The Special Committee on Nursing, pursuant to resolution of the Workhouse Committee of the 7th of March instant, report,
That the Men’s Hospital (exclusive of fever patients) is at present exclusively nursed by skilled, i. e. specially trained nurses and paid assistants, who are themselves undergoing training as nurses; the staff consisting of the Superintendent, nine of the nurses originally sent from the Nightingale School, five nurses who have been trained in the Workhouse, and fifteen probationary or assistant nurses.
Of the character of the nursing in this portion of the Workhouse, your Committee have heard but one opinion. The Governor and the Medical Officers concur in speaking of it in terms of the highest praise, and throughout the whole period during which the Committee have superintended it, no single circumstance has come to their knowledge calculated to make them speak of it otherwise than in terms of approval.
The nursing of the women’s wards continues to be done by paupers under the superintendence of paid officers. The superintendence of these officers is of necessity very imperfect, as not only has each charge of from 150 to 200 patients, but these patients are located in several rooms, each ward containing about twenty patients. The only portion of the nursing, properly so called, which these officers undertake, is the administration of stimulants and in some exceptional cases of medicine. The bulk of it, as the giving of medicine, the dressing of wounds, the distribution of food, is left to be done by paupers. So much has from time to time been said of the untrustworthiness of pauper nurses, of the evils resulting to those patients who are placed exclusively under them, of the mischievous consequences upon the discipline of the Workhouse of a large number of petty offices being filled by able-bodied women, that your Committee believe they rightly interpret the feeling of the Select Vestry, as they undoubtedly do that of the general public, in supposing that the actual nursing of the sick in the Liverpool Workhouse can no longer be left in the hands of pauper nurses.
Starting from this point, your Committee considered that they had principally to inquire what sort of nursing can be most advantageously substituted for that of nursing by paupers. Two courses only appeared to be open to them—either to increase the number of paid officers, giving to each such a number of patients as she could reasonably be expected to look after, and treating each as an independent officer; or to extend over the whole hospital the system now in existence in the men’s wards. Your Committee were much aided in forming a judgment upon this point, by what has taken place during the last few months in the fever hospital.
Here, originally, the paid attendants were in precisely the same position, with precisely similar duties as the paid officers in the women’s hospital; but the number of patients rapidly diminishing, and no corresponding reduction taking place in the number of officers, the staff was so large that Dr. Gee felt able to call upon the officers to act as nurses. The result was what might have been anticipated, that although an improvement upon the old system of nursing by paupers was perceptible, the state of the nursing was still far short of the standard reached in the men’s wards.
The officers were told to nurse, and they did their best, but never having themselves been taught, their attempts in a great measure failed; they were paid and retained as nurses, without being efficient nurses.
Your Committee therefore recommend that as soon as the requisite number of trained nurses can be procured, the nursing in the women’s hospital, and afterwards in the fever hospital, be placed in the hands of trained and skilled nurses, acting under the direction and control of Miss Jones, the present Superintendent. The expenses (beyond the item of wages) attendant upon the necessary increase in the number of nurses will not be great, as all that will be necessary will be to convert two of the rooms now used for sick boys into sleeping apartments for the nurses. In making this recommendation, the Committee are glad to know that they are fortified by the unanimous opinion of the Governor and the Medical Officers of the Workhouse.
Your Committee are bound to add that they can produce no statistics shewing that the nursing in the men’s hospital has been of any economical advantage to the Parish; but as it needs no argument to prove that the cheapest course that can be taken with a sick pauper is to cure him as quickly as possible; as it is evident that the care and attention of a skilled nurse must tend to a more speedy recovery; as the order and discipline of a well-regulated ward is more distasteful to many of the more worthless inmates, than the laxer management of a room in the hands of a pauper nurse; and as the abolition of a large number of petty offices for able-bodied paupers must lead to many of them leaving the Workhouse, there are strong grounds for hoping that the economical results of the change cannot but be beneficial.
With regard to the future, your Committee recommend that the Department of Nursing should be placed under the direction of a small committee of your body, and that all changes in the staff should be made only by them. From information they have received, your Committee have reason to believe that if, after the Workhouse is supplied with Nurses, the two classes of nurses, i.e. trained nurses and probationers, be maintained, the cost of the Department may be considerably lessened by training nurses for other hospitals; the cost of the probationers being either paid for by a Government grant, or by the bodies for whom the nurses may be trained.
THOMAS H. SATCHELL,
RICHARD BRIGHT,
THOMAS OWEN.March 15, 1867.
This report was unanimously adopted by the Workhouse Committee and by the Vestry; and already the new system has been extended to the Female Wards. It is in contemplation to extend it also to the Fever Hospital, as soon as a sufficient number of suitable nurses shall have been trained.
It will be observed that the report contemplates the training of probationers for other Workhouse Infirmaries. And it is, indeed, to be hoped that in this and other ways the Liverpool Workhouse Hospital may serve as a normal school, from which the system there adopted may spread. The special expenses of such a school would naturally be borne by the parishes which profited by its services in educating nurses for them, or by the Government. But this point is one which, as yet, has hardly demanded practical consideration.
The experiment whose results have been recorded, could hardly have been tried at all—certainly could not have achieved such rapid success—had it not been for the powerful and liberal assistance of Miss Nightingale, and the Trustees of the Nightingale Fund. Feeling how very important was the extension of the system of superior professional nursing, now gradually gaining ground in general hospitals, to workhouses, they sent, to assist in the initial experiment made in this direction, a lady superintendent and twelve superior nurses—a very expensive and quite invaluable contribution. To the Liverpool Vestry and its officers belongs the credit of having overcome all the difficulties, and persevered in spite of all the discouraging incidents, which necessarily attended an attempt to introduce a new system of management into such an institution as a Workhouse Hospital, combining as it does two subjects so different in their aspects and conditions of treatment, so difficult to deal with together, as pauperism and sickness. Of the Lady Superintendent I shall say little. When a lady leaves a happy home, and goes through a long and laborious course of training to fit herself for such a situation, purely because, feeling that she possessed the capacity for nursing, and the requisite health, energy, strength, and spirits, she desired to devote such powers to the service of those who stood most in need of them, human praise or criticism of her choice is out of place. One of the incidental results of her exertions has to her, no doubt, been even a higher reward than that improvement in the condition of the sick, in their progress towards recovery, and their material comfort, which has been the direct object of her labours. The improvement in the tone and behaviour of the patients has been wonderful. Many of the inmates of a pauper hospital are persons of the worst character, and its wards, under the control of pauper nurses, often present scenes so disgusting that the respectable poor shrink from them with utter abhorrence, and after once becoming acquainted with them, will often rather die than return thither. When the trained nurses were first introduced, the most offensive language was frequently heard in the wards; and the Lady Superintendent has repeatedly been obliged to call upon the Governor two or three times during one Sunday to use his authority to put a stop to actual fighting. Now, though his support is always promptly rendered, she is rarely compelled to apply for it; the feeling of the wards promptly suppresses all offensive language or unseemly behaviour in the presence of the nurses. The following letter from Sir H. Verney, Chairman of the Nightingale Committee, serves to illustrate the influence of the nurses upon the conduct of the patients; he came down to Liverpool to inspect the Hospital, and ascertain the progress of the work:—
Liverpool, October 3, 1866.
My dear Sir,
By the kindness of Mr. Carr I have paid a visit to the Workhouse, and have been greatly interested by remarking the change among the male pauper sick, effected since I was here about two years since. I conclude that this is owing to the nursing by a class of females so entirely different to those who nursed the male paupers at that time, and who still nurse the female sick. I have always seen that the influence of respectable and well-educated females over the most debased men is very striking. Men of that character, accustomed to intercourse with only degraded women, feel the restraining and humanizing power of virtuous and well-mannered females. They have never been admitted into intercourse with such before, and they are most beneficially affected by it. I have been told that the police officers, who sometimes come to the Workhouse on business, and who see the sick paupers, are much astonished. They see the men whom they have known as the very worst characters, conducting themselves with propriety and decency, and giving no cause of complaint.
I am sure that the Workhouse Committee must rejoice and feel thankful that there is such a change in the condition of the poor creatures brought under their rule.
Miss Jones, and her nurses and probationers, must have had much difficulty at first—indeed their work is still very trying; but the improved demeanour of the men must be highly gratifying and encouraging to them. I walked through the female sick wards; they were clean and sweet, but I could not help contrasting the pauper nurses who attended them, with the intelligent-looking respectable attendants of the men.
I thank you for the note of introduction which procured admission for me, and
I am,
Yours very faithfully, HARRY VERNEY.
Such, and so entirely satisfactory to the Guardians, were the results of the experiment of nursing by trained nurses, as tried for two years in the Male Wards of the Liverpool Workhouse Infirmary. It is in order to render those results, the experience acquired in this initiatory attempt, available for the assistance and encouragement of others, that they have been thus briefly recorded. Much more might have been said; but what is here set down is sufficient to explain all that practical men would wish to know, and it would be presumption to waste the time of such men with comments and inferences which they are perfectly able to make for themselves.
One suggestion, in conclusion, I may be permitted to offer. In all unions or parishes where additional accommodation may be required, whether for patients or for healthy paupers, it is eminently desirable that in providing it regard should be had to the entire separation, at once or at a future time, of the sick and infirm from the able-bodied, as will be the case, at least partially, under the new régime introduced in the Metropolis by Mr. Gathorne Hardy’s Bill. Miss Nightingale has from the first held and expressed a strong opinion in favour of the separation of the hospital and workhouse administrations. The Governor of the Liverpool Workhouse, Mr. Carr, expressed himself decidedly in the same sense; and the Chairman of the Workhouse Committee and of the Sub-Committee appointed to superintend the Hospital, has been induced by practical experience warmly to advocate the absolute separation of the Workhouse and the Infirmary. So large a proportion of the able-bodied inmates of the workhouse are drunken, lazy, and vicious, that, if the poor-law relief is not to become a temptation and an injury to the honest and struggling poor, the discipline must be almost of a penal character. The paramount object must be to make the workhouse, if not absolutely unpleasant, less agreeable than the condition of laborious and striving poverty. On the other hand, in a hospital the paramount and almost the only object is to promote recovery and to mitigate suffering; all other considerations yield to this, and consequently the treatment must necessarily be liberal in spirit and indulgent in fact. The modes of treatment necessary for the good management of the hospital patient and of the able-bodied pauper, respectively, are distinct—almost opposite: the infirmary and the workhouse must be controlled on divergent, and even contrary principles; and by bringing the two together under one roof and one administration, they injure each other. The indulgence of the infirmary creeps into the workhouse, or the sternness of workhouse rules cripples the benevolent energy which should rule the infirmary. And the treatment of the able-bodied pauper becomes too lax, or he is tempted to scheme, and does scheme, to get himself transferred to the more comfortable quarters close at hand; a desire so prevalent as to give rise to malingering—the wilful production of disease: while, partly no doubt in order to counteract this tendency, there is in such mixed establishments an unconscious disposition to treat the hospital patient with the same stern economy that is justly made the rule in dealing with able-bodied pauperism, but which, in the infirmary, is not only cruel, but in the long run is not truly economical. Another most serious evil is entailed upon the hospital by connexion with the workhouse. The habits and traditions prevalent among the habitual paupers—able-bodied paupers—in the workhouse (at least in the workhouse of a large town), are too often deeply infected with cunning, deception, and dishonesty of all sorts, against which strict precaution and stern repression are requisite; and it is most important that no communication should be allowed, whereby these habits of vice and stratagem might be introduced into the hospital, where indulgence is the rule, and where many things strictly denied to the inmates of the workhouse, as stimulants for instance, are necessarily permitted. The introduction of workhouse tricks into a hospital, where they cannot be met by workhouse control, must bring in an element of confusion, disorder, and waste, and therefore the intercommunication which might introduce those tricks should be as effectually prevented as possible, which it cannot be while the two institutions are, as at present, combined. The two systems—to use an English word in its French sense—demoralize each other; and even in the English sense, their union demoralizes the individuals subject to each.
When this is better understood and more clearly apprehended, as it soon will be, through the experience of several Unions in which the separation has been already resolved on—it is probable that it will be enforced by law. This may be expected to take place in no very long time; and then it will be found that any expenditure incurred in providing increased accommodation on a plan which does not recognise the necessity of separation has been, in part at least, thrown away; and the work will have to be done, and the money to be spent, over again.
Footnotes
[1]Liverpool is a seaport, and a receptacle where the poverty and vice of Great Britain and Ireland seem to accumulate; and it is probably on this account that the able-bodied female paupers are peculiarly vicious and worthless.