by Sheila Quinn
"VURSING has become. a A 1 profession.". . . This is no new discovery. These words were written by Florence Nightingale over a century ago. The Nightingak image is connected with the lady with a lamp—with the spirit of dedication—but also with discipline, austerity, long hours of work and little pay.
We hardly expect to find a person who emphasises the profession of nursing, and indeed. there are those who still think that such an approach is inconsistent with a sense of vocation. But another 'quotation says . . "there can be no separation of the !individual from the family and community or of nursing from citizenship and religion". .
The message bridging the intervening century is that dedication alone is not enough, and today's nurse must he a well educated. professionally trained and competent man or woman. In common with the other caring professions, nursing is built up on an ideal of service.
The small girl playing nurse is confronted with a wide field of choice in later years, when she makes a decision about her future. and because of increased opportunity, a smaller proportion of 18-year-olds is attracted into schools of nursing. Even the increasing number of young men who come into nursing and form a stable core of the profession at all levels, do not make up the deficiency.
We have used nurses wastefully over the years, and have squandered our most precious commodity, skilled nursing power. There is probably no real shortage of nurses. but there is certainly a shortage of nursing hours.
We have seen the need to utilise other groups of personnel for tasks which do not require nursing skill, and in this way, the nurse is able to do that for which she is trained. to give a high quality of nursing care to the patient.
From next year, a 40 hour week will be in force, and recent salary increases enable the nurse to use leisure and to live as any other young man or woman commencing a professional career. No one would dispute that work is hard and exacting on duty, but so is any work of responsibility. Today's new hospitals offer the best possible working and living conditions. and improvements in our older hospitals often offer equally good facilities.
But how does today's 18year-old become this highly
skilled professional? Florence Nightingale has the answer here too . ., "training is enabling you to use the means you have in yourselves." . . . Equipped with at least two '0' levels. the student can take a three-year course studying the total health care of patients. to lead to the qualification State Registered Nurse (S.R.N.).
In at least one training school there is a special course for the mature woman. The sixth form student with higher educational qualifications has a choice of over 30 special or experimental courses. These include a degree course for intending nurses and health visitors, a choice among various sandwich courses leading to S.R,N. and a degree in Sociology. Human Biology or Economics. or a course leading to a Bachelor of Nursing degree.
All these are designed to equip the student with a deeper and wider knowledge of the comprehensive Health Service of the future. For the less academic student, or the one who prefers a shorter and more practical training. a twoyear programme in practical bedside nursing leads to the qualification State Enrolled Nurse (S.E.N.). The married woman with family commitments can train part-time over a longer period to achieve this certificate.
In the school of nursing. modern teaching techniques are used to the full, and because nursing is a practical art and science, the student and pupil nurse must form part of the,ward team while gaining experience in the varied clinical areas which make up the modern hospital.
Neurology, radiotherapy, cardin-thoracic surgery, maternity, care of the elderly and care of children, are but some of the special experience available to the student while in hospital, and there is also a wealth of knowledge gained in the community nursing field. /sitir-Sing itself is not easy to define. Florence Nightingale described it as "helping people to live." A modern and thoughtful American writer, Virginia Henderson. defines the unique function of the nurse as . "to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knOwIedge."
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We need very many people who know how to nurse well, hut we also need those who know both how and why. Once qualified, there is a world of knowledge still to be explored, and many special branches of nursing from which to choose. Care of the mentally sick, mentally handicapped, care of the aged, all require a high degree of skill in communication.
Nurse teaching offers scope for those interested in education;_ the armed forces of the crown offer a variety of experiences in a different setting. Yet we should not forget Florence Nightingale's warning "it is much cheaper to promote health than to maintain people in sickness."
While the students' training is largely carried out in hospital surroundings, she will spend time with nurses who work in the specialist field of community care. learning bow the nurse can use her skills in homes, schools, clinics and health centres. She may choose to work in this field herself, after post-registration training.
A shortage of skilled nurses is not new. Miss Nightingale commented . . . "the demand for nurses iS at this moment, far greater than the supply, and will be for years to come."
, .. We must. therefore, deploy nurses effectively. This fact, together with the grouping of hospitals, and the need to define the role of Matrons and nursing administrators, and the relation between nursing services and "hotel services," caused the Government to set up a committee to look into the structure of senior nursing staff.
This committee, on which nursing was well represented, published its report in 1966— by coincidence on Florence Nightingale's birthday. Now known as the Salmon Report after its chairman, its recommendations are being put into force throughout the country.
Three levels of management are identified—the few at top management level who are responsible for making policy —the middle grades who programme the policy, and the first line management who execute or carry it out. In this way, a career pattern is available for the newly-registered nurse who steps on to the first rung of the ladder up to the Chief Nursing Officer of a large group of hospitals.
The latter is the leader of a large nursing service and may have come to her position through any field of nursing, general, psychiatric, .maternity or teaching. The essential quality for the man or woman at the top, is management ability. and the capacity to act as the one authoritative source of nursing ill the group.
This k a very demanding, but intensely rewarding job, and men shale a fair proportion. of these posts with women. For the specialist in nursing education, the post of Principal Nursing Officer, Teaching, offers control of teaching staff, responsibility for student and pupil education and the administration of a large school of nursing.
A planned career development is needed to equip the nurse for the career she wishes io follow, and both manage. ment and specialist clinical courses are available. The community nursing services are developing a similar structure to that of the hospital service.
But management training is not an end in itself, and we need to constantly remind ourselves that all innovations are .for the ultimate improvement of patient care. The end of nurse tra Ming is to produce excellence in nursing care. While management training fits the nurse to manage her ward, department or hospital, the implementation of the. Salmon structure should also allow the clinical specialist to achieve promotion. and to make use of her spejalist knowledge in a wider area.
Care of the patient brings together the skills of many people—those of the doctor, nurse, administrator, paramedical protessions and medico-soeial workers. The complexities of modern medicine demand a learn approach. If all our complex buildings and equipment and advances in skill and knowledge do not improve patient care, we shall have failed Nursing is certainly a profession and in nursing, as in other professions, Catholics Can express and give witness to the Catholic concepts of life, the dignity and value of the individual and the special application of moral principles within the practice of nursing, Sheila Quinn is Chief Nursing Officer of the Southampton University Hospital Group Management Committee.