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affairs which was usually possessed by the applicant of twenty years ago. Nor has she met aany of those home responsibilities which we used to consider, nd still do consider, one of the most valuable qualifications which an applicant can bring

For these reasons alone—the lowering of age of entrance, the lack of maturity, of home training, of proper ideals of duty and responsibility—the applicant of today needs a longer and more careful training to bring her up to the standard of her predecessor in this work. But to this fact we must add another, and one not sufficiently recognized, that there is a wide difference between the requirements which the profession of nursing made of its members twenty years ago and the professional requirements of today.

Twenty years ago our pupils as they left the training school had practically but one field of work open to them, since the institutional positions were few and district nursing almost unknown. Today not only have many new avenues for the nurse opened up that were practically undreamed of at that time, but the familiar ground of private work has itself so developed as to call for a more thorough, varied anad longer training for the pupil. During recent years the care of infants aand children has become the subject of special study and investigation among physicians, and now ranks as a specialty, requiring of the nurse that some months in her training be devoted to this most important subject. In nervous diseases, to which, as Dr. Weir Mitchell says, “the nursing of all other diseases is as mere child' play,” the pupil must at least during her training be thoroughly grounded, even if later she obtains additional and special training. The advance of surgery and its development into many separate and distinct fields, such as brain, abdominal, orthopoedic and other special branches, compels some corresponding increase in the training of the pupil. It must be enlarged and strengthened to meet the new needs. Where formerly one month in the (perhaps single) operating room used to serve for the entire training of the pupil, now not less than three months, as a rule, suffices to give the pupil any real familiarity with the bewildering variety of artticles aand materials used, and with the prescribed technique in handling them; any lack of understanding on her part which leads her to an error may be as fatal to the patient as if made by the surgeon himself; and the same holds true of almost any phase of her work.

As to institutional positions, they grow in number and importance, and where a few years ago there were few nurses so occupied there are now some thousands, if one includes, as one should, not only the superintendents of hospitals and training schools, but those who fill the offices of assistants, supervisors and head nurses in them. A farr number probably of the members of this Society are trained nurses, the product of our training schools, and are in the positions they hold by virtue of that training and the powers which it developed in them, and, apart from the more personal issues of general education and culture, are filling their high offices with skill and ability in direct accordance with the character of the training and the ideals which it set for them. The call for nurses to fill such hospital positions is ceaseless, and we cannot meet it adequately unttil we cannot attract into our training schools more women of thorough education and the serious and earnest purpose in life which it usually brings.

Nor does the call for the graduate nurse cease when the institutions and private households are supplied. It comes even more clearly and imperatively to many nurses from the sick poor in the crowded quarters of our cities; from our factories and department stores, where hundreds of our own sex can be advised and helped; from our public schools, and from numberless other places where the stress and strain of our modern life calls for trained and skilled helpers imbued with the spirit of service to their fellows. All the long hot summer they are climbing the high teriement stairs to show the young mother how to feed and care for the new baby, whose life may hang on just that teaching, or to teach the consumptive patient what he must do for himself, and for the protection of those about him. In this world-wide struggle with tuberculosis our nurses are placing themselves on the firing line.

It needs no argument of mine, I am sure, to convinice you that the foundation for any of the various kinds of work which have been touched upon here needs to be broad, strong and carefully laid, and that no brief or limited prepaiation will suffice. In saying, however, that it cannot well be given in less than three years, I would not be understood as agreeing that a course of such length should be offered in the majority of hospitals. Unless a hospital can provide for a full training in every service, it is not justified in keeping the pupil for three years, and the tendency in hospitals and sanitaria of almost any kind or capacity (and frequently with very limited opportunities) to insist upon a three years' training must be looked upon as deplorable. Looked at baldly, one sees the institution willing to take an addition year of work from the pupil, in return for which it can offer little or nothing. I have in mind a private hospital, the property of one man, in which the work is, I believe, largely surgical. A training school with a two years' course was established, and not long since a third year was added. Almost all of the special nursing in this hospital is done by the pupils, and they are, I am told, placed on special duty at a very early stage in their training. One year of training would probably amply cover all that this enterprising institution has to offer.

In this attempt to place before you some at least of the problems with which the training school is confronted, I am led to believe that they are all mere aspects and phases of one single problem, and that problem is the relation of the hospital to the training school. Familiar as we all are with the present system, it is not easy to entertain the idea of anything different. Yet there are those who feel that in the best interests of both hospital and training school some reconstruction of that system is necessary; that much of the teaching, especially al of that fundamental work included in the preparatory course now given in the hospital, should be given outside of it in a central school which could do for a number of hospitals what each one is now trying to do for itself; and that this central school should take upon itself the direction of the education and responsibility of arranging with different hospitals for the practical training of the pupil in all the various services. In other words, that the training school should rest upon a foundation not unlike the medical school. Such central schools could in course of time help to solve the problem of nursing in some of the small, special or private hospitals, now struggling to maintain their own separate schools.

I should like to add my personal belief that the pupil should pay for her training straight through, but that she should be more independent of the requirements of the hospital, which in some departments should be partly met by salaried workers.

I am by no means presenting new ideas to you in these suggestions. Most of them have already been made by a good many people. The need of such a central school was admirably presented by Dr. Francis Denny in the Boston Medical and Surgical Journal for June 1903; Dr. Richard Cabot has written frequently and convincingly on the subject; while Mrs. Hunter Robb, in a noteworthy paper read in Washington some years ago, outlined a plan for such a school, which should be carefully studied. An article by Dr. Oldfield in the Westminster Review a few years ago advocated a Royal College of Nurses and the granting of degrees. I confess that nursing as I see it seems to me as worthy a place in the scheme of the university as any art or science in it.

I have tried in this paper to lay before you as faithfully as I could some of the difficulties with which our training schools are contending which are apparently the inevitable result of the present relationship between school and hospital. To me, at least, they seem serious, and I would think they merit your attention and most thoughtful consideration. This is no question of doctor versus nurse, or of hospital versus training school; each is essential to the other. The question is, what is the very best that we can do for our training schools? The various classes of people and the institutions in the community which have come to lean upon the trained nurse, and to be dependent upon her services, require of us that we should in our teaching and training put her in the way of developing those services to their ultimate power and usefulness.



Rev. A. S. KAVANAGH, D. D.,

The Methodist-Episcopal Hospital, Brooklyn, N. Y.

This subject has been so fully and ably considered from all standpoints during the past year or so, that there is little room left for anything new or original in this report. The most that I can expect to do is bring to your attention what has been expressed by others, together with my own convictions concerning certain phases of the question.

First of all, I will ask you to consider with me the generally acknowledged shortage of nurses, for which certain defects in our treatment of the pupil nurse may be partly responsible.

At the outset let me say that the shortage does not seem to be equally distributed. At our meeting in Chicago, a year ago, a few of our hospital superintendents claimed that as yet they had experienced no difficulty in securing a sufficient supply. So far as I can discover from personal interviews and magazine articles, this is especially true of Canada. The shortage I think is very generally felt throughout the United States, for there is scarcely a convention of nurses anywhere that does not give it a place on its program. The claim is made, however, that where the best training is given the shortage is felt the least. That is a wise suggestion; it will make us all loth to confess any lack of applicants. Perhaps no one can speak with greater authority on this subject than Miss Sophia F. Palmer. In her address before the New York State Conference of Charities and Correction, she spoke of “the sharply felt embarrassment in the majority of our hospitals, owing to what seems to be a sudden decrease in the number of young women desiring to enter the nursing field.” And again, "the personal care

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