The hours of duty are from 7 A.M. to 8 P.M. with two hours off for meals, etc. Leave during a month varies with the different hospitals, but is usually two whole days, three half days, four evenings from 6 P.M. to 10 P.M., and four evenings from 8 P.M. to 10 P.M.: there is also annual leave of fourteen days after the first twelve months, increasing to three weeks after three years' service.
The work in a mental hospital is totally different from that in large asylums. As there are fewer patients, individual treatment is the rule, and the nurse gets more intimate knowledge of her patients' condition, which she may thus do much to ameliorate. Owing to the homelike freedom allowed, nurses need to be specially patient and tactful. In return for this, however, by their much closer companionship with their patients they gain the opportunity of thoroughly knowing and therefore sympathising with and guiding them, and on this, successful treatment largely depends. The majority of the patients in these hospitals are suffering from acute forms of insanity, and this adds both to the strenuousness and to the interest of the nursing work: the fact that such patients frequently recover, acts as a great incentive to the work.
Private asylums are on a different basis and do not as a rule offer training.
A trained nurse may hope for promotion to posts as Sister of a ward, Night Superintendent, Assistant Matron, or Matron. These posts demand personal attributes in addition to good training—e.g., powers of organisation and administration, a knowledge of housekeeping, laundry work, etc. For the higher posts, training in general nursing is essential. In all forms of mental nursing it is undoubtedly a great advantage if the nurse has had a preliminary general training before entering on the special branch of the work.
The conditions for private mental cases are the same as those described under private nursing for general work (see page 184). The fees, however, compare very favourably with those obtained for general work, being almost universally higher. The great disadvantage is that the hours are very long and the work necessarily exhausting.
Much has been done of recent years to improve the conditions of service for workers in institutions, and there is still room for amelioration. Particularly is this so with regard to the long hours on duty and insufficient leave, due, chiefly, to shortage of staff. Increase is also urgently needed in the salaries in every department so that the nurses may be able to make provision for old age. When, as now, so many of them are dependent on a pension as the only provision for their old age, they are bound to stay at one institution for the whole or nearly the whole of their lives—an arrangement which is not to the benefit of either party, for "change is necessary to progress, and the tendency is, from long years of service in one place, to narrow and lose the adaptability of earlier years."
More arrangements are needed for the recreation of the nurses when off duty, especially in institutions situated in the country. Swimming baths would be a real boon; the beneficial effects of this form of exercise upon both nerves and body being too well known to need further comment. Its value also in promoting mutual helpfulness is by no means negligible. Reading-rooms, apart from the general common-room, are very valuable, as are also tennis courts where they can be arranged. All these, of course, mean expense, but, if the better class woman is to be attracted to the work, her interests must be considered. Moreover, healthful recreations, apart from their benefit to the nurse herself, must re-act favourably on the patients.
IX
NURSING IN THE COLONIES
Colonial nursing is usually undertaken by those who possess the spirit of adventure, and do not mind the prospect of pioneering work. Love of novelty, strong interest in fresh scenes and peoples, a desire to make more money than can in most cases be made in England, help a nurse in colonial work, provided that work really means her life, and she loves it. But let it be emphatically stated that the nurses who are not wanted in the colonies, in any capacity, are those who are failures in their work in England, or who simply leave the dull work of the old country with the object of having a good time abroad. Such women may do immense harm in countries where it is essential to the Empire that English people should be looked up to with respect and admiration, and where almost the most important part of an English nurse's work (quite the most important if she is working in a hospital), is to make the native nurses, of whatever race they may happen to be, see the dignity and possibilities of their profession, and be stirred with the desire to become proficient themselves.