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My first idea was to avoid the training school problem by employing graduate nurses; but it did not take many months before I found out that thirty-five ($35) dollars per month was the minimum salary that these graduate nurses expected; that they wished short hours, light work and that discipline with them was out of the question. There was no certainty as to how long you would have them even though you had a written contract for a definite length of time. In other words, this system was very unstable and unsatisfactory. It seemed to me imperative that a training school be established in order to secure permanency in the nursing force. At first it was difficult to secure probationers because the hospital had only recently been established. I believe that most young women have a misunderstanding about training in small hospitals, coming from an erroneous idea that they do not secure as good an experience as they would in larger hospitals. However, I have found that the difficulties of securing probationers of the right kind. lessens as the age of the institution increases. It should be the aim of every small institution to make its training as near first class as possible. Its ability to do this depends largely upon those having these matters in charge. There is no reason why instruction in all departments of general nursing should not be given, although I do realize that it may demand more time on the part of the instructors. One prime factor is that of having an intelligent chief nurse who has not only the ability to teach, but who is able to secure and hold a corps of competent lecturers on the various subjects. I believe that from the time a nurse is accepted as a pupil, she ought to be paid sufficient to meet ordinary current expenses.

Whether or not a small hospital can give its nurses practical instruction in contagious and obstetrical cases depends largely on whether or not that hospital is so arranged that it can handle such cases. I think that many small hospitals do accept these cases. Where they do not, it is possible to secure such experience in

one of two ways-either by affiliation with another hospital, or by permitting its nurses to go out on special duty for local physicians.

I think that in the majority of small institutions affiliation with other hospitals it not necessary, especially for obstetrical work, because there are usually or can be enough cases admitted during the course of training. Affiliation with other hospitals is a matter of serious import. It may engender dissatisfaction and discontent because the pupils are meeting with different conditions, different and often conflicting rules and regulations, and the peculiarities of different supervising nurses. The feeling of loyalty to the interest of any one institution is hard to create. We send our nurses out for obstetrical experience and usually they are anxious to return home, but there are grave difficulties in the plan. A good many hospitals in small towns, and especially church hospitals, are almost obliged to respond to calls for pupil nurses for private duty. There is a demand for such service from the hospital by the physicians and by the laity, who aid materially in the support of such an institution. Frequently in smaller places it is impossible to secure the services of a trained nurse except from the hospital. In one to two months of such practical work in homes, each nurse during her period of training gains very valuable experience, and secures practical work with contagious and other cases which the hospital may not be able to give. This experience is a very valuable asset for her to have when she starts out upon her life work, and when she is left to her own resources with the general public. Certainly the nurse having had this varied experience in acute cases in private homes will have something she cannot secure in the class room. I understand, however, that the registration law in some states provides that she must not have this valuable experience or her school cannot be registered as a training school. It seems to me that this is an unjust and unwise provision and savors of the monopoly plan. The policy of the graduate nurses should be to live and to let live-providing that by so doing there is no serious menace to the public.

There is reason to believe that one serious difficulty in securing probationers is due to the stringent provisions of some of the registration laws. It may be possible to maintain the standard set in some localities, and by some hospitals, but I believe that for most hospitals it is too high for the age in which we live, and works a great injustice to nurses in general. Experience has shown that it works a hardship to not only the hospitals, but to the general practitioner and to the public. A two-years' course exclusive of probation period is sufficient to round out the average nurse and fit her to render capable service to the physician and to the public. I believe the two-year period should be the only one required by registration laws. If any nurse feels that she can give another year or two in order that she may specialize on any one line of work, or may broaden her education along general lines of nursing, that is a subject for her own determination and not to be legalized through the influence of a few. I believe that restrictive legislation should be condemned. A minimum schedule should be approved for hospitals in general, which is practicable and just, in order to insure efficiency to a degree such as is satisfactory to the physician and not a menace to the public. Of course, no obstacle should be placed in the way of any nurse desiring higher education and I would not have it understood that I would wish to restrict any such ambitions; but I do wish it understood that I do protest against the legalizing of the impractical ideals of a few of the bright lights in the nursing profession.

The experience of the last few years teaches that there is a waning of probationers, that many hospitals are suffering for lack of applicants for their training schools, that many bright, ambitious young women are yearning to secure a good, substantial, practical nursing education which will enable them to sufficiently serve the ordinary practitioner and the public, but are deterred from doing so by the requirements for entrance, and by the long period required for training before they can secure the title of graduate nurse. Let every one have as much knowledge as they feel they can afford,

but do not let us try to force every nurse to prepare herself to such a degree that she is qualified to teach and able to hold executive positions in any institution.


The rate that a hospital should charge for the ward or private rooms is more or less a local problem. In cities where there are several hospitals a great deal of injustice may be done by one hospital having what you might call cut-rate prices. I believe that the prices for ward and room should be determined on a business basis; giving to the patient in proportion to the cost of maintenance. It is my contention that it is wrong to give a pay-ward patient something for seven dollars per week which it costs twelve dollars to supply. Even if a hospital is blessed with an extraordinary endowment, it is no reason why it should give it away to the general public. It seems to me that much money is raised every year for beneficient purposes that is improperly expended. If any hospital has a surplus let is use it for improvements, or to help out some less fortunate institution. ose who can pay good prices for services rendered should do so; if a patient is worthy of public help there is no greater humanitarian work than to supply it. There is no doubt that the charitable fund of many institutions is misappropriated by being used to defray the expenses of patients able to pay; and I believe that such funds are often misused in caring for patients from whom the physician in attendance exacts a generous fee for medical or surgical attention. Every charity patient in a hospital should be turned over to the medical or surgical staff, and it should be a misdemeanor for the collection of any fee for such attendance. The attending physician or surgeon will be recompensed from the fees he is able to collect from the patients amply able to pay.



BY DR. THOMAS HOWELL, CHAIRMAN, Superintendent Worcester City Hospital, Worcester, Mass.

At the Chicago meeting of the American Hospital Association it was voted to amend the by-laws to include a committee on development of the association. It was provided that this committee shall present annually a report on the further development of the Association's work.

While the present committee has few recommendations to make, it desires to justify its existence by calling attention to a number of matters which it believes are entitled to your earnest consideration.

This report is based largely on expressions of opinion obtained from members of the Association, who have been freely consulted regarding the lines along which they thought the society should be developed.

What should be our policy regarding expansion? Should members of the attending staffs, superintendents of nurses, secretaries, and officers of local hospital associations, and contributors to the support of hospitals, be eligible to membership? Should we have a council or house of delegates? Should we have a paid secretary, and should our treasurer be bonded? Should the association be incorporated? Should future conferences includes both general sessions and section meetings? Should we have a committee on program? Should provisions be made for publishing in pamphlet form some of the more practical papers each year? These are all propositions which should receive consideration at your hands.

*Read by Miss C. A. Aikens, Detroit.


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