Training in Small Hospitals

Kai Tiaki : the journal of the nurses of New Zealand, Volume II, Issue 2, 1 April 1909, Page 41

Training in Small Hospitals

The frequently discussed point of the advisability or not of allowing nurses to be trained m small hospitals is one which very largely affects a country such as New Zealand, which has for a very limited time been settled and provided with nurses and training schools at all. As you all know, the Act for the Registration of Nurses does not debar the smaller hospitals from training and sending up pupils for the State Examination, and it has not infrequently happened that the nurse who heads the list of successful candidates for her term, has been a graduate from one of these small hospitals. While freely acknowledging that our opinion is m favour of small hospitals not attempting to turn out fully qualified nurses, except under the difficult conditions of a young country, justice compels us to admit that given favourable circumstances, nurses may

have some advantages in those hospitals which they lack in larger training schools. The favourable circumstances are first of all a n edical officer and matron who are capable, keen in their work, and willing to make the fullest use of the material at their command. The doctor who is up-to-date and able, will have patients in his hospital who would otherwise go to one of the larger centres for treatment in serious disease, or for grave operations ; and a well trained matron, who is also head nurse, will be able in nursing these cases to give instruction to her pupils in a practical and detailed way impossible in the rush of a large place, where administrative work is all she can undertake. We must not forget also, that to an individual probationer in a large hospital, the work outside her own ward of sixteen or twenty or more beds, does not concern her ; so lhat

she has only to do at one time with about the same number of patients as a nurse in a smaller hospital. Moreover, as there are more nurses, the available practical work is divided between more pupils. Therefore, perhaps in a h/ spital of twenty beds, a nurse may have had during the term of her training to do with as many patients as the nurse in a hospital of 200 or mote, and she v ill have been able to watch each patient during the full course of treatment. We are not advocating training in small hospitals ; but, being obliged to accept the conditions in this country as they are at present, it is well to recognise all the possible advantages as well as the disadvantages, and to point out the best way of utilising those advantages. We must remember that hospitals are not established merely for training nurses ; if so they could be placed in large centres only. They are principally for the benefit of the sick, who are to be found in larger or smaller numbers everywhere. Here, where our towns are scattered, and some many miles from railways, it is necessary to have hospitals for quite small numbers of sick, and it is necessary for those hospitals to be staffed. There are not enough trained nurses to do all the work of these hospitals, even if the money could be provided to give them adequate payment, and it is hard for a girl to spend three or four years learning all she can and getting much good practical expeiience, and at the end of that time being no further advanced in her professional career. The ideal manner of staffing these small hospitals would be to have certain districts, with one main hospital ; the outlying small ones to be staffed from this centre with a sister in charge, the staff nurse and so many probationers being sent from the main hospital every three months or so ; just as they are in the different wards and departments of a large training school. This would ensure uniformity of training and be of great advantage to nurses, whose ideas would be much broadened by the variety of work and stirsoundings, and who would still have the

privilege of belonging to a large training school. Nurses may think that time would be lost by being away from the more important hospital, but that need not be so ; a probationer in a small hospital is called upon to do many things, which in a large place are reserved for the more experienced staff nurse, medical student, or even resident surgeon. For instance : we recently visited a country hospital where the operation of apendicectomy had been performed in the morning. The medical officer had done the operation, which had been a particularly difficult one, vith the matron as his assistant, one of the pupil nurses as anaesthetist (of course under his direction), and the other pupil attending to the sponges, and so on. The third pupil would have charge of the patient at night. Now in a la r ge hospital the probationer nurses have no chance of such close association with a major operation until well on in their training, or as post-graduate nurses , therefore, although the number of operations is very much larger, yet each individual nurse in the large staff cannot have much more practical experience. Then in small hospitals the pupils may, if they take an interest in their work, know, and help to carry out, the full treatment in every case. There is ample time for them to observe, and for the matron to point out to them, all important symptoms of diseases and results of treatment. They get a chance of assisting in the dispensary, and learning a great deal about drugs, and last but not least, they have the major part of the invalid cookery to do. Another point apt to be lost sight of, is that in a small place v ith a lim'ted staff it is impossible to adhere closely to any systematic time on duty, and that the off times of the nurses has to be made subordinate to the needs of the patients. This fact alone is of advantage, as it is more calculated to promote unselfishness and the true spirit of nursing, than any set, eight -hour system of duty. The chief disadvantages of training entirely in a small hospital are largely caused

by the indifference of the teachers, who do not think it necessary to put forth their best for the benefit of two or three pupils (and it certainly is difficult to deliver formal lectures to so few), and the carelessness of the pupils, who have not the same incentive to study as m a larger class. It is necessary for the teachers, doctors and matron to be the more earnest m their efforts, and to seize every opportunity for demonstrating and teaching all the proper methods of nursing, with the material at their command ; also to keep themselves up-to-date m lines of treatment

both medical and surgical. As we said before : given an up-to-date medical officer, and a well trained matron, there is no reason why the pupils should not become valuable members of their profession. Discipline is a part of the training which is more difficult to enforce among small numbers, but that also rests largely with those in charge. It cannot be as strictly carried out as in a large training school ; but nevertheless, the ethics of nursing can be well taught by 'precept and example.