THE INSPECTION OF NURSE TRAINING SCHOOLS: ITS AIMS AND RESULTS.

BY MISS A. L. ALLINE.

Inspector of Nurse Training Schools, N. Y. State Education Department (By Invitation.)

To report the inspection of Nurse Training Schools of the State of New York to this body of hospital workers is a privilege greatly appreciated.

The report seeks to hide nothing; it speaks plainly of conditions which cannot be approved, but gives evidence of a promising future.

State inspection is a new feature in nurse training schools. The idea was the outgrowth of organized effort on the part of nurses to improve the system of training they, themselves, had experienced and found wanting. Training nurses is pre-eminently an educational matter. When it was discussed in the state meetings, the State Education Department was turned to as the proper body to conduct the systematic development of a professional course. The statutory enactment prescribed certain requirements, and placed in the hands of the Regents of teh University of the State of New York the responsibility of the work.

The Regents made special rulings on preliminary and professional education and hospital facilities as regards departments for experience. The Education Department handling the same questions in many other educational lines, was asked to arrange the many details in proper compliance with the law. In a short time the chiefs of divisions passed upon the problem as regularly and systematically as though they were as familiar with them as they were with those of other institutions of learning. In other words, instead of it being necessary to form a new system, it was a mere matter

of classification, and at once the movement had back of it the experience of decades in educational methods.

Thus inspection by the department came as a natural feature, in as much as all classes of educational institutions are inspected and reported on by it.

In training schools inspection brings to the authorities the actual condition of each school at least once a year, and of those in special need several times a year.

The fundamental aim is to graduate efficient nurses, efficient in the full sense of having a general all-round, practical training, which fits them to be self-supporting, useful citizens.

Standards of admissions, of instruction and care must be established and maintained to insure such results. The controlling idea in fixing the standards must be this state of efficiency in the graduate nurse. From whatever standpoint this is considered, it is not only legitimate, but it is in fact the only course for which there is any defense by laws, moral, mental, physical and financial.

Look at the financial side one moment. A hospital without a training school employs graduate nurses at forty dollars a month and maintenance; a hospital with a training school engages students at an allowance of ten dollars a month, or less, and maintenance. Maintenance is the same for both, supervision the same for both. Therefore if graduates instead of pupil nurses are employed the additional expense to the hospital at the least calculation would be thirty dollars a month for each nurse. For a school of ten nurses it would amount to $300 a month, $3,600 a year; thirty nurses $900 a month, $10,800 a year. This tells plainly why the training school is organized, although the object as stated in the constitution, usually reads "To train young women in the art of nursing."

Considering the standards of training under the three heads mentioned, admission, instruction and care, does not for a moment replace the old proposition that the hospital unit is the patient. It may be well to state it the other way, for the comfort and well being of the patient, training school standards must be considered with regard to admission, instruction and care of the nurse. Admission covers the time from the date of the application through the probation period to her acceptance as a student of the

school. What the woman has been, what she is, and how she adapts herself to the new environment are questions to be studied in each individual case. Error in judgment as to her fitness, if she is accepted, may mean a burden to the school, an expense to the hospital, a graduate who is no credit to her profession and is an imposition on the public. To have the best idea of what is required is to know by actual experience what the responsibilities of the nurse are. One must keep in mind the last month of the course as well as the first. The principal points to be considered in the applicant are health, strength, endurance, education, character, age and personality. During probation the points to be watched are characteristics, temperament and aptitude in class and practical work. Experience teaches that students who have not had at least one year of the high school course or its full equivalent, are not capable of taking proper advantage of the opportunities offered in the training, and, therefore, to a greater or less degree fall short of first grade work. The State requires as preliminary education, a year in the high school, or its equivalent. The professional course must not be less than two years in a hospital or sanitarium having not less than twenty-five beds; the age not less than twenty-one years at the time of her regents examination. The other points cannot be definitely stated in so many words, therefore, the necessity of having experienced women to judge of qualifications and supervise the entire course is evident.

Having accepted a promising class, the next question is that of instruction. The principal points here are first, the departments for practical experience. Those deemed essential are medical, surgical, obstetrical and children, which are really the four corners of the foundation for some special course as a satisfactory superstructure after graduating in the general course. The next point is supervisors to observe all practical work and correct methods to insure the best care and comfort of the patient, and instructors who have been selected because of their ability to teach, not merely because they are otherwise associated with the interests of the institutions. A course of theoretical instruction should be such as can be practically applied day by day, no fads or frills, but what a nurse really needs to know to intelligently nurse a patient as a skilful physician should

desire her to be nursed, and also to be able to bear her responsibilities in the prophylactic movement which are being forced upon her in these days of rapid progress in the medical field. She has her part to do in preventing the white plague and the black plague with its manifold forms.

In connection with all of these points the most essential thing is a mind not benumbed by a body physically exhausted. Practical work together with mental strain, nine hours a day for seven days a week, or twelve hours a night for seven nights a week, precludes all possibility of a nurse, who is after all human, being over trained by being taught too much theory. In fact is she able to absorb enough to protect her patient in emergencies?

The last of our three considerations, the care of the nurse, is of no little importance to the patient and to the nurse. An institutions well equipped, with able instructors, and carefully selected candidates cannot guarantee efficiency in the graduation if they are over-worked, under-fed and too closely confined to the hospital atmosphere.

Living conditions must be practical examples of what makes for health and happiness. The underlying principles are what the nurse is called upon to instill into the minds of her patients, both in the hospital and private practice.

A single room properly lighted for study purposes, well heated, thoroughly ventilated, with simple furnishings, including washstands with toilet sets, and, even though it be small, free from hospital sights and sounds, is the least that should be provided for women in this exacting work. Until this can be practically met, the demand for students will be greater than the supply from the class of women most desirable.

By contrast, some hospitals room four to eight nurses in dormitories on a floor of the hospital building with dilapidated furniture, no rugs, bare walls and not a washbowl, the only available receptacle for even washing their hands-the bath tub. Common decencies are not provided, yet the graduate must be a refined, delicate gentlewoman.

The food question is being studied all the time and from all sides. Hospital food is better today than it ever was before, yet there is still room for improvement. There is no argument in favor of poor food, particularly in hospitals. To sum it up briefly, hospitals usually furnish a good quality

of raw material, but it must also be well cooked, properly served, and variety must be considered. Appetizing, nourishing food is less expensive than tonics, and usually far better for the patient.

It is not so much a question of material as brains. The trained dietetician is solving the problem in small as well as large institutions. She is an economic factor, too. The patients are both benefited and satisfied; the doctors, much to their relief, have no occasion to enter those hackneyed complaints; the nurses keep in better health and are of that much more service to the hospital.

The health of a nurse is her capital; it is her inheritance and her right. Entering a hospital in good health, she should certainly stand a reasonable chance of retaining it. She gives all she has and all she is to the institution at the risk often at the sacrifice-of health, not infrequently at the sacrifice of life itself.

The aim has been dealt with at sufficient length to show that it is honest, that it is fair to all and certainly commendable.

Inspection, registration and examination are so closely related that results cannot be credited wholly to any one. Inspection acts as the leaven. "A little leaven leaventh the whole lump," but it will take time.

In the two years of inspection only four schools have had registration actually withdrawn. This does not mean that all of the schools are up to the minimum requirements, but weak schools retained on the list are adjusting themselves and making improvements as best they can. This is no small matter, as, for instance, in the State Hospital schools it really takes legislative action to empower the State Lunacy Commission to make some of the improvements the commission itself deems most desirable. No less time is required in a small and poor community to raise funds to pay for competent instruction in foods and dietetics. It takes even longer for a hospital proprietor to be convinced that registration requires a full course of training first, and that the special course must be supplemented by experience in the essential departments to meet that requirement.

Where there is honesty of purpose and progress is steady, though it be slow, the policy of the State Department is to encourage and assist. If lack of interest is evident on the