Once a Week (magazine)/Series 1/Volume 3/The training of nurses
THE TRAINING OF NURSES.
In treating of the profession of the Nurse, some months ago,[1] I observed that, “it is not the fatigue, nor the disagreeableness, nor the anxiety, nor the low and doubtful position of nurses which keeps us so bare of them, while other departments of female industry overflow. It is that no woman who would be a nurse knows where to go, and what to do to qualify herself.” There is now an end of this difficulty. Every woman may now ascertain her own fitness or unfitness for the nursing profession, and, if found capable, can at once enter, without expense or trouble, on the training which shall qualify her for her business.
The fund which was formed in Miss Nightingale’s honour, on her return from the East, and placed at her disposal for her great object of training nurses, has been accumulating since that time, under the care of trustees, the failure of Miss Nightingale’s health compelling a long delay in the formation of plans. In spite of illness she has framed her scheme; and the Committee of the Fund have published it in a way so plain that no woman can now be under any difficulty how to proceed.
St. Thomas’s Hospital is to be the training-school. There, in those wards, some of them 100 feet long, and among the new cases coming in by the hundred in a day, and in full view of almost every disease but small pox, and of every conceivable accident, the future nurses of the English people may now learn their business. The matron will be their ruler, the Resident Medical Officer and the “Sisters” (superintendents of the nurses) will be their instructors; and they will act as assistants to the regular day and night nurses. By due diligence, the novices will become fit for professional employment in a year; and a year’s training at St. Thomas’s Hospital is the amount offered.
The candidate must be fully resolved to stay the year out. There may be circumstances—such as a failure of health, or other accident—which may induce the Committee to allow an earlier departure; but nothing of the sort must be depended on. The candidate must know her own mind, and pledge herself for the twelve months. The authorities of the hospital, on the other hand, have the right of dismissing any “Probationer” (as the nurses in training are called), at any time, for obvious unfitness, as well as for misconduct.
The best age is from twenty-five to thirty-five. Of course, the candidate must be in good health and vigour, and must bear a good character. She will be registered on her entrance on her training, and a record will be kept of her conduct and qualifications, which will be laid before the Committee of the Nightingale Fund once a month. If this record presents a satisfactory account at the end of the year, she will be a certificated nurse,—no doubt eagerly sought, and nearly certain of being provided with an engagement, either in that hospital or some other. The Committee declare that they “look forward with confidence to being able to find situations for their certificated nurses,” at the end of their term of probation.
The Probationers will be trained at the expense of the Nightingale Fund. That is, they will have board and separate lodging in the hospital, and their washing, and a certain provision of outer clothing. They will be paid 10l. in the course of the year; 2l. the first quarter, 2l. 10s. the second quarter, and also the third; and 3l. the last quarter. A certain degree of merit will obtain a gratuity of 3l., and the highest of all a gift of 5l., from the Committee at the end of the first year of independent service.
It does not appear that there is at present any limitation of number. In fact, any woman of the proper age, and good health, and character, may offer herself, with a tolerable certainty that a useful and honourable career is open before her, in which she cannot fail except by some failure in herself. It is inconceivable that there should not be a crowd of applications when the plan is once known and understood, for in no profession or occupation is there such a scarcity of hands, or therefore so clear a prospect of constant employment.
The candidate has simply to apply to the matron—Mrs. Wardroper—at St. Thomas’s Hospital, Southwark; and, if in person, between eleven and twelve in the forenoon. Mrs. Wardroper will supply her with a slip of paper—a form to be filled up with replies to eight inquiries:
Name of applicant.
Age.
Place of birth.
Where educated.
Previous occupation.
Whether single, married, or widow. (If married, the certificate must be produced.)
If married, or a widow, whether with children; and, if so, with how many.
References.
This is all very plain and easy; and here we see the beginning of a new period, in which the traditionary “old nurse” will die out, and the sick of our country will have less suffering in illness, and a better chance of recovery than ever before; and in which the most womanly of professional occupations will have been, for the first time, effectually thrown open to all who are worthy to enter it.
It is to be hoped that while the Committee are providing tendance for every disease and every terrible accident which is admitted into a hospital, or is found in any private house, they will not overlook the brain-sick, who are the severest sufferers of all. In the words of one who has known that suffering, and the misery of bad attendance under it, “There is far more need to train attendants for the insane than for the sick. The sick can tell if they are ill-treated, and will be believed; but the poor sick in mind may be neglected and ill-used to an extent that the world knows little of, and find no remedy.”
The Lunacy Commissioners, and all the benevolent men in the profession cannot secure justice to the insane, while the race of attendants is what it has always been, and is now. There is actually no existing remedy for the enormous evil of subjecting persons of education and refinement to the management and control of ignorant attendants, coarse in language and manners. Go where we will,—among asylums, physicians, matrons, and patients,—we hear the complaint of the difficulty of obtaining any attendants who can be trusted or tolerated at all, in their demeanour towards the patients. They are not all tyrannical,—not all unkind; but in ignorant minds there is a radically wrong notion of their relation to the brain-sick. Few can conceive that the feelings, and most of the thoughts of the insane, generally speaking, remain very much what they were before the disease set in, and very like other people’s; and that therefore they should be treated, as far as possible, with the same consideration shown to other persons, and formerly due to themselves. Few of the ignorant class of “keepers” have any conception of topical brain disease and partial insanity, except as a curious phenomenon. With them a crazy person is crazy, and must be managed rather than ministered to; and the misery thus caused to sensitive and self-respecting persons is dreadful to think of. The coarse and hard tyranny once prevalent in lunatic asylums has given way, to a considerable extent, under the happy influences of advancing knowledge and improved social conscientiousness; but there is a kind of infliction on the brain-sick which no supervision can obviate, and no vigilance check, while the true remedy of good nursing and fitting attendance is out of reach.
There is no natural or insurmountable reason for its being out of reach. There are humane and enlightened women, full of good sense as well as kind feeling, who would be willing and even eager to nurse and guard the insane, if they knew how to set about it without encountering unknown evils, and committing themselves to the society of persons whom they dread and dislike far more than the patients. It is all a chance whether a woman of this quality can get any training first, or enter on the occupation afterwards, without running risks which amount to an effectual discouragement. It would be a great blessing if the Committee of the Nightingale Fund could open a way to such women, and bring them face to face with the patients who are suffering so keenly, and often so fatally, for want of them.
It could hardly be difficult to do. The teaching and training is small in comparison with that required for hospital-nursing. In fact, it is an opening which is needed; an access to the patients, and a trial of the mode of life. No doubt there is something to be learned in preparation for so peculiar an office. The usual hospital methods of securing good general conditions of air, warmth, food, cleanliness, &c., are as necessary in lunatic asylums as in all other abodes where the recovery of health is the object; but, beyond these general methods, there is not much that can be taught to attendants on the insane. The art necessary for them is that of exerting their own faculties, intellectual and moral, for the benefit of their charge. They have constantly to exercise good sense, readiness of mind, good humour, and never-failing patience. These things cannot be taught: but they may be incited and encouraged by wise authorities in the presence of the duty to be done. This would soon appear if the Nightingale Fund Committee would make arrangements with the authorities of Bethlehem Hospital or St. Luke’s, or some other well-managed asylum, by which probationers might be trained for the office of attending on the brain-sick. The increasing proportion of cures among the insane which has rewarded such improvements as we have been able to make in the management of that class of patients, would be rapidly and enormously extended, if we could get rid of the one terrible impediment complained of by all parties,—the bad quality of the attendance. As far as appears, the object is one which fairly comes within the scope of the Nightingale Fund. If the Committee should think so, and should act accordingly, there would be rejoicing, not only in every corner of every asylum to which the news should penetrate, but in many thousands of English households where it is now a daily and nightly sorrow that the insane member of the family is not, and cannot be, ministered to either wisely or tenderly. Cannot this consolation be afforded? and, as the pattern method is provided, without much delay? I am sure the Nightingale Committee will bear with the question.
Harriet Martineau.