooms

There is a possibility of people becoming so charitable that they forget to be just. Some are so intent on providing the most modern equipment for the care of the unknown indigent patient that they entirely overlook the necessity of proper living conditions for those who must help in caring for the unknown indigent. How many hospital managers would throw open with pride, for the inspection of a party of visitors, the doors of their servants’ sleeping quarters, as they do the doors to the free wards? While text-books and teachers are emphasizing the necessity of pure air, the need of a certain number of cubic feet of air-space for each occupant of every sleeping room, hospital authorities are defying these self-same rules of hygiene, by compelling their servants (and often nurses, too) to sleep in crowded quarters without proper means of ventilation, and which sometimes the direct rays of the sun can never penetrate. It is nothing uncommon to find six or eight people crowded into one dormitory not larger than 10x15, and that not only in a New York tenement but in a modern hospital. Every intelligent person professes to believe that “Pure air is as important as pure food in the production of vital energy of the body and mind, but it is another case of not living according to one’s belief. What we greatly need is a realization of the fact that hygiene is not alone a science to be studied, but an art to be practiced, in the hospital, in all its departments and elsewhere.”

Attire

The working attire of the servants may seem a trifling thing to mention, but it too is an indication of the standards of the management in that respect. A hospital is no place for a slovenly, untidy man or woman. If they have not sufficient self respect to keep themselves clean and neatly clad they certainly cannot be expected to cook and serve food in a respectable, appetizing, healthful way or do their work in a cleanly manner. “The apparel oft proclaims the man.” It oft proclaims the institution, too. If the hospital is to make a desirable reputation and maintain it, heads of departments must be on the alert in minor as well as major matters. A chain is no stronger than its weakest link, and each individual in the long human chain of hospital employees is either helping to make or mar the good reputation of the institution.

Housekeeper’s Relation to Servants

The housekeeper’s relation to the servants is too large a subject to more than touch, but it is altogether too important to be left out entirely. It is well to bear in mind the fact that laxity does not mean kindness, nor does it always mean “good nature,” as some people appear to believe. Neither does severity mean dignity. It is quite possible to be dignified and approachable at the same time. It is quite possible to be systematic about methods and work, and strict in the observance of the rules of the institution, and at the same time thoroughly kind and tender hearted and womanly. The housekeeper who lets her servants know that she sympathizes with them in the trials and difficulties incident to their life will have much less trouble in governing them than the one who maintains a frigid air, shuts her eyes and ears to things that are large to them, and treats them like machines. There are a hundred ways in which she can touch their lives helpfully, and influence them to higher ideals if she chooses. Questions of dress, health, morals all suggest themselves at this point. The all too prevalent tendency with the servant class to spend their hard-earned dollars in silks, cheap feathers and tawdry finery, to follow the fashions, even if they have to go in debt, is something that can be observed in the hospital as elsewhere. This often has a bearing on health. Many who have spent their all in jewelry or finery which they did not need, are obliged to go without proper shoes, stockings, under-clothing and things that are really essential for health and comfort. If the housekeeper has won the respect and confidence of her help, she ought to have a decided influence in checking this tendency among her maids and promoting habits of thrift and wise expenditure.

Proper hours for retiring is another matter that will come in the housekeeping province as it relates to servants, and one that no institution can afford to neglect. Late hours are neither conducive to good health nor good morals, and certainly do not help in getting good work done. For all these reasons the housekeeper, where the help are housed on the premises, should insist that the same hours that nurses are obliged to observe in getting home, and getting lights turned out should be observed in the servants’ quarters. Whether she wants the responsibility or not, whether she thinks it or not, the influence of the head of the domestic department is felt in the lives of her servants. Characters are being molded and built up that will leave their impress on future generations. The world of the average servant is as a rule very small. They live on the surface of things. Trifles seem large sometimes. At other times very serious and far-reaching questions seem to them quite unimportant. Education of the conscience and of the hand can go on, ought to go on, together.