H.—3l.

PART VI.—DIVISION OF NURSING.

I have the honour to present the annual report of the Division of Nursing for the year ending 31st March, 1933. The year has been an extremely busy one, particularly so in view of the considerable amount of reorganization that has taken place not only in the field and institutional staffs of the Department, but also in regard to the training schools for nurses. With the assistance of Miss Moore, inspections of all public hospitals throughout the Dominion have been undertaken at least once, and an endeavour has been made to make these inspections of a more intensive character so as to obtain personal contact with the ward sisters. Special attention to various nursing procedures has been paid, and a definite improvement in method is noted in many places. Health or Nurses. Matters affecting the health of pupil-nurses have been the subject of special inquiries both by a committee set up by the Otago Medical School and the Health Department. It has been found, as is the case in other countries where investigations have been made, that the incidence of tuberculosis amongst this group of young women is comparatively high as in relation to the young women of the community at large. A large majority of the entrants to the nursing profession are young girls who have had a more or less sheltered life in regard to exposure to infection, so that their immunity is practically nonexistent. It would appear that to obtain the necessary improvement it is essential that changes are necessary in three distinct measures :— 1. A Careful Initial Medical Examination followed by Adequate Provision for Health Supervision during Training. —There are still hospitals which accept candidates who only present a medical certificate from their family physician, and only a very limited number have an X-ray of the chest done for all candidates. In regard to provision for routine health supervision during training, the position is more unsatisfactory, as the majority rely on nurses reporting themselves sick. This I consider too haphazard. Only two schools have a regular yearly health examination and four have provisions for monthly weighing. Hospital authorities are apt to consider that these examinations take unnecessary time and tend to make the staff hypochondriacs. If, however, the examinations are carried out in proper routine manner they serve as excellent opportunities for teaching personal preventive hygiene, and, considering the economic aspect alone, the time taken is more than repaid if even one long illness is prevented. As a protection against typhoid a few of the northern hospitals have a routine innoculation of all the nursing staff with T.A.B. vaccine ; and, in the case of two hospitals, innoculations of toxinantitoxin are also carried out. 2. Better Preparation of the Pupil-nurse before entering the Wards. — The Nurses and Midwives Registration Board has now definitely laid down in the curriculum that pupil-nurses must have certain lessons and demonstrations in elementary bacteriology, particularly as regards the conveyance of infection, during the first six months of training. It is the junior nurse who in the majority of instances handles all infectious material, therefore it is most necessary that she should clearly understand the dangers to which she is exposed. 3. Better Medical Asepsis. —If the principles of bedside isolation could be applied to all admissions to hospital until a thorough and extensive diagnosis was made, much trouble would be avoided, because frequently, for instance, a chronic tubercular patient may be admitted for some other complaint. There is one matter which to my mind requires much more attention, and that is nurses' uniforms. There are only four hospitals in the Dominion where nurses in the wards wear overalls which are not taken over to the Nurses' Home. It is almost impossible for a nurse not to get her dress contaminated in some way during the handling of her patient. If she goes to meals in the dress she has worn in the ward even if her hands and arms are thoroughly scrubbed there is a definite risk of infection from her dress. Nurses and Midwives Registration Board. The personnel of the Board has seen no changes this year, the Board consisting of Dr. Watt, Director-General of Health (Chairman), Miss Muir, Miss Tcnnent, Miss Morgan, Dr. Young, Mr. Wallace, Miss Lambie (Registrar), and Mr. J. W. Buchanan (Secretary). The meetings of the Board have been held quarterly, the agenda being in each case lengthy, so that the deliberations of the Board have taken a full day. At the present time on the register the number of registered nurses is 6,100 ; registered midwives, 2,778 ; and registered maternity nurses, 657. A very large number of these are not in active practice, and it is very probable that many of the names of those appearing on the register are those of deceased persons. It is most necessary that at an early date power should be given to provide for purging the present register if it is to be of the value it should be. Further, an " annual practising certificate," if

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