AFFILIATION BETWEEN THE LARGER TRAINING SCHOOLS AND SMALLER HOSPITALS.

Kai Tiaki : the journal of the nurses of New Zealand, Volume XVII, Issue 4, 1 October 1928, Page 182

AFFILIATION BETWEEN THE LARGER TRAINING SCHOOLS AND SMALLER HOSPITALS.

Among the subjects for discussion at the Central Council meeting of the New Zealand Trained Nurses Association is the question of affiliation between the larger training schools and the smaller hospitals. Ist. — That the pupils from the smaller hospitals should attend the Preliminary Training School of a larger institution. This would be a very difficult, but not an impossible matter to adjust. Under present -conditions it would depend on the accommodation available at the larger hospitals, and it would necessitate one tutor for preliminary school work only as with the increase of pupils she would be entirely engaged in this class of teaching. A second tutor would be required for the pupil nurses in training. The cost of the training of the pupil nurse in the preliminary school would presumably be the responsibility of the hospital to which she is to be attached. Also the question of her salary, uniform and travelling expenses would have to be arranged. A much more satisfactory plan would be the establishment of, say, six or eight preliminary training schools for New Zealand, quite apart from any hospital, as now exist in connection with the most important hospitals in England. To these properly equipped schools and their attached homes, pupils selected by the various hospitals should be sent for three months. The practical instruction they should receive would be the care of

the household, preparation of simple foods, handling of drugs and lotions, the construction and uses of ordinary hospital apparatus and nursing appliances, and practise in simple nursing procedures. The theoretical instruction would be the principles that underlie the practical application of the above subjects and also anatomy, physiology, chemistry, bacteriology and hygiene. History of nursing and ethics should also be included. These preliminary schools would be maintained by the Hospital Boiards in accordance to the ratio of the pupils they present for instruction.

Miss Nutting states that the Preliminary Department of the London Hospital Training School, "where twenty-seven probationers are always being prepared for the hospital, costs just £1,000 per year to keep up." She also goes on to say that the idea that it shall cost anybody anything to give nurses a proper education, has been for so many years unthinkable that we cannot wonder if it stands in the way of better development for training school work. All good education anywhere is costly, and it is a bad day for our training schools, for our nurses, for physicians and for sick people everywhere when the first question is always "How little can we do it for?" rather than "How well can we do it?" 2nd. — That there should be a three months' exchange of nurses between the larger and smaller hospitals before the conclusion of the third year of training. The Nurses and Midwives' Registration Board have now decided to approve for limited training purposes, hospitals, which are not eligible for approval as training schools for nurses, but in which satisfactory preliminary training may be given. A pupil nurse who has spent a year in a limited training school may receive six months' credit when she enters an approved training school. At present there are in New Zealand 36 hospitals approved as training schools for nurses. Of these, twenty-two hospitals, or more than half, average less than 80 occupied beds. Thirteen, or more than

one-third of the total, average less than fifty occupied beds, and five of these have less than thirty occupied beds. In the interests of the general standard of nursing education, I would suggest that the field of limited training schools should be extended further.

Hospitals that average less than fifty patients cannot possibly give a satisfactory all-round training. Pupil nurses in such hospitals can only receive a very meagre, if any, training in the nursing of infectious diseases and of children, especially infants, or in the care of specialists' cases. Also, the teaching facilities must be very limited. The Medical Officer and Matron would probably be the sole teachers available, and they would have very little time and poor equipment for the purpose. Instruction in invalid cookery and dietetics could not be adequate. I would suggest that the present approved training schools of less than fifty beds should accept pupils for two years* training only. Anatomy and physiology and general nursing procedures should be taught in the first year and general medical and surgical nursing with some instruction in dietetics and operating theatre experience in the second year. At the completion of the two years the pupil nurse should sit for an examination in general nursing up to the standard that may be expected of her after two years' work. Such an examination should be conducted by the Registration Board to ensure that satisfactory teaching has been given. The nurse should then pass into a larger school of over 100 beds for her third year, where she would receive instruction and experience in the branches of nursing which had not hitherto been available to her. This would necessitate the re-arrangement of the present syllabus as laid down by the Registration Board. The syllabus should be arranged

with the subjects for the first, second and third years of training. This would ensure that nothing would be omitted in the education of the pupil nurse from the smaller hospital. Third year instruction should include: Nursing of children, with special instruction in the feeding of infants and young children Dietetics and invalid cookery. Venereal diseases. Gynaecological nursing. Nursing of eye, ear, nose and throat cases. Infectious nursing. Diabetes, goitre, etc. If the nurse from the smaller hospital proved satisfactory, there is no doubt that she would be asked to remain in the larger hospital for a further year, after registration, and she would thus obtain some post-graduate experience. If the scheme outlined were adopted, a slightly larger trained staff would be required in the hospital of less than fifty beds to balance the more junior staff in training. The graduate nurses, if they so desired, could go to the smaller hospitals for the fourth year for experience as^ staff nurses, and they would thus obtain an insight into the management of a small institution. The proposal that there should be a three months 'exchange of nurses between the larger and small hospitals before the conclusion of the third year of training, I do not consider to be good. In Dunedin Hospital the syllabus of training is so arranged that there is definite teaching given in each six months of the three years of training. None of these lectures are repeated, though revision, of course, is carried out in the classroom. Also, the practical work for the second and third years, when the pupil nurse takes senior duty, is planned so that she will receive training approximately as follows: —

Men's Surgical Nursing Women's Surgical Nursing j " months Children's Surgical Nursing 3 months Gynaecological Nursing 3 months Men's Medical or Women's Medical Nursing ) Children's Medical Nursing \ months Continued on next Page

Scarlet Fever or Tuberculosis or nursing of Infectious cases 18 months Operating Theatre 4h months Two periods of holidays 3 weeks Sick Leave, say 6 weeks Preparation of Special Diet 1 . 6 weeks Includes Nursing of Eye, Ear, Nose and Throat cases 3 months Includes 2 weeks' duty in preparation of Infants' Foods 3 weeks

(The training- in preparation of special diets will be carried out next year. It is not yet in operation.)

This leaves six weeks not filled in. As frequently the probationary or junior period is over twelve months in length owing to the date of the examination, this six weeks, or even longer may be used up before the nurse takes senior duty. If a nurse were sent from this hospital to a smaller one, there would be a definite break in the continuity of her education, which she would not be able to overtake. Such nurses would be at a disadvantage. The pupil nurse from the smaller hospital would really gain very little in the short space of three months in a larger hospital. It would take her some time to adapt herself to new conditions, and she would probably return dissatisfied with the lack of teaching facilities in her smaller training school and its general isolation from the attractions of town life. The two schemes I have quoted, first for preliminary training, and secondly for the better teaching of the pupil nurses of smaller hospitals, would, I think, do much for increased uniformity of the standard of training throughout New Zealand. E. P. TENNENT.

Miss Bicknell : You have listened to two excellent papers, Miss Tennent's paper on the Affiliation of the Larger Training Schools, and to Miss Smith's discussion. I may mention that when I was in England five or six years ago, I was particularly interested in the Preliminary Training Schools, and brought back a good many papers regarding these schools. On my return, I always made a point of going round the hospitals and approaching two things, and one was the

Post-graduate Course and the other the Preliminary Training School. We have, partly as a result of the efforts I made, if I am right to claim the c.'cd!l myself, created a little public opinion among the Boards. We have just got in the thin end of the wedge and we want to make it wider. In the smaller hospitals I asked them if they would be prepared to send out nurses to the preliminary schools, the larger training schools paying for their maintenance, and they welcomed the suggestion. If the smaller centres send their nurses to that school, of course the nurses would understand they would go back to the smaller hospitals that sent them. In regard to Miss Tennent's, of course, all that she has said is most interesting and very much to the betterment of our trainee. I would like to hear what any members have to say in regard to these suggestions of Miss Tennent's. As far as St. Thomas's Hospital is concerned, the London Hospital, Guy's Hospital and various others, the Preliminary Training School is really part of the hospital. It is a training school for their nurses only. I went into that very carefully. There, the nurses are not paid; they pay a fee of £12 125., which is not refunded to them if they give it up. Now, if anyone would like to say anything, these papers are open for discussion.

Miss MacDonalcl: I think it would be unsatisfactory for both pupils of the larger and smaller Training Schools to have a transfer in the third year, but in the fourth year I think it would be a benefit. The nurse from the smaller school has a very narrow outlook compared with the nurse in the large school. She has also been used to make shift with many inexpensive things, for the smaller schools cannot afford the expensive up-to-date equipment the larger schools Use, but it makes the nurses resourceful

and they turn out very good practical nurses. We have been trying for some time the effect of a small preparatory school for the nurses before they go into the wards for work, and so far we Have been successful. One of the Board members thought it large enough to have a sister tutor, so I hope in a very short time we shall have one. T shall have all the teaching of the junior nurses as at present; I enjoy teaching the girls, but I think it would be a great advantage to have a sister tutor. I don't think I should like a nurse from our hospital to go to the smaller hospital, I think it would break into the time of training, but I think, for smaller hospitals, it would be a great thing for the nurses to go to a larger hospital. Miss Barnitt : I think the Preliminary Training School for the nurses is an excellent idea, but there is a good deal of difficulty in the way of it. Suppose that smaller hospitals send their trainees to the large centres for three weeks or three months, and then the nurses are sent back to the smaller hospitals whether they in-

tend to train or not. After they have been in the wards for three or four months, they may begin to think they are not going to like the work and wish to leave. This is going to be a big expense to the Hospital Boards. I do not think it can be managed. Miss Tennent : Some would be picked out as not suitable, and would not be sent back to the smaller hospital. I certainly do not think they should be paid anything at all. They should just get their keep and provide their own books. Miss Bicknell : When I was in England at St. Thomas's Hospital, the Matron told me that every week the matrons, sisters and tutors met and discussed any new method in vogue, and always spoke openly to each other. When a nurse in the Preliminary School used a different method from that used in the ward, usually the Sister asked her if she had learned it in the Preliminary Training School, and if so they would then discuss it together. (To be continued in our next.)