A further division is governmental and directive skill. The total division is given a rating of 32 per cent. The last three classifications of social, projected and achieved efficiency are less strictly applicable and may, for our purposes, be omitted though they may be interesting and valuable in other departments of nursing, such as institutional or administrative work. The four classifications of physical, moral or native, administrative and dynamic efficiency may be applied with little modification to nurses in training schools or in public health service. A fifth on technique may be added as applying especially to the nursing profession. Let me illustrate by applying the grading to a graduate nurse who has had one year of infant welfare nursing, taking the five classifications as given in the previous paragraph and giving them arbitrarily a value of 20 per cent each: In physical efficiency she is slightly below par in endurance and is graded at 18 per cent. In moral or native efficiency she is slightly lacking in poise, self control or balance and also in adaptability and is given a rating of 18 per cent. In administrative efficiency she lacks in executive capacity and somewhat in initiative. Her grade here is 18 per cent. In dynamic efficiency her professional preparation is very high, the best, but her academic education is low, through no fault of her own. Her professional attitudes and interest and her appreciation of social, moral and intellectual values are high. Her instructive skill or ability to teach analyzed according to attention and interest of patients, the formality versus vitality of instruction to patients and organization and presentation of the subject matter (child welfare, specifically in this instance) are all of very fine order. Her grading here is brought down by lack of academic education and is placed at 17 per cent. Her technical efficiency is high and is graded at 20 per cent. The total efficiency is found by adding the totals of the five classifications and equals in this case 91 per cent, a very fair estimate of the qualities of this nurse if I had been asked to give an estimate without such a standard as this. However, estimates made without a standard are likely to be unfair in one way or another. The standard overcomes the danger of vague and general terms and forms a sound basis of computation for the qualities of a nurse even in the hands of a supervisor. It seems a fair beginning toward the proper certification or grading of nurses coming to various departments for short-time experience and avoids that opportunity for critical commentary when inquiry is made for a nurse's record and it is found that none has been kept. It is in all fairness due the nurse as well as the Association. Further standardization is seriously needed in the matter of records suitable for a specialized type of work, such as infant welfare. Annual financial statements also should be standardized if the work of one city is to be comparable with another. The outline given above is merely suggestive; the subject is exceedingly complex and it is hoped may be discussed concretely rather than in the abstract. DISCUSSION Miss Etchberger: Miss La Forge has given us a most interesting outline on the standard for the infant welfare nurse. I think we all agree that this standard should be as high as possible and think the grading for efficiency would be most useful to the organizations that thus far have not been using this method in their work. The organizations that make these demands must be prepared to pay a living salary to the nurse, and I would like to recommend that this section of the American Association for Study and Prevention of Infant Mortality go on record as recommending a minimum salary that would make it possible for us all to be able to secure the service of the best qualified nurses. I personally feel that the time has come when we must first standardize the salary of the nurse engaged in infant welfare nursing. Then we can demand the highest type. Miss Wheeler Everything we have heard read and said today proves more and more how high are the qualifications that the nurse should have, and I think with this view that we ought to feel that the time has come when we should be willing to ask the organizations to pay these nurses a proper living salary. Miss Jones: To whom would this resolution go? Who would do it? Miss Leete: I was hoping some committee might be formed to study this card and perhaps try it out, I think we cannot make any decision now, but a committee might perhaps be appointed which would take from this card the points essential and have various organizations try it out during the year. Miss Ahrens: Miss Kelly: Our card is very different from this. We grade the nurse on her school work, her technique, adaptability, quality and quantity of work, accomplishment of her plan of work, and then her personality; her field of work, her standing in the district, how she is received in the homes, her observation, her perseverance in following up cases, and her attitude toward her coworkers, medical inspectors, supervisors, etc. In regard to this outline there are two points I would like to have given a higher rating, the second and sixth. Under II "Optimism, enthusiasm and a sense of humor" are given a rating of 2. I would like to suggest a higher rating for these qualities, even if there is a lower rating for the other things. Miss Kelly might tell us how their official card works. Miss Wheeler: I move that the chair appoint a committee, a sub-committee of the committee on Nursing and Social Work to try out this outline and bring recommendations next year. Miss Leete: Would you like them to touch on Miss Etchberger's minimum standard? (The motion was put to the vote and carried.) Miss Leete: I wish we might send a letter to Miss Shaver expressing regret at her illness and appreciation of her taking the chairmanship of this committee and starting it. (The above was put in the form of a resolution and duly seconded and carried.) (The chair then appointed the following committee on Standard Card, Miss Etchberger, Miss Wheeler, Miss Kelly, Miss Daniels and Miss Jones.) AMERICAN ASSOCIATION FOR STUDY AND PREVENTION OF INFANT MORTALITY (Headquarters, 1211 Cathedral Street, Baltimore, Maryland) Suggested Outline for Report of Affiliated Societies for year ending Reports were asked for in accordance with Article X of the By-Laws. The headings given below were intended to be suggestive only, and the Affiliated Societies were asked to include in their reports, brief descriptions of distinctive features of their work which were not touched upon in the outline. Unless otherwise designated, the statistics are for the year ending September 30, 1916. Marginal figures in the reports which follow refer to corresponding ones in the outline. The replies to section VI do not appear in the separate reports, but are tabulated on pages 276, 277. I. Name and address of organization. Outline briefly the activities that are included in the work of your Association, prenatal care, obstetrical care, postnatal care, feeding conferences, prevention of blindness, hospital care for sick babies, rural nursing. II. What features do you find it possible to develop with the greatest success— the preventive and educational, or the remedial? III. What do you regard as the most important advance in the work of your Association during the current year? IV. Is all your work done gratuitously, or do you make any provision for the instruction or care of mothers of moderate means who are willing and able to pay for the services such as are rendered by your Association? V. If your work is financed by voluntary subscriptions. in what way do you bring the work you are doing, and its needs, to the attention of the public? Summary of prenatal work Summary of postnatal work VI. As far as possible, please supply the figures asked for below. for each year, for the years ending Sept. 30, 1915, and Sept. 30, 1916. (1) Date of organization (2) Age limit of children cared for (3) Staff: doctors, nurses (4) Budget (5) Total number of children cared for (6) Total number under 12 mos. old cared for (7) Total deaths, babies under 12 mos. old under care (8) Total number births recorded in your city or town (9) Total deaths of babies under 12 mos. old in your city or town |