THE NURSE'S TRAINING : H. THE PATH OF REFORM
By A MEDICAL CORRESPONDENT THE advance of medical science within recent years, the growing activity of the State in preventive medicine, and the popular campaign for physical fitness, all demand as their . corollary an advanced nursing profession.. The doctor and the sociological worker are powerless without the intelligent co-operation of highly trained nurses. And yet, so far from attracting better educated girls to take up such a career, our present system of training, as was shown in a previous article, acts as a serious deterrent. How can this be remedied, And the whole status of the nursing pro- fession. ,raised: to a higher- level ? , In the first- place, the heads of the nursing world require to take their courage in their hands, in exactly the same way as doctors and dentists have previously had to do, and erect -effective safeguards around their profession. At present nursing is more of a craft than a profession, for its portals are absolutely' unguarded, and any hospital, with or without the approval of the General Nursing Council, can take in candidates of any or no educational standard and intelli- gence and pretend to turn them out as fully fledged nurses. This is a scandal which ought to be stopped. But it will never be stopped, nor will the status of the nurse ever be raised, until the Nursing Council secure statutory powers to close down every Training School which does not conform to minimum requirements, and to prevent anyone in the future claiming the title of nurse or practising as such unless possessing , the necessary credentials and passing successfully through the educational_ course of an approved school.
But something far more drastic than that is needed, if nursing is to be placed on the level of the other scientific professions. The whole system of training requires to break loose from the limitations of apprentice life, and to start on a new basis of modern higher education in which nurses will be trained as students and not as mere crafts- women. Isolated items of reform, such as those previously recommended by the . Lancet Commission, have proved utterly inadequate ; it is radical reconstruction which is needed. Instead of a series of Training Schools organised on present lines, with probationers wasting half their time in unnecessary repetition in return for board and lodging and a partial wage, what is really wanted are properly estab- lished Nursing Colleges, with everything planned from an educational 'Standpoint. We do not dreani of training our teachers by plunging them from the' first into full-time duties in -school and giving them a few lectures at night. We provide suitable Training Colleges for them ; why not then for nurses? Such colleges would necessarily be attached to hospitals, which would- offer adequate scope for the practical instruction of the students in every branch of nursing, and such practical work would, as at present, form the major part of the nurse's education. But these hospitals should not be dependent, except in a minor degree, upon the work of the students for the carrying out of their own routine ward services. Students would thus be exempt from duties which poSsessed no educational value once they had become familiar with them. Their ordinary course of study would be carried out by means of lectures, demon- strations and individual practice in the college itself, which should be snitably equipped for the purpose, whilst clinical teaching in the application of nursing methods to individual patients would be provided by means of regular bedside classes and the performance of their own allotted ward duties.
A score of objections will be raised at once to any such proposal. We shall be told that the whole essence of the nursing tradition depends upon full-time service in the actual work of the wards ; that the raising of nurse-pro- bationers to the rank of collegiate students will spoil them for their future routine work ; that the cost to the hospitals of a larger percentage of trained nurses, in place of the cheap student labour which they at present enjoy, will impose upon them a burden which they cannot meet ; that Nursing Colleges of such a standard will never be able to recruit a sufficient supply of students, nor to meet the demands of our widespread hospital systein ; that many institutions have a place for nurses of inferior training, and that all over the country there are numbers of young women who gladly take up such work but would be unqualified to enter a real Nursing College. Such objections demand the most careful consideration, in view of their serious nature and the large problems which they raise. None of them are, however, insuperable, and though space does not permit of any reply to them here, a small book on the subject shortly to be issued by the Oxford University Press deals with them all in detail. For the present it is enough to suggest that the time has come for the inauguration of such a reform, and that in no other way can the science of nursing be raised to its proper level. What we need today is a group of nursing educationists who will pioneer the reform, a pro- gressive hospital which will provide the necessary venue, and a far-seeing philanthropist or Minister of Health who will supply the financial subsidy needed. We look to the Minister of Education to supply the necessary funds for the training of our teachers in suitable colleges. Why should not the Minister of Health be asked to provide in the same way for the equally important work of subsidising the education of our nurses ? Once such colleges were established, there should be no lack of suitable. candidates.
Meanwhile, valuable lines of reform might well be adopted in Training Schools not yet able to face so sweeping a change as that above indicated. The most important of these is the engaging of a larger percentage of trained nurses for the actual work of the hospital, thereby reducing the amount of routine duty which at present falls upon the probationer. This in itself would provide for a considerable reduction in the nurses' hours of ward duty, with ampler leisure for mealtimes, recreation and study. If at the same time systematic clinical instruction were introduced in the wards, the system of discipline modernised, and many of the present vexatious restrictions relaxed, much of the present discontent would be removed, and it should be possible to secure an ample supply of good candidates without the present some- what derogatory inducement of quarterly wages.
There is still another aspect of the problem which deserves far wider study than it has yet received, and which touches vitally upon the question of nursing services in hospital". It is the training and employment of higher-grade domestic workers, and the relegation to them of many ward dutiei at present restricted to the overworked nurse. Such daily routine as the washing of convalescing patients, the making of beds, the attendance on sanitary requirements, the carrying of food-trays, and the dusting of service rooms, are, in essence, domestic duties, and in a large number of cases could surely be performed by well-trained maids or orderlies. In every ward there would be certain patients requiring a skilled nurse's hands even for duties such as these, but that is not true of every patient nor indeed of every hospital. The recruiting and training of paid domestic workers would go far to relieve the strain which at present rests upon pro- bationer nurses, and in the case of many of our special hospitals and institutions all the necessary services might be undertaken by such workers, together with a relatively small number of fully trained nurses.
This is but a bare outline of a possible scheme of reform, fuller details of which will appear in the book above men- tioned ; but it may serve to indicate the direction along which the pathway to a more scientific and attractive system of nursing training should lead.
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