EIGHT HOURS.

Evening Post, Volume LXXXIII, Issue 20, 24 January 1912, Page 3

EIGHT HOURS.

HOSPITAL NURSES. MEDICAL SUPERINTENDENT'S REPORT. A REARRANGEMENT RECOMMENDED. At the recent conference of delegates from the Hospital Boards it was decided to enquire from hospital authorities who had* instituted an eight hours' system of duty for the nursing staff, what their opinions were as to its efficacy or otherwise. A series of questions as to the working of the eight hour system were submitted to the medical superintendent and the matron of the' Wellington Hospital. Their reports are as follow :— ' INFLUENCE OF THE SYSTEM. Dr. H. Hard wick Smith says :— lt is 6oraewhat difficult to deal with all sides of the eight hours' system, of training, and at the same time condense the resort into a reasonable space. Each uestion in itself, if fully answered, ■would require a lengthy report, so it k my purpose to take each separately, and, as far as possible, condense my report. 1. (a) The influence of the system on the canning out of the treatment ordered by the medical staff; (b) is the system in the beet interests of the patient? The answer to the first part of this question is, in my opinion, that treatment suffers, and to a certain extent the treatments ordered by the medical staff are not carried out now with that amount of care and detail which they deserve. I believe that the nursing staff conscientiously carry out their duties to their patients, and that they do not fail in their duty, but it must be obvious to you, sire, that (1) it is not good for three sets of nurse* to treat one patient, either medically or surgically ; (2) patients who are very ill always prefer the same nurse to attend them, and often become discontented when their needs are attended to> by several .nurses during the day; (3) again, a patient is ordered a certain line of treatment throughout the. day. The morning nurse carries it out. She may do the treatment in a certain way and note certain points, etc., and uses care after *"nret noticing such things. The afternoon nurse then comes on duty, and even if she is told by the morning nurse the points worthy of note often causes the patient the same discomfort that the morning nurse caused, Again, this' same brocees may be repeated in the | night by the nignt nurse. I have mentioned this to prove my point. It may be further added to by the fact that all nurses have not the same amount of skill and sympathy, and it is more likely that the patient will suffer less if a less number of nurses are in attendance. The second point in the question is proved in the anewer to the first. .The modification which hae been introduced into thishoepital to a certain extent gets over this difficulty. The charge nurses lately appointed being senior nurses, are not restricted to the eight hours' system, and they spend some part of their time each day on duty. In consequence there ie always one nurse in the ward who can advise the nurses coming on duty about any new treatment or' any new complication which has arisen in a former , duty, IS THE TRAINING AFFECTED? 2. The second question asked is whether or not the eight hour system affects the training of • nurses with regard to the. necessary qualifications of a nurse. To a certain extent it does, but in my opinion it depends on the woman herself whether she becomes a good nurse or not. The qualities of a nurse are inherent, in some women ( but in others not so, and any form of training will not make a bad nurse into a good one. At the same time it unconsciously influences the nurse, for with the eight hour system the nurse in a full ward is always in a hurry, and oftentimes worried ; she has fixed work to do and only a certain time to do it in. That being so, each patient gete a certain amount of attention and no more. This tends to make a nurse think that patients only need a certain amount of attention, so she commences to forget thoee (little extra kindnesses which at first she would wish to give to the patients- under her care. I am surprised that the nurses carry out their duties as well -as they do. Where there is hurry and worry, which the' eight hour system .tends to create, then must patience and gentleness, tact, observation, attention to detail, thoughtfulness as to the comfort of their patients, etc., be leas, .though the latter. I believe, is ever present, in every g*ood nurse, still she has not the time to carry it out as she would wish, and' this lack of power blunts the keen edge of her sympathy. 3. The influence of the eight hour - system on the length of training necessary in order to, give in the larger schools adequate' experience in all the branches of work. Can _this be ac- ' complisEed in the three years course of training? I consider that',the eight hour system has not £0 much to do with this question, for with an eight hour system />r a modified twelve hour system three years is, in my opinion, too short a time for a nurse to leatn her work and apply . it. In a 'large 1 hospital, , such as the Wellington Hospital, the patients are * divided more thoroughly than in a smaller one.. The surgical cases are separated' into clean surgical cases and septic surgical cases. Then again into male and female. A different ward is provided for each class of case, Again in the medical wafds they are divided into male and female wards. Besides these wards mentioned are other wards, containing other classes- of patients, such as infectious diseases, consumption, incurables, and children. The latter is one of the most important training grounds for nurses. If nurses wish to get proper experience in each of these wards, and it is important that they should do so, it, is impossible to give that experience in three years. A nurse should work in a ward for at least three months at the beginning of her career, and again in the most important wards at the entt of her training. I often find nurses who tell me "that at the end of three years they do not know such and such a thing which is important, because they have not had the time to get experience in, that special department., From what I have said you will perceive that three years is not adequate tune for training for a nurse, and if I may suggest a remedy it is that the Stato < certificate be given after four years' training and not three. The Wellington Hospital has inaugurated the four years' system of training, v.hkh will come into force next year, but the nurse can still get her State certificate at the end of three years. This to a certain extent defeats our aim, for, though the hospital certificate is withheld till the end of the fourth year, a nurse may leave without the certificate of the hospital, and be allowed to practice her profession on the Stats certificate alone. Again in the three 1 years the nurse has developed her mind in the elements of nurdng. In the 1 fourth year she is given extra duties and greater responsibility, and can exercise her knowledge with the result she becomes a nurse who is ready to go into work equipped with powers which will mr.ke her successful. If she wishes to stay a longer period than four year* there are posts in the hosptal which will ,

still further develop her knowledge and reliability and finally make her into a woman equipped with all the attributes which contribute towards the making of a good sister. A sister should not be appointed to a hospital who has not spent at least five years in gaining know- , ledge necessary for her post, for it de- | pends greatly on the sister if the ward) work is carried out successfully. 4. The possibility of giving- that work during the time the nurse is on duty. It is not possible to give that work to a nurse whilst on duty for several reasons : (1) If she is a very junior nurea she is of little or no use in" the theatre because her lack of experience will hamper the operator and may lead to sepsis; (2) If she is a senior nurse it is necessary for her to be in the ward whilst the sister is with the case in tha theatre ; (3) Again at times the sister of the surgical ward is away for two to three hours in the theatre, and it is not possible to carry on the work of the ward if an extra nurse from thdt ward is there also. At the Wellington Hospital the nurses attend the theatre ir the morning, if they are on duty — in the afternoon, and vice Versa/ — provided the case is of such importance as to warrant an extra nurse being present. I would' like to make a suggestion^ here, and that is that the theatre sister be appointed permanently to that post. It is one of the most important positions in the hospital, and it is detrimental to the work of surgery to change the position yearly. The nurses at Wellington Hospital do theatre, duty after they have received their certificate. They hold the position for three months under the sister in, charge, but on. account of the large number of nurses undergoing their training at the hospital some, of them do not receive theatre experience because they leave before at becomes their duty. HEALTH OF THE NURSES. 5. The influence on the health of the nurses of the eight hour system. As far as Wellington Hospital us concerned, I do not think it affects the health of the nurse to a great extent. They often come off duty complaining of great tiredness, but I consider that the rush and hurry is inclined to make them at times hysterical and irritable. If the* had more leisure to do their work I think it would be of benefit. The percentage of nurses off duty through illness is about 3 per cent, during the year, and the health of the nurae largely depends upon herself. Some are very careless on this point, others sensible. If a nurse spends the whole morning running about the town, comes 1 in just in time for dinner, then rushes on duty, she will be naturally tired before that duty is ended. A nurse's work in training is a serious vocation, and if she wishes to do it thoroughly, she cannot keep up her social duties outside her nursing hours. Her life and relaxations should be quiet and orderly. At all times her life is strenuous and necessitates care for both mind and body. DISCIPLINE AND LOYALTY 6. The influence of the 8-hour system on the discipline and loyalty< of the nurses to their training school. Here again I do not consider the 8-hour system affect* discipline and loyalty to any great extent, though it does to some — in that it tends to make the nurse dislike her work because it is hurried. Discipline and loyalty depends chiefly on the type of -women received as a nurse and the officials she is trained under. If the officials exercise firmness/ with absolute fairness and tact, then the nurses will . respect " those put in power over them. Added to this it is essential'that the' nnrses have comfortable quarters and healthy food. I consider it would help if the boards of the larger hospitals assisted the nurses to form an Old Nurses' Association of the hospital in which they have, been trained. At the same time place • lists of names ' on boards at' the nurses' 'home of those nurses' who 'have gained distinctions both at the hospital and after they leave. 7. Where the 8-hour system has been extended to the more responsible officers, such as sisters in cnaTge of a ward, the influence of their work ac trainers of the probationers and as Ward managers. _ To this questions there is only one answer, and that is that it would be very detrimental to the patients, nurses, and ward work generally. Unlike an office, which can be attended between, the hours of 8 and b, » ward must have someone in authority, in charge for the -whole of the twentyfour hours.' It Bhould be the sister's first thought and duty to watch 'over the well-being of the ward' in whicti ' she is placed in* charge. A sister rightly feels this responsibility, and would 'not wish to give up her duties to those of less . experience or share the responsibility with another. If a sister and other responsible officers were to act under the 8-hour eystem the ■ ward -must suffer. The sister would- feel that when 'she was in. the ward she was responsible for its well-being, but in her absence if anything happened she couid not be blamed, and would lose interest' in her ward and the training of the nurses , under her. If the flistera were in charge for fixed periods it would create, jealously and discontent, and the methods of' each might easily clash, and patients and nurses suffer. There must Toe continuity of service in a ward, and that continuity of service must be carried out by one mdividual\ in charge. ( The sister always in charge knows her patients and their wants and wishes, and takes an interst in ■ them both whilst in the ward and afterward. Nurses acting under her know that she will be there , at fixed periods in the day to see if they have carried out their duties properly. The sister criticises and helps and teaches her nurses in their work. She becomes attached to the ward, and f6r tfie time being feels it is her home and takes a pride in the patient*, the nurses, and the well-being and the management of her ward. In fact, she associates herself with everything to do with the ward, and learns to 'take full responsibility. MATRON'S COMMENTS. The Matron of the Wellington Hospital reported on the subject as follows :: — ■ , 1. Where a number of nurses are engaged in carrying out treatments im- ! portant details are likely to be forgotten, the patient suffers inconvenience from the various methods >of nursing, I therefore the system is not-- in his best ; interest. 2.* Under the eight-hour sys- ! tern the nurse has less facility for acquiring the qualifications named in the letter. 'She. has to hurry through her work, losing valuable knowledge which could be gained by closer observation of patient*. ,She probably leaves work, to be done by whoever follows, her on duty because she has made arrangements outside, ' which necessitate a rush through her work in order to get away, and, consequently, the patient is f not sufficiently considered and 'attention to detail is lost. Under such a system nurses 1 do not feel responsibility sufficiently. 3. It is not possible for a nurse to get sufficient experience in all the branches of her work in a large or small training school in three years. 4. Nurses could not leave their ward work when on duty to attend operations, nor could they very well help in the operating theatre except when off ward duty, as it is only cases from their own particular wards that they attend^ apd it seems quite necessary to be present at those operations, if possible, which later on they have to nurse. This gives an excellent experience, which is always looked on as a privilege by nurses . in this hospital. 5. When a nurse has been working more than eight hours her health has not suffered under the strain in this hospital. ' 6. The impression conveyed is, that in the long hours spent by, jaarses, y/iih putrid^ people, hospital.

work, patients, rules, and restrictions, are too much discussed, the latter often made into a grievance, the necessity for having such rules and restrictions being unknown to those not in authorityThis, of course, might occur at any time, but not to such an extent. 7. The influence of a person such as a sister, charge nurse, etc., is better when on. more ( than eight hours. Her sympathies go out more to the patients. She sees the capability or otherwise of all those under her charge, has more time to .devote to training, becomes more careful of the details of the ward management, and gains a sense of responsibility which she is not likely to have when someone else would take over her charge at the end of eight hours' work. I The temptation to return just in time for duty after, say, a long morning out, when most people would probably' be fatigued, is not a good preparation for 'good work being done in a ward. Tiredness brings irritability and a distaste for work. It is a very usual thing for nurses on the eight-hour duty to go out either before or immediately after breakfast and not returning until, perhaps, 1.30 p.m., or even later. COMMITTEE'S RECOMMENDATION. The Hospital Committee submitted the following recommendation on the subject to the Hospital Board :—: — "That, having perused and considered the reports of the medical superintendent and matron ujpon the working of the eight hours' system, this committee, from its experience, endorses the conclusions arrived at by those officers ; and is of the opinion" that a rearrangement of nurses' hours, without strict reference to eight hours per day, and without materially increasing the actual hours of duty, will be in the interests of both nurses and patients." The acting-chairman of the board (Mr. R. C. Kirk) moved the adoption of the recommendation of the committee. Mr. F. T. Moore asked how the nurses regarded the proposed change? Mr. M'Ewen asked if it was intended to increase the hours of duty for nurses ? The' acting-chairman replied that what had .been submitted to the board were simply answers to the questions forwarded by th« Inspector-General of Hospitals, Dr. Valintine. f » The report of the committee was adopted.