The experiment which I should wish to try, by which greater variety could be secured, but which could only be practised where there was a market at hand, would be for a commutation to be made of rations for money. Each nurse to supply her quota of “mess money,” the “mess money” to be all expended on the “mess,” and the Matron to manage the “mess” day by day, and arrange for the cooking to be done in common. If each nurse’s dinner is to be cooked separately, it necessarily entails great waste of nourishment. The Nurses would not like this so well as “finding themselves,” but it would ensure them a far better diet.[7]
Wages and Mess-money must be distinct.
It would be a question whether the Queen should pay the Superintendent-General so much for each Nurse’s wages, and so much for board, the latter to be retained by the Superintendent-General, or whether the Superintendent-General or each Matron, with the Superintendent-General’s consent, should arrange with the Nurses. This is important, as which ever way it is settled, there must not be disputes between Matron, Nurses, or still less Superintendent-General, as to what amount of wages is to be allotted to the board, or what savings can be effected in the coals, &c.
On the whole it would seem best for the Nurse’s pay to be so much in money for herself, and so much in money for food into the Superintendent-General’s hands. But the question of how much is a serious business.
5. Washing, how to be done? Rule to compel the Nurses to put it out.
5. Washing.—Except in war-emergencies, this must not be suffered to be done by the Nurses, they must be compelled to put it out. I would not trouble the Authorities about this; the Nurses can afford it, and the more things are simplified the better. In out-of-the-way districts, the Matron might arrange with a laundress, the Nurses making a fair payment. In war-emergencies, if possible, provide a strong washerwoman, but this would have to be settled each case on its merits. Except in emergencies they must not wash; it takes up far too much time; it takes up strength which is wanted for other things; and washing and drying either in wards or nurses’ rooms is unhealthy and objectionable. There must be a rule as to this: some worthy souls would scrub at every rag, rather than pay a few pence weekly. The Nurse ought, however, to be compelled to have certain changes of linen weekly, which some will not, if they pay for it themselves.
6. Cleaning their own Rooms. No Orderly, on any pretence, must enter a Nurse’s Room. Scrubbing the only thing the Matron may arrange for a Soldier’s Wife to do. Nurse must do nothing of her own in Ward, or Ward-kitchen, or Orderlies’ Kitchen.
6. Cleaning their own rooms.—I well foresee sundry difficulties in the little rooms at the entrance of their wards, where I hope it will be managed to quarter the Nurses. But there is no other way of fairly and really working a ward; and I trust this plan will receive a fair trial. For efficiency, also for comfort, it is most objectionable to make the Nurse sleep at a distance from the patients. This is one of the points on which theories, and the practical working of things, are very divergent. It is an excellent thing when the Head-Nurse’s room opens into the ward and when part of the upper part is of glass, with a thick curtain, so that she can see into the ward, without being seen. Let each Head-Nurse have a small room, with a window opening into external air, with a curtain making an alcove, behind which there should be a small iron bedstead, with good bedding, and a washing table; and in the foreground a table, a small one for meals, a chest of drawers, and a comfortable arm-chair, two chairs, and I should add a sofa. Each room should have a few shelves on the wall, and a large cupboard or small closet with broad shelves, and space at the bottom to stow away the Nurse’s box. Simplification and avoiding all trouble which can be spared to the Departments are very important. I would not therefore insist upon a little kitchen for the Nurses, nor upon a very capital arrangement in some of the Sisters’ rooms in Guy’s Hospital, where, behind a decent little door in the sitting-room, there is a sink, with water laid on, a little safe for meat, &c., at top, and a complete little apparatus of the very few utensils required for cooking one woman’s meals; so that a Nurse can cook and wash-up, in her own room, without carrying things out of it. This is much better than a kitchen, if the Nurse is to cook her own meals; but, as above stated, I would rather she did not. One room, with a curtain making an alcove, is much better than two. The Queen is saved fuel; the Nurse is saved cleaning two rooms; and if fuel is only issued for one, she sleeps in a warm room, instead of one where there never is a fire, and where her things get damp and spoiled. Often, where Head-nurses have two rooms, one is built without a fire-place. Condense and simplify all things—one great object is to form a body of useful hard-working women, of simple self-helping habits. Two Nurses’ rooms should be together, but separate. Sudden illness might occur, and the two women should be at each other’s summons. The Quartermaster-General must grant a cabinet between the two: this is must, not may. The Superintendent-General must see to this herself, at first at all events: there is a singular obtuseness in the small officials, by whom these things are managed: if not overlooked, they will be sure to put the construction in a particularly awkward, exposed place. These things do enter into an Englishwoman’s daily comfort or misery—it is worth arranging them decently in the first instance.
Now as to the cleaning of these rooms. Head Nurses generally are far too much disposed to make servants of their nurses; put orderlies for nurses, and this objectionable tendency would be a hundred-fold more objectionable. The Matron must make it an absolute rule, that the only thing an orderly does for a nurse is to carry her box in and out on the two grand occasions of her entering and leaving the Hospital. The one thing which in a Civil Hospital, an Assistant Nurse should be allowed to do for the Head Nurse, is the cleaning her fire-place, a thing done in a few minutes, and with satisfaction, by women who have done it all their lives; but a dirty tedious messing business to those who have not. But never mind: the orderly must never enter the Nurse’s room: she must do it, and learn to do it. The prosaic little business of black-lead, ashes, and mess lying on the threshold of the work will do good rather than harm. And even black-lead is unnecessary, as a varnish now obtainable looks better. The orderly must never enter the Nurse’s room—a sine quâ non. The Nurses should have, at their choice, a carpet, not nailed down, or none. In either case the room will require scrubbing, once a week if no carpet, (which is best and cleanest in Hospital life), seldomer, if carpet. Now the Nurses should not be required to scrub their own rooms—it is useless waste of strength—it makes their hands coarse and hard, and less able to attend to the delicate manipulation which they may be called upon to execute—and with all the nursing proper which ought to fall upon them, and not upon the orderlies, their time can be better occupied than in cleaning their own rooms. Also, while trying to keep clear, on the one hand, of the tribe of “fine ladies,” it will be possible, on the other, if such menial offices are to be performed, to fall into the opposite mistake and to fail in obtaining the class of women desirable to fill such important trusts. Let the Matron consent to a charwoman, soldier’s wife, or some one person named and defined, and found, to be paid by the Head Nurse, to come for the two hours, which, at furthest, this business will take. It would be well worth while for the Matron to look out and provide two or three strong women to do this, by fixed rotation—each Nurse making a fair payment—and to ascertain that they are in and out of the Hospital by a particular hour, so as to prevent these external persons doing other things than scrubbing. But do not trouble the Departments as to this—the more things are simplified, and the fewer expenses are in connection with the Nurses, by far the better.
Take the trouble to see that a tidy useful fire-place is in each Nurse’s one room. Some fire-places will consume thrice the fuel of one which can do ten times more work. A compact useful little fire-place, to burn as little fuel, and do as much business (in a very small way) as possible, is a thing of daily use, economy, and comfort.