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History of Nursing in Pacific Canada

Survey of the nursing question: with special consideration of the problems arising therefrom and their… MacEachern, Malcolm Thomas, 1881-1956 1919

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To the Readers of this Paper:
The Hospital Administrator today finds that his management resolves itself very readily into three main divisions,
and these are:
Wa)    Medical;
(b) Nursing;
(c) Business.
Although these divisions must have separate, responsible
heads with much different and clearly defined policies and
activities, and though they can be discussed separately, yet
there is a very intimate connection existing between them in
order to make a well-balanced, complete and efficient management. The remarks, therefore, that follow are directed to the
Nursing phase of Hospital administration, and though my
remarks are based entirely on information gained from personal experience and study of the problem—partly from information gained elsewhere, but mostly from local conditions—
and though geographical location finds us situated in the far
West and in a young country where there are many new questions to solve, yet I hope the practical application of some of
the thoughts contained therein may find place elsewhere, as it
has in our institution.
Yours very truly,
M. T. MacEachern, M.D., CM., fj|
General Superintendent, Vancouver General Hospital
Vancouver, B. C, June 15th, 1919.  PART I.
It is not good wisdom for any Superintendent of a Hospital, other than a nurse herself, to say much about the Nursing profession or venture suggestions or outline policies of
development such as I propose doing in this paper. However,
it has been my privilege as the administrative officer of a large
institution, to give this subject much consideration and deep
thought, and this, let me say, has been of great pleasure to
me, as I have always been keenly interested in the Nursing
I believe that our hospitals are only efficient so far as our
Nursing and Medical services are efficient. I do not think for
one moment that the Nursing profession is by any means perfect, but must say that the advances made in recent years are
marvelous, and the great part played in the recent war has
never been excelled, and I doubt if ever can be in time to
come. Still, there is constructive and reconstructive work to
be done, and the next few years will undoubtedly see many
scientific advancements in the Nursing service of our hospitals. In this paper, therefore, I desire to throw as much light
as possible on some of the problems arising today, which must
be wisely solved.
Investigation of the entire question reveals a number of
problems which we can well deliberate on for a few minutes.
These problems are:
(a) Long hours of duty;
(b) Need of higher education and broader training
(c) Shortage of nurses;
(d) Physical health of nurses.
The above conditions form a basis for this paper which
cannot be dealt with in full by me at the present time, but I
intend to touch upon them only. All these have been dealt
with in full recently in my report to the Board of Directors
of this Hospital, and have since been acted upon in many
instances. From the above it readily appears that five great questions arise, and we will deal with them in this order:
(a) The Eight-hour Duty;
(b) The Training School and the University;
(c) The Post-Graduate and Affiliated Courses;
(d) The Ward Assistant;
(e) Physical Examination of Nurses.
Before commencing the discussion of any o£ these, I want
to quote a paragraph from a paper entitled "The Modern
Trained Nurse," given by Miss M. MacLeod, Superintendent
of Nurses in this Hospital, before the B. C. Hospital Association Convention, which reads as follows:—
"Many hospitals are getting away from the ten-hour
day which used to be in vogue. Recent investigation regarding the effect of fatigue upon efficiency has shown
that after an eight-hour day the efficiency of the worker
greatly diminishes. It would seem best, therefore, to
reduce the time on duty per day from ten to eight hours.
If this were done, then a sufficient amount of time would
be left available for the increase in technical work which
would be required by university affiliation. More time for
the purely nursing part of the training could also be
obtained by eliminating from the duties of the pupil nurse
the ordinary housekeeping duties in connection with the
wards. It has never seemed reasonable to expect pupil
nurses to entirely assume all the housekeeping duties
which usually are connected with hospital wards. These
duties might better be undertaken by ward attendants or
helpers who would receive adequate remuneration for the
work they did. In this way the pupil nurses would be
relieved of the monotony of doing certain tasks continuously throughout their training, which in reality have little or no bearing upon the actual teachings or learning of
their profession. If such a procedure were adopted, more
time would be available for the proper instruction in the
actual principles and practices of nursing, and the pupil
nurse would be in a more receptive mood for study."
This paragraph has a great deal of bearing on much of
the thought which I have tried to elaborate in the following
pages, and indeed this whole paper from which the paragraph
is taken, is well worthy of your reading and consideration.
I suppose the eight-hour duty system is carried out in
several hospitals today, and first met with considerable opposition, which readily fades away on consideration of:
(a) The efficiency curve of the nurse;
(b) The work curve of the institution.
In regard to (a)—It is agreed that human efficiency wanes
after an average of eight hours' continuous duty, and from our
own personal experience there is no need of further argument
regarding this. It is also agreed that resistance to disease
drops with fatigue. This latter condition is, of course, a very
serious one for a nurse, as her resistance to disease is her
health asset. The former condition is very serious to the institution, which at all times needs efficient service. Similarly, a
study of the work curve of a hospital as this is, so far as it
affects the nursing side, indicates clearly that the "peak load,"
so to speak, is from 6.30 a.m. to possibly 2.00 p.m., when it
gradually wanes till from 5.00 to 7.00 p.m., when there is a
slight rise owing to so many cases coming in for operation
next day. After this the load gradually drops till midnight,
when it falls to its lowest and remains down till 6.30 a.m. or
thereabouts, when the cycle commences again. The application of the eight-hour system seems to be more suitable, therefore, than any other system in such a case. If there are sufficient nurses, a divisional basis of fifty per cent., twenty-five
per cent, and twenty-five per cent, of total number of nurses
might be used, thus:
7.00 a.m. to   3.00 p.m    50%
3.00 p.m. to 11.00 p.m    25%
11.00 p.m. to   7.00 a.m     25%
After conferring at length with our Superintendent of
conditions, the following system was recommended for the
Nurses in training:
7.00 a.m. to 7.00 p.m., with four hours off daily,
besides the usual half day and Sunday hours.
3.00 p.m. to 11.00 p.m.
11.00 p.m. to 7.00 a.m.
JJ This modification was made on account of the shortage of
nurses and being very desirous of first improving hours of
night duty. We cover the entire nursing service with the
same number as formerly. This scheme would have been
introduced on the 1st of October last had it not been for the
epidemic of influenza, and had to be deferred for a few months
till all the nurses were back again and recovered from the
effects of the epidemic. The arrangement naturally provides
advantages on both sides—to the nurse and to the institution.
By this system the nurse has more time for recreation and
study. Nurses coming on at 3.00 p.m. have had a night's
sleep and almost an entire day off, whereas those who come
on at 11.00 p.m. have had a very long evening to themselves.
As to the effect on the health of our nurses, I am not prepared
to say definitely, but believe that we have had very little illness since the epidemic, which of course delayed the introduction of the system.
As to the advantage to the institution, I feel sure it produces a more efficient nursing service, and on the whole we are
very pleased with it. During the coming year we hope to take
a step further, inasmuch as we will endeavor to separate the
lectures and demonstrations, as far as possible, from the duty
hours. Possibly a six months' preliminary instruction period,
both theoretical and practical, for all nurses coming in will be
introduced, by which a large number of the classes will be
covered before the ward nursing service commences. This
will be dealt with later in this paper.
The attention of leaders in the Nursing profession is now
directed to the linking up of the Training Schools with the
higher education, or bringing them closer to the Universities.
Towards this end we have taken a definite step here, and in
dealing with this question in my recent report I was prompted
by several motives:
First—The recognition that the Nursing service today is
expected to enter much broader fields than formerly, such
fields being Public Health, Sociology, etc., and more and more
is demanded of them, in so much that a broader education is
Second—The elevation of the Nursing profession to the
highest possible plane by drawing our Training Schools closer
to educational development and present-day advances.
Third—The more readily establishing of leaders in the
Nursing profession.
Having made a complete summary of the whole question,
it was then recommended to the University of British Columbia:—
Firstly—That a College of Nursing be established with
a Faculty.
Secondly—That a degree be granted nurses on completion of the requirements to be laid down later.
Thirdly—That through the College of Nursing or Department of Nursing in the University, supervision be kept over
our training, theoretical and practical.
After considerable negotiations with the educational authorities of the University, and after they had given the matter
due consideration with investigation of conditions elsewhere,
they recommended the following:—
First—That a Department of Nursing be established
under the Faculty of Science.
Second—That a degree be granted on the fulfillment of
the following conditions:
(a) Two years' Arts or preparatory Course;
I r
(b) Completion of three years' training in a recognized
Training School (the required standard of Training Schools to be laid down later).
It is further hoped that the Directress of Nursing of this
Hospital may be head of that department, if she is properly
qualified, and which required qualifications will guide us in
our selection to fill the present vacancy. It is further desirous
that all our nursing instruction be put, as much as possible,
under the supervision of the Department of Nursing in the
University. In due course there will therefore be two nurses,
holding different standards graduating from our Hospital
Training School, yet both having the same practical training
course. No. 1 will hold a diploma from the Hospital and a
degree from the University which may be either "Bachelor
of Nursing" or "Bachelor of Science of Nursing." No. 2 will
hold a diploma from the Hospital only. No. 1 will likely follow an institutional career or become a leader in her profession. Possibly she may take charge of a smaller Training
School or follow Public Health, Social Service, Research or
other broader fields. No. 2 will most likely follow the art of
skilled nursing, an equally important post and one which today is demanding thoroughly well-trained nurses; that is to
say, the young woman coming in to this Hospital to train,
* having two years' Arts or the equivalent, or higher, can secure
the degree on completion of her practical training here; but
the young woman coming in with less than this requirement
will not get the degree, but will secure exactly the same training for nursing as the other will get. The present-day requirements of this Hospital for admission to the Training course is
three years' high school or the equivalent, and we trust that
the day will soon come when we will demand the degree admission requirement to the course. Not only is it an advantage to the nurse herself to raise the standard, but it stimulates higher education, and by this present University arrangement, high school and normal school girls who are not of age
to come in to train, can continue their studies in the University preparatory to taking their course. The complete details
of this new system are not yet fully worked out, but undoubtedly will all be completed by October.
In regard to the three years' training in the Hospital—
the first six months will be spent in intensive and concentrated instruction, both practical and theoretical teaching,
practical teaching to be carried on through demonstration and
on the human subject, so that at the end of the first six months
the nurse is well-equipped to assume ward duties and do her
duty with a good knowledge thereof.
10 ^ For those desiring the degree, therefore, it will be seen
that five years must be spent, and as mentioned before, many
young women attending the high school can continue their
studies direct into the University, making their education and
training continuous. Two years' University or academic work
will be equivalent to two years' Arts, and it is planned that
specially arranged courses may be had so as to have particularly beneficial bearing on the future technical education to
be secured, thus laying a widened, sounder and better foundation for the practical training to follow. Possibly such subjects as English, Psychology, Biology, Chemistry, Household Economies, Dietetics, etc., will be taught. This, therefore, is not only a great boon to the Nursing profession, but
allows the University to extend its service in another direction and enter an extremely useful field. In addition, there is
no doubt that this arrangement will have a stimulating effect
on all our Training Schools in this province in making them
adopt higher standards.
11 i
This is the day of specialization and advanced training in
all lines. I therefore desire to invite your attention further to
the following:—
First—Post-Graduate Courses;
Second—The Affiliation of Smaller Training Schools.
In this Hospital, and a large number of others on our
continent, Post-Graduate work is usually confined to the following lines: Surgery, Obstetrics, Pediatrics, Dietetics, Eye,
Ear, Nose and Throat. Speaking generally, and in a critical
way, I do believe there is something wrong and something
lacking in our post-graduate courses. Annually the Training
School for Nurses of the Hospital here receive several scholarships from various members of our Medical profession, and
these are of sufficient value to cover a six months' course in
certain special work elsewhere, and I say frankly, and regret
to say, that we have great difficulty in finding a place for such
candidates where we feel they will receive a thorough training and wide experience carefully directed, which we desire
they should have. There seems to be a loss of perspective in
the arrangement of post-graduate work in our hospitals and
a failure to recognize what these courses should be. Usually
a large amount of work, which has been thoroughly acquired
in their own school, is demanded of these post - graduate
nurses, and that time is lost so far as spending it in the more
purely essential technical portion which she is seeking. It is
argued, and possibly quite truly so, that any other course
would interfere materially with the nurse-in-training. If so,
there seems to be other arrangements which could be made;
but such courses should not be offered unless sufficient in
return can be given to call it a Post-Graduate Course. We
all are aware that too often there is lack of strict supervision
and of instruction. It is much like this: 'Well, there it is,
go to it and get all you can." That is alright in itself, for
I do not approve of "spoon-feeding," as one of my college
professors called it, but I do recommend systematic instruction with good supervision, so that a student can make the
best use of her time. Of course there is a great deal to be
said on the other side, as so often young women are selected
for post-graduate work who are not suitable at all for any
such special line.   There are many cases that cannot be devel-
12 oped, and this must be discouraging and aggravating to the
Superintendent of a Training School who has to deal with
such a pupil; and therefore, possibly the cause of many cases
failing in this respect is the fact that we do not select the proper nurse to take this course. Be that as it may, a well-
arranged Post-Graduate Course should embody the following
First—Well-arranged and thoroughly systematized
Second—Intensive practical or technical experience
and training along that particular line;
Third—Expert supervision over such work;
Fourth—Tried responsibility;
Fifth—Final examination, oral, practical, written.
This Hospital will insist on such conditions being fulfilled
in the future. The most recent advance along these lines is
the addition of an Instructor in the Operating Room Department, who will do the teaching and instruction, and similarly
the instruction will be taken care of in the other Departments
where Post-Graduate work is being given. It seems to me*
however, that it is the duty of every well-equipped Training
School to give such courses for the advancement of Nursing
Coming now to the second question—that of Affiliation.
We find throughout our country that many of the smaller hospitals with smaller Training Schools are affiliating with the
larger institutions, and this condition now exists in the Province of British Columbia, where there are some ninety to one
hundred hospitals and a conservative estimate of forty to fifty
Training Schools at least. The question, therefore, is: How
can the larger Training School help the smaller and help the
nurse to acquire a broader training through a more widespread and diversified experience? They can offer affiliated
courses, and in connection with this Hospital and others in
the province, such arrangements have been made by several
Training Schools so that third year nurses can come here and
spend their final year, devoting their time mostly to Operating
Room, Maternity, Pediatrics and other specialties. |1 The hospital desiring such privilege must measure up to certain requirements which must be complied with, and are as follows :—
1. Nurses having had two years' training in their own
Schools are allowed to take their third year in the Training School of the Vancouver General Hospital, provided, however, that their work has been satisfactory in
13 the hospital in which they are now training, and that
they are willing to comply with all the rules and regulations as laid down by the Vancouver General Hospital
Training School for Nurses.
2. All applications must have the approval of the Superintendent of Nurses of their own Training School.
3. All applicants must have their third year holidays before
coming in. 4
4. Nurses will wear the uniform of the#School sending them.
5. Nurses will graduate and receive diploma from hospital
6. Nurses must be prepared to demonstrate their ability in:
Bed-making of various kinds of beds;
Bed baths, simple and temperature sponges;
Enemata; Giving Medicines;
Douches; Charting;
Catheterizations; Local Applications;
General Ward Care;
Preparation and general aftercare of Surgical Patients.
7. Provided nurses can comply with Regulation No. 6, the
course for the third year will be devoted mainly to:
Operating Rooms; Maternity;
Pediatrics; Dietetics.
8. In order that uniformity of teaching may be obtained,
it is recommended that the following text books, which
are in use in the Vancouver General Hospital, be used:
"Practical Nursing" Maxwell and Pope
"Anatomy and Physiology for Nurses"	
 Pope or Kimbers
"Materia Medica" | Paul, 3rd Edition
9. Nurses are advised to study the following:
"First Year Nursing" Goodnow
"Clinical Studies"  Aikens
"Essentials of Medicine" Emerson
"Nursing in Acute Infectious Fevers" Paul
In making application the following information is necessary and must be filled in by the nurse desiring admission to
such a Course:
1. Name in full 	
2. Home address 	
'.    Il4 3. Name of School in which you are training	
4. Are you single, married, or a widow?	
5. Date of birth ,	
6. Are you in sound health? 	
7. Were you vaccinated against Small Pox, and if so, with
what results ? 	
8. What preliminary education have you had prior to entrance into your Training School for Nurses?	
9. Give name and present address of Superintendent of
Nurses in charge of School where you are a student	
10. State  number of beds  in hospital where you  are in
11. Have you received regular class instruction and lectures
during your course of training in your hospital?	
12. State length of time spent in the following Departments
of your Training School:
Medical Wards, Male  -	
Medical Wards, Female 	
Surgical Wards, Male 	
(Please answer all questions fully.)
Surgical Wards, Female	
Obstetrical Wards 	
Children's Wards   '.	
Infectious Diseases  , ....
Operating Room	
13. When can you enter? 	
The nurse graduates from her own Training School,
though she has spent her final year here. Each pupil is on a
two months' probation, and if her services are not up to the
standard, will be returned to her own institution. In this you
will readily see that there is a distinct advantage to the nurse
who secures a broader training than she could secure in her
own institution in the final year, but there is a disadvantage
to the hospital in losing her services during the third year
when she would be most useful to them. If the smaller Training Schools, however, are to continue, such affiliation must
be carried on because we must not graduate nurses without
a thoroughly broad training along nursing lines. There does
exist in the province a lack of uniformity of training, and
during this year an effort will be made through the B. C.
Hospital Association whereby a standard curriculum will be
established for all Training Schools in British Columbia, and
this will help affiliation considerably.
15 PART V.
There is a more or less shortage of applications of young
women, with the necessary educational advantages, to take up
the .Nursing profession, and a large number of institutions
throughout our country are short of nurses. Why this should
be is difficult to say, and it is impossible to point to any particular factor causing such a shortage. There is, however,
I feel, something existing which appeals to me as being lacking and possibly due to the modesty of the Nursing profession. I refer to the failure of the Nursing profession to impress the world at large of the changes and advancements in
the profession and the actual work they are doing, and that
they are required to do at the present time; in short, there
seems to be a lack of publicity. They do not impress the
world at large that the Nursing profession is the ideal one for
womanhood, that it is a grand and noble work, that it stands
for the highest and best ideals, as well as many additional
things which could be mentioned and to which more publicity should be given, but undoubtedly through modesty, I
suppose, is not. Indeed, I am afraid in these strenuous times
with socialistic movements so rampant, that both the Nursing
and Medical professions may be brought closer to a more commercial plane unless we keep our ideals constantly before us.
However, the fact is that we find fewer young women entering the profession, and it is therefore necessary that we must
see what the cause is and apply the remedy thereto.
Possibly the linking up with the higher educational development may be more of a stimulus in this direction. Possibly the greater prominence now being given and interest
taken in the Nursing profession throughout our land will
stimulate a larger number of young women to enter it. On
the other hand, possibly the shortage is due to the fact that
there is a greater demand than ever, as all Training Schools
are growing and the field enlarging. It is thought by some
that the standard required for admission to many Training
Schools was too high, but this is not the case provided you can
offer the young woman a thorough training and equipment,
which will be a great asset throughout life. Then again, there
is the question of remuneration or the financial return after
graduating. Nurses* fees have gone up in the last year or two,
and I do not think will ever come down again.   Provided the
16 ^y •#4
nurse doing special work gets continuous work, the fees now
seem fairly satisfactory, but if she does not get steady work
she may have some discouragement in her profession. However, the cause underlying such a shortage requires our serious consideration, and I have only two thoughts to leave with
Firstly—The educational campaign, so to speak, to impress on the public the importance of this profession;
Secondly—The improvement of all training courses and
linking up with the higher education so far as is practical,
offering the nurse all we possibly can; and, I consider that
it is up to the Nursing profession themselves to make or
unmake conditions which are present or may arise.
In reference to a paragraph quoted in the introduction of
this paper, mention was made of the ward assistant or helper.
These were originally introduced into the Vancouver General
Hospital Military Department some two years ago, nurses
being exceedingly scarce, owing to the war. They are still
serving in this capacity, and the system has been quite satisfactory. They are not the so-called V. A. D.'s, as they are
paid a living salary and provision made for room, board and
laundry. During the war such young women were very easily
secured, as they felt they were doing a service. During the
epidemic they were used extensively throughout our emergency hospitals, but unfortunately we were not able to give
them the necessary instruction to make them of the greatest
use. These young women do the housekeeping duties of the
ward, which duties I do not need to enumerate, but as you.
know, take up a good deal of the time of the nurse. The
graduate nurse attends to all medication, treatments and dressings, as well as charting and supervising the meal service.
This arrangement, I may say, has been exceedingly satisfactory and in fact saved the situation for us when nurses were
absolutely unobtainable. These helpers or assistants are not
generally used in the civilian wards of our hospital, though
they were during the influenza epidemic. The reasons why
they have not been used are as follows:—
First—We do not just know how far it might interfere
with the training of nurses;
Second—It is a financial question and a greater outlay
of money;
Third—Will it tend to make graduate nurses less resourceful when out in private practice, having been used to such
assistant in the hospital?
17 I am not in a position to answer these questions. They
can best be answered by the leaders in the profession. However, if we have the right kind of young women in the profession, with the proper ideals before them, the third objection
will not obtain. There are certain definite advantages in the
system both to the nurse and to the patient. The present system means a large proportion of a nurse's duty, and thus her
time, is taken up with household matters which she continues
to do day after day, over and over again approximately three
hundred and sixty-five days a year for three years. Is it
not true that every nurse in her training usually makes three
to four thousand beds at least, and do you not think she
would be efficient at this particular duty when she had made
say, three or five hundred ? Why not take the balance of her
time for the true nursing science for the training of observation and application of nursing principles? We depend
greatly on efficient nursing observations and refer at all times
to the nurses' notes which are the outcome, of course, of well-
trained observation. This is admitted as being exceedingly
important, and more time allowed for such observation and
expression of same is necessary today. Furthermore, more
time would be allowed for the actual instruction and teaching, which would be a distinct advantage in the training.
There is, therefore, a great deal to be said in favor of this
system so far as the training of the nurse is concerned, when
put on a proper basis.
In regard to the advantage from the hospital administration standpoint—we all know that the innumerable abnormal
dispositions we have to deal with demand a diversified attention indescribable, and many of their whims and desires, being
the so-called "little things," scores of which may arise which
I cannot ennumerate, and often the attention to some little
desire or request or whim may do them more good than medicine and keep the patients happy and contented and easy to
wait on; in short, they take their treatment better. In such
cases it is almost impossible for any nurse to attend to such
little things as I refer to, as she is busy with the more essential matters pertaining to her actual nursing service. Therefore, I believe that these little things which seem to us so
unimportant and non-essential to the patient's recovery, are
very important after all and might materially help to keep up
a fine "esprit-de-corps" amongst the patients. We all know
that a cranky patient impedes efficient service, makes nursing
a burden; in short keeps everybody unhappy around the
ward, and looking at it from a hospital administrator's standpoint, I am beginning to feel that it is our duty and distinctly
to our advantage to keep a good "esprit-de-corps" feeling
18 amongst our patients, and remember that we are at all times
dealing with patients when their dispositions are more or
less abnormal.
I think I am safe in concluding that some day this system
of ward assistants will be generally adopted throughout the
civilian wards of our hospitals and put on a'sound basis with
classes for instruction arranged, and thus become a recognized
feature of our institutions.
During the past two years we have had the experience
in this hospital of training nursemaids at the Infants' Hospital, which seems almost on a parallel basis. These girls are
taken in for six months' experience and training, receiving
instruction, passing an examination, and are eventually turned
out as nursemaids, many of them finding their way to good
families, where they secure positions looking after well babies.
I may say from our experience that this arrangement is working out satisfactorily, and does not in any way interfere with
the nurses training in this institution.
If the hospital is going to live up to its health ideals and
its health demands, it should necessarily adopt measures to
put the health of its staff foremost. The remarks which I
intend to make might apply to the entire personnel, but in
this paper I am referring only to nurses.
Many young women desirous of entering the profession
of Nursing are physically unfit for such a calling and cannot
stand the arduous duties which are before them; whereas in
other cases persons who are considered physically unfit or
below par may develop into healthy, robust young women.
During the past eight years I have had the opportunity of
studying the health problem of nurses very fully, and this
paper will embody, as far as possible, my conclusions on the
It is the responsibility of every hospital management,
especially on the medical side, to see that adequate interest
and care is taken in the health of the Nursing staff, and this
phase must be considered more seriously by our hospitals
than it has in the past, for the Army has taught us many
things, and in fact has revolutionized the medical service.
Routine examinations have unearthed conditions which would
have been a serious consideration to the person if passed over
and sent into service. Likewise our nurses must have a well-
organized medical service which adequately discovers any
diseases or physical unfitness, as well as treating such conditions as arise during the training. Today there is no excuse
for any young woman who is physically unfit to enter the
profession and later on to break down in health. My experience is based on a large number of physical examinations and
observations of nurses which passed under my care during
my years of hospital work. I find that prospective applicants can always produce a certificate of health, usually from
their dear old family doctor, and they tell me invariably that
he did not examine them but issued the certificate because the
family was always healthy. These girls at one time entered
our Training School and were not examined till at the end of
their probationary time—about two months after they entered
—when it was found that eight to ten per cent, were unable
to continue their duties, and were rejected. This often causes
very serious disappointment to the young women, to the f am-
20 — ■ ','PHi
ily, and to the Superintendent of Nurses, for not infrequently
do we find that there are fine prospects of this particular person making an excellent nurse. However, they had to be
dropped. It was next decided that we should adopt a certain
prescribed medical form for physical examination, of a stereotype nature, and that the prospective applicant should have a
doctor fill it out when applying. This form would necessitate
a complete examination, and is as follows:—
Report of Physical Examination.
Name  Age.
Previous residence	
Previous occupation 	
Family history	
Personal history 	
Physical Examination:
(a) Development, Nutrition, Temperament, etc	
(b) Eye, Ear, Nose, Throat, Teeth, etc	
(c) Respiratory System  .	
(d) Circulatory System 	
(e) Digestive System 	
(f) Nervous System 	
(g) Glandular System 	
(h)    Integumentary System 	
(i)     Locomotor System 	
(j)     Genito-Urinary System j	
(k)    Remarks or Recommendations	
(Signed) I .	
Medical Examiner.
From this you can see that a complete examination is
necessary, and usually if a doctor has to fill this in he will take
more care to examine the person. This was adopted, and it
was further arranged that physical examination No. 2 should
be made by the Hospital Staff on the first day or day of
admission, and in this way any physically unfit candidate who
passed her own doctor was further checked over by the Hospital Staff according to their standard, and therefore was
found early and before she had developed a love for her future
21 work. Occasionally at these examinations now one or two
may be found who are not recommended, whereas one or two
may be recommended for two months' probationary physical
trial. With this system very seldom do we find anybody at
the first examination to be rejected, and there is not more possibly than one or two per cent, at any time. Physical examination No. 3 takes place after two months' duty, records of
all being kept. As a result the number of cases who are
rejected on physical examination and the number who break
<down in their training is practically nil, at least not worth
regarding. Today we insist on a high standard of health,
systematized and rigid examinations.
In the physical examination of nurses on admission the
following conditions have been found: Heart Murmurs and
Irregularities, Varicose Veins, Fallen Arches, Tonsils, Pyorrhoea, Alveolaris, Spinal Curvature, Goitre, Tuberculosis, Diphtheria Carriers, Malnutrition. It is rather remarkable and
interesting that in several instances we have found Diphtheria
Carriers from our routine cultures of nose and throat. Many
cases have to be referred for special examination to the different specialists and the different laboratories, and reports
received from the respective experts. No trouble or expense
is spared and the examination made as rigid and efficient as
possible; in fact, today our physical examination is very difficult and one of the hardest to get by if there is any evidence
of physical unfitness. In many cases extensive consultations
and deliberations may be necessary before acceptance or
There are certain physical conditions, however, that are
not detrimental to a nurse's training and may be improved
with her work. So often, indeed, do we see nurses improve
and put on flesh, owing to the regular life, regular sleep, regular diet and constant hygienic conditions; the latter the hospital must provide. When there is a history of Rheumatism
or Tuberculosis or such diseases which are regarded as more
or less protracted, recurring or incurable, such condidates are
rejected, and are not given a chance of continuing. We have
found in many cases that the nurse usually gains flesh, especially during the probationary period, and we have seen girls
who were considered delicate, leave the school physically
robust. Therefore, I trust that you will realize the importance
of careful physical examination of all nurses before entering
on their training, as well as other examinations throughout
their  course.
In regard to the health of the nurse while in training—
this is another feature. The minimum illness should be maintained, and this can only be done by an organized medical ser-
22 vice and a daily sick parade by a competent hospital official.
Many can secure treatment to carry on while on duty, and by
such a parade early reporting of disease is made more customary. Others must be confined to bed, and all must receive
the best medical advice and consultation at the disposal of the
hospital for diagnosis and treatment.
The incidence of disease here amongst our nurses is very
low. During the influenza epidemic, of course, we had a large
number, but come through with one of the best records possible. This was due to the expert medical care, the very early
treatment and the careful guidance of convalescence given to
the nurse. The marvelous health record of our Nursing Staff
throughout the terrible epidemic cannot be surpassed anywhere, and to my late assistant, Dr. Mahony, should be
ascribed that credit, as is well known to all.
One disease particularly more prevalent than any other
among nurses is the so-called "Sore Throat." Careful examination on admission, with removal of Tonsils if necessary,
and the constant use of gargles throughout training will prevent many such throats. Fallen Arches were at one time
prevalent, but with more attention to footwear this has decreased rapidly. The incidence of Infections of Fingers is
still high, and most cases proves distinctly that the safety pin
is the greatest offender. More nurses from our Infants' Pfos-
pital develop such conditions than in any other portion of the
institution, and the prevalence of safety pins there explains
this. Another condition which we have considerable trouble
with is Eczema or Dermatitis, from the irritating solutions
in cases where there is a tender and susceptible skin. These
are indeed hard to deal with, but with treatment and care
along prophylatic lines the hands will eventually become
hardened and withstand the irritating solutions. The incidence of Infectious diseases should at all times be minimum.
In conclusion, there is a great deal which could be said along
these lines and many other conditions that I could enumerate.
Undoubtedly the use of serums as Typhoid, Anti-Diphtheria
and others have had a wonderful effect, and are much approved by all.   To summarize:—
First—Rigid examination on admission, and follow up
as necessary;
Second—The daily sick parade at a stated hour;
Third—Organized medical service for sick nurses;
Fourth — Prophylatic measures for diseases, especially
for the more prevalent.


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