THE CASE FOR HOSPITAL NURSES

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In the April number of the Nineteenth Century and After there appeared an exceedingly unfair article against hospital nurses, written by Miss M. F. Johnston.

The article is headed The Case against Hospital Nurses,' but almost the whole article is an attack on them in their capacity of private nurses. That part of the article which treats of hospitals shows so much strange ignorance that it carries its own refutation to anyone who knows about them, and I deal with it first.

I have searched in vain to discover what experience Miss Johnston has had with nurses. Every word of her article leads me to believe that she has had none at all with hospital and a very specially unfortunate one with private nurses.

I claim to be able to speak of nurses collectively and individually with some knowledge, and I only allude to myself, and ask pardon for doing so, with the view of showing that I have an experience which ought, at least, to get me a hearing.

For twelve years I have been very closely, I had almost said daily, working at hospitals. I happen at the moment to be on the committee of three hospitals, and of these the 'London' has 500 nurses, of whom 100 are on the private staff, and the 'Poplar' has thirty. I am also on the Council of the Queen's Jubilee Nurses,' with its 1,000 nurses working in all parts of the United Kingdom; so I ask that what I write may, at any rate, have the same attention shown to it that has been shown to Miss Johnston's unfortunate diatribe.

The comments on the training given in hospitals put into kinder language than Miss Johnston has used are, that the hours are so long and work so hard that nurses cannot do more than learn the technical side of their work, if they do not break down altogether; that the treatment they receive is harsh if not brutal; that under such conditions their characters not only do not develop, but deteriorate; that nobody cares if they do deteriorate, nobody caring about the personal character of the nurses provided they do their work; and lastly, that there is no one responsible for the nurse's efficiency when her apprenticeship is over.

Such is the case to be answered so far as hospitals are concerned. I admit that the hours of nurses are long both in hospitals and when nursing private patients. But it would indeed increase the cost, and, according to Miss Johnston, the curse, of an illness if we had to engage three nurses instead of two to divide the twenty-four hours of the day and night between them.

A twelve hours' working day or night, however, sounds to some extent worse than it is. While 'on duty' nurses must be at hand to attend to any needs that may arise, but they are not working all the time in the sense that a factory hand is. The rough work of the wards is, moreover, done by wardmaids, and so is the heavy part of the fetching and carrying.

No one who has any knowledge of the working of hospitals throughout the country is ignorant of the fact that the hours of duty have been much lessened of late, and the off-duty times increased.

At the London Hospital, for instance, care is taken to provide a long half-day every week for sisters and nurses, though not necessarily always on a Saturday. Nurses get this half-day on a Saturday occasionally, and then take it in conjunction with every fourth Sunday, which is their regulation day off, sleeping the night away from the hospital if they like. Sisters, who are the only members of the nursing staff in a well-managed hospital who may be detained on duty overtime, get a half-day every week, and every other Sunday off duty, and may take the Saturday afternoon and sleep away every fortnight if they prefer to do so. Staff nurses on night duty may sleep away from the hospital for a night every fortnight if they like. Probationers both on day and night duty get a whole day off every fortnight, with breakfast in bed to ensure a long rest, or an early pass to get a long day in the country if inclination points either way. There are two hours off duty' daily in daylight to be spent wholly or in part out of doors, and extra time granted, as far as possible, for attendance at the necessary lectures and classes. I only quote the London Hospital because I happen to know the details of the hours there, but some such regulations as the above obtain at all the best hospitals.

Miss Johnston laments that Sundays are not free, and that all Saturdays are not half-holidays. She forgets, however, that there is no cessation in the suffering of the poor patients as these weekends come round.

It is sheer nonsense, and, shows a complete ignorance of hospital life, to write that because nurses have long hours of duty they have only time to learn the technical part of their work, and that therefore their characters deteriorate.

No training, whether the hours be long or short, will endow a young woman with gifts which Nature has failed to bestow upon her.

No training will make a selfish, hard, or self-centred woman into a good nurse, any more than teaching a woman how to rear children. will make her a good mother. Maternal instincts and nursing instincts are much the same, and women are born with them or without them. Few women will stay in a hospital for the years necessary to learn the technical part of nursing if they have not nursing instincts. Apart from the desire to serve others, and to brighten other lives by the cheerful devotion of their own, there is not much in the prospects or pay of nurses to attract many women. The fact that large numbers of women take up nursing because they must earn their living is not incompatible with their rejoicing in the work for its own sake.

The care of sick people is arduous work. No one says the life of a nurse is easy, but there is abundant testimony as to the happiness to be found in it. In whatever conditions it is carried on, it will never be possible to have perfect nursing without willing selfsacrifice. But to write as Miss Johnston has, that as a result of hospital work a large number of nurses fall victims, and collapseand go home in a more or less shattered condition, is grotesquely untrue, and a visit to any of the London hospitals would convince anybody as to this. A more healthy-looking and more cheerful body of young women it would be impossible to find, comparing well with any other set of women working in any other profession.

It further pleases Miss Johnston to make general charges of inhumanity both against nurses towards each other and against hospital authorities towards their nurses. Even the doctors, whose kindness to sick nurses is proverbial, do not escape Miss Johnston's hasty censure. Wholesale accusations prove nothing. But why should Miss Johnston be so eager to make us believe that women and men who work in hospitals have such exceptionally harsh dispositions? To put the question on its lowest grounds, would it 'pay' to wear out valuable material at the preposterous rate Miss Johnston describes? Would it be to the interest of the authorities to do so? Would it be to the 'interest' of the nurses to submit?

If the workers in a hospital were habitually treated with the cruel indifference to their happiness and welfare that Miss Johnston states, it is possible that the results might approach what she conceives them to be. But I must insist on the claim that daily familiarity with hospital life and its workers gives me to speak, when I maintain that Miss Johnston's attack on the system is as grossly unfair as is her flagrant disregard of the true proportion between good and bad nurses when she writes of private nurses.

And this daily familiarity with hospital life enables me to say, without the smallest fear of contradiction from anyone with knowledge of hospitals, that far more attention is paid to and value put.

upon the character of the nurses than on their success in the technical part of their training.

Of course no woman could be kept in a hospital who found it impossible to master the technical part of the work, but it is equally certain that none would be kept who proved wanting in those qualities which alone will make a good nurse.

When a nurse has left a hospital with her certificate, and is private nursing on her own account, it is true, as Miss Johnston writes, that ' no one is actually responsible for her efficiency.' I agree that the public, if they will not go to the hospitals or good institutions to get their nurses, have a difficulty in protecting themselves from bad nurses.

A woman whose technical knowledge and skill are her sole claim to don a nurse's uniform is a very unsatisfactory representative of her profession. This is one reason why it is such a mistake for people to agitate for the 'registration of nurses.' It sounds so plausible to say that if all nurses were registered the bad ones would be stamped out. The subject is too long to deal with here, but it is obvious that registration could only deal with the technical qualifications, which, as a rule, are never complained of (except in the case of the self-christened midwives), and would leave the important question of character untouched. Moreover, once on the register, it would be almost impossible ever to remove a nurse's name from it, except for some gross or criminal act, and so bad and worthless nurses would be going about hall-marked, and would do still more harm to the public and to their fellow-nurses.

But this objection that when a nurse has served her apprenticeship no one is actually responsible for her' as applied to the profession generally is largely met by the increasing number of hospitals which keep and send out a private staff of nurses, and are, of course, very directly responsible to the public for their efficiency -efficiency, may I emphasise it once more-not merely in the technical part of their work. It is also met by the various agencies who send out nurses, who are similarly responsible for those they send out.

(In passing I may say that it would help if patients and doctors would send confidential reports as well as formal ones to the various matrons or institutions who have supplied the nurses.)

From these two sources most nurses are obtained—and all should be. The first is the best source because the nurses are better known in their hospital than they can be to the secretary of an agency to supply nurses, who has only their certificate and the reports from their cases to go on. But both hospital and agency would be greatly discredited if it were known that they were supplying bad, or even indifferent, nurses.

And now to pass on to what Miss Johnston has to say against private nurses. I think it is to be regretted that she should have

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served up for her readers a collected mass of ill-natured gossip reflecting seriously on the characters and conduct of a large body of very hard-working and good women.

To cry aloud that nurses are a bad, cruel set of women appeals to the few who have found them to be so, who have been badly served by them, and who have never hidden their experience, we may be sure. But it proves nothing reflecting on nurses generally. If I proclaim that in my experience nurses are not what Miss Johnston has described them to be many will agree with me, but we neither of us advance matters. Yet there is very little else to be said in answer to Miss Johnston. She has collected many evil reports, and evil-speaking and slandering spread. more quickly than the remembering of merits. An ill-natured story spreads further and is believed more readily than any kindly one. We see this in nature. One fried fish shop can scent a whole district, but it takes many thousand roses to make an ounce of attar-of-roses.

I do not deny that there are some bad nurses, some of them well trained technically, perhaps, but bad in the sense-the all-important sense that they think of themselves first, and their patients afterwards; that they are in a word selfish and inconsiderate. And if in illness one has been unfortunate enough to have had such a nurse, it is perhaps only human nature thereafter to abuse nurses generally. No one speaks of the blessing of thirty-two good teeth, but let him, or shall I say her, have one bad one, and who is not told of it?

The same treatment is meted out to the members of any profession which we think we can criticise-barristers, solicitors (when we lose our case), and in a less degree doctors (when we do not get well), and even to domestic servants, though the good outnumber the bad one hundredfold.

Last year we had 1,000 applications for our London hospital private nurses, and have before me as I write piles of letters from patients and their friends expressing the deepest gratitude for the help the nurses have been to them, written not in the formal language of a testimonial, which so often suppresses the real truth, but in language which shows that the nurses have not only been a comfort to the patients, but by their unselfishness and adaptability have been of real help to the whole household.

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I am sorry to refer so often to one hospital because I fully realise the suspicion to which I lay myself open. I know that what I have said of the London Hospital and of its nurses applies with equal force to other hospitals. I claim no special merit for the London,' but am compelled to give definite facts with chapter and verse for them, and to quote the actual experience gained there to refute Miss Johnston's vague generalities.

Impartially judged nurses will be found to be very like other women-never mind of what rank-some perfect, some good, some