It seems hardly necessary to speak of the qualities of honesty, loyalty, and conscientiousness. When they are lacking, all or any one of them, the nurse is useless. The nurse is alone in her district all day long, from early morning till late in the afternoon, and she must be a woman with a high sense of responsibility and worthy of her trust. Patience, that despised virtue, is also an essential part of the nurse’s equipment, for she must listen to long details of illness, and must be willing to reiterate, over and over again, without show of annoyance, the rules which have been needlessly and exasperatingly ignored. No one knows better than the nurse the awful hiatus that exists between preaching and practising—the glib promise and the broken pledge—but she must never show her irritation. We have known many excellent nurses who gave up this work because they could not stand discouragement of this sort, and who had not vision enough to look into the future for results.
This standard of requirements may seem high, but it is not impossible. In fact, it is the minimum from which successful work can be expected. A superintendent who has a choice of nurses will of course approximate it as nearly as possible, in choosing her staff. The higher and finer the type of woman, the more valuable she will be—probably in no other field do fine instincts and fine feeling tell so strongly.
CHAPTER III
Salary—Increase of Salary—Carfare—Transportation—Telephone—Vacation—Sick-Leave—Uniforms—Badges.
Salary. A good nurse should command a good salary—she is worth it. There is a tendency to underpay nurses even at the present day, because of the tradition handed down from the Middle Ages, that nursing service should be given largely as a matter of love or charity. A woman who gives up her whole time to district nursing, doing highly specialized work, should at the very least receive a living wage. Associations are often asked to supply nurses at a salary of forty or fifty dollars a month, and surprise and indignation have been expressed because such a woman was not forthcoming. Salaries should be large enough to attract and retain efficient women; a small salary does not attract desirable applicants, as a rule, and this limits the field of selection. Large sums are appropriated for hospitals, sanatoriums, dispensaries, and physicians’ services, but retrenchment takes place when it comes to the nurse. Her work seems to be the one point where economy prevails.
In Baltimore, the staff nurses are paid seventy-five dollars a month, and this is the very least that any woman should receive. A small town or country community would doubtless have to pay more than this, especially if it looks to the city for an experienced nurse. The reason is simple enough—other things being equal and the character of work the same, one would hardly expect a nurse to prefer an unknown locality, away from home and friends, unless some extra inducement were offered. A nurse might be willing to organize work in a small city, at a low salary, for the sake of the experience. In that case, it is the experience which offers the inducement. This once gained, however, she would shortly be in a position to demand more salary or seek a wider field of service.
Increase of Salary. The question constantly arises whether or not it is well to increase the salary of the staff nurse from year to year. If she enters the work at seventy-five dollars a month for the first year, is it well to increase this to eighty dollars a month for the second year, eighty-five dollars the third, and so on till a definite maximum has been reached? To this question there are two answers.
Undoubtedly a nurse becomes more valuable as her experience ripens. Her first six months on duty are largely spent merely in acquiring rudimentary knowledge concerning her work. As she learns to know her district, her patients, the doctors, the institutions, the social workers, her value to the community increases. Each succeeding year, therefore, which increases her knowledge of social conditions, should make her in so far more valuable. It would seem but just, under these conditions, that her remuneration should be raised accordingly. But at this point there enters a factor which we must recognize. To specialize in tuberculosis work makes peculiar demands upon one’s strength. Quite apart from the physical strain, which is always great, it demands the expenditure of a vast amount of nervous force, required in the constant combat with opposition. For this reason it is peculiarly wearing and exhausting. Also, by its nature, it tends to become monotonous. These two factors—one of which tends to wear out the individual, the other to make her indifferent and stale—make us hesitate to say that the nurse’s value keeps increasing year after year. It undoubtedly does increase up to a certain point, but after that point has been reached, it tends to diminish. Such being the case, the obligation of raising the salary is debatable.
Two kinds of nurses are usually found on the staff. One is the ambitious nurse, who comes for the experience and training, to fit herself for an executive position elsewhere. To such a woman, the routine of field work will not be desirable for long—not for more than a year or two, or until she has gained enough experience to prepare herself for a wider field of service. That point being reached, her executive ability will seek an outlet in work where she herself may become the organizing and directing force. To such a nurse, salary increase will offer no inducement, since she will seek that increase through work which provides greater opportunities and responsibilities.
There is another sort of nurse on the staff however, who has no such ambition; no executive ability, no desire to occupy any other than a subordinate position. This one will never venture into a position of responsibility, such as her experience might warrant, but prefers instead the easier path, choosing to be guided rather than to guide. She prefers to work under direction, rather than to direct others. To such, an increase in salary would seem but a just reward for faithful service. But, as we have said before, the monotony of tuberculosis work tends to produce stale workers. There is danger, after a time, that the first alertness and energy may wear off, the nurse may settle down into a rut, and her daily task, though faithfully performed, tends to become one of mechanical routine.