REMIT REFERRED TO ROUND TABLE.

Kai Tiaki : the journal of the nurses of New Zealand, Volume XXII, Issue 4, 1 November 1929, Page 187

REMIT REFERRED TO ROUND TABLE.

That m order to improve the present practical side of nurses' training, whether general or maternity, the future appointments of Ward Sisters be made from those realising that : (a) The Hospital Nursing Service; (b) The Responsibility to the Public ; (c) The Teaching of Practical Nursing is: "Her Responsibility." Miss McKenny stated that it seemed as if those who sent forward this resolution thought that even greater care might be exercised m the direction of the Ward Sister, or perhaps the candidates for ward sistership.

Miss Moore said: "We all quite agree that the Ward Sister should be more carefully selected. She should have all those qualities we have spoken of, hut the poor thing- has not got the time to do it all. I feel we ought to try and lighten the burden of this most important unit. We do not fully realise that she has only eight hours a day. She may have from 26 to 52 patients under her. She may have trained nurses assisting her. or she may not. They may be third-year nurses — very often withdrawn for lectures, and she has untold responsibility m her ward. This woman wants added trained assistance. If someone could be brought m to do the lighter domestic work, the nurses would not be so over-taxed and could be occupied with study. You need not have as many nurses m the ward, but those nurses who are m the ward would be entirely occupied with the bedside work. We realise the Sister ter is the pivot and wants more practical trained assistance. If this woman had some time to take her group of students m the ward, she could discuss properly the problems. The patient is here ; here is the opportunity ; this woman is here to do it, but she has not got the assistance. Some resolution should go forward m which this woman may have added trained assistance to enable her to impart this wonderful knowledge which she has to the nurse m training." Miss Muir: "One point I would like to raise — that is, m the appointment of the Ward Sister from the ranks of the staff nurse, we do not get efficiency m the first year of our responsibility. We are all growing; we are all attaining knowledge and experience, and with the young Ward Sister, when the Matron is making her selection, she makes it m regard to the headings that have been noted on this list, taking into consideration the personality of the individual, which also has a very great bearing m regard to the three other headings, and the Ward Sister, after her appointment, as apart from the difficul-

ties of her duty during the first year, also expands and grows, and is enabled to encompass or to acquire greater knowledge and expediency m the management of her ward. Through a period of years you will find the experienced Ward Sister is able then to concentrate more on the teaching of the nurse the administrative side of her ward and eliminate the unnecessary elements. She gets with experience what one may call a perfect balance, and I think most of the Hospital Sisters and Alatrons realise that when an appointment is made, she has to train herself not to worry over unessentials. She should realise, if she is going to be an efficient Ward Sister, hers is a period of growth from the time of her appointment until she completes her service. The growth continues, embracing all new methods, new practices, all the latest science m regard to close co-operation between Matron, Sister and the Tutor Sister." Another point which Miss Moore raised was over-burdening with routine work. The point to be avoided is that the Ward Sister becomes over-tired and gets into a rut mentally as well as physically. In consequence of over-crowding of the ward she becomes over-tired and then just simply settles down into a rut and loses the enthusiasm of growth and development." Miss Nutsey : "I think with Miss Moore that the W T ard Sisters have too much to do m the wards. They have not time to devote to the teaching of the student nurses. Reds are crowded into the wards. Wards are supposed to accommodate thirty beds ; I know m this hospital, not only the wards, but the verandahs as well — and one sister is controlling between fifty and sixty cases. Just lately we have appointed fifth year nurses, giving Sisters more trained assistance, but even so they do not get the time to devote to the teaching of their students. Ido think tljat if the Sisters had more trained assistance, they would be able to give better teaching to their students,"

Miss McKenny : "The Sister is often driven through zeal and enthusiasm. She knows she can give a service to the patient with more skill and she wants to give him the benefit of her greater skill. That is why she serves him when time presses, instead of letting one of her assistants. Matrons make the best selection they can. They have not always got a very valuable candidate for the sistership, but they take the best they can get. The real problem is giving them enough help to leave them free to devote to the student. This is an economic problem. This is a remit, and the Council has referred it to us. Patients should not exceed twenty, for a Sister to do her work as it should be done and give the patient that care he is entitled to." Miss Moore : "It do not think that the public or our Boards quite realise what responsibility they are putting on this one Sister. They demand skilled nursing service for 30 up to 50 patients, and complain that the patients are not getting skilled care. How can she do it when she is the only trained one and those under her are getting training?" Miss Holford: "You are going to suggest that adequate help be given to the Sister, but if the Sister has from 50 to 60 patients, she is still responsible. We must agitate for smaller units m our institution." Miss Swayne : "We find a difficulty m getting trained nurses to remain to help the Sisters m the ward. Directly the nurse trains she immediately wants to go. That. T find, is the difficulty with me." Miss Bagley: 'T would draw the attention of the meeting to the difficulty there might be m dividing the ward into two units owing to the construction of the ward. Tt might sometimes be difficult to appoint two sisters to a ward which may be considered too large. Therefore, I would favour the giving of more assistance m the ward."

Miss Bicknell : "I think we all recognise, and have done for many years past, that the Ward Sisters have not sufficient trained help. In fact, the Conference has brought this up several times. The root of the matter is that our wards are over-crowded. Fifty to sixty beds are too many for one person to be responsible for. I would like to tell you here that the Department at present is advising Hospital Boards where they are building to go m for smaller wards. There is a large hospital being built at Invercargill. The wards are small wards of about ten — not more than 20. There is another Hospital to be built by the Government, and the largest ward will contain ten beds. There are other smaller wards. "I think the only thing we can do at this juncture is to send some recommendation to the Hospital Boards that the number of patients is too great for one person to be responsible for, and ask them if they cannot alter the construction of their wards. A hospital building is a very expensive item m the country at present. If the}' cannot divide the ward, they can at least do what is being recommended m some hospitals, partially divide them, thereby making the large wards into small wards. This is done m America and Scandinavia ; perhaps two Sisters could work this. Whenever they are adding to their hospitals they will bear m mind the necessity of building smaller wards." Miss Muir: "The whole thing hinges on overcrowding. That is where the Sister cannot manage, but where the ward is kept to its regulation bed list, -and adequately staffed, the position is just a Httle different/* Miss Bagley proposed, and Miss Lamhie seconded : "That more trained help be given to Ward Sisters, who should not have an excessive number of patients under their care, and that this be sent as a recommendation to the Hospital Boards' Association." — Carried.

Remit: That, as many hospitals are demanding a fourth year from the student nurse, a proper curriculum should be outlined for this nurse, including such subjects as: "Sanatorium Treatment of Tuberculosis," "Clinical Welfare" or "Maternity Nursing," "Nursing* of Neuropathic Patients" (the subjects to be elective). Dietetic, X-ray and Administration. Miss Muir: "The training is three years and the fourth year is optional. The qualified nurse finds the fourth year the best year of her hospital service. During that time she is able to take more responsibility ; has the opportunity of doing what we can term a staff nurse duty, and understudies more or less the Sister, and we consider that the fourth year is the period m which we can select promisingpupils for suitable promotion to charge duty later on. The fourth year is of great value ; she is preparing to take her midwifery training, and 'as so many of them do, to take her Plunket training, and return possibly to hospital training after having obtained these certificates. Some of them desire to take the post-graduate course and get that tuition over before they decide what work they are prepared to carry on. The general opinion among staff nurses is that their fourth year is the best year of service, and they are very often waiting a few months m their fifth year before finally leaving the hospital service for some other branch." Miss Moore : "The fourth year is supplementary to the other years. What they have not had m the third year they get m their fourth year. I feel that the fourth is the test for administrative ability, but m return she should have some added certificate for that year. In three years she should have finished her training. In Christchurch they are doing practically what is suggested." Miss Goldsmith: "Napier gives maternity training during the fourth year." Miss Muir proposed, and Miss M. Bagley seconded :

"That during the fourth year, wherever possible, the student nurse gets added responsibility and administrative experience as suggested." — Carried. Remit: "That registered nurses m private practice for two or three years be accepted on the staffs of hospitals for a refresher course of six months as fourthyear nurses." Miss Muir: "In regard to that remit, as far as we are concerned, that has been done, but not m the capacity of the fourth-year nurses. The invitation is sent to the nurse, and she is a free lance." Miss McKenny suggested that the words "fourth-year nurses" be deleted. Miss Moore proposed, and Miss Bagley seconded : "That registered nurses m private practice for two or three years be accepted on the staffs of hospitals for a Refresher Course of six months. I '— Carried. Mrs. Tracey-Inglis moved a vote of thanks to Miss Nutsey. The meeting 'terminated at 5.30 p.m. * * * *