The Tuberculosis Nurse: Her Function and Her Qualifications / A Handbook for Practical Workers in the Tuberculosis Campaign

by Ellen N. La Motte

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.