HOSPITAL NURSES

Otago Daily Times, Issue 16645, 17 March 1916, Page 2

HOSPITAL NURSES

MATRON AND PROBATIONERS.

BOARD'S DECISION CHALLENGED.

ADHERES TO ITS RESOLUTION.

Considerable interest wae manifested at last night's meeting of the Hospital and Charitable Aid Board in the question that has arisen bofcwoen the board on the one hand and the superintendent and the matron of tho Hospital on the pthor hand, with, reference to the position of the (probationer nurses in the Hospital. At ite meeting last month the board rejected tho recommendation of tho Hospital Committee that Nurses Elsie Connelly and Irene Collie, "not having given satisfaction, be not to the nursing staff at Dunedii" Hospital," end unanimously agreed to request the two nurees to continue in tho board's service and conjnlete their training. • Several letters •were received on the question.

Dγ Newlands, hon. secretary of the Honorary Medwal Staff, wrote stating that at a meeting of the staff on February 23 he was instructed to write to tho board expressing the staff's regret at the action of the board in over-riding tho lecorninendation of its responsible officers. Hie following resolution was passed unanimously: "That in the opimon of_ the Honorary Medical Staff of the Dwnedin Hospital, reports made by th" matron and the mtdical superintendent upon tho suitability or uMmifca'bility of probationer nurses should b3 accepted by the board as final." - The superintendent and the matron were responsible for the discipline and efficiency of the institution under their control, and if their joint recommendations were no£ accepted discipluo and efficiency must necessarily suffer by this lessoning of their authority. The staff at the same time, wished to convey to the board its keen sense of appreciation of the monner in which the matron_ had, in the face/ of great difficulties, maintained the standard of nursing in the Hospital. It was dooided that the board be requested to reconsider its.action in this matter, and that a deputation be appointed, consisting of Drs Batchelor. Fitehott, Eiley, Roberts, Fergiisoii. and Newlands. Miss Annie Borne, secretary of the Ofcago Branch of the New Zealand Trained Nurses' Association, wrote statin? that at the meeting of the Council of the branch, held on February 18. attention was <>a!led to the report of the board's proceedings in tho Otago Daily Times, of February 18. regarding the dismissal of probationer nursns. The matter was dismissed, end the following resolution was unanimcuely carried: "That this association views with the action of the Dunedin Hospital Board in not upholding the superintendent and matron in their recommendation respecting the dismissal of probationer nurses, as such action places the matron and superintendent in a fnlse position, and will affect the future' status of the Hospital as a training school." _Dr Valinfcine, Inepector-pengral of Hospitals, wrote, under date February 25, as follows: "I have read with very great regret the account of thr> recent board meeting at Dunedin. at which it was decided to accept for training t/wo probationers not satisfactory to ' the lady superintendent, whose report was endorsed by the medical superintendent, and accented by tho Hospital Committee. I would remind the 'uoard that our public hosDitiil's arc governed by the board_ nndei; by-laws whiVh are apnrovec! by tho Minister in Charge of Hospitals, and that_ it is not optional for tho board to <*o outside these bv-laws. Apart from the legal aspect, of the case, I would point out to the board that the matron of the Hospital is the resDonsible officer of the board in regard to the training of nureee under the Nurses Registration Act. and that if the high standard of our nurses is to be kept up it is absolutely necessary that she should have the power of deciding uivon the fitness and suitability or otherwise for training of probationers on trial. I hope you will therefore reconsider tho decision' of the board, or defer any action, until I am able to meet you." The deputation from the honorary medical staff was received. Dr Ferguson (chairman of the honorary medical stoff) said: I am present with some of tho members of the honorary staff of the Dunedin Hospital to say something in support of a letter expressing the views of tho stafi) on a recent resolution of the board.

My colleagues who are present will expres their views; but, in tho first place, I wist to make it clear that this' is not a case oi unnecessary interference on the part of the staff, -but an imperatively needed warning on a matter of which our knowledge , is much more intimate than that of the board can possibly be. I am speaking- with a full sense of responeibility • as chairman oi the staff, and with a personal knowledge gained during practically 40 years of constant wprk_ in hospital warde, and I hav« no hesitation in ,saying that the letter deals with a matter which is of the utmost importance to the staff and to the patients under their care. The efforts of the stag in the interests of their patients are either forwarded or brought to nothing by the manner in whioh the nursing etaff carry out their duties, and any interference on the part of the board with the expressed view of ite responsible officers as to the suitability or otherwise for further training in, the nursing profession of a probationer who has been three months under their observation w as unjustifiable as if they were to order the dispenser to continue to use drugs which three months , trial had proved to be worthless. The question of efficient nursing is one of such vital necessity in our treatment of the siok, and comes so essentially into the province of lie staff that we should be failing in our duty to the public if we were to allow without protest any interference by a lay board calculated to impair -that efficiency. The Jlospital is not only a medical school but is an important training school for nurses, and we have trained in the past many nurses who now occupy important positions in their profession elsewhere. Anything which tends to lower the standard of ■ discipline in the school depreciates the value of its diploma, and no blow could be more fatal to its value than the knowledge that the recommendations of the matron and medical superintendent were ' not adopted by the board, and that the diploma did not imply a guarantee that the matron and superintendent considered . they had the essential qualifications for a nursing career, whioh are not disclosed by examination results. It is my duty to point out to the board that it is a very dangerous proceeding for a lay board to meddle- with tho regulations which safeguard tho standard of tho nursing profession of New Zealand— a high standard whioh has been built up by the pelf-sacrificing work of many good women. You have a lawyer among you, and no doubt he has advised you as to whether you are bound by your 6y-laws, or whether in over-riding them in this case you are within your rights, but I warn you that interfering in a professional training of which it knows nothing a lay board is incurring a serious responsibility. The board called for the confidential reports of the sisters to the matron as to the probationers' work and suitability and purport to have been guided by these reports in re-, fusing the recommendations of their responsible officers. Much feeling has been skilfully worked up about one of the cases, bat the board's action must be judged in connection with both, and by taking action on written reports the board challenges criticism if their action is at variance with the substance of the reports they act on.

The reports in one instance are absolutely clear and free from ambiguity, and I am entirely at a loss to understand how any member of the board reconciles a resolution to continue to train this girl in a profession •for which the reports show her to be unsuitable, with any sense of responsibility to the nursing school, to the Hospital, or to the public." Dr Colquhoun said: "In addressing the board on the difference of opinion which exists between the board and its advisory and executive officers, the matron and the surgeon-superintendent, we of the honorary medical staff recognise that we are fulfilling an urgent duty. Iho nurses are the eyes, ears, and hands of the doctors. Trained and disciplined nurses are essential to the "carrying out of our duties, and, next to the pat.i-'ii--. themselves, no one is more interested 'Vii we are in tho maintenance of a high standard of nursing work. In addition to that, your honorary staff has been peculiarly interested in tho nursing school. We have given lectures to the nurses; we have carried out the .necessary examinations; we have advised from iimo to time methods of increasing tlv efficiency of the school. The result of many years' work is that there has been opened , to hundreds of women a means of beine: trained in a useful and honourable profession, and a standard has been attained which has led to the New

Zealand nursing certificntp beine; reoognfeed as evidence entitling the holder to practise her profession in most parts of tho Empire. nu*>» the government of Mifia Fraser,, Mre

BaJfour, and Mies Myles tho Dunedin Nursing School has attained and maintained a high position in the dominion, «wl wo !»• uevo that position ia jeopardised by the interference of the board with the duties «£ ite executive offioera. Your powers aro very large. You can suspend any of your oiticere, honorary or paJd. You can refuse to appoint any of ua to posts in the Hospital; but your power has limits. You caunot, once they aro appointed, interfere with your physicians and surgeons and the treatment they think necessary for their patients So with your exeoutivo officers. You can suspend or dismiss your medical superintendent and matron if you think they are incompetent or unjust, but to interfere with them in the most delicate and important part of their work, the choice and supervision of their subordmates, can only lead to anarchy. This is especially the case with the decision as to the retention or non-continuance of probationer nursee in the institution. It is obvious that the matron and surgeon-superintendent must in the course of their duties aequiro knowledge which may guide their judgment, and yet winch it wo'tild be quite impossible and improper to lay before a large mixed body 'ike the board. The ladies who have been advised not to continue their studies are not likely to bo benefited by the action of the board. In the first place, they learn that it is better to have friends on the board than to eatisfy the matron, whom the board has placed over them. Discipline, order, and obedience are the first virtues of a nurse. How can you expect these if your nurses begin their work undler the conditions proposed by tho board , ? There is. a graver objection as far as they are oonoerned Tlje examinations for trained nurses are not now conducted by the Hospital, but by the central authorities. Can you expect that these ladies will be admitted to their examinations when those authorities know that their studies have begun against the advice of the matron, the surgeon-superintendent, your own Medical Committee, your honorary medical staff, and the Trained Nurses' Association? There is another aspect of the case. It is impossible to imagine that any self-respecting woman could either retain office or accept office under such conditions as the board has established .by its recent decision as to these probationer nurses. For these and other reasons, and believing that the efficient working of the Hospital is seriously threatened, we most respectfully urge that the board should reconsider the matter. It seems hardly necessary to add, but it may be as well to do so, thnt we have no special knowledge of the circumstances which have led Miss Mylee and Dr Falconer to ffive their opinion upon the unsuitabtlity of these ladies for the nursing profession, but we, believe they aro the best judges, and that, for their own sakes. the two probationers would act wisely in accepting their judgment rather than that of the board." Dr Fitcliett. said the. staff was unanimous on tho matter, and regarded it is one very nearly concerning itself. If a nurse was untrustworthy she could do incalculable harm, despite what the knifo or medicine could do for a patient. No 'one would say that an instrument or a drug that had been pronounced by experts to be unsuitable should be used, and the 'public and tho patients would not thank the board if it insisted on women who, after a term of trial, had been pronounced by the experte to_ be incompetent or unsuitable, beinsr retained in the board'e service, and yet this was apparently whit the board proposed to do.

[ Dr Batchelor said he would merely endorse the remarks'of the previous speakers. Dr Riley said everyone would admit that they could not have discipline without authority.. If they undermined authority they undermined discipline. The position of matron was a difficult position to fill. The matron at the Dunedin Hospital had 100 nurses under her charge, and women were not_ less difficult to contro! than men. Unless discipline was maintained the work could not be carried on to the satisfaction of the staff or anybody else. If they ignored the recommendations of the matron they undermined her authority and undermined discipline. Dr Newlands said, speaking for the junior members of the staff, they were 'ust as keen ae the senior members on maintain-' ing full discipline at the institution. A faithful service by the nurses was absolutely essential. One had seen things happen where through either incompetence or remissness, or actual untruthfulness, if disasters had not occurred they had nearly occurred. If .there was a false record of a case—-perhaps the temperature' was , not taken down or put down haphazard—it might mislead in the diagnosis of cases or in the progress of cases. It. was necessary to have only women in the position of nurses who. held the full confidence not only of the matron and superintendent, but also of the honorary staff, who depended for a faithful record of what happened on the nursing sisters .and their juniors. There was no half-way house in the matter. The board had appointed a person to the trusted position of matron, and if it had not confidence in her the only thing it could do was to get rid of her. Mr Templeton asked if the medical staff

insisted on discipline at any cost. If a probationer had not had fair treatment, would the staff still insist on the board approving of the report of its executive officers?

I>r Ferguson said the question implied an assumption that there had been unfair treatment in the institution, and''the staff had knowledge of such a thing. In the case of one of these two niirsee the reports were clear that the girl was unsuited for nursing. The board, however, took a different view. That made the position of the matron impossible, andi the staff felt it would make it quite impossible for its members to depend on the nurses. .Could the board, with any sense of_ responeibility to the Hospital, to the nursing profession, or to the public, say that that girl ought to be retained in its service ? ■

In reply to another question, Dr Cblquhoun eaid if the board received a report adjudicating- adversely on any nurse or nurses it must either accept it or dismiss 1-he matron as' being incompetent.The Chairman thanked the deputation for attending, and assured it that its representations would have due weight. He agreed that discipline must be maintained. But the point was broadened very considerably in connection with this question, and in coming to a decision the board had been guided by more facts and more statements than the medical staff had had before it. In considering the matter it took into account more than simplo justice to one or two, of its officers. It endeavoured to administer justice as fairly as possible to all under its control. He was sure the board would do nothing ro weaken the control of its officers at the institution or to take away from the good work done by the nurses.

Subsequently, Mrs Ferguson moved that the board .rescind its resolution of last meeting that Nursea Elsie Connolly and Eileen Collie continue in the service of the board to complete their training. In speaking to the motion, she said: "With regard to the resolution passed by the board on February 17, I question the right of any board to act in defiance of its own by-laws as to the training of nurses.. What do a body of laymen and women know about nursing or the suitability of nurses for training? We must leave these matters in the hands of our responsible officers—the medical superintendent and the matron—otherwise what a-re they there for ? Perhaps members may bo. interested to hear the opinions of matrons in charge of large hospitals in New Zealand on the subject of probationer rrursce; I quote from a letter from the matron of the Chrietcnurch Hospital: 'How can any matron train and be responsible for any probationer who is not entirely under her discipline? A matron's position is not an easy one to fill, and certainly untenable unless supported by governing board.' The matron of the Auckland Hospital says: 'For the sake of discipline alone your board ought to support the matron. I would never recommend that a nurse be taken back again for any other reason than bad health, and as for a nurse of a few months' standing, it is ridiculous. It is a pity your board does not appreciate the extra work and responsibility kid on your

matron in this year, with most of the senior nurses away.' For the sake of the principle involved 1 should have supported our medical officers, even had I considered Miss Myles and the medical superintendent to have made an" error in judgment with regard to the unsuitability of thcee girls for further training. If the board does not uphold the recommendations of its responsible .officers, how are wo expect candidates of high qualifications to enter the board' 6 service? And we want the best service in a hospital holding such an important position in the dominion as the Dunedin Hospital does. It is to bo regretted that this matter over came up before the board, and I feel sure that those members who at the last meeting did not support the decision of their responsible officers will this evening change their views. They, perhaps, have not realised what a very serious step they are taking. If there are members of this board who wish Miss Myles to leave (ho employment of the board, why don't they say so honestly instead of endeavouring to force hor resignation by a step prejudicial to the discipline of th<> institution? We are here as representatives of- the public, and I consider that I am safeguarding the public's interests in pointing out the inadvisability of girls seeking further training in a branch of work in which matters of life and death .are concerned—work of which one of them at least has proved ter-

eelf oven in four months and a-half to bo icciipiibl.;. It is very much bettor for tue girls to dud out now than, later that nursing is not their vocation in life. A girl may get an excellent reference as a milliner, but that does not vouch for her nursing capacities.. A girl may be a very sweet girl, but an inferior nurse. This year hae been one of great difficulty for Miss Myloa —perhaps moro difficult than 'most of ua have realised. Fourteen eisters havo gone to the front, and any business man can understand that if 14 heads of department are suddenly taken away, there is some considerable difficulty in cariying on. Miss Myles, in spite of this, has carried on the work of the Hospital as well and faithfully as has lain in her power. Havo any of you considered what it means to a medical man to have indifferent nursing for his casce? It doubles hie responsibility, and may lnean loss of life to his patient. We all have our limitations — medical superintendents, nwtrons, nurses, and, may I say, even members of a Hospital Board. I feel suro that this evening members will vote as sensible and intelligent men and women, and support law and order." Dr Brown seconded the motion. The matter was not so easy and simple as the members of the deputation seemed to think it was. All tho right was not on one side, nor was all the wrong on tho other. Tho board could not seriously entertain the suggestion mado to it that no matter what recommendation a responsible officer mado it was bound to aoocpt it. It had a perfect right to claim that any recommendation that camo before it was founded on reason. It seemed to him that the matron had mado a mistake in this matter. Her recommendation respecting one oi the pro bationers was so entirely at variance with tho report given by tho nursing sister under whom the probationer was working that tho board naturally wished to niako further inquiry. Dr Ferguson had said that if the matron was unjust tho board should get rid of her. But tho board had adopted a more sensible plan. It was not out to get rid. of tho matron, but to. find out the rights and the wrongs of tho case. When the matron camo before the committee it was evident to the members that she had done what she believed to bo her duty. She had a very disagreeable duty to do, but she had acted conscientiously, and the committee supported her. One special reason why the board ought to rescind the motion was the fact already pointed ■ out —that the resolution, adopted at last meeting placed on the list of probationer nurses a girl in whoso case the reports were distinctly unfavourable. If it was only to remove that blot tho board ought to rescind the resolution. Mr Talboys supported the motion. He had every sympathy with the two probationers, but he could not help looking at the matter in this way, that unless the management of a business concern was supported, whether it was a hospital or anything else, they would not havo discipline. At the same time, he felt that the cases 6f the two. probationers should have been separated. Mr Knight opposed tho motion. He gave a history of the two probationers, and was proceeding to read reports on their work by the nursing sisters when The Chairman said those reports were confidential, and ought not to be read. They were favourable to the probationers, bin on principle, being confidential, they .ought not to be made public. ' Mr Knight said lie would obey tho chairman's ruling. Ho quoted from the reports of the matron on tho nursing work of tho two probationers, and said that, judged by those reports, both girls were worthy of positions in the Hospital. As far as Miss Collio was concerned, her report was excellent. Under these circumstances, he asked the board to give fair play to tho probationers. The future status of the Hospital as a training school for nurses would be injured :f the trainees were not sure of

getting fair play and if they knew they were liable to dismissal bv an officer who might be an autocrat. Regarding'the resolution of the honorary medical staff, it could hardly be said to be part of its duty to criticise the administration of the board, the members of which were the representatives of the public. There could be only one head of the Hospital, and that was the board. The board had a higher duty than to quietly accept every recommendation from its responsible officers. It must be satisfied that such, recommendation's were fully supported by facts, and was , entitled to the fullest information from its servants to

• ena-ble it thoroughly to inquire into any recommendations before approval or otherwise. Clause 346, which wds quoted by Mrs Ferguson, only gave the matron power to obtain an agreement if the probationer proved satisfactory to her, but she Had no power of dismissal. Dealing with newspaper articles on the question, he said only one of them invited comment. In reply to it, ho pointed out that the resolution adopted.by tho board was "that Nurses Elsie Connolly and Irene Collio continue in the service of the board to complete their training." The words

"bo asked to " were not in the resolution, and the sarcastic remark atjout " the spectacle of the board petitioning two probationer nurses, upon whom their superior official had reported adversely, to take advantage of the opportunity 'it offered them to continue their course of training," and also " the board humbly invites probationer nurses upon whom the matron has expressed_ an unfavourable judgment to remain in training at tho Hospital," were quite uncalled for. The board was a representative body, and it could be eaiely left to it instead of to a newspaper to say who was, and/ who was not, fit and,capable to represent it in carrying- out it# onoroue duties.- The board was willing, to be guided by its respdnsiblo .officers, but' could not stand aside when a palpable injustice was likely to be done to any member of its staff. If the matron, felt her position untenable it was open for her to take such action as she pleased, lii.it the board must remain masters of the situation

Mr Scurr supported Mr Knight; and said he intended to oppose the recommendation of the' matron. If a manifest injustice wae being done—and he believed it was so in this case—it was the duty of members of the board bo oppose any recommendation containing such an injustice. The reports on the two probationers would not justify any person m turning them down. He contended there had been a certain amount of animus in the matter. When th'e girls were eent back for a further month's trial the matron said, "They are coming back for a further month's trial, but I know what my report is going to be." That remark wae made in the presence of a member of the board. When asked before the committee if she had said such a thing she admitted that she had. An attempt had been made to explain away the statement by saying that what the matron meant was that she knew they could not so improve as to warrant her m reporting in their favour. No amount of 6ophistry, however, could explain away that statement of the matron.

Mr F. G. Cumming, Mr Templeton, Mr J. Cumming, and Mrs Jackson opposed the motion.

The" Chairman said, in the event of Mrs Ferguson's motion being lost, it seemed to him the matron's position would be untenable. Respecting the resolution of the Nurses' Association, as that body had not the full information before it, its resolutiozi was of no avail.

The motion was lost. It was supported by Mrs Ferguson, Dr Brown, and Mr Talboys, and opposed by Mrs Jackson, Mrs Gordon, Messrs Templeton, F. G. Cumming, Knight, J. Cumming, and Scurr. The Chairman said if it had come to a casting voto, hie vote would have gone with th§ management.