Women Workers in Seven Professions / A Survey of Their Economic Conditions and Prospects

by Unknown

VIII

NURSING IN HOSPITALS FOR THE INSANE

Mental nursing as a profession for educated women has much to recommend it. It is of absorbing interest to those of a sympathetic nature and of a scientific turn of mind, and it develops all the finer qualities, self-control, patience, tact, and common-sense. It gives scope for originality and accomplishments of every kind. The work itself is difficult, and is the one of all the many branches of nursing which demands the closest personal devotion and service, great as is the necessity for these in all forms of a nurse's work.

Mental nurses are employed in (1) county asylums, (2) mental hospitals, (3) private work.

(1) County Asylums—These may take from 1,000 to 2,000 patients each. They are usually situated in the country with healthy surroundings and large grounds, and they are generally placed within reasonable access to some town.

Probationer nurses are received for training from twenty-one years of age. They must be of good health and physique. A nurse who is successful in this branch of work should be able to obtain her certificate from the Medico Psychological Board at the end of three years' training. The salary is £19 the first year, with an annual increase of £1 up to £35. Free board, lodging, washing, medical attendance, are also supplied and uniform after three months' trial. The hours on duty are from 6 A.M. to 8 P.M., with two hours off for meals. Nurses get leave from 8 P.M. to 10 P.M. daily and one day weekly; they also have fourteen days' holiday after the first twelve months, increasing subsequently to three weeks a year.

The duties of the nurse in an asylum consist of the care of the patients, the supervision of the cleanliness of the wards and linen, and also of the work done by the patients in the various departments—the needleroom, laundry, kitchen, corridors, etc. It is obvious that in view of the number of patients, individual attention is practically impossible. Entertainments of all kinds are provided for the help and amusement of the patients, and nurses are expected to assist in arranging these. Consequently any one with a gift for music, acting, singing, or other accomplishment is an acquisition to the staff.

(2) Registered Mental Hospitals.—These, owing to their different circumstances, vary much in their conditions of service. Most of them are training-schools and receive probationers of good education, from twenty-two years of age, for a course of training. This consists of lectures by the Medical Staff and Matron, the subjects receiving most attention being Elementary Anatomy, Physiology, and Psychology; and there is, of course, practical training in the nursing of mental cases: in some hospitals a course of Massage and Swedish Drill are added in the fourth year.

Salaries are on the whole lower than in the County Asylums, beginning at anything from £15 rising to £19 in the third year with a bonus of £3 on passing the final examination of the Medico-Psychological Board. There must, however, be set against this lower rate of remuneration, the fact that these mental hospitals are often situated more centrally than the county asylums, thus making less expenditure necessary for travelling to and from the hospital when out on leave. The usual free board, lodging, washing, medical attendance, and uniform are also given after three months' satisfactory service.

The hours of duty are from 7 A.M. to 8 P.M. with two hours off for meals, etc. Leave during a month varies with the different hospitals, but is usually two whole days, three half days, four evenings from 6 P.M. to 10 P.M., and four evenings from 8 P.M. to 10 P.M.: there is also annual leave of fourteen days after the first twelve months, increasing to three weeks after three years' service.

The work in a mental hospital is totally different from that in large asylums. As there are fewer patients, individual treatment is the rule, and the nurse gets more intimate knowledge of her patients' condition, which she may thus do much to ameliorate. Owing to the homelike freedom allowed, nurses need to be specially patient and tactful. In return for this, however, by their much closer companionship with their patients they gain the opportunity of thoroughly knowing and therefore sympathising with and guiding them, and on this, successful treatment largely depends. The majority of the patients in these hospitals are suffering from acute forms of insanity, and this adds both to the strenuousness and to the interest of the nursing work: the fact that such patients frequently recover, acts as a great incentive to the work.

Private asylums are on a different basis and do not as a rule offer training.

A trained nurse may hope for promotion to posts as Sister of a ward, Night Superintendent, Assistant Matron, or Matron. These posts demand personal attributes in addition to good training—e.g., powers of organisation and administration, a knowledge of housekeeping, laundry work, etc. For the higher posts, training in general nursing is essential. In all forms of mental nursing it is undoubtedly a great advantage if the nurse has had a preliminary general training before entering on the special branch of the work.

The conditions for private mental cases are the same as those described under private nursing for general work (see page 184). The fees, however, compare very favourably with those obtained for general work, being almost universally higher. The great disadvantage is that the hours are very long and the work necessarily exhausting.

Much has been done of recent years to improve the conditions of service for workers in institutions, and there is still room for amelioration. Particularly is this so with regard to the long hours on duty and insufficient leave, due, chiefly, to shortage of staff. Increase is also urgently needed in the salaries in every department so that the nurses may be able to make provision for old age. When, as now, so many of them are dependent on a pension as the only provision for their old age, they are bound to stay at one institution for the whole or nearly the whole of their lives—an arrangement which is not to the benefit of either party, for "change is necessary to progress, and the tendency is, from long years of service in one place, to narrow and lose the adaptability of earlier years."

More arrangements are needed for the recreation of the nurses when off duty, especially in institutions situated in the country. Swimming baths would be a real boon; the beneficial effects of this form of exercise upon both nerves and body being too well known to need further comment. Its value also in promoting mutual helpfulness is by no means negligible. Reading-rooms, apart from the general common-room, are very valuable, as are also tennis courts where they can be arranged. All these, of course, mean expense, but, if the better class woman is to be attracted to the work, her interests must be considered. Moreover, healthful recreations, apart from their benefit to the nurse herself, must re-act favourably on the patients.