hospitals the training is shorter, being for one or two years. There seems to be a constant tendency to increase the requirements. At St Bartholomew's, St George's, the London Hospital, St Thomas's and others, probationers must enter for four years, and at St Bartholomew's they have to pass an entrance examination in elementary anatomy, physiology and other subjects. At all the more important schools the number of applications is many times greater than the vacancies.
In Great Britain trained and certificated nurses generally belong to a society or association. The most noteworthy of the associations is Queen Victoria's Jubilee Institute for Nurses. It was founded in 1887 with the object of providing skilled nursing for the sick poor in their own homes. A great many of the provincial nursing associations are affiliated to it. The number of nurses supported by each branch varies. The qualifications for a Queen's nurse are as follows: (1) training at an approved general hospital or infirmary for two years; (2) approved training in district nursing for not less than six months, including the nursing of mothers and infants after child-birth; (3) nurses in country districts must in addition have had at least three months' approved training in midwifery. Candidates possessing the first qualification are received on trial for one month, after which they complete their six months' training for the second qualification, at the same time entering into an agreement to serve as district nurse for one or two years at the end of the six months. The salary during training is £12, 10s., and afterwards £30 to £35 a year, with board, lodging, laundry and uniform. With regard to the earnings of nurses in general, the salaries paid in hospitals have already been mentioned; for private work the scales in force at different institutions vary considerably, according to the other advantages and benefits provided. At some the nurses receive all their own earnings, minus a percentage deducted for the maintenance of the institute; at others they are paid a fixed salary, as a rule from £25 to £30 a year, plus a varying percentage on their earnings or a periodical bonus according to length of service. This is perhaps the commonest system, but some of the best nursing homes give a somewhat higher fixed salary without any percentage. In all these cases the nurses receive in addition board and lodging, laundry and uniform, or an equivalent allowance. For special cases—infectious, massage, mental and maternity—nurses on a fixed salary usually receive extra pay. The fees commonly charged by high-class institutions for the services of a trained and certificated nurse are—for ordinary cases £2, 2s. a week, for special cases £2, 12s. 6d. or £3, 3s. a week; but many provincial associations supply nurses for £1, 1s. a week and upwards. The discrepancy between the fees paid by patients and the salaries received by nurses, especially in London, has occasionally excited unfavourable comment, but it is to be remembered that the nurses are maintained when out of work or ill, and have other advantages; many institutions either provide pensions or assist the members of their staff to join the Royal National Pension Fund.
To complete this account of the organization in Great Britain a few details with regard to special nursing are added.
Fever.—Regular training on the same plan as in general hospitals is provided in London at the fever hospitals of the Metropolitan Asylums Board (12 in number, with from 360 to 760 beds each), and at a considerable number of provincial institutions.
Insanity.—The Medico-Psychological Association of Great Britain and Ireland holds examinations and grants certificates in mental nursing; candidates must undergo three years' regular training, with instruction by lectures, &c., which may be obtained in a large number of public asylums by arrangement with the Association; one county asylum (Northampton) gives its own certificates after a three years' course.
District Nursing.—In addition to the Queen's nurses, of whom details have been given above, many local associations train their own nurses for this work. Cottage and village nursing are varieties of the same department; the former is organized on the benefit. system, and aims at supplying domestic help and sick-nursing combined in rural districts for an annual subscription of from 2s. to 10s., according to the class in life of the family, and a weekly fee of the same amount during attendance.
Monthly Nursing and Midwifery.—Systematic instruction in these subjects is given at some fifty lying-in institutions in different parts of the kingdom. The usual course for nursing is not less than three months, and for midwifery not less than six months; a premium is required of 12 or 13 guineas for three months, and 25 guineas for six months.
Male Nursing.—Two or three associations in London supply male nurses (fees 2 to 4 guineas a week), but there appears to be only one institution, apart from the military and naval services, at which they are systematically trained—namely, the National Hospital for the Paralysed and Epileptic.
Massage is taught regularly at the hospital just named, and at a few other special hospitals. Competent operators are supplied by the Incorporated Society of Trained Masseuses and, to some extent, by other nursing associations; but this branch of the profession is still imperfectly organized (see Massage).
Children.—A large number of children's hospitals throughout the country give regular training in the nursing of children; they take probationers at a somewhat earlier age than the general schools; the course is usually shorter (one or two years), and the salaries slightly lower.
The State offers employment to nurses in the naval and military hospitals. Queen Alexandra's Imperial Nursing Service was organized in 1902. Candidates for it must be between 25 and 35 years, single or widows and of good social status. They must have had three years' training in a general hospital. Foreign Service must be taken as required. Nurses are eligible for a pension after 10 years' service, the amount increasing up to the age of 55 when retirement is compulsory. The Royal Naval Nursing Service is organized on much the same basis. Other organizations are The Army Nursing Reserve and Queen Alexandra's Imperial Military Nursing Reserve, and there is also a nursing reserve attached to the territorial forces.
In the more important British colonies—Australasia, Canada and South Africa—there are now a considerable number of hospital schools and other institutions formed and conducted on the English model. Salaries and fees are very much the same in Australia; in Canada and South Africa they are higher.
In the United States a similar system prevails in New York, Boston, Brooklyn, Chicago, Baltimore, Philadelphia, New Haven and many other large towns. The period of training is either two or three years. At the Johns Hopkins School at Baltimore twelve scholarships of $100 and $120 each are awarded annually; graduate nurses are paid $360 (£72) a year. Salaries are altogether much higher in the United States. At the Boston City Hospital graduate nurses receive $420 (£84) a year, and at the Indianapolis City Hospital those on private duty are paid $72 a month, which is equivalent to £172 a year, with board, lodging, laundry and uniform. This may be taken to indicate the possible earnings of trained nurses working independently, as they usually do in America. The fees charged for trained nurses run from $12 to $25 a week, and even more for special cases. Male nurses are trained at the Bellevue Hospital, New York, the Grace Hospital, Detroit, and elsewhere. In the American schools more attention is paid to the preparation of nurses for private work than in the British (Burdett), and a directory or registry of them is kept in most large towns.
In Germany, their original home, both training schools and societies have multiplied and developed. The period of training appears to be considerably shorter than in Great Britain and America. Members of the Albert Society of Saxony, however, spend two years in the wards at Dresden, and a third at Leipzig, attending lectures and demonstrations. They are sent out to nurse rich and poor alike, and their pay is very small. Most of the German institutes have pension funds.
In France a great deal of the nursing was formerly in the hands of religious orders, but there too the hospital school system, inaugurated in 1877, has grown. The schools managed by the Assistance Publique in Paris give a very thorough course of instruction.
In Russia nursing is mainly in the hands of the Red Cross Society, whose members are, however, trained in the hospital schools.
In Italy, Spain, Portugal and Belgium scientific nursing is in a backward state. The old religious system still prevails to a large extent, and, though some of the orders do their work with great devotion, the standard of knowledge and skill is not up to modern requirements. At San Remo and Rome institutions have been established for providing English trained nurses to private cases.
