II. Nurses in Civil Hospitals.
Isolation of each Head Nurse and her Nurses.
1. The isolation of each head-nurse and her nurses appears to me very important. The head-nurse should be within reach and view of her ward both day and night. Associating the nurses in large dormitories tends to corrupt the good, and make the bad worse. Small airy rooms contiguous to the ward are best. The ward should have but one entrance, and the head-nurse’s room should be close to it, so that neither nurse nor patient can leave, nor any one enter the ward, without her knowledge.
All to Rank and be Paid alike, with Progressive Increase of Wages.
2. All the nurses should rank and be paid alike, with progressive increase of wages after each ten years’ good service, or a slow annual rise, which is better.
Night Nurses.
3. The night-nurses should be on duty 12 hours, with instant dismissal if found asleep; 8 hours should be allowed for sleep, and 4 hours for daily exercise, private occupation, or recreation. If they have no time to themselves for their mending, making, &c., they do it at night, sometimes innocently, sometimes to the injury of the patients. I would not however prohibit occupation at night; as sometimes the ward-duty is slight; and doing something is far better and more awakening than doing nothing. This is one of the matters the head-nurse should constantly look to. I do not fancy, but at present am not positive about, cleaning or scrubbing at night. The night-nurse should have a reversible lamp, or something that without disturbing the patient, gives her light, brighter than the dim fire or gas-light properly maintained in the wards at night. She should have a room to herself.
Day Nurses.
4. The day-nurses should have eight hours’ sleep, and if it be possible, 4 hours daily for exercise, private occupation or recreation. They may have one room.
Nurses to fetch nothing.
5. All provisions, &c., &c., should be as much as possible brought into the wards, or to the ward-doors, by lifts. Nothing should be fetched by the nurses. This would save much time; would enable the nurses to do more work, and yet have more leisure; and above all, would obviate the great demoralization consequent on the nurses, patients, and men-servants congregating in numbers several times daily.
Patients to fetch nothing.
6. The patients should be made as useful as possible, consistently with their capacities, inside the ward; but should be permitted to fetch nothing to it.
Scrubbing.
7. I strongly incline to have the scrubbing done in each ward, by a nurse assigned for that purpose, and for general attendance when the scrubbing is done. There should be hours for the scrubbing, before and after which it should not be done. This whole matter is one on which I am not positive at present.
Distribution of Ward Work.
8. At present, I incline to something of the following scale. Two wards, single are best, but it might be one double ward, with 40 beds, served by 1 head-nurse and 3 nurses. The head-nurse to superintend all things, and to do the dressings not done by the surgeons and dressers, assisted mainly by one nurse, whom she thus instructs in nursing. Another nurse to do the scrubbing, and mainly the cleaning, and when these are over to mind the ward during the remaining hours in turn or in conjunction with the first nurse. The third to be night-nurse. In the morning, before dressing begins, and before the night-nurse goes off duty, all three nurses to clean the ward, make the beds, wash the helpless patients, &c.
Hours of Dressing and Poulticing,
9. Hours of morning and evening poulticing and dressing to be fixed.
and of Medicine.
10. Hours of administration of medicine, always except at night given by head-nurse, to be fixed.
Hours of Exercise, and Holidays.
11. Hours of exercise of head-nurse and nurses to be fixed, and arranged with reference to the ward-duties. A fixed occasional holiday given in turn to the nurses is good. An annual longer holiday for them and for the head-nurses is good; a fortnight is, I think, a good limit. The holidays cause inconvenience, no doubt, but on the whole do, I think, far more good than harm. The holidays should be distributed in rotation during a fixed time of year, and comprehended in two or three months, or four at the very outside; and no woman declining her holiday at the proper time should be allowed it at any other.
Permission of Matron for extra time out.
12. No head-nurse or nurse should be out of the hospital before or after the limit of her daily exercise time, two hours, without written permission of the Matron. The Matron, I think, should put the cause and amount of the extension in writing, and report the same to the Treasurer or Chief Officer, at the next general meeting, whenever it is called, of the Officers of the Hospital. She will find this a great protection against petitions. There is not a doubt that the fewer extraordinary absences, the better.
Place of Exercise.
13. Were it possible to have a small garden (in college gardens much effect and much refreshment is produced by a green sward, a few trees, some shrubs, a fountain, and some seats), in this, at strictly separated hours, the men-patients, the women patients, the head-nurses and nurses, the men-servants, if they choose, which perhaps is not likely, could walk or sit down. This arrangement would little interfere with its enjoyment by the dignitaries and their children, who require it quite as much, and would be found in its results practically and not poetically useful. Hospitals are, and perhaps must be, in or near crowded thoroughfares. Streets are miserable places to walk in during great part of the year. Nurses want and unconsciously crave for fresh air, and often half-an-hour is better than more, given them close to their work—and away from the streets, it would be often a great preservative.
Caution.
14. I should, however, be very cautious as to introducing music or anything of that sort. Hospitals are not tea-gardens, nor homes, nor meant to be either. Great quiet and some severity of discipline are necessary, and ought to be exacted.
Dress.
15. I think the head-nurses should wear a regulation dress, and the nurses another; if we adopt the honest word livery, in use in the hospitals, it will perhaps do no harm. Caps, dresses, aprons, should be prescribed: whether or not out-of-door dress should be prescribed is to be considered apart. Each should have three dresses yearly. Better, I think, avoid washing stuffs; they require endless change to look decent. Head-nurses and nurses might wear the same dress, and some difference in the cap would be quite distinction enough.
Wages.
16. I incline towards giving the head-nurses £50 a-year, one or two rooms (one room with an alcove and curtain would be best), fuel and light. The nurses lodging; the night-nurse a room to herself, the others together; entire board, fuel, light, and good wages to be decided upon.
Furniture.
17. The nurses’ rooms should be supplied with plain comfortable furniture. In the large Hospitals the head-nurse furnishes her own room or rooms, which doubtless promotes her comfort and her care of the furniture, both desirable things; yet the tendency of many to accumulate decorations, which take time to clean, &c., is a drawback. I should be inclined, as an experiment, to try the furnishing plan, or at least to have some scale as to furniture allowed. A bed, arm-chair, and sofa; a chest of drawers, wash-hand table or shelf; book-case or shelves; a little table, and a larger one, a couple of chairs, a footstool, and a cupboard with broad shelves, are the utmost that can be required.
Visitors.
18. A difficult and important point to settle is the amount of liberty allowed as to receiving visits. It is desirable on all accounts to make head-nurses and nurses feel comfortable, and, as it were, at home: it is also better they should not be unnecessarily out; also London distances are great, and even omnibus-fare is a consideration; also it is important to remember that these women are apt to feel and say: “We are not in a nunnery,” nor should they be. Still upon the whole, considering the nuisance of ordinary visitors, and the greater nuisance of extraordinary (e. g., visitors to some head-nurses, kind friends come to see how we are getting on, &c., &c., &c.), I think if it were possible to make the rule that no visitors are allowed, it would be a great gain. I am not sure, at present, whether it is possible or not—still less whether it is possible to keep such a rule, if made. But, at all events, nurses and head-nurses should only be permitted to receive visitors on certain days and hours of the week; and those hours and days should be strictly kept to. In Military Hospitals a still more rigid rule will be necessary.
Discharged Patients.
19. No discharged patients, however previously well-conducted, should be allowed to visit the wards.
Graduated scale of Pensions.
20. Apart from raising the wages of good nurses after every ten years’ service, I think it would well answer to establish a graduated scale of pensions, for both head-nurses and nurses; beginning with a small pension after ten years’ good service, increasing every five years afterwards. Many women are quickly worn out in this life; and it is equally undesirable to turn faithful worn-out servants adrift without any provision, or to retain them in duties for which they are become unfit. It is a question whether there should not be a compulsory stoppage from wages, in order to entitle the nurses to pension under conditions.
No occasional Wards.
21. Have no occasional wards, or wards for accidental and peculiar patients.
Head-Nurse to each Ward.
22. Every ward, or set of wards, should be under a head-nurse. Discipline is always defective under other arrangements.
Religious Influence.
23. This turns greatly upon a previous question. Every endeavour should be used to bring the women under the influence of religion, God’s instrument for saving, strengthening, and comforting souls. So far as this work depends on rule, system, and superintendence, great things may be done at any rate—so far as moral influence is concerned, it can only be hoped for in the channels appointed by Him who turneth all hearts whithersoever He will.