The Trained Nurse as an Assistant

Kai Tiaki : the journal of the nurses of New Zealand, Volume II, Issue 4, 1 October 1909, Page 153

The Trained Nurse as an Assistant

(By T. Hope Lewis, M.R.C.S., 1y.1y.A., Consulting Surgeon, Auckland Hospital)

Many surgeons the world over now employ a trained nurse as an assistant in their general surgical work, and no surgeon who has had experience of what a good nurse assistant can do, would be without when he is in really busy work. Nurses will have to teach themselves out of their hospital curriculum if they intend to take up, when qualified, such a position, and it is with the idea of pointing out what to learn and look for that I have written this article. The principal duties of a nurse assistant are : (1) The preparation of dressings, sutures and ligatures and the storage of the same ; (2) the manual assistance at an operation ; (3) the attendance on patients at the consulting rooms ; (4) the care of surgical instruments ; (5) the keeping of medical accounts and dispatching bills ; (6) the overlooking of preparations at private houses for operations in such places ; (7) the surgical dressings of minor cases ; (8) the answering

of a thousand and one questions from patients about ailments, directions to nursing homes, and every other conceivable subject. A glance at the above list will convince any nurse that the position is not one to be undertaken lightly, and it is not by afiy means every trained nurse who can fill the post with success. Now, to take these duties in detail : (1) The preparation of dressings, sutures and ligatures. You may or may not have had opportunities of learning this in hospital ; in private you need to do all these things thoroughly and tieatfy, and your various articles must be stored conveniently for travel. All must be ready every day and all day, so that emergency work at a distance can be as well done as at home. This is, of course all a matter of arrangement with the surgeon. He would keep a bag which contains when stocked, all the necessities for an ordinary operation. A book with a list of such necessities would be in a handy

position in the surgery. This book would also contain lists of instruments for various operations ; the containers for sutures, ligatures and dressings would be filled daily from the stock lockers, etc. To do all this work well is of the highest importance, and needs the greatest care and conscientious detail. Lives, often valuable, depend on the care with which this work is accomplished. The methods employed for carrying out this work do not come into this article. 2. The manual assistance at an operation : Now the surgical assistant is born, not made. A man may be a good surgeon but a bad assistant ; but I know a few nurses who are perfect assistants. The two faults that most assistants — male and .female — make when beginning are : (1) Keeping swabs too long on the operation wound, and (2) holding their hands in such a position as to obscure the view of the operation. There are many other minor faults, but these are the common ones. The great thing for a nurse who is in charge of sutures, ligatures and instruments, at an operation, is to think about one minute ahead of what the surgeon is doing : In another 30 seconds the surgeon will need the pedicle needle, have it ready, and hand it when he asks for it ; then the silk or gut, have it ready at his hand when he actually needs it. This is not spoiling the surgeon, it is doing your work. Giving him all sorts of good tea and buns, etc., after operations is spoiling him. Three meals a day are enough for him and he ought to know it. Women have beautiful hands for surgical work as a rule, and make excellent assistants if they are keen on their work. Some are and some are not. Those that are not should cease to be nurses, or at any rate should not aspire to the position of a nurse assistant. This part of a nurse's duty is best acquired by watching one who is an adept at the work. Surgery is full of dodges and tips, and it is the attendance to and knowledge of the detail that counts in this art. 3. The attendance on patients at the consulting room, and (81 the answering of innumerable questions by anxious patients and their relatives is by no means a small part of the nurse-assistant's duty. When the patient is a female, she will probably be accompanied by one, two or more relatives. After the examination by the surgeon has been concluded, and he has given his opinion that an operation is necessary, a consultation is

often" held in an ante-room by the relations and patient. We will suppose that another patient, say a man, has been shown into the surgery by the nurse, after which she leaves the room. The nurse-assistant has then to be questioned by the patient and relatives about a thousand things : Does she think Nurse So-and-so's home a good one ? will the patient have much pain after the operation ? How long will it take ? and so on. It is quite immaterial that the surgeon has told the party all this before. You see, the nurse-assistant is a woman and so are they, and feelings are at fever heat with some patients. The operation may be a small one, but of immense importance to the patient. In no position in life is tact so needful as in this one, and you must be very, very careful what you say. I happen to have overheard parts of these plays, some are comedies but, sad to state, some are really tragedies. Oh, what a chance of a study of human nature has the nurse-assistant, and what chances of judging character ! I^et her use her opportunities well. In no part of the nurse-assis-tant's duty is she of such importance to the surgeon from a business point of view as in her manner, behaviour and tact in and around the consulting room ; she may make or lose a patient almost as easily as the surgeon can. I. The care of surgical instruments and appliances is another duty of the nurse assistant. How instruments deteriorate by bad treatment is well known to many surgeons. I am sure a good nurse could save a busy surgeon many pounds each year by care bestowed on surgical instruments, rubber goods and electrical appliances. It is after an operation that ordinary surgical instruments suffer from neglect in some places ; but at that time it is the nurse's duty to see them well scrubbed, and rendered clean and ready for the next case. 5. The keeping of medical accounts may or may not be entrusted to the nurse-assis-tant, but a knowledge of how to keep accounts, at any rate, medical ones, is easily obtained, and this work may enable a nurse to gain a somewhat higher salary. 6. The superintendence of pieparations for an operation at a private house at one time often fell to the lot of the nurse-assis-tant, and it was a most important part of her work. Here again, her personality counted for a great deal. Her work was done the day before the operation as a rule. In these cases, except in the case of the very

poor the nurse-assistant would have the assistance of the nurse who was engaged to look after the patient when the operation was finished. 6. The dressing of minor surgical cases : Amputations of the fingers, crushed hands, small operations about head and neck, etc. These dressings are often done by the nurseassistant, and much study should be given to its satisfactory performance. Cleanliness and neatness are first-cousins in surgery : so learn to bandage well as well as to be clean. Remember the patient takes a great delight in showing how his wound has been bandaged up when he is in his family circle at his own home or elsewhere, and it is well he should show a neatly-dressed and bandaged wound, and a well applied sling, etc.

In conclusion, I do not know any work which is more interesting in these days of clean surgery than that of the nurse assistant. I think that a tactful, well trained woman, who has not lost all or most of her womanly sympathy by undergoing a hospital training (and mark you, many women do lose it !) could find in the post of nurse- assistant, an interesting, congenial and lucrative form of occupation. At present the openings are not many, but by-and-bye there will be more. In many country districts a qualified nurse as an assistant to a general practitioner would be of inestimable value, but the nurse must know her midwifery well, and also some dispensing. In such a position a woman should earn a good salary.