A Socialist Policy For Nurses

undated, probably 1967

Every year, the Ministry of Health informs the public that it is doing better and better.  To take one aspect, nursing, there are more nurses doing more work, an increase which is true of each year since the National Health Service began in 1948.  The public may well feel confused by such complacency, for if it should feel ill and go to hospital, it will see that the nursing staff is rushed off its feet, perpetually harassed, and that inadequate staff is available for the night shift, and that reality contradicts official balm.

Those who are familiar with the situation, perhaps with relatives or friends who have tried the career, will be aware that there is much unhappiness – as well as the satisfaction innate in serving patients -so that many nurses leave. Up to one-third of entrants leave by the end of the first year, complaining not so much of the hard work, excessive hours and unpaid overtime, split, shift systems and low wages, but of antiquated attitudes.  They are ruled by military matrons and starchy sisters; if they live in. residence, their free time is restricted, they may be denied visits by boyfriends, and they are subjected, to a discipline totally out of keeping with modern views.  Indeed, the shortage of money all hospitals face leads them to cut down on cleaning and other ancillary staff, so that nurses serve meals, wash-up, clean, lavatories and sort linen – instead of using the skills for which they were trained.

Every year or two, august committees deliberate and produce reports on  nurses’ training, administration and working day, yet little action results.  The reasons – and a policy for nursing – can only be found; by looking at the N.H.S. in relation to society as a whole.

THE SOCIAL SERVICES

All social services in a capitalist society are involved in the contradiction outlined above. On the one hand they are instituted to serve the population as a whole – they belong to the nation and have a communal purpose.  But the wealth of society is privately owned, and the class which owns the wealth controls the State which in fact administers the social services. Not only does this class dislike social services, for political reasons as we saw with the N.H.S. for 13 years under the Tories, for these services divert some of the national wealth to the working class (the bulk of the population), but because they also demonstrate the conflict between the social nature of production and services (as we said, the social services are communal) and the dominance of private wealth and the anarchy of social relationships this entails.

Again, in the N.H.S. there is a permanent conflict with the private sector in medicine with its private nursing homes and pay beds and Harley Street doctors.  For if a socialist-conceived National Health Service can do better than private medicine, this is a threat to the very concept of individualism and the market as the supreme arbiter. The fact that the private National Kidney Centre had to close down because it needed the services of a general hospital i.e. the whole social network of medical care as a framework – this closure is a blow to private practice.  Similarly, the Nuffield nursing homes, despite their higher staffing ratios and modern equipment and theatres, cannot deal with many major conditions which require facilities only available in large hospitals.  They thus batten on the N.H.S. by using its comprehensive provisions as a reserve whilst creaming off the time and skills of the medical and nursing profession for a monied minority.

Dilemmas And Perspectives

There is a second, more fundamental reason for the permanent inadequacy of the social services.  In Education, let us suppose the slum schools are rebuilt, the comprehensive reform is completed, streaming is abolished and the teachers converted to the concepts underlying the reform, and teachers given the training, status and incentives to educate instead of instilling a little rote learning. Given all this, the root problem would still remain, the influence of the homes and parents of the children, the profound deprivation due to poverty in terms of learning, skills, language and attitudes, the class approach of the teachers (who feel more at home with middle class children). Above all, there is the impossibility of education which – implies free and fully developed human beings when all society will demand of the children when they grow up is to be ‘hewers of wood and drawers of water’ as the 1944 Education Act so charmingly puts it.

Similarly in health, not only is there the overall lack of finance, the divided administration of the NHS and the competition of the private sector, but society creates illness faster than the medical services can expand to cope.  The waiting list for hospital admissions rose again by 1% some 15% of hospital beds remain empty despite a further fall in the average stay of in-patients and higher bed utilisa­tion. Nurses have increased their productivity but cannot keep pace.

Geriatric wards, with their heavy burden, have long waiting lists. 20% of admissions are reckoned as directly caused by social conditions, and the majority of the remainder relate to the end processes of poverty, bad health, illness and poor food, unemployment and so on, during a patient’s working life.

Casualty departments are crowded all day. The commonest source of accidents is in the home (over 1 ¼ million annually). Accidents are preventable – but not by exhortations to individuals, only by living a different life in a different environment.

A socialist policy for nursing must therefore combine a struggle for the immediate improvement of nurses’ conditions and pay with the perspective of a socialist society, with its continuous improvement in the health of the community and the involvement of the people themselves in a programme of preventive medical care.

As a first step, nurses must be encouraged to have a trade union attitude, to join a union and strive for unity between the unions concerned.  The Labour Movement must support this both by fighting against anti-union discrimination from hospital administration, and sympathetic action over claims.  Threats of sympathetic strikes, along with nurses’ demonstrations and protests have won wage claims in the past. Efforts to improve conditions must be linked with a need for a democratic -integrated structure for the N.H.S. as a whole, in which nurses, like other health workers, will have real participation in policy, and a sense that they are serving society as a whole through the N.H.S.

These aims, and the struggles they will necessarily involve, will inevitably be part of the diverse pattern of activity through which the Labour Movement seeks to reach a different and socialist society.

A Little History

One way of viewing this socialist perspective is through a historical lens. As in so many aspects of British social life, the historical phases of the development of nursing as a profession remain alive, if anachronistic, today. This dross of the past is one of the problems to overcome.  The earliest nursing care was given by the religious, orders and pre-Reformation Church. The sick were marked off as a separate sector from social life – epitomised by the mediaeval leper colonies. Illness was a manifestation of sin, the great pandemics were like the biblical plagues, a punishment and warning. At the same time, the sick acquired grace, nearer to salvation through suffering. Nursing the sick was a demonstration of the religious devotion of the nurse rather than a part of anticipated cure.

These values still persist in the cutting off of the ill from consideration as whole persons, in religious life in hospitals (morning ward prayers are not unknown), in attitudes to taboo subjects such as abortion, in disinclination to employ married nurses (chastity is part of ‘devotion’,). Transmuted by the charity attitude of Victorian middle class women, it is part of the voluntary spirit in which nursing care is a manifestation of the goodness of the voluntary worker, rather than an awareness of the mutual involvement of patient and health worker in restoring health.  Voluntary work received a great impetus in the First World War when large numbers of nurses were recruited, often from sheltered home backgrounds, into the Voluntary Aid Detachments.

During the centuries before the Nightingale era, nursing outside the family circle was largely confined to untrained middle-aged women, sometimes kindly, often of the Sarah Gamp type. They were recruited into the developing Poor Law Hospitals of the nineteenth century, and their lack of skill and frequent lapses into callousness persist in areas such as the care of chronic sick or geriatric patients – as the recent book “Sans Everything” (published by AEGIS) and detailing cruelty and neglect, only too clearly demonstrates.

Florence Nightingale initiated modern nursing, with formal and systematic training.  Nursing was elevated to a para-medical skill, the hospital transformed in her image.  Most hospital building in this country is based on her concepts of the open ward. Her pupils went out from the training school at St. Thomas Hospital and transformed the teaching and large voluntary hospitals and, more slowly, the children’s, fever, and Poor Law hospitals.  She inspired Henry Dunant when he founded the Red Cross in 1864.

But Florence’s starched severity is also still with us.  The ‘ladies’ whom she recruited brought with them a determination to dose with moral reform as well as medicaments, and respectability, a grim maternal attitude, no nonsense, and don’t ask too many questions, with a semi-military discipline – all this is part of the institutional atmosphere of a hospital.  Class attitudes persist – the patients should be grateful for what they receive.  Long hours of work, a lack of private life, the autocratic rule of matron and sister were accepted as part of a way of life.

In 1919, the Nursing Registration Acts provided for a Register under the General Nursing Council, the ethical codes were reorganised, syllabuses drawn up, and standards of training and experience necessary for registration set up.  Three year training courses, combining theoretical instruction and practical ward work led to the examination for State Registered Nurse (Registered General Nurse in Scotland). The object was to obtain recruits of good educational status, and the teaching hospitals have generally managed this. But it has always proved impossible to reconcile this with the lack of suitable candidates for other hospitals.  They have had to accept girls who would put up with low pay and harsh conditions – and these have traditionally come from the most exploited section of the population, the immigrants, such as Irish and, more recently, coloured.  Recruiting improves in times of economic depression, as was obvious in the 20’s and 30’s. In 1967 in the Birmingham Regional Hospital Board, recruiting for the first time filled up the usual staff vacancies, so that emergency measures had to be taken because of the unexpected overspending (i.e. the normal budget runs on a permanent staff shortage).

It has also never been possible to reconcile the needs of training with the necessity to get the work done and keep down costs, so that pupils perform a high proportion of the work and have to study in their free time.  These problems are not peculiar to the N.H.S. and were the subjects of many committees before 1948, and of contemporary Council of Europe and World Health Organisation reports.

A further source of recruits has been the use of auxiliaries with the influx required by the second world war. Later they were called assistants and then, by the Nurses Act 1943, regularised with a Roll, and there is now a two year training course. In 1961 the title became State Enrolled Nurse.  Again, this implies dilution of the service, and this should be borne in mind when considering total figures of the nursing establishment.  Further, untrained auxiliaries are still recruited and have, as yet, no status, being referred to as ‘other’ in the statistics.

Advances Under The N.H.S.

Undoubtedly the N.H.S. has stimulated a tremendous improvement where local initiative has taken advantage of its opportunities. There has been a relaxation of discipline and a shortening of hours (from a basic 56 or more to a 44 hour week). There has been increased interest in recruiting male nurses, and half the psychiatric nurses are male (and the main source of union strength), But it is recognised that for the majority of women nursing may be a temporary profession before marriage.  Where the hospital atmosphere is friendly and permissive, the hospital stands high in the esteem of the local community, and part-time and married nurses are used in a carefully arranged schedule, recruitment has been much easier (see Miss Ensing on Crawley Hospital, Medical Care Vol.3, No.4) Similarly, Revans has shown that there is a correlation between the attitudes of consultants and matron to staff, and the level of communication with both the rate of turnover of staff (and wastage in training) and also, significantly, with the speed of recovery of patients. The more the team concept is developed, the greater the sense of participation of staff, the lower has been the tendency for staff to leave.

In teaching, there have been improved facilities, appointment of tutors, the “block” system whereby study time is provided in periods of weeks during which only limited nursing work is done by the student. There is a trend to area selection committees, group training schemes, and co-ordination of a number of hospital management committees. There has been expansion of pre-nursing schools and cadet schemes to bridge the gap between school leaving and the minimum age for a pupil nurse (17 ½ years).

The upgrading of former local authority and provincial hospital services, along with the technological advances in hospital care have also brought numerous changes. Thus intensive care units and progress­ive patient care leads to a more sophisticated analysis of the needs of patients as they progress from the acutely ill stage with constant monitoring and technical nursing, to the convalescent stage, when many more patients can be supervised by one nurse. This also determines hospital design and demands small (2 or 4 bed) units (see Gainsborough, “Principles of Hospital Design”).

Again, it must be emphasised that all these developments have been uneven and compounded with relics of the past. They point clearly to the need for comprehensive planning of services under Regional Health Authorities. The activation of Joint Consultative Committees with real statutory powers would involve all staff in democratic decision-making in administration, (See the S.M.A’s “Wanted! A Socialist Health Service“),

Education Or Training?

Discussion on the content of training is still controversial. The dilemma between the desire for upper class, highly educated entrants, and the needs of the N.H.S. persists. The Platt Report of the Royal College of Nursing, collapsing under the weight of its impracticality, shows this quite clearly.

A study by J. MacGuire  “From Student to Nurse” of training in five schools in Oxford area hospitals showed that under Platt recommendations two-thirds of entrants would have been turned away. Yet over three-quarters qualified, and the group who failed to complete the course was not inferior in academic attainment to those who passed.

There is something of the absurd in debates centering on whether or not nurses should have a full theoretical knowledge, even a degree course, or whether practical needs should be paramount, whether psychiatric teaching is necessary for all nurses or only for nurses in psychiatric hospitals, and similar disputes in the professional press.

The present system of apprenticeship produces nurses who find it difficult to function in situations beyond those for which they were trained. Their ability to communicate is poor, and this is as much a reflection of medical training as of nurses.  A study in “Medical Care” (Vol. 4. No.2) analysed 514 incidents in which only 233 were judged to be helpful in their work by the communication level of nurse and doctor, whilst in the other 281 they were hindered.

We believe there should be a basic general two year course for all nurses with a single portal of entry, combining practical experience with adequate time for theoretical study, and carefully organised at an area level. It should enable nurses to cope with the following elements of their works

• (a) team work (it takes 4.4 nurses to have one on duty and give 24 hour, 7 day a week cover for patients);
• (b) individual care and attention to patients;
• (c) technical procedures;
• (d) administration such as organising a ward, reports and records, doctors’ rounds, dealing with visitors and relatives;
• (e) domestic duties, depending on circumstances in the particular hospital.

Following this two years, specialisation according to the aptitude of the nurse can be pursued under (c) – there is a tremendous range of skills involved, from theatre work for specialised surgery, or acute medical cases, to mentally subnormal or autistic children or disturbed adolescents.

A similar perspective is involved in the different levels of administration. The need for change is detailed in the report of the Committee on Senior Nursing Staff Structure (Salmon Committee) issued in May, 1966. This points out the confusion at present between the functions of matron, ward sister and nursing committee of the hospital or board of governors. It rightly suggests that much of the work of the latter should be under­taken by senior nurses (often decisions are taken which affect nursing without a nurse even being present on the committee). Administration should be taught (management courses, such as are being developed for the administrative grades of the N.H.S.). And it is again emphasised that nursing and education must be integrated.

But the main recommendations for three grades of senior nurses to act as ‘top management’ to formulate policy and to organise its imple­mentation by others is, in our view, retrograde and dangerous. It separates practical from administrative work and is a certain recipe for bureaucracy. On the contrary, as we have pointed out before, what is needed is more democracy in hospitals and the health service generally, with nurses at every level, including students, from their first day, participating in discussion and decisions on policy and training, with elected representatives.

To conclude, we have not tried in this pamphlet to work out a blueprint for every aspect of the diverse functions of nursing, nor to give an answer to every problem in nursing care. This is something the nursing profession, in conjunction with all those who are trying to advance the National Health Service, can do for itself, through experimentation and detailed study of local conditions.

What we have done is to bring out the socialist principles on which the Labour Movement and health workers ban strive to achieve this end. In doing so, it should be obvious that it is impossible to deal with such questions separately from their context in the N.H.S. Only through the collective, that comprehensive care which is the essence of the N.H.S., can devotion of the nurse, as of every facet in the N.H.S., realise individual satisfaction.

Appendix: District Nurses

Before the N.H.S, district nursing was almost entirely in the hands of voluntary agencies and local associations, co-ordinated under the Queen’s Institute of District Nursing (founded in 1889). The local Health Authorities have largely taken them over, though the Institute remains the training body, with a four month course for the S.R.N. whose experience is hospital based.

With the failure to develop health centres, district nursing has remained isolated, though it performs vital functions particularly in caring for the elderly and chronic sick at home.  There has been a trend to seconding nurses to general practitioners which is a help to both, but only health centres can develop the full team concept in domiciliary care, including overcoming the social gap and authoritarian attitudes of doctor towards nurse.

Current difficulties are brought out in the Queen’s Institute survey “Feeling the Pulse”, January, 1967.  Thus “much of their work did not require their professional skills and they were rarely able to use their specialist qualifications …. they frequently lacked full information about their patients’ condition and treatment and did not know what therapy had been prescribed”.  Less than two-thirds of her working day was spent in contact with patients – travelling and clerical work took up the rest.  But not communication with doctors; only 10 per cent spoke to a doctor more than once a week, and often  they are isolated from each other. There is an. unnecessary separation from health visitors who are responsible for preventive work, and some confusion as to their separate roles.  In rural areas the functions of nurse, midwife and health visitor are often combined. Many complained of a lack of confidence shown by doctors. Refresher courses and a better syllabus in training are needed.

A Word On Midwives

We can start with a problem engendered by the administrative chaos of the National Health Service. As more confinements are rightly taking place in hospital, district midwives, until recently grossly overworked, are now finding themselves without enough cases in some areas, or caring for 48 hour admissions in the post natal period, without coordination with hospital staff.

That midwives in general complain of just the same problems as we have discussed above is usefully summarised in “More Midwives” issued by the Association for the Improvement of Maternity Services. This was abstracted from 107 essays on how to improve the service, “..much attention was given to the lack of status … the midwife was given the impression that she was the least important part of the obstetric team..” “…the need for more joint consultation at all levels was stressed …” in one case “Staff who have occupied senior posts for years resent newcomers and quietly make their lives unliveable till they leave, their employing authority quite unaware of the real reason.”

An Occupational Health Service For Health Workers

This subject is usually considered in relation to nurses in residence in hospitals. The Socialist Medical Association thinks this is a useful opportunity to draw attention to our principle that occupational health cover should be available for all workers.  The basis of this case is that it must, be integrated, with the N.H.S. (under Regional Health Authorities) and responsible to statutory safety committees of the workers concerned.  In hospitals this means all staff – non-medical, ancillary, nursing, technicians, therapists and so on.

Too narrow a view of such cover must be avoided. Health education is the most essential aspect – accidents can occur in hospitals as anywhere else. There is dangerous equipment. Hospital kitchens are no great advertisement for the N.H.S. The survey “Food in Hospitals” (Platt, Eddy & Pellet) describes places which would be prosecuted if found in commercial undertakings. Staff frequently have, the same food as patients – in many hospitals this was found to be inadequate to maintain nutrition in patients lying in bed, never mind working. Some of the most militant complaints of nurses have arisen over poor food and canteen, facilities.

Low pay and fatigue from long hours of work are factors for ill health.  So are the difficulties married nurses face – a hospital crèche or nursery may be better occupational health than tonics or tranquillisers. Again, old building, inadequate for modern needs, contribute to infections, e.g. gastroenteritis in mental hospitals, cross-infections in surgical wards and obstetric wards. There is some evidence that nurses suffer an excessive amount of infectious illness. There are plenty of topics for research here, along with socio-medical research into medical care itself. More specifically topics we suggest are availability of drugs and drug addiction, the incidence of psychiatric illness in the staff of mental hospitals, radiation hazards in X-Ray and radiotherapy departments, sensitisation to drugs, back strain and other mundane subjects with occupational factors.

In discussing the principles of medical care for nurses it should be remembered that this is often uncoordinated and inconsistent. The medical registrar usually takes it on as an unsought duty, but houseman or even matron may deputise, or there may be no free access to the R.M.O. (matron’s permission must be sought and thus free choice of doctor, i.e., a G.P., may be denied.) There can be pressure, to return to duty though still unfit, and no arrangements for emergency illness in specialised (e^.g., psychiatric) hospitals

We would recommend:

1. An Occupational Health Service applying to all health workers.
2. Joint Staff Consultative Committees to elect a statutory health, welfare and safety delegate(s) to represent them and consider with management, all relevant matters.
3. The scheme to be free from employer’s influence- Hospital Management Committee, matron, or local authority.
4. Strict privacy of medical records;
5. Free access of patient to a doctor of his or her choice. We envisage health centres providing medical care for hospital staff, resident and non-resident, where possible.
6. The codified provisions of the Factory Acts, Office, Shops and Railway Premises Act, etc. should apply to Ministry of Health premises. At present there is no inspection over matters such as accommodation, heating, lighting, ventilation, the handling of toxic or dangerous substances, or machinery and accidents.
7. Accident and health statistics must be kept, and made available to the safety delegate.
8. The value of initial and periodic health checks should be examined scientifically.
9. A co-ordinated health-education programme should be planned in each hospital.
10. Research into occupational factors affecting health workers

Pay

The usual pre-war pay was £50 -£60 per annum, full board included. Salaries, less resident board and lodging charges, should be divided by three when comparing present day-scales.

The Whitley Council memoranda on pay and conditions of service for nurses and midwives stand an inch thick on my bookshelf. But some examples are given below (all per annum):

• Student Nurse – £365, £390, £420 less £143
• Pupil Nurse – £365,  £390 less £143  over 21    £520, £545 Less £190.
• Pupil midwives (who are fully trained S.R.N.) go. back to £545 less £163

There are incremental points and subdivisions for subsequent grades. Thus:

• S.E.N.  ….. £725 to £835 less £230
• Staff Nurse ….£690 to £850 less £230

(This is about double pre-war rates. Compare around £10,000 per annum for A+ award consultant doctor.)             ,       .

• Ward Sister/Charge Nurse £890 to £1,205 less £265 Principal Nurse Tutor £1,245 to £1,455,less £340
• Matron (of Training School) £1,910 to £2,235 less £470

Then there are extras such as London weighting (£15-to £55) uniform allowance (up to £6o), Sunday duty and night duty.-

Local Authority staff pay is similarly complex: District Nurse and midwife basic scale is £840 to £1,155 (less £250 where resident).

Senior and supervisory staff go up to a maximum of £1,995. A third-year student in a residential nursery gets £330 less £125. (in this field alone there are 27 grades with up to 7 increments.)

NUMBERS    Whole time     Part-time

1949     125,752     23,060

1961     162,857     49,864

1966    184,212      74,463

1966:

S.R.N Whole time  Part time   Students      S. E. N.Whole time Part  time Pupils    Other Whole time Part  time

57,670       24,296     56,064              19,841                      13,694   14,062         24,414                       33,236

Midwives: whole time – 7,145 part time – 2,814- pupils -5,008

The whole-time, qualified S.R.N. forms less than one-third. The number of pupil (S.E.N.) nurses in 1949 was only 1,658; of ‘Other’ (auxiliary) only 27,525 in 1949. Thus nurses not on roll or register have shown much the largest increase in numbers – dilution is clear.

Beds         In-patients New Outpatients Total Outpatients  Casualty

1949  453,000  2,937,000     6,148,000               26,001,000         10,108,000

1966  468,295  4,898,000      7,598,000              31,359,000           13,410,000

The work load has kept well up with the increase in numbers of staff.

Local Authority, 1966 whole-time  5,999 part-time 4,731 (equivalent to 2,387) Total … 8,386

RECRUITMENT

World Medicine,  21. 2. 67

“Despite a desperate shortage of nurses, hospitals in North West Surrey have had to call off a recruiting campaign.  They couldn’t afford to pay the nurses if they got them.

“The R.H.B. has told the N.W. Surrey Hospital Group that only 900 nurses – about 200 below the required establishment – can be employed” …… “at another hospital in the group, student nurses on night duty are being left in charge of a ward of 65 difficult mentally sub-normal patients ….. A Ministry of Health spokesman states; We accept that this sort of thing happens where there is a shortage of trained staff. In some ways it is good experience for students. It helps them to take responsibility.”

From the S.M.A. to The Minister of Health, 15.12.65:

“The S.M.A. views with grave concern the decision of the NW.  Metro­politan Regional Hospital Board to cease recruitment of nurses till the financial year ends in March, 1966. This is due to a shortage of funds. What is the use of expensive recruiting campaigns if the money is not available to pay the nurses? Yet the example given in The Times report of December 11th of the New End Hospital, Hampstead, shows that they are 50 shorts of their 137 nurses, 101 ARE TRAINEES. We ask you to take action to see that the Ministry releases special funds.”

The Minister’s reply, 13.1.66:

“I should perhaps begin by explaining that my Department’s campaign is not a recruiting campaign. It is a publicity campaign – to tell the public what the modern nurse is like, what her job is and the opportunities open to her, and how conditions of work and pay have improved. The aim is to build up the status of nursing and provide background support for local recruitment campaigns as and when they are under­taken by individual hospital authorities, not simply to increase the numbers employed but also to allow better selection from among those who apply.

“In the North West Metropolitan Region recruitment has exceeded all expectations (numbers of nursing staff rose by 5.6%, in the last year) and the Board decided it was necessary to restrict temporarily recruitment to certain grades in order to contain expenditure within their budget. But even in the grades affected, recruitment to maintain the present strength continues and the standstill does not apply at all to student and pupil nurses.  Moreover, a Hospital Management Committee can still maintain some expansion in the trained staff of a particular hospital with a serious shortage providing the total for the Group remains constant. i.e., by making balancing savings elsewhere.

“You will realise that all Boards and Committees are limited by the total amounts of money provided by Parliament for them to spend. Some have decided to allow a very high rate of nurse recruitment to continue and to find the money by cutting some other forms of expenditure, but it is for each Board and Committee to decide how best to spend its money. Unrestricted recruitment can easily lead to exhaustion of financial resources, and where this seems in danger of happening Boards and Committees must take what, steps they consider appropriate to ensure that expenditure does not exceed allocations,

“There is no possibility of providing any Board with additional funds for nurse recruitment, or, indeed, for anything else, in the current financial year.  Our policy is not to keep large reserves but to allo­cate the maximum sums possible to Boards before the year begins, so that they can plan sensibly in advance the disposition of their resources. There are in short no ‘special funds’ for me to release.”

The Ministry’s circular P/N.61/32 of 3/9/63 is headed “Nursing Publicity Campaign”, but it refers specifically to the need for recruit­ment in four places,   Words!  Words! as Hamlet said.

Memorandum On Nursing Establishments

(Royal College of Nurses and National Council of Nurses)

“Money is always scarce, and the lack of it probably the most frequent excuse for shortcomings in recruitment and retaining staff. It is not, however, the lack, so much as the unknown quantity, which makes planning virtually impossible.”

‘If establishment is suddenly frozen, the students cannot be sacked equally, if there is a shortage of 3rd year nurses, they cannot be replaced by doubling the number in the first year.

A further example of waste is the increasing use of agency nurses,at higher cost, to fill vacancies where, due to the present system, establishments have to be made up in emergency.

NEWSLETTER, 27.6.67 (M.P.U.)

1. “Experience shows that staff who make complaints may suffer from lack of promotion, bad ward assignments or poor testimonials” – Mrs Robb, Chairman of A.E.G.I.S.

2. “In a hospital in Sheffield recently a petition was displayed on the notice board asking that complaints about terms and conditions of service for nurses should be given sympathetic consideration. The two nurses whose names appeared at the head of the form were promptly carpeted by the-matron and threatened with dismissal.”

Nurse That Accent

Celebrating its silver jubilee, the Nursing Recruitment Service was told by its secretary that a nurse’s work nowadays is harder and more responsible.  The Service prides itself on going to a good deal of trouble to fit a candidate into the hospital where she will be happiest.    “I wouldn’t dream of recommending a cockney East-ender to try to get into one of the famous London teaching hospitals however brilliant she was.”

As training in these hospitals often leads to the major senior nursing posts, might this prejudice the careers, of some girls?  Miss Darnell said it was a question of a girl’s happiness. On the whole it is the girls who have been to independent schools whom she would recommend to apply to London teaching hospitals.  One of these said they have mostly ‘girls of a public school type’ but St.George’s, Hyde Park Corner, were insistent that they take students from a wide cross section of backgrounds.