from the Minister of Health
By MISS P. D. NUTTALL
Ed itor of NursingTimes IT GIVES ME great pleasure to accept the Editor's invitation to contribute to this supplement.
We have close on a quarter of a million nurses and midwives of the varying grades and branches of nursing in our hospitals today —17 per cent more than we had five years ago. But we need every one of them, and more too.
In the artificial kidney unit, in surgery on the heart, or in the modern treatment of burns, which can bring a child back to health and activity whereas once he would have been crippled for nearly all of the hundreds of valuable treatments which our doctors are introducing the nurse has a major part to play.
Indeed frequently it is the quality of nursing which is decisive for success or failure.
In the Load Authority Service, too, nurses and midwives-27,000 of them—are playing a vital part in keeping our community fit and happy. Here health education is being expanded, and a nurse who by teaching the rules of health and safety seeks to prevent disasters, plays as important a role as her hospital colleague who seeks to cure them.
Most of us are more familiar with the work of general nurses and midwives than with the work of psychiatric nurses (in both the hospital and the Local Authority Services) who care for those who become mentally ill, or for those who are born mentally subnormal. So I will end my introduction with a few sentences about these branches of nursing.
Increasing knowledge about mental subnormality and the rapid expansion in both training and treatment are bringing even greater rewards for the individual, both patient and nurse.
Perhaps it is in the nursing of the mentally ill that the greatest changes of all have taken place— as we have been able to move forward from mainly custodial care to treatment in the true sense by the application of modem methods of diagnosis and therapy.
May I commend to you Miss Nuttall's excellent summary of the qualities particularly needed by the psychiatric nurse, and her suggestion that those who have these qualities should consider mental nursing very carefully?
There could be no more useful work: It is vitally important that we seize to the full the great new opportunities in this field, where, so crucial is the nurse's own part in drawing the patient back to the real world, an increase in nursing staff could now undoubtedly bring about an even higher rate of success.
I hope this supplement will help to stimulate interest in the great profession of nursing.
THIS year the Royal College of Nursing celebrates its Golden Jubilee; nursing as a profession has not only arrived, it has become established.
Dickens' Sairey Gamp has been replaced in the public mind by an image of the young nurse in cap and apron; but the reality is a body of professional women and men in positions where their responsibility is matched by authority.
The Nightingale aphorism "I would rather found a profession highly paid than establish another Religious Order" has to a large extent come true. At one end of the scale is the first-year student nurse, paid a training allowance of 1365 a year (often non-resident and increasingly often married while in training); while at the other end, the chief nursing officer of the Ministry of Health, a marrieds women with a salary of £3,895 heads a group of 24 nursing officers at the Ministry.
Between these financial extremes, in the National Health Service are some 80,000 trained nurses working full-time and 30,000 working part-time (plus about 65,000 trainee nurses) and an increasing number of nurses working in industry, in regional hospital boards and in nursing organisations.
Katherine Whitehorn, in a recent article in The Observer, wrote that an SRN certificate was the easiest passport to employment anywhere in the world. Everywhere there is an immense demand for British trained nurses.
Hospital administrators from the United States journey regularly to this country to tempt British nurses to go to the States to staff American hospitals. The developing countries have British nurses as advisers and the Mission fields have our nurses in every part of the globe. Nurses form a large part of our "invisible exports".
To talk of a shortage of nurses to an African from one of the developing countries is to invite a hollow laugh. Yet in some American hospitals the shortage is said to have reached crisis point. Like the length of a piece of string—it all depends on what is meant by "shortage".
The National Health Service is like a huge sponge, capable of absorbing an almost infinite quantity of people. Paradoxically, the very moves that have been made to ameliorate the shortages, by stimulating recruitment, have created further shortages.
All nurses now work a 42hour week. All trained nurses have six weeks' holiday a year. There are many opportunities (which are eagerly grasped) for secondment on full pay to undertake post-registration courses of one or two years duration. Nursing is particularly well-endowed with scholarships for overseas visits.
The world is indeed the trained nurse's oyster.
What of the other side of the coin? Nursing is a 24-hour service, carried on seven days of the week for 52 weeks of the year. There is much to be done in the anti-social periods of evening and night duty and at the weekends. The sick must be cared for, even after 5 p.m. and on Saturdays and Sundays.
No nurse would have it otherwise.
The dilemma caused by the apprenticeship nature of nursetraining (where all too often the apprentices outnumber the trained nurses in the ward situation) causes a constant headache for those who are responsible for nurse-training schools and for staffing the hospitals to which they are attached.
Student nurses cannot be counted as "pairs of hands"; they are apprentices who need constant supervision and who have to be withdrawn from the wards for theoretical lectures, for demonstrations of new techniques and for visits to the health and welfare services in the community.
The urgent need for each nurse-training school to plan their students' training programme in order to fulfil the clinical requirements of the General Nursing Councils (the examining and registering bodies set up by Parliament) in a logical and meaningful manner is fully recognised, together with the need to enable the students to plan their own off-duty activities well in advance.
But it is not easy to reconcile the training needs of the students in a large school with the stalling needs of the hospital.
Broadly speaking there are two main training schemes; the two-year training for the Roll of Nurses and the three-year training for the Register. For those who wish to become ward sisters or to go abroad or to move out of the hospital field. the three-year training (SRN) is almost essential.
But for those who aim to stay at the patient's bedside, ministering to his personal needs, the
two-year training is often preferred.
Having decided upon the length of training, the prospective nursing candidate needs next to consider the type of patient she would like to nurse. If she is especially good with people, imaginative and sensitive, she would do well to carefully consider training in a hospital school where psychiatric patients are nursed. Such patients occupy 42 per cent of the NHS hospital beds in the country.
The young man or woman, motivated by the same ideals of service, but who is manually dexterous, may prefer to train in an acute general hospital or in a children's hospital. Promotional prospects are excellent in all three fields, although the psychiatric or paediatric nurse would normally be required to have a second certificate.
England and Wales has a more highly developed pattern of specialisation in nurse-training than any other country in the world. The Scottish pattern is more comprehensive and the legislation different.
For the registered nurse. trained in a hospital among the sick, there are ample opportunities for work in the community
in citizens' homes, as a health visitor, or as a district nurse. There are opportunities in industry, in schools and in colleges. Much of this type of work needs further training (for which scholarships are available) but they provide openings which often do not involve the "anti-social" hours.
hospital (where more than 80 per cent of trained nurses are non-resident living in their own homes) can choose to specialise in the clinical field, in nursing
administration, or as a nurse tutor. Again, further training is essential.
Although men are making great headway in nursing, being appointed to an increasing number of senior posts, nursing is, and is likely to remain, a predominantly women's profession. The nursing profession together with all those other occupations where personnel are often religiously motivated and dedicated people, will suffer, in the coming years, from a shortage of spinsters.
It is difficult to envisage married women devoting all their time and energies in their work to the same extent as have done the unmarried women in the past. Nor would it be reasonable to expect them to.
It may well be that the future of nursing lies in the hands of the Religious Orders. The Reformation brought about the secularisation of nursing and reduced it to the depths portrayed by Charles Dickens. Florence Nightingale, in an Imperial Victorian era, established nursing and was enormously helped by the suffragette movement.
The wheel may yet come full circle.