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part of the school officials, or conditions seem impossible, and a careful study of details reveals no remedy, the Inspections Division informs the school authorities that as the minimum requirements of the law have not been maintained in certain particulars to which their attention has previously been called, a recommendation to have registration privileges withdrawn will be brought before the Board of Regents at their next quarterly meeting.

As previously stated, four schools were thus dropped. Others receiving the same notice immediately became interested, and as a direct result cleanliness and order, proper supervision and instruction, and improved housing conditions are making them creditable institutions.

Three other schools not having responded to suggestions, and making no move towards improvement of standards that are notably low, are now in a position to. receive the formal notice.

Formerly, affiliated relations between schools were mainly between general hospitals and those giving obstetrical experience. If any school lacks an essential department or sufficient experience in an essential department, affiliation with some school to obtain that training is advised. Small schools with limited experience in all lines, or special schools limited in several departments, are assisted in forming affiliations. Institutions not entering into such relations are the exception instead of the rule in the New York schools. Training in a certain branch is not the only result of affiliation. The schools themselves are brought into closer relations, and the nurses are afforded a broader outlook than can be obtained from one institution.

The comparative size of the hospital is coming to be of little moment in considering actual results in the matter of training. If small hospitals would be satisfied with nothing less than capable, well-trained, progressive women as superintendents of nurses, the size of the hospital would be of less importance than at present. This is not a matter of conjecture, but an actual condition exemplified in the classification of more than a hundred registered schools. Some of the small schools are graduating excellent nurses year after year, nurses that are acceptable in any place where a nurse is needed.

The State requirement, as mentioned above, is a hospital containing not less than twenty-five beds, meaning of course a daily average of twenty-five patients. Empty beds are of little value in considering experience. The range of departments is more important than the number of patients, and affiliation to meet the departmental question obviates any necessity of concern over the number. Inspection searches out the weak points in the course of training and then just as diligently, just as persistently searches out the remedy. It directs attention to the necessity for improvement and the method by which the weak places may be made strong.

The length of the course of training in large and small schools is the same. Three years is the term approved by an overwhelming majority of those in a position to know. It is not expected that an applicant to the school will be able wisely to determine how long the term should be. It is clearly not the undergraduate who can be depended on to justly fix the length of the course.

In the whole educational field these matters are always regulated by the people who have had the benefit of the actual training in school or college, supplemented by the experience obtained by close contact with students and supervision of courses of instruction. The reasons why the course should be three years instead of two are obvious, but will bear repeating. The majority of women entering the schools have had little or no home training. They must needs be taught home economics—the science and art of housekeeping. The importance of this branch of woman's education can best be realized by noting that some of our colleges are now offering a four-year course in home economics subsequent to a full high school course. They have an increase in numbers enrolled each year. The daily routine duties of hospital work, which are in reality housekeeping duties, are made the field of experience for the nurse; this is justifiable so far as it is needed in her education. Beyond that it is requiring her to be of general utility in the institution to the sacrifice of time needed for actual nursing, and makes it necessary to lengthen the term to get the required amount of experience in the care of the patient. Clerical work increases steadily. In a ward of twenty-five patients, the bedside notes, requisitions for supplies, diet lists, records of reception, and discharge of patients, and various other like demands take almost the entire time of one nurse. Preparation of surgical supplies has more than doubled its demands on the nurse's time in the last ten years. Other good reasons might be enumerated, but these certainly are sufficient to support the ground taken.

It is hardly to be expected that any school will take pride in a standing which is the minimum requirement of the law. Of one hundred and five registered schools, seven have the minimum two-year course; twenty-eight range from two years and two months to two years and nine months, and seventy have a full three-year course. Figures go to prove that the schools having a three-year course and the educational requirement for admission is a high school diploma are given the preference by candidates. One such school had nine hundred applicants last year. This is not an unusual record. The best class of applicants seek that which is of most worth. This is just as true today as it ever was, and there is every reason to believe it always will be true.

Inspection stands for thorough training and creditable results. Until the students have much better preliminary training and more assistance in routine duties there must be sufficient time granted to meet their needs.

The dawn of this new era was recorded in the State of New York at the last session of the Legislature, when it empowered the Board of Regents to establish industrial schools. To the girls of our public schools this means training in home economics. Time allowance can be made in the nurse school for credits obtained in the industrial school.

The educational requirement of one year in the high school, or its equivalent, contrary to expectations, is being satisfactorily met. The rigid demand for it induces young women to resume their studies to obtain the required number of Regents' counts. Five schools raised their requirement from a one to a two-year course in the high school, and report their ability to fill their classes with little difficulty.

There has been a marked improvement in the theoretical course. Grading the classes, abler instructors and more of them, day classes instead of night classes, and up-to-date reference books all tend toward better results. The greatest need and most improvement has been in the dietetic course; as its importance is just making an impression, there is much to be expected of it.

In looking over the work for results, many features have presented themselves in a definite way, figures given, calculations made and conclusions drawn. But fully as important is the spiritual influence which is developing one common aim, one great interest throughout the entire field.

Discuss the question of the nurse training school as a whole or its details point by point, when its standing is finally determined its measurements will be found to correspond with the aim, purposes and principles of the nurse directly in charge of the students. The school will not be greater than its teacher, but as the teacher is so is the school. The responsibility is on the official management of the institution, for the success of the school depends on their placing the right woman in charge and making it possible for her to do her very best work.

I thank you for your attention.

THE RELATION OF THE TRAINING

SCHOOL TO HOSPITAL EFFICIENCY.

By Miss C. A. AIKENS,

Detroit, Mich.

Before beginning to discuss the relation of the training school to hospital efficiency, it seems desirable to have a clear and general understanding as to exactly what is implied in the use of the term "efficiency" in this connection. Webster says efficiency is "the ratio of useful work for the energy expended." This is the test I propose to apply in discussing the subject assigned to me. I take it for granted that what we all want is the highest possible ratio of useful work, for the time, energy and money expended in our branch of the world's activities. I take it, that we are met here, not to discuss efficiency in the abstract, not simply to talk about efficiency in a pleasant, sort-of-non-commital way, but to look fairly and squarely at conditions and possible hindrances--in short, to study ways and means of getting there.

It is not necessary, in addressing this audience, to take time to show how the introduction of the training school into the hospital has lowered the death rate, increased the comfort of the sick, and improved the work of the institution in ways that can neither be measured nor tabulated. I believe that we all agree with this sentiment which appeared in a recent hospital report : "One of the most important branches of our hospital is the training school for nurses; for upon the quality and efficiency of the nurses, the ultimate success of the hospital rests. It is the nurse behind the case, no less truly than the man behind the gun, who is a controlling factor. Modern buildings and splendid appliances cannot secure good results with poor nurses;

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