A Protest

Kai Tiaki : the journal of the nurses of New Zealand, Volume X, Issue 1, 1 January 1917, Page 53

A Protest

In connection with the State Examination held m December, and for the first time since the registration of nurses necessitated such an examination, a formal protest was received from certain medical practitioners and lecturers, connected with one of the training schools. The protest was worded as follows :— Dear Sir, — The undersigned, being the medical and surgical staff of the — Hospital, herewith enter a strong protest against the questions set on medical nursing m the paper of 6th December, 1916. Of the six questions two only, Nos. three and five, are questions properly covered by the syllabus. In our opinion the questions numbered one, two, and part of four and six do not come properly within the purview of medical nursing Question 1. Describe the symptoms, complications and treatment of erysipelas, etc. This is a surgical question and not medical. Nurses are not taught to diagnose but to treat disease by nursing. Question 2, part of. Describe the symptoms of duodenal -ulcer. This, m our opinion, is hardly a fair question. The nurses are m essence asked to differentiate between duodenal and other intestinal ulcers, and this is not a matter of certainty even to surgeons.

Question 4 is again a diagnostic question and its treatment has to do with drugs, and being controversial should not be asked. Question 6 is a hopeless question to ask a nurse. Part (d) m question 5. " Diet for a bilious temperament." We should be glad to hear from the examiner what he means b}^ this, as we, as teachers m this hospital, do not understand or recognise the term. While clearly appreciating the difficulties of an examiner, we do think that the choice of subjects is large enough to admit of putting purely nursing questions contained m the syllabus with which we are instructed to deal m our lectures and teaching. Signed — — ■— The Inspector General of Hospitals, Wellington. 15th December, li)l(>. Dear Sirs,- In reply to your letter of 1 ith instant ; I am writing to acknowledge the protest you have sent regarding the questions set on medical nursing for the recent State Examination. I must point out to you m the first place that the questions are set from the point of view of nursing patients, and not of prescribing treatment. They are expected to be answered as a nurse should answer them, and not as a medical student would be expected to. I must also point out to you that nurses are not being trained only to work m hospitals where they are constantly under supervision and direction of a medical officer. They are frequently stationed m positions where it is necessary for them to recognise and diagnose different conditions until medical advice can be obtained. Matrons of country hospitals without resident medical officers are frequently called upon to recognise the symptoms of cases brought m, and to carry on their treatment m absence for many hours of the responsible medical officer. In private nursing, nurses are expected to understand and be able to recognise symptoms of different diseases and thus assist medical attendants m diagnosis.

I may add that similar questions to those of which you complain have been set for State Examinations on many previous occasions. I will send your protest to the examiner who will, I am sure, regard the answers sent by candidates from a fair point of view as from nurses, and not medical students. Yours truly, (Signed) T. H. A. Valentine, Registrar of Nurses The Medical and Surgical Staff, — ■■ — Hospital. The examiner replied as below : " I have received your letter enclosing protest from certain doctors re the medical examination questions. I must say the protest rather surprises me, as the questions are quite straight forward, and so far as I have at present corrected, up to the first three questions, they have been answered splendidly, showing that the paper was right into the hands of the nurses. Indeed not only will there be very few failures, if any, but the percentage of marks obtained will be very high. Taking the doctors' objections m turn. Question 1, erysipelas. This has been answered without a single failure, everyone obtaining over sixty per cent, and so many splendid answers given that I shall have difficulty m choosing the best for insertion m the Journal. Question 2. Symptoms of duodenal ulcer. This has also been well answered ; naturally only the points which a nurse is expected to report to a doctor m attendance are required, chiefly the length of time after a meal m which the patient complains of pain, and the fact that the patient feels relief from the pain after a little food ; then a few of the outstanding symptoms which would indicate sudden rupture, and warn a nurse to send for immediate surgical help. I consider it essentially a nurse's duty to know those symptoms. Question 4. The morphia habit. Here again only the symptoms and treatment from the nurse's standpoint are required, but again I must say that, it is essential for a nurse to be able to recognise those symptoms. In the course of my own practice. I remember distinctly two occasions on which I was treating patients

for certain illnesses, and the nurse m charge was the one to detect the morphia habit. On both occasions it came as a surprise to me, because the patients were extremely clever m their deceit, and I gave the nurse great kudos for recognising it. The morphia habit will complicate any other illnesses for which a nurse is attending a patient, and she must know its symptoms. Part (d), Question 5. The term " bilious temperament " is evidently found fault with. I agree that it is not a term which would be used m an examination for medical students, but when a district or backblocks' nurse is asked by a poor mother what she should do for her Jane as she gets bilious every time she eats a pork pie or a bit of pastry, it would be a poor kind of nurse who would reply that she did not recognise the term bilious, and therefore could not give her any advice. Nurses are turned out into the world to live among people, not to live for ever m hospitals where they hear only the accurate scientific terms used by the medical profession. I have turned up a few of the answers, and fortunately I find that the term has been perfectly well understood and correctly answered. Question 6 " Anaemia." With regard to this all too common disease, I consider that not only nurses, but every woman throughout the length and breadth of New Zealand (and every other country) should be made familiar with its main causes, and a few of the main lines of treatment. Nurses are not expected to go into abstruse questions concerning the size of the heart and the blood-vessels, but they must know what unhygienic factories and sleeping quarters, want of sleep and sunshine, and poor feeding "will cause anaemia m people who are organically sound. If our nurses cannot give that much advice to the thousands of women with whom they come m contact, then I should say the

whole training of our nurses is fundamentally wrong. Fortunately this is not the caie : from the few papers 1 have looked at, 1 think I shall find that the question has been very well answered/

We must comment on the curious point of view presented by this protest. Evidently these doctors objected to nurses being expected to understand the symptoms of diseases or to even m their own minds, form any diagnosis. We would like to know what intelligent nurse does not know at least m a general way, the symptoms of most of the common ailments of humanity. It is certainly not the place of a nurse to usurp the function of a doctor and put f oi ward her diagnosis, but many of the cleverest men recognise that the nurse has opportunities to observe symptoms no one else can have, and rely on their nurse assistant to help them m many a decision. Nurses are no longer merely the handmaid of the surgeon and physician. They are his assistants and the success of his finest work more often than not ' depends largely on the skill and knowledge of the nurse m charge. There is scarcely a modern movement for the benefit of the community m matters of health, that does not require for its carrying out, the services of the trained nurse. They are asked for for all sorts of positions m which a very wide knowledge of their profession, not merely the essential practical skill m handling patients and dressing wounds, is required. They must know the causes which lead to illness, they must know how to advise and how to guard against illness. In country places, far from medical aid, they must, to the best of their ability, prescribe as well as carry out treatment.

News lately received from England, states that Miss Elizabeth Nixon is to take Miss Thurston's place at Walton -on -Thames Hospital, while Miss Cora Anderson has been selected to be Matron at Codford with Miss Nixon. Miss Anderson was Matron a t , : — Convalescent Hospital.

These changes are necessitated by Miss Thurston's removal to Headquarters m London to act as Principal Matron and Organiser of the Nursing Staff of N.Z.E.F. previously combined with her Matronship at Walton.