Happiness in the Hospital -Recruitment of Nurses

By Iris Brook, S.R.N., S.C.M.

Open Air TB Ward at Addenbrookes

Open Air TB Ward at Addenbrookes

MEDICINE TODAY AND TOMORROW,”  OCTOBER,   1937

It is now generally recognised that there is an acute shortage of nurses in all types of hospitals in this country. It is true that the larger voluntary hospitals are still able to obtain recruits, but smaller ones find it increasingly difficult to get new nurses.

In the last few years the reluctance of girls to join a service, regarded as no longer attractive has been increased by the work of those municipal authorities who have taken over the old poor-law infirmaries. So many municipalities are offering conditions which are more advantageous than those of voluntary hospitals that it appears certain that unless conditions comparable with other professions are given, there will be still more difficulty in finding a sufficient number of nurses.

The shortage not only affects probationers, but in some districts so great is the demand for staff nurses that hospitals are having to pay a salary of three guineas and more a week with maintenance for the services of unattached nurses.

This can only be rectified by the hospital authorities not only increasing salaries, but improving conditions generally. That this would be more economic than the present position is shown by the fact that the London County Council is paying thousands of pounds annually for private nurses.

Agreement is fairly general throughout the nursing profession as to the changes necessary to attract suitable girls to the ranks. The voluntary hospital system makes it difficult to bring about any great change immediately, for the basis of these changes is financial. Change, however, there must be, and a move in the right direction has been made by the Trades Union Congress. Allied to a drive this autumn to organize nurses into an effective trade union, the Congress at Norwich adopted a “Nurses’ Charter” which will be made the basis of national negotiations.

This must not be regarded, however, merely as a trade-union move. The hospitals—and the community generally—will gain as much from it as the nurses.

The chief points of this charter are:—

  1. A 96-hour fortnight with elimination of the spread-over system.
  2. Improved conditions with regard to overtime and annual leave.
  3. Provision  for  sick pay,  compensation,  and  superannuation.
  4. Improvement of the amenities of nurses’ homes, with better facilities for study and recreation. Unnecessary restrictions must be abolished, and trained nurses should, wherever possible, have the choice of living out.
  5. The establishment of a National Council representative of all sections of the profession, with local consultative committees, to standardize rates of salaries and hours of duty.
  6. Additional educational facilities must be provided. There must be preliminary training before a probationer goes into the wards.

There is, too, a way in which the education authorities can assist in easing the nursing shortage. Something must be done to fill the gap between leaving school aand entering hospital.

The average secondary school girl leaves at sixteen, and two years must elapse before she can become a probationer nurse, yet few parents can afford to keep their daughters at school without financial assistance.

One solution would be to award scholarships for intending nurses in the same way as they are awarded to intending teachers, keeping them at school until they are eighteen.

Then if the Preliminary State Examination were separated into two parts, and anatomy, physiology, and hygiene placed in Part I, this could be taken before entry into hospital. This would have two advantages. It would greatly relieve the strain of the first year in hospital, and girls still at school would feel that they were really beginning to work for their profession, in the same way as those who take the first M.B. or the Inter. Arts or Science examination.

Nevertheless, it is the shortage of trained nurses which is most seriously felt, and that can be rectified only by changes such as the T.U.C. Charter suggests. This charter does not, of course, cover the whole field. Innumerable details will require to be dealt with when the committees which it proposes are actually set up.

They will find that the same difficulties are arising in every country, and proposals have been made in America by no less a person than Dr. B. M. Bluestone, the director of the Montefiore Hospital in New York City, which follow very closely on the lines of this British charter.

Writing in Modern Hospital (Chicago), he outlines a programme of desiderata which should ensure that the relations of employer and employed are mutually satisfactory. Dr. Bluestone deplores the tendency in some voluntary hospitals to exploit the staff on the ground that they are working for a charity and that they entered hospital service more or less out of philanthropic motives. He contends that all work done by the non-professional staff, where there are no other benefits to an employee, should be done on a full salaried basis. ‘He strongly recommends hospitals to create special committees from their governing bodies to take sympathetic and continuous interest in problems relating to employment, for, apart from any other consideration, salaries form the largest single item of expenditure. The cash salary of an employee should be adjusted in accordance with prevailing economic conditions, and an adequate cash equivalent should be given if maintenance is not provided.

He goes on to say that maintenance, generally speaking, should include:

  1. a room, preferably single, but double only in those cases where the room is large and well ventilated;
  2. at least three substantial meals a day, planned on a certain minimum, to which additions should be made for those engaged in heavy physical work (for employees who are given maintenance all .meals should be served in the dining-room);.
  3. laundry of a reasonable quantity of personal linen;
  4. incoming telephone service at all times, except during work hours, when only emergency calls should be put through;
  5. extra facilities in individual rooms such as radio outlets and bed-lamps;
  6. uniforms;
  7. medical care over reasonable periods in accordance with prevailing practices in industry, ward beds, separation rooms, semi-private rooms, and private rooms to be made available for this purpose, depending on the rank of the employee and the availability of beds.

The hospital authorities, both voluntary and municipal, of Britain are well aware that they must make at least some of the changes discussed here. The T.U.C. Charter gives a valuable lead in the right direction, but before they can obtain sufficient support for their views/ they must have the backing of the nurses themselves.

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