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

by Ellen N. La Motte

On the other hand, if the administration of the Health Department is “in politics,” the reverse of this will take place. Unfortunately, in many American cities, the business of “politics” is the business of providing people with jobs at the taxpayers’ expense, regardless of the fitness of the applicant. Many of our cities are managed in this way. Moreover, in the same city, this corruptness may affect certain departments only, some being negligently and dishonestly conducted, others cleanly and efficiently. Or we may find both conditions existing in a single department, some of whose branches or divisions may be well conducted and on a high level, while other divisions may be grossly mismanaged and worthless. If a Health Department is hampered by politics, either as a whole or in certain mismanaged branches or divisions, it is useless to expect results. Placed under such a handicap, tuberculosis work would fail. Not only would the taxpayers’ money be wasted, but the community would suffer through a false sense of security, gained through its faith in, or rather its ignorance concerning, a badly conducted department. To trifle with the health of a community is a criminal act, and a Health Department which is “in politics” is the most immoral of all corrupt city departments.

Evil results of a Health Department being “in politics” may be of several sorts. For example: the Superintendent of Nurses may be an inexperienced, incapable woman, appointed by a ward politician to clear off political debts. A ward politician is hardly one whose judgment—in nursing matters at least—should be relied upon.

On the other hand, the Superintendent herself may be capable and efficient, but she may not be permitted to select the members of her staff. Instead of being able to choose them herself, according to their fitness and ability, she must accept any unqualified woman whom the ward boss may appoint. A staff of incompetent nurses, appointed without regard to character or education, is not a force from which to expect results. Moreover, nurses chosen in this manner feel that they are “protected” and can do as they like, subject to neither restraint nor discipline. This means that their work cannot be controlled, corrected, or directed in any way. Dismissal can be made only for the most flagrant offences—not for any such trifle as incompetence, laziness, or stupidity. When the Superintendent’s hands are thus tied—when she cannot select her nurses, cannot control them, and cannot dismiss the worthless as well as the unscrupulous, the result is a low grade of work. No able and self-respecting woman could hold the position of superintendent under such circumstances, thereby making herself responsible for work which she cannot control.

The acceptance of registered nurses only, and the requirement of Civil Service Examination in addition, would do much to raise the level of efficiency. These requirements, however, valuable as they are, would by no means ensure the suitability of the applicant, or guarantee the selection of nurses best adapted to public health work. Over and above this, the Superintendent should have free choice in selecting her workers, not only from the point of view of education, but also that of personal worth.

“Politics” in the Co-operating Divisions. Sometimes the Tuberculosis Division itself may not be on a political basis, but the various other divisions of the Health Department may be conducted in such a manner as to nullify much of the nurses’ work. For example: much depends upon the co-operation of the Fumigation Division. If the men employed to fumigate houses do their work badly or improperly—if they are too lazy to stop chinks and crevices, thus permitting the disinfectant to leak out; if too ignorant to properly measure the rooms, and unable to calculate the necessary amount of formaldehyde, this work will be valueless. Worse still if they are the kind that can be “bought off” and so shirk work entirely.

Or the trouble may be with the Sterilization Division, where the duty of the employees is to carry mattresses, etc., from the patient’s home to the city sterilizer. When there is no law compelling this sterilization, and it is an optional matter with the householder, if done, its doing is altogether the result of the nurse’s teaching and advice. If the waggon drivers are lazy and do not wish to carry the heavy mattresses, they can shirk work by means of false excuses often difficult to detect. For example: they can report that when a certain mattress was called for, the family had changed their minds about having it sterilized and refused to have it done. Upon investigation, we find that this refusal was at the instigation of the waggon driver himself—he had assured the family that sterilization was an unnecessary and stupid proceeding. To ignorant minds, one Health Department employee is as good as another, and when the advice is conflicting, they choose that which best pleases them.

Again, the fumigators or drivers may report that they cannot get into a certain house; the key could not be found; there was no one to admit them, or give them the articles to be removed. In innumerable ways they may compel the nurse to return again and again to the same house, to make arrangements which they try to frustrate by every conceivable device.

If, therefore, the employees of the various co-operating divisions are mere jobholders—if they are neither honest nor intelligent, nor interested in anything but pay-day—it is a heartbreaking task for the honest and efficient division to work with them. All of these activities interlock, and must work together to gain a common goal. If all are operated at their highest level, working in close and intelligent accord, then indeed we may expect results. But if the reverse is the case—if the co-operating divisions are a drag and a hindrance—then the task is overwhelming. The weak are corrupted and the strong discouraged.

Those responsible for placing tuberculosis work under the city’s administration—where it rightfully and logically belongs—should continue their interest still further. It is not enough to transfer it from pioneer, private control, and then drop the responsibility.

If a Health Department is clear of politics, and all its divisions work together harmoniously, magnificent results may be obtained. Power, prestige, and efficiency is a combination which results in forceful work.