CHAPTER II
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.