Matrons' Council

Kai Tiaki : the journal of the nurses of New Zealand, Volume XXII, Issue 2, 1 April 1929, Page 51

Matrons' Council

The second biennial meeting of the Council was opened on Tuesday, April 9, at the Wellington Hospital, when the Hospital Board had courteously placed the lecture room at the service of the Conference. Owing to the death of Miss Stott, the first President of the Council, Miss McKenny, Vice-President, was voted to the chair pending the election of officers at the end of the meeting. A motion of regret was carried, the members standing m silence. Miss Bicknell, Director of Nursing, addressed the meeting and commented on some of the remits which were to be brought forward. She stressed that it should be remembered that three years was the recognised term of training for the State examination. The fourth year was really a post-graduate year, and did not count m this, but was very necessary for the nurse. She asked that all Matrons should urge their nurses to join the Nurses' Association. Unity was strength. and the Association could do a great deal for the profession of nursing if it had the support of all nurses. She also recommended to them the support of the Nurses' Memorial Fund, which was of great help to nurses, and expressed regret at the death of Mr. Chamberlain, Hon. Treasurer of the Fund, who had taken great interest m nurses.

Correspondence was read from the Hospital Boards' Association, to which the resolutions passed at last Conference had been submitted. The Association recommended that the members of the Matrons' Council should each approach her own Hospital Board on these questions, as the problems were often of a local character. The remits were then considered. 1. From the Council N.Z.T.N.A. (a) That the Council of Hospital Matrons review the whole method of examining nurses. That the Council consider the suggestion contained m a remit received by the former that the State examination include a review of a nurse's three years 1 service — a proportion of marks for this to be a part of the practical examination. This remit gave rise to much discussion, and the opinion was expressed (that the present system of conducting the practical examination was unsatisfactory. Miss McKenny advocated that the nurse's work m the wards should count m her final examination instead of the short practical examination now given. It was suggested the visiting nurses might be appointed to examine students m their own hospitals, which could then be taken over a period of more than one day if necessary. A Sub- Committee was appointed to go into the question and bring down a report. . This report was as follows, and recommended : "That papers be set by surgeons and physicians as at present, with a recommendation that the

questions be more of a nursing standard than those set for a medical student; that the viva vocc examination conducted by the nurse examiner be purely practical, taking m surgical and medical procedure ; m first and second grade hospitals the following arrangements be made whenever possible : If four candidates are present m a hospital, that hospital be considered a centre ; m the case of a small hospital when nurses have to go to a larger centre that the visiting nurse be examined first to enable her to return to her own school without delay, and that the hospitals house the visiting nurse whenever possible; that a report, either m the form of the nurse's record cards or matrons' confidential, report, be forwarded to the nurse examiners .at the time of examination ; that it is not esseriitial to give nurses exactly the same question, but they must be of the same value." The report was discussed on the following day, and the meeting passed the following resolution : "That the practical examination of candidates be conducted by nurse examiners, and as far as possible, m hospitals where nurses belong, and that m a case where a nurse is not examinted m her own hospital, a record be sent from her Matron to the nurse examiner, and that the records of the nui se's ward duty be reviewed by the nurse examiner." This resolution, to be forwarded to the Nurses' Registration Board. The question of hoirsing the nurse and of examining visiting nurses first was left to the good sense and kind feeling of the Matrons. (b) That it is desirable that nurses of suitable personality be selected and specially prepared for charge of all out-pa-tient clinics. This remit was passed unanimously. 2. Auckland : That first year nurse's ward reports, general conduct (off and on duty) be reviewed m conjunction with the prescribed examinations at the conclusion of the first year of training. Should such reports indicate an unsatisfactory position, the Matron, after consultation with the Medical Superintendent, recommend the resignation of the nurse. This w r as discussed and approved by the Council, and it was recommended that the Matron should approach her Board m the matter. 3. Dunedin : That the question of affiliation between the larger and smaller hospitals be considered m regard to nurse training. That nurse-students from the smaller schools be given six months' experience m a larger institution m their third year of training.

This remit was introduced by Miss Tennent and discussed fully, and the difficulties of the smaller hospitals m sending away their more experienced trainees was stressed by the Matrons. Miss Tennent stated that m hospitals of under 50 beds, of which there were 13 training schools m the Dominion, it was not possible for trainees to get the variety of cases necessary for efficiency m their training, and m their interest some such arrangement should be made with larger hopitals. After much discussion of the difficulties of sparing nurses or of exchange, it was decided to pass the remit and refer it to the Registration Board to make the necessary arrangements and to authorise the time spent m hospitals under different Boards to count m three years' course. Miss Tennent said that hospitals of 46 beds should make application to be registered as a partial training school, whereby a year's work of a nurse would be recognised as six months' training on proceeding to a full training school. 4. Kaikoura : (a) That domestic science teacher (dietitian?) preside m the hospital kitchen with an adequate number of nurses and one domestic employee, the usual cook to be dispensed with. That the food values be taught, and costs also, by such teacher. That during the period of duty m the kitchen, nurses get practice m the responsibility of ordering goods and managing meals. Discussed and decided that present system of instruction m invalid cookery meets with the requirements. It was felt that pupil nurses have not sufficient time to spend m this way outside wards. (b) Nurses to advance on merit — not time. A nurse to remain a "junior" until she gives promise of ability to do senior work. This rule to apply to both theory and practice. This was approved. (c) At the conclusion of two years' training each nurse be asked to indicate the special line of nursing she wishes to follow, with a view to assisting her m the practice of its special needs, i.e., private duty, administrative, etc. This remit was discussed, and the Conference approved the principle, but considered that any special training for different lines of nursing should be for a Post-graduate Course. 5. Oamaru : (1) That the Trained Nurses' Association and Hospital Hoards be urged to establish a preliminary training school — one m the North and one m the South Island — where all candidates for nursing

training would receive a uniform preliminary training of at least six weeks before entering the Hospital wards. This training to include nursing procedures, practical demonstration, followed by practical work by pupil, cleaning, care of food, serving of food to sick people, methods of economising m food and dressings, etc., care of hospital equipment and some lectures (physiology and anatomy?), with a qualifying examination before going on to hospital, thus ensuring a correct beginning and sound basis for ward training. If necessary, candidates be asked to pay for preliminary training and board out. Much discussion took place on this remit, but it was felt that the time was not ripe to urge the measure on the Hospital Boards on account of the great expense involved. It was preferable to institute some preliminary training m each Hospital. Miss Cookson considered that small classes are better than a large number, and Miss Tennent concurred, saying a class of six to eight pupils was sufficient for each instructor. Wellington, Dunedin, Christchurch and Auckland Hospital all had fully equpiped preliminary class rooms and instructors. The proposal m the remit was an ideal to which to look forward, and that might be achieved m years to come. Members then gave outlines of the various methods they had instituted for preliminary training. Many were able only to take the pupils m for very short periods and place them m children's wards, where the sister m charge would also act as sister tutor. (2) That refresher classes be arranged for ward sisters, and uniform methods of teaching with a set syllabus, be advocated for the sisters to follow m the wards. That the Department be asked to arrange classes m main centres, say, Christchurch, Dunedin and Invercargill, for South Island, to be given by Departmental Instructors when not engaged with Post-graduate Courses, and that each Hospital send its sisters so that a more stable method of practical teaching m the wards would be assured. Course to last, say, two weeks m each centre, so that the sisters could each get at least a week's instruction. I think, by attention to these factors, (1) good general education before commencing training, (2) good preliminary training, (3) good organised ward teaching, a sound nurse for the rank and file will be the result. That for the enthusiastic and as-

piring nurse, Post-graduate work, i.e., Post-graduate Course now established, Midwifery (if not included m general training) and Karitane or Plunket training will give scope enough for the present at least, and for some time m the future. I greatly favour the idea of midwifery training being included m the four years' general training if practicable for so .many nurses. This remit was discussed very fully, and m principle approved by the Conference. It was decided to forward a recommendation to the Director, Division of Nursing, on the lines of the remit concerning the refresher classes. (3) That the cases which a fourth year nurse takes m a cottage Maternity Hosiptal, which is m charge of a registered general nurse and midwife, but is not a training school, should count as "cases" when she takes her training for midwifery at a training school. Note. — Kurow Hospital is staffed m this way : A registered general nurse and midwife m charge permanently, and a fourth year nurse supplied by Oamaru Hospital for term of three months. This nurse gets experience, but no material benefit towards gaining her midwifery certificate. The arrangement is helpful to the Matron m charge of a small Maternity Hospital with one accident bed, because it leaves a nurse with general training m charge m her absence, instead of a young probationer. Thus the General Hospital takes the raw probationer to fill the place of the fourth year nurse and the expense to the Board is the same, and it protects the Board m case of emergency. This remit called forth a great deal of discussion regarding the necessity for all nurses to have some knowledge of obstetric work. It was painted out that while this was certainly desirable, it would not be possible for all nurses qualifying to obtain even a maternity nurse certificate, as this involved taking five cases, and there would not be sufficient material available. In regard to the remit, Miss Tennent informed the Conference that the five cases obtained by a maternity nurse would count towards the full number of 20 required for the midwifery certificate. Matrons were advised also to encourage only those nurses who are prepared to carry on with obstetric work, to enter for the maternity or the midwifery training. It was not desirable to w^as'te the available material on those who desired only to add the certificate to their qualification, with no intention of using it.

Members stressed the fact that m making new appointments of Matrons, the midwifery certificate was asked for by Boards, even when the Matron is not required to practise midwifery. It was pointed out by Miss Tennent and Miss Macdonald, who have midwifery hospitals under their control, that m such cases it is most dedesirable that the Matron, although she has a sister or sub-matron m charge of the maternity work, should herself be qualified and so able to understand the work and necessities. It was moved and passed that nurses should be encouraged to take the course of maternity training during the fourth year of service, and that their acceptance at schools offering maternity training be facilitated. (4) That the confidential report sent to the Director, Division of Nursing, on a nurse about to sit final examination, should, m the case of a bad report being sent, be accompanied by the whole of the nurses' progress reports signed by ward sisters and approved by the Medical Superintendent, so that the Director can decide if the report is just m face of accompanying ward reports. I think that under the present system, there is too much power m the hands of one person, and that is not British justice. Moved by Miss Lewis and carried: "That the present system is satisfactory." It was felt that Matrons should be trusted to furnish a just report. (5) That Hospital Boards, Medical Superintendents and Matrons of Hospitals be urged to do all m their power to assist nurses to take the Post-graduate Course, which I feel is of incalculable benefit to every trained nurse, and especially to those whose sphere of activity will be m Hospital, Public Health or Departmental work. That the T.N.A. be asked to consider whether they could assist nurses financially with a loan if necessary. This was approved, and Miss Inglis. Hon. Secretary of Central Council, who was present, was asked to let the Matrons present know the proposal of the T.N.A. regarding loan bursaries. Miss Iraglis informed the Conference that there is a sum of money collected by the T.N.A. for nurses' educational purposes, which the Council is prepared to lend to a nurse unable to finance herself, to be repaid m instalments when she is again earning a salary. The nurse must be a member of the Association and apply through her branch. Miss Tennent said that the Fund collected m Dunedin, which was specially ear-marked for the

interest only to be used, is scarcely available for much assistance even on loan, but possibly the difficulty might be overcome. Patea: That where suitable, the services of a travelling tutor-sister be shared by several adjacent small hospitals affiliated for the purpose, a timetable to be arranged to fit m with the usual lectures given by matrons and medical officers. The Conference approved of the suggestion as very helpful to small hospitals, and it was proposed that the Matrons of adjacent hospitals should confer among themselves and make recommendation to their Boards. Tauranga : Recognition of nursing service done m a public hospital of 46 beds by applicants for general training elsewhere — with a view to accrediting. Dealt with elsewhere. Wellington : (1) That whenever possible, Dental Nurses, Dietitians, Masseuses, X-Ray Sisters, Violet Ray Sisters, etc., should be chosen from trained nurse applicants. This remit was approved, and a resolution was moved by Miss Cookson, seconded by Miss Tennent, that m view of the fact that such positions are better filled by trained nurses, the remit should be forwarded to the Hospital Boards. (2) That the Council recommends the training of nurses m gynaecological work as far as possible, and that this training be added to the syllabus. It was pointed out that gynaecological nursing comes under surgical nursing, and therefore is included m syllabus. (3) That Nurses' and Charge Nurses' salaries be made as uniform as possible and according to their responsibilities. Decided that while it might be possible to lay down some scale according to the different grades of the hospitals, it was better for this Conference not to deal with finance. There has already been a suggested scale of salaries drawn out by the Health Department. (4) That all nursing and domestic help come under the control of the Matron as laid down m the Hospital Boards' Bylaws. The Conference unanimously approved of this remit, and instances were given of difficulty where it is not so arranged. Matrons were advised to refer their Boards to the by-laws approved by the Health Department. (5) That Training Nurses receive more practical training m diets than at present.

It was decided that this was most desirable and that the system of the special diets being prepared by the domestic staff under a dietitian deprived the trainees of the experience previously obtained of preparing all the special diets m the ward kitchen. When the kitchens are under the control of the Matron, the preparation of such diets could be arranged by the Matron to be done, under instruction, by the trainees. It was pointed out by Miss Cookson that when, as now, the diets are the chief form of treatment m many diseases, it is essential that nurses should be trained m preparing them. Wairoa : (a) Standardisation of uniforms m all training schools. This was not thought practicable. (b) The question of dispensing by matrons or other members of a staff not qualified to do so m small hospitals. This remit led to much discussion. It was decided, on the motion of Miss McKenny, to draw the attention of the Director-General of Health to the fact that m twelve hospitals the dispensing is done by the Matron, and that this work should be done only by a qualified dispenser, and places an unfair responsibility on the nursing service. (a) The advisability or otherwise of accepting nurses who commence at one hospital, try another, and still another. The remit was fully discussed. Miss McKenny said that the nurse "on tour" was very undesirable, and that many girls go to Hospital without any real suitability to train or desire to stay m one place. Many reasons for transfer were trivial, and should not be encouraged. Miss Cookson said many instances came under her notice where girls, simply because their parents had moved to another town wished for a transfer. Miss Tennent pointed out that except with the authority of the Nurses' Registration Board, the time spent m one hospital cannot be counted m another, and this authority is not given except with good reason. The only way Matrons can discourage this is by refusing when they know that an applicant has been m hospital before, unless recommended by their Matron, and the Conference left the remit with this recommendation. (b) Charges for sick nurses at public hospitals. Could a recommendation be made ? (a) Free treatment. (b) A standard fee. Several members gave instances of the procedure m their own hospitals, showing that some Boards are exceedingly generous m the treatment of sick nurses, while most Boards give special consideration to their own staffs at least. It was decided to take no action.