Memorandum On The Nursing Problem

NHS history Nursing Staffing


The S.M.A. regards the present shortage of nurses as a major crisis endangering the implementation of the National Health Service Act.  It believes that the main causes of the shortages are caused by:

a)     Insufficient recruitment to the profession.
b)    Wastage of large numbers of nurses before qualification.
c)     The small number of nurses who remain in hospital after qualification.

This shortage is acute even in the present state of the country’s medical service, and is one of the chief causes of a distinct­ly lower quality of the care of the sick than obtained before the war.

This shortage, if it continues, will clearly make it impossible to improve the health services of the country as envisaged by the Health Service Act.

In spite of a few reforms and slight progress in one or two directions the nursing profession remains in a most unsatisfactory state.  The chief reasons for this are:-

a) Those most intimately concerned, i.e. nurses and doctors show a continued lack of initiative in analysing the causes of this unsatisfactory state and in removing them.
b) Extreme conservatism of the senior members of the nursing profession.  This factor cannot be over-emphasised either in its extent or its effects.

The S.M.A. believes that the following are among the chief causes of the shortage of nurses and the unsatisfactory state of the nursing profession. Of these caused it is convinced that the first given is much the most important at the present time. It is an aspect of nursing life that is almost untouched in the Mini­sterial pamphlet “Staffing in Hospitals” 1945.

The type of institutional life which all nurses are compelled to endure while training and which most of these in hospital practice continue to endure after qualifying, remains unchanged.

The main characteristics of this life are:-

a)  Deprivation of home life. (This is all too often unavoidable, but therefore all the more reason to be alleviated).
b)  Existence in a building usually within the hospital grounds, if not actually part of the main buildings (hospital), so that the nurse can never “get away” from the hospital.
c)  Existence off-duty in an environment dominated and organised completely by the same persons of her own sex who dominate and organise her working hours.
d)   Ridiculous restrictions on the freedom which no other type of student would tolerate,
e)    All too often poor and inadequate food.
f)    Seldom any redress for just grievances and complaints.
g)   Unapproachability of the Matron.
h)  A chance for the hardened older woman nurtured in the tradition to mould the young defenceless girl through the years to a state of mind not dissimilar to her own.

This institutional life with all that it implies, inevitably affects a girl’s outlook, narrows her interests and produces an all too common state of apathy and cynicism, with ignorance of most of the world outside her job,.  It has been largely responsible for the fact that most nurses have not joined trades unions.  Their state of mind makes them extremely doubtful that any useful result would come from, their joining, and their surfeit of unnecessary discipline makes them distrustful of any attempt to press them to join.

All these aspects of an institutional life deter large numbers of intelligent girls from entering the profession or from continuing in it after starting training.

The well-founded belief that considerable numbers of nurses now hold that their labour is being exploited –

a)           by the hospitals

b)          by the general public

is one of the reasons now being given by nurses who are leaving the  profession.


  1. Qualified Nurses.  The present rates of pay compare very unfavourably with those of almost any other worker, and are totally inadequate for the work? which demands intelligence, a high degree of training, considerable responsibility and not infrequently great physical effort,
  2. Student nurses.  The present rates of pay (better termed training allowance) are, inadequate for the increased cost of living. If it is conceded that the student nurse must be able to be independent of her parents, and in the existing shortage this must be granted, then a very strong case can be made out for increasing her maintenance allowance, (see Lancet, 1947,1,190 & 181).

Drudgery in Hospitals. Although efforts have been made to alleviate this, with little success, much yet needs to be done: more domestic staff and ward orderlies, together with improvements in the mechani­cal efficiency of the wards.

Hours of Work. These are too long for all nurses, students or qualified, and the usual practice of a break of 2-3 hours off duty is inefficient as it is not long enough for much use to be made of it and it in effect prolongs the working day.

Medical Care – preventive and curative – of all nurses, often leaves much to be desired, as does the matron’s attitude to the illness of the staff.

In the continuing shortage of manpower, the health of the coun­try is clearly of the greatest importance. Nursing services are intimately bound up with the maintenance, of this health.  The SMA believes that something must be done at once to increase the supply of nurses.

In view of the urgency of the situation additional efforts must be made from outside to effect drastic, urgent, and most nece­ssary changes in the nursing profession. It is fully realised that suggested changes will meet with every type of resistance from a variety of quarters, apart from the genuine difficulties that are inevitable.  But the situation is now so critical that no opposition must be allowed to hinder the rapid introduction of necessary improvements.

The S.M.A. puts forward the following proposals:

That every one of the measures put forward in the Ministerial pam­phlet, “Staffing the Hospitals” 1945 be fully implemented as quickly as possible.  In the meantime, all nurses should be informed, if necessary by a personal circular from the Minister himself, that improvements are under way, what they are, and when they may hope to be achieved.

That the nurses’ institutional life be abolished. To effect this it is proposed;

a. that all nurses homes be removed at once from the hands of the medical institutions they serve, and be called hostels,
b. that these hostels be run by a competent warden, preferably female, assisted by a committee of about ten, composed half of lay members and half of representatives of the inmates. Chairmanship of the committee should be by rotation and the lay members should include local authority arid Trades’ union representatives. That these hostels should provide accommodation not only for students and qualified nurses, but also for other kinds of male and female students. That students shall pay for their board and lodging as other students and not have “emoluments” taken off their salary.
c. That these hostels (new) should be built to standards not below those laid down in “Staffing the Hospitals”

That students living in the hostels be under no more restrictions than any other university student.

That any nurse, student, qualified or otherwise, be allowed to be non-resident if she wishes and can conveniently get to work. This would stimulate recruitment of local personnel for the local hospitals.

That qualified nurses have their rates of pay increased as follows:

a)  Trained staff nurse:  minimum £360 exclusive of emoluments.
b)  Ward Sisters          ”   £525    ”    ”    ”
c)   Enrolled Assistant Nurse ”   £275    ”    ”     ”

The higher grades of nurses such as sister tutors, assistant matrons and matrons have their salaries raised in proportion.

That student nurses be provided with a “training allowance” of a flat rate of £50 a year gross from the beginning of their training.

That domestic workers and orderlies be encouraged to enter hospitals by offering better pay and better living conditions on similar lines to those indicated above for nurses.

That qualified nurses  should work an 8 hour day on the shift system, 3 shifts in 24 hours) and no more than 44 hours per week. (98 hours in a fortnight might be allowed in the present emergency),

That student nurses should work no more than 6 hours a day, including lectures, to allow adequate time for study, see “Nursing in the Post War World”).

That every effort be made to see that the democratic processes which have been laid down by the Minister (Nurses Representative Councils) are-

a) put to effect immediately
b) made to continue working properly
c) that complaints, recommendations, resolutions, etc. formulated by these councils be dealt with adequately and quickly.

That an annual report on the workings of the Representative Councils be submitted by each individual Council to the Minister of Health or his delegate (not a nurse). That these reports contain details of the number of meetings held, their dates, who was present, and the business transacted, together with the results of complaints, sugge­stions, etc. That a selection of satisfactory and unsatisfactory reports be published in the daily press.  In this way the nurse’s faith in democratic processes might be rekindled.

That the practice of Matrons giving sealed testimonials to nurses when they leave an institution be abolished at once. By this method it is possible, and a not uncommon practice to decry any girl who has shown initiative towards progress and improvements that is who is “troublesome”.

That professional testimonials for nurses be open as for doctors.

That where possible the student nurse does no more than three months night duty a year. That the imposition of night duty never be used for penal purposes.

That in the present emergency any suitable person, qualified or other­wise who is willing and able to work part-time in any medical institution be encouraged to do so.

That some scheme for part time help, such as the Gloucester County Council has been able to demonstrate as workable, be applied to the whole country.

That, a well-cut uniform, adequate in quantity, quality and comfort, be provided for all nurses for indoor and outdoor wear, where necessary, i.e. District nurses.

That every effort be made to make the public aware of the urgency of the situation and its implications for everyone. That to this end a vigorous campaign be carried, out in the Press through the Government public relations officer, stress being particularly laid on the facts of the situation and its remedies. That the S.M.A. assist the Press campaign in every way at its disposal. That the following papers and journals be particularly invited to cooperate:

  • News Chronicle
  • Daily Herald
  • Daily Worker
  • Manchester Guardian
  • Observer
  • Times
  • Daily Telegraph
  • Tribune
  • Common Wealth Review
  • New Statesman & Nation
  • Lancet (which has already done much)
  • British Medical Journal.                                           

The last two will have a special appeal, to doctors.

That the government make every endeavour to recruit girls of school leaving age (16-18) to the Nursing Profession or into Pre-Nursing courses; or to train for the Nursery Nurses course which girls are eligible to enter at 16 years of age.

That other pre-nursing courses be set up through the country on the lines of the L.C.C. scheme for a two year course at the Borough Polytechnic.

That the possibility of extensive lectures on the Nursing Profession be considered to be given to secondary and high school girls in their last year. Girls and boys to be encouraged to take up Social Medicine apprenticeships (Almoners).

That nurses, make every effort to get themselves elected to the Nurses Representative Councils in order to try to get the democratic mach­inery working. That these nurses follow up complaints, resolutions etc. formulated by Nurses Representative Councils but not promptly dealt with, through other channels, so that in the end grievances etc. are dealt with, and remedied. Only in this, way will non-socialist nurses come to understand how properly organised democratic institutions can work and the nursing and hospital hierarchies come to appreciate their power.

That the whole status of the nursing profession be raised far above its present level.  It is important that every effort be made to make the student status for the trainees a reality as soon as possible. This would be far easier if the hospital training were reduced in length; The SMA recommends that training should consist of a prep­aratory or pre-nursing period of variable length following by two years in hospital as a student. This can be followed by periods of further training after, qualification for higher posts i.e. Ward Sister or Sister Tutor.

That the SMA urges the Minister to prepare for an extensive publicity campaign by means of leaflets, the BBC, the Press, and films, to encourage recruitment to the Nursing Profession. That the SMA stress to Mr. Bevan the facts and urgency of the present situation with regard to nursing. That the SMA pass on to him such facts and recommendations as concern him at once for immed­iate action.  That it be suggested to Mr. Bevan that he meet some young nurses to hear their views.

That an SMA deputation see Mr. Bevan soon with a view to dis­cussing the facts and proposals with regard, to the Nursing Pro­fession, and the present shortage of nurses. We feel that much more might be achieved by such an interview than by merely sending him proposals and recommendations in writing.