Tuesday, 24 May 2016

17 July 1880 - 'Nursing as a Profession' by S.F.A. Caulfield

 I am given to understand that many of the readers of this paper are anxious to obtain all the information that can be procured on the subject of nursing, with a view to its selection as their vocation in life. The task of writing an article on this question is one of some little difficulty. Although regarding it as a grand profession, and one supplied with a staff most inadequate in numbers for a population such as ours, I decline the responsibility of recommending it, or of dissuading those disposed to join its ranks. According to the rough calculation made, and that probably under the mark, "to nurse the sick of all England properly, twenty-five thousand trained nurses, officered by one thousand fully-trained lady-superintendents, are required." In such hands with the work to be done could be fairly proportioned.

Before supplying any information as to the schools and hospitals in which the requisite training can be obtained,  the individual qualifications for a nurse should be carefully considered. These may be classed as mental, moral, and physical; each and all being indispensible in a "probationer."

Under the mental and moral she must possess good temper, self-control, patience, punctuality, cheerfulness, and a willing obedience to those in authority over her. Under the physical, good health, good sight, a delicate touch, quickness of hearing, dexterous fingers, cleanliness, and suitability of age. A chronic cough, a heavy tread, a tendency to faint, or to attacks of hysterics, any description of deformity, or repulsiveness in appearance and expression, would disqualify a candidate for permanent employment as a nurse.

Furthermore, it is only fair to those having so arduous a calling in contemplation, to prepare them for loss of rest, painful scenes, and the necessity  for the performance of every office that one human being could perform for another, both to relieve suffering, and to render the surroundings of a sick bed as comfortable and cheerful as possible.

No "fine lady" who calls any charitable service "menial work" should adopt such a vocation. And besides the trial of performing personally repugnant and painful duties, the ill-temper, ingratitude, and fretfulness of her charge must all be anticipated, and accepted patiently, as a part of the sacrifice that a nurse has to make.

Nursing should not be lightly undertaken, nor merely as a means of obtaining a livelihood. A competence, a home, an interest in life, and in some cases a small pension, are to be found by the professional nurse, but certainly not a fortune.

Judging from those whom I have seen or known, they seem to be happy and contented, and even cheerful; yet with a certain amount of gravity, which an intimacy with so much suffering must inevitably produce. But the cheerfulness can be quite as naturally accounted for in the fact that, they are able to assuage that pain, to aid so much in the cures effected, and to comfort the sad and sorrowful. You may now weigh the blessedness of the work against all its trials and self-denials, and then deliberately make your decision.

The profession is divided into three departments - viz., District Nursing, Hospital Nursing, and Private Nursing. Thus the intending nurse has some choice permitted her in the description of work to be done, and the external circumstances with which she would prefer to be surrounded. Beginning with the first-named departments - giving, as I consider, the severest description of work - I cannot do better than quote from Florence Nightingale, when she describes the extra labour incumbent on the "district nurse," over and above the personal attendance / sick. For instance, she goes into a dirty, squalid-looking room, and before she can hope for any change  for the better in her patient, she must "recreate the home," and "show it clean for once; sweep and dust away; empty and wash out the dirt; air and disinfect; rub the windows, sweep the fireplace; carry out, shake, and replace the scraps of carpet; lay them down again, fetch fresh water, fill the kettle, wash the patient and the children, and make the bed." Besides this she must "bring such sanitary defects as produce sickness and death to the notice of the public officer whom it concerns."

Having shown the dark side of the picture, I proceed to tell that the district nurse is well cared for when she returns to the home provided for her, and the pleasant companionship of those who have selected the same honourable profession. I need not enter into particulars, as the intending nurse should visit the several institutions where training is to be obtained. Let her see the home for herself, learn its rules, and take a view of the prospect which would open before her, as a probationer in one of the twenty-two institutions that train for themselves, or supply other hospitals.

The "Institution for Nursing Sisters" in Devonshire-square, is the oldest of the kind, and was established in 1840. It provides no less than 20 districts each with a nurse free of charge, but untrained; and trained ones for those who can pay for their services.

With the "Metropolitan and National Association' for providing trained nurses for the poor (free of charge) I have had some acquaintance, for through the kindness of Miss Florence Lees, late Superintendent-General of the institution, I have inspected every part of the central home in Bloomsbury-square. The four branch homes connected with it are all governed by the same regulations. In these houses candidates reside for a month on trial, and if suitable are passed on to the Hospital Training School, as "nurse probationers," to receive a year's training in hospital nursing. They are then returned to the Central Home to be trained in "district nursing," receiving technical class instruction during a period of three months, when, if found satisfactory, they are entered on a register, and placed on the staff of the association. A member so enrolled is expected to continue in the service of the association for three years, three months' notice being given on either side, should a termination of the engagement be desired. Nurse candidates have to pay £5 on admission to the home, to cover the expense of her board, lodging, and washing during the month of trial.

For the year's training in St. Thomas's Hospital Training School the probationers pay £15 on admission, and £15 after six months of residence and training. For this she will have full board, 1s 6d a week for washing, a uniform dress, a separate furnished bed-room, and the use of a common sitting-room. The instruction is paid for out of the "Nightingale Fund," but in case of dismissal, or of voluntary withdrawal the cost will be charged.

When the probationer returns to the home, after the year's training, she will have to pay in advance £14 for three months' training in "district nursing," class instruction, books, full board, and extras; 2s 6d allowance weekly for washing; a separate room (or compartment), and the general sitting-room. Once fully trained, and on the staff of the association, the nurse receives a salary, payable quarterly, of £35  for the first year, £38  for the second, and so on, increasing by £3 yearly until the sixth year, when it will amount to £50 per annum, in addition to their uniform dress, full board, separate bed-room, washing, etc.

From giving a sketch of the terms on which the candidate enters the "Metropolitan Nursing Association," I will give a general idea of those of other institutions. The age at which a candidate is taken varies between twenty-five and forty. At St. Thomas's Hospital she enters as a "Nightingale probationer," at a rising salary, beginning at £10, with partial uniform; and her services are at the disposal of the committee for a period of four years. Here ladies may be trained on a payment of a £30 premium, and after one year will receive a salary rising from £25 to £50, but they are expected to give their service for four years.

At the Royal Free Hospital (Gray's Inn-road) the nursing is done by the "Training School of Protestant Nurses," of Cambridge-place, Paddington, and probationers begin with a salary equivalent to fourteen guineas, rising to £25. Here they give a three months' training at the rate of £1 15s per week, or £30 for one year. In this latter case they are required to give their services for a period of two years extra.

At the Middlesex Hospital lady pupils are receives for not less than six months at one guinea a week. Probationers begin with a salary of £12, rising to £18 after the first year, and then by £2 yearly up to £26.

At the London Hospital "nurse probationers" receive £12 on admission, rising to £21; but they are not promoted to be "sisters." These latter are educated women entering as "sister probationers," whose salary begins at £25 six months after their admission. Both these and the nurses are required to remain three years in the hospital.

At King's College and Charing Cross Hospitals, probationers receive £15 per annum and their uniform. They are bound for three years' service, an engagement renewable for another three years, with a rising salary. Both hospitals are nursed by the community of "St. John's House," Norfolk-street, Strand. Pupil nurses for district work or other institutions are trained for six months at the rate of £24 per annum. Ladies also are trained for not less than three months at a rate of £50 per annum.

At Westminster Hospital probationers begin with £16 per annum. If willing to pay £52 for their training, they are not required to remain there beyond it.

At University College Hospital nurses receive £16 per annum, and everything found for them.

St Mary's Hospital, Paddington, trains gentlewomen and nurses desirous of qualifying for public appointments, or private nursing for one year. If required by the matrons so to do, they remain for fifteen months. They serve then as assistant-nurses, and are paid at the rate of £10 and uniform. Those who pass this year of probation satisfactorily are entered in a register, and recommended for employment.

The Deaconess Institution and Training Hospital will train women of known religious character gratuitously, if they propose to become deaconesses; and will supply them as nurses to public institutions at £12 per annum. (The Green, Tottenham, N.) These have a branch institution at Mildmay Park, and a hospital at Poplar.

The Institution of Nursing Sisters, in Devonshire-square, supply's Guy's Hospital, where the annual salary of sisters amounts to £50 and dresses, and which has a Superannuation Fund for them.

Nurses are also trained at St. Bartholomew's and other institutions in town, including the Children's Hospital (Great Ormond-street), where lady pupils are received of from 21 to 35 years of age, at one guinea a week; and nurses of from 17 to 35 years at 7s 6d a week, for not less than six months. At the London North-Eastern Hospital ladies are received for training at a guinea a week.

In Edinburgh and Dublin, at Liverpool, Manchester, Cambridge, Leeds, Winchester, Leicester, Rhyl, Nottingham, and elsewhere, training is to be obtained.

There are other descriptions of work connected with the profession of nursing, such as, for instance, tending the insane, into which it is not necessary that I should enter in this article. Were I to give my private opinion as to the nature of the work to be performed, in the three departments to which I have referred I should say that "district nursing" was the severest of all; hospital nursing ranking next, in the trying nature of its experiences; and private nursing the least troublesome, allowing, of course, for some exceptional cases.

I have only named a few of the training schools for intending probationers, amongst the twenty-two or more valuable institutions which exist in London or its suburbs. Of the "Bible and Domestic Female Mission" at 13, Hunter-street, of which Mrs. Ranyard was founder, I should have made a particular mention, but that our magazine is especially designed for young people, whereas the nurses connected with this missionary society are required to be nearly of middle age. Still, the young nurse may have this institution in view, as providing a sphere of usefulness for her of a two-fold character in her after life.

Of such a sacred vocation as that of nursing it may indeed be truly said that

"If it is twice blest;
It blesseth him that gives, and him that takes."

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