If there is no Visiting Nurse Association in the community, under whose auspices the new special nurse may be placed, the lay organization will have to do the best it can. In this event, it will be absolutely necessary to select a nurse thoroughly trained in social work, and since the number of women with this equipment falls far short of the demand, a delay of some duration may take place. This delay is always borne with great impatience by the newly formed group of people, anxious in their enthusiasm to attack the tuberculosis problem at once. Yet policy would counsel postponing the undertaking until a suitable person can be found, for it is usually a fatal mistake to begin new work with an inexperienced worker. Moreover, a situation which has existed for years may be tolerated a few months longer without undue alarm as to consequences.
If it is impossible to obtain a nurse fully trained in public health work, the community may select a good nurse and send her for a few months’ experience to some well recognized centre of public health work, such as New York, Chicago, Boston, Baltimore, etc. The money thus spent will prove a valuable investment to a community thus far-seeing, and an ample return will be manifest in the efficiency of the nurse’s work.
A wrong start in choosing a nurse has driven many an enthusiastic organization into deep waters, and caused trouble and misunderstanding of a most grievous sort. In several instances, the local campaign against tuberculosis has come to a disappointed end; in others, public interest has been so antagonized and repelled that the movement received a check from which it did not recover for several years.
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.