The Nurse's Larger Sphere

Kai Tiaki : the journal of the nurses of New Zealand, Volume V, Issue 1, 1 January 1912, Page 21

The Nurse's Larger Sphere

Miss Amelia Bagley

An Address to the Nurses' Association, Wellington Branch

By

Last winter I had the honour of being asked to talk to you on the subject of the Back-block's District Nursing scheme, so dear to the heart of our Registrar of Nurses. I had at short notice prepared something, and it is perhaps a blessing that circumstances prevented me giving it you— for I am afraid it was not at all worthy of the subject dealt with. I have been again asked to speak to you, and in case you never wish the dose to be repeated, I am going to take advantage of the opportunity and extend my subject, and try to bring more before your notice the increasing sphere of work for trained nurses, and touch briefly on each branch of our work, but more especiall}' the new avenues for usefulness, which are opening up to us so plentifully now. We will proceed to note what are the different branches of work open to trained nurses in New Zealand, and what will make each in its own way attractive to different nurses.

Nursing is, comparatively speaking, a new profession or calling. In England, by many, nursing is not yet considered a profession and nurses there are having a hard fight for proper recognition ; still it is beginning to be realised in most countries that the trained nurse of all women, if possessing the right characteiistics, can be capable of doing almost limitless work for the private and public good of humanity. And why "> Because in no other way can a woman receive anything adequate to a hospital training to fit her for so many branches of useful work, as well as the actual nursing of general medical and surgical cases. This is an age of specialisation, but it is considered by the best authorities that a three years general hospital training is the best basis to secure before taking up any of the different branches of nursing work. Apart from the valuable training in the technique of general nursing, it gives an insight into human nature, and diverse character, schools one in self discipline and self control like no other experience can, provided of course, one possesses the suitable character, temperament, education and physique. I propose then to enumerate the different branches of nursing

work open to us here in New Zealand, and to dwell a little on the value to humanity, and advantages to ourselves of each.

We will take general nursing in hospital ; private nursing in hospital and privately ; mental nursing ; district and visiting nursing; in town and country ; work under the Infant Iyife Protection Act; Maori nursing. Some day, I daresay, we shall have school nurses, and nurse sanitary inspectors, but for many years in New Zealand it would seem that the district nurse could also combine the school work with her own — it will come soon. We must move with the times, and this preventive nursing work will be invaluable to our own and future generations. Florence Nightingale with prophetic vision foresaw it, when she spoke of ' ' Health Nursing," as distinguished from ll SickNursing, " and pointed out that " The same laws of health or of nursing, for they are in reality the same, obtain among the well as among the sick. The breaking of them only produces less violent consequences among the former than among the latter, and this sometimes, not always. We have medical officers, immense sanitary works ; we have not nurses— missioners of health at home."

Hospital nursing in general hospitals — we must all have our beginnings there — and whatever work we take up later perhaps our three years training will be to us the happiest time of all ; at any rate we always preserve our love and loyalty to the hosptial that was our training school.

To go on to larger work in the hospital, first as charge nurse, then sister, and perhaps in time as matron, makes a grand career. I sometimes wonder if anything is as much worth while.

To have the privilege of nursing and directing the nursing of so many who truly need, to teach others what we have learnt and have proved ourselves. Although the work is often hard, the day too short to do all we want to do in, then to be associated with medical men, and see all the wonderful progress in scientific medicine and surgery (we see it at its best usually in our hospitals),

as. well as to enjoy the fellowship and friendship of our contemporary nurses. The daily routine, and all the deep human side of life we must enter into in our hospital work, appeals to many nurses more than any other branch of the work. To succeed at this we must be capable of managing people and affairs, and be methodical above all things. Outsiders think that long hospital work makes nurses unsympathetic. I can never understand that. Why should it ? They think the constant contact with all sorts of suffering and familiarity with so much of life's sadness and grossness blunts one's sensibilities to such, but I don't think so, rather should we learn from one patient how best to help another and so on. Certainly we have to learn self-control. But looking at the work from a more business like standpoint, advantages to ourselves, etc. In the hospital we are sure of a comfortable home, have no living responsibilities and a regular salary, which is of late years much larger than it used to be, so that something can generally be put aside for a rainy day. Just here I would like to point out to what a great extent the new Hospitals and Charitable Institutions Act of 1909, will increase the facilities for hospital training in our Dominion, and consequently the better positions available for nurses who are qualified. I allude to the centralization of hospitals, where the base hospital in a district will staff the subsidiary hospitals and all institutions where nursing is required under that board, thus making institutions at present unable to train by themselves, capable of training in conjunction with their base hospitals.

At private nursing one's opportunities for good are very many. Apart from the actual nursing of the patient which is, of course, often very arduous when there is only one nurse on duty for a very ill patient, there is often a great deal of tact required to manage the patients relatives and friends, they often need the nurse's sympathy just as much as the patient does. To really succeed as a private nurse a good training should be followed by further experience in hospital, adding as much fever nursing and mental nursing as possible, and a midwifery qualification is, of course, an advantage — indeed, the more a nurse can learn in special work before she takes up private nursing the better she will succeed, as many of the cases she is

called upon to nurse are not perhaps met with during a general hospital training. A private nurse should be cheerful, kindly, sympathetic, tactful and firm, she must be domesticated in New Zealand. To be a good reader and conversationalist is also, of course, an advantage ; her success depends upon her ability to " fit in" with the variety of patients, their friends and servants, also the different doctors and nurses with whom she comes in contact. Her trials are often many — the continual moving about of one's clothes, etc., living in a suit case or dress-basket, etc. Still, many prefer the variety of private nursing to the routme of hospital work. At any rate it is well worth while to be the needed helper in times of illness and anxiety, and to share others sorrows and in a measure be a tower of strength." The reason that so many well trained nurses do not succeed as private nurses is their want of adaptability, if the nurse is not to be an encumberance, she must adapt herself. The private patient should not be treated with the business-like routine of the hospital ward. It is not necessary or desirable to insist on hard and fast rules with regard to times of washing, sleeping, tidiness of bed and ways of ct doing hair," etc. And of course the private nurse is in honour bound to keep closely to herself what she sees and hears in different households. It is impossible to be too discreet in this particular, people are often completely thrown off their balance by the anxieties of the illness and household arrangements are generally disorganised. These words of Keble sum up the ideal private nurse pretty well : — " The world's a room of sickness. The truest wisdom there, and noblest art, Is his who skills of comfort best." Here also is another apt line or two : — " A wise old owl sat on an oak, The more he looked, the less he spoke, The less he spoke the more he heard. Lets imitate this wise old bird." Midwifery Nursing. — Is it less or more important than general nusing ? Well, is prevention better than cure ? The great aim in good up-to-date midwifery is to preserve the normal and prevent the abnormal. In this way we seem to be imposed with more responsibilities than with general nursing. We are trained to quickly detect

any departure from the norma l , if within a midwife's sphere to correct it, or if necessary, obtain medical aid at the right time. This sounds easy, but really requires a great deal of skill on the midwifery nurse's part, at any rate, she must know her work, which can only be taught her properly by a systematic midwifery hospital training, where she learns practically under good tuition. Sometimes I think, perhaps, no woman's work can be more really worth while than a good midwifery nurse's. Not only to comfort and help another woman through that most trying time of labour, be it a long or a short one (if the patient has ten doctors she must have also a nurse, she cannot be done without), and then there is the little new life — the future man or woman, whose life's health depends upon the care received greatly during the first few weeks of existence. A trained midwifery nurse now realises that her responsibility does not consist only with the proper care of the mother and child during the puerperium, that is a great deal and strictly speaking, under the Midwives Act, is sufficient, but what nurse knowing her work can resist assuring herself that after she leaves, the patient will look after herself, at any rate know what to guard against in order to keep well, and above all things how to feed her baby and attend to those details which mean so much for its future health. So man}*- of our patients are hopelessly ignorant of the best way to care for themselves and the baby ; in teaching and advising in these matters a very great deal can be done. Hospital midwifery work is a very busy life for a nurse — the teaching of nurses is very interesting, but requires much sustained effort, on the part of matrons and sisters to see that the details are properly learned. In our New Zealand midwifery training schools much more is taught of nursing details and a much higher educational and moral standard is required than in some other countries even where a Midwives Act is in force, in England the need of such is being realised now, for in reading accounts of the C.M.B. meetings the proposals are put forward and motions carried to make a longer and more practical training necessary before a pupil may present herself for the C.M.B. examination. The field for midwifery nursing is perhaps the largest of all. Since the Midwives Act has been applied in our country

much better midwifery facilities are available for the people, but a great deal yet requires to be done, and many more midwives trained before the best attention can be, as it ought to be, within the reach of everybody's means. To gain that end, and to get the midwifery into trained midwives and medical men's hands so that the untrained, mostly ignorant midwives of the past will no lon£ er exist we must do our part and be willing to work in ways that will suit the conditions of the people, who cannot all afford the undivided attentions of a trained midwifery nurse for the whole puerperium, and this is where visiting midwifery will come in. It is not new, the old untrained midwives do it, and have always done it, but how ? Often carrying dirty appliances from one patient to another, persuading the patients not to engage a medical man, perhaps meeting an obstetric emergency ivhere medical attention is imperative and deferring sending until irreparable mischief is done. A trained midwife knowing her work does nothing like this, she will see that her patients receive proper attenticn. It may be difficult for a nurse to work up a connection on these lines at first, but it can be done with patience. I know of one or two nurses who are doing it now in Christchurch and Dunedin. For a nurse who has family ties and must keep up a home, it suits better than private nursing, and it seems the only possible way of nursing the less well-to-do people who cannot afford the private nurse, but who must be nursed in their own homes, and can afford to pay more than the maternity hospital small fee. A nurse working in this way would do well to know of some decent women who would go to the houses where she attends and do the work, feed the patient and mind the children. Having to pay her nurse, say 25s or 30s a week including) confinement if the doctor was not required, the patient could then afford to pay domestic help to 15s or £1, and keep help until she was strong. Daily visits from the nurse if everything was normal with the good advice and teaching, would benefit her more in the long run than the struggle to pay six guineas for the fortnight, the nurse having to do washing, cleaning, everything if she would at the end of that time leave the patient, not at all fit, but taking up the domestic burden again with the addition of a new baby, if not^ already soon requiring supplementary feeding pst-

haps, owing to the mother's harassed condition and the nurse too tired out for her next case. In country towns that way of working would suit so many cases, especially where there is no accomodation for a nurse in the house. If nurses co-operate, and are adaptable, these methods will adjust themselves in time, and the work will pass successfully into trained midwifery nurses hands.

Next there is district nursing, by which, till recently, was understood the nursing of the sick poor in towns in their own homes. The nurse receives a salary for her work and has no worry on the score of fees. Such work requires much tact (as does private nursing), patience, common sense and 1 should think not to be at times too discouraged to go on — a saving sense of humour — • and above all things a great love of humanity and deep insight into human nature, both its light and its dark side. It must be very hard work, but full of opportunities foi teaching better house sanitation, feeding of children, etc.. as well as relieving many who would otherwise receive little musing attention.

District nursing in New Zealand is going to mean much more than the nursing of the sick poor in the towns. The country and back-blocks district nursing scheme is a large and splendid sphere of nursing work, calling for the very best qualifications, both general and midwifery, a large experience and exceptional personal adaptability, as well as good health. I will read to you the scheme as outlined by the InspectorGeneral, and adopted by the Hospita 1 Boards, which have in certain districts already adopted the scheme. This has already been instituted in Kai Tiaki, July, 1911.

The nurse receives an adequate salary. It is thought that where possible she may have her headquarters at a country hospital, which arrangement would be much pleasanter for her. as she would have the advantage of mtercouse with the hospital staff. Of course in many districts the nurse is required most in parts far removed from a hospital. Wherever the district nurse has been tried so far she has been a success, the people wondering how they ever did without her. As Uiuti, in Taranaki, Nurse Bilton did and Nurse O'Callaghan is doing, splendid work. Nurse Warnock is at Seddon — is leaving

shortly to take the sistership as St. Helens, and feels sorry to give up the district work. I would suggest that Nurse Warnock be asked, during the winter, to talk to us about her work at Seddon. Nurse Beethan is at Hawera.

The Bay ol Islands Board has a district nurse at Russel and at Whangaroa. These are just beginnings — more volunteers are wanted for the work. Letters from the district nurses are full of descriptions of interesting cases exciting adventures, and humorous incidents. To be so truly appreciated is compensation far a lot of hard work. The Health Department is going to organise the Maori nursing, which will be chiefly in the hands of Pakeha Nurses for a long time. So few Maori nurses are as yet qualified, the death of nurse Akenehi Hei, just when a great career of usefulness to her people was opening up before her, being a set back to that work. Nurse Whangaparita having been married recently, depriving them of another.

[Note.— Nurse Wangaparika, now Mrs. Reid, has not given up her work and has been of great service at the Isolation Camp at Tuparoa, in helping to nurse an outbreak of typhoid.]

The positions of Nurse Inspectors under the Infant Life Protection Act, have been proved to be best filled by trained nurses, and I believe in future the Education Department intend appointing only trained nurses to those positions. Exceptional personal qalifications are also necessary to fill these positons. Much discernment and tact, and a knowledge of children and their ailments. It is good to know that there is a choice of work for nurses, that nurses are more in demand than ever, it seems as if there never will be enough to " go round." Nurses coming from abroad get positions almost immediately. Our own trained nurses seeming to prefer private nursing to hospital positions whether private or public.

Hospital salaries have greatly improved of late years ; private nurses fees are larger ; private hospitals are much more in demand! The salaries offered for district nurses are good £150, or where a country nurse is employed as in two districts under the B. of I. Board, a retaining fee of £50 a year, the nurse to collect her own fees. For the Maori district work the salary is £150 and actual

travelling expenses. It is hoped that for that work it will be possible to provide a cottage for the nurse.

Mental nursing is recognised now to be the highest class of nursing work, and when we think of all it requires of observation, tact, pity, kindness and skill, on the nurses part, we realise that only exceptional women can excel in that branch. Mental certificates are now obtainable in New Zealand. I had the pleasure of listening to the best postgraduate lecture to nurses I have ever heard a few weeks ago. It was given by Dr. Beattie to our Auckland branch. His subject was mental nursing from a private nurses standpoint. Every class of mental case was touched upon, and sound advice given for

the management of each in a private house. It was most practical and helpful, and though a long lecture was listened to intently from start to finish. The doctor was asked (at his invitation) many practical questions at the close, and every one felt that we had learned a very great deal of invaluable information.

It is gratifying to know that our field is thus extending, and our work recognised as requiring more adequate remuneration. At the same time it is well for us to remind ourselves of added responsibilities and seek by every means in our power to fit ourselves, not only technically but personally to meet these.