THE FUTURE OF THE SCHOOLS OF NURSING

IN THE STATE HOSPITALS B Y M I S S H A R R I E T B A I L E Y ,

SECEETAEY~ NEW YORK STATE BOARD OF NURSE EXAMINERS

That a high standard of nursing for patients committed to its care has been the aim and the desire of this State is evidenced by the fact that the training of nurses was incorporated in Chapter 545 of the Laws of 1895. Since that date instruction of variable quality and quantity has been given to groups of attendants.

For many years I have been especially interested in the nursing of patients with mental disease and in the education of nurses in this very important, but for too-long-neglected, branch of nursing.

For nearly three years it was my privilege to be principal of the school of nursing in the largest of the State hospitals. There I learned the great need of these patients for intelligent care, and also some of the problems incident to the conduct of the school and the instruction of the students.

Since ] 924 it has been my further privilege, as a representative of the State Education Department, to inspect all of the training schools in the State hospitals. Therefore, what I shall say is based upon knowledge gained first hand over a period of more than 13 years and is offered not in a critical spirit, but with a very real desire to bring before you some of the changes which must be made if the schools of nursing in the State hospitals are to keep pace with those in general hospitals.

The advances in all branches of education during the last decade have been outstanding. This is true of many of the nursing schools. Some of the better schools are literally deluged with applications for entrance. More than 10,000 records of preliminsry education submitted by prospective students of nursing were evaluated last year by the credentials division and 5,300 entered our registered schools in this State. With two exceptions, the State hospital schools do not attract students in the number that even the poorer general hospital school does. The wage that is offered is three or four times as much as other schools offer but that alone does not attract student nurses, obviously, as many schools that give no

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allowance and some that charge an entrance fee are besieged with applicants. What are the reasons for this condition? It is not dislike of mental patients because students in general hospital schools are demanding opportunity for this experience.

It is my conviction that for too long a period the belief has been held by some that exceptions should be made in the requirements for the conduct of nursing schools when applied to the State hos- pital schools. I believe that this practice has tended to keep these schools from .developing as fast as other schools.

Another unfavorable practice is this: Although the law pre- scribes for the training of "nurses" , the law also classifies as "a t tendants" all who give nursing care, except the graduates, who on]y may be termed nurses. This has deterred many young women with better educational and cultural background from entering these schools, for it seems to minimize the type of service which may be rendered by student nurses.

The lack of differentiation between students enrolled in the train- ing school and the attendants has also been a handicap in,developing these schools. When I went to Manhattan State Hospital early in 1916, the nurses' home had just been opened. Instead of disrupting the group of employees as very many predicted, it proved to be the greatest incentive for ambitious girls to qualify for entrance to the training school, and no greater disappointment or shame came to a young woman than to be obliged to leave the nurses' home because she had failed to meet the standards of deportment and scholarship that were required.

Learning alone is not the object of education. There must also be a .deep sense of responsibility that character and right ideals must be developed and inculcated in all our students. To meet the principal and instructors in the class room only does not offer suf- ficient opportunity for the development of morale. The home environment, the organization of the social and recreational lif:' of the students, does offer opportunity for the development of an esprit de corps, which is a stimulus that affects every student's work and conduct on the wards, in the class room and off the cam- pus. Only last week a well known educator in speaking of a mental hospital in this State, said "The atmosphere is like a college, and everyone reacts to i t ."

492 THE FUTURE OF THE SCHOOLS OF NURSING IN STATE HOSPITALS

It is most gratifying that within the last few years and at the present time new residences for nurses have been or are being erected in ten hospitals. I plead for the assignment of these to the training school to be used for school purposes, Some years ago when President Butler of Columbia University laid the cornerstone of the first residence hall for under-graduate students of Columbia College, he said " I t is difficult to see how the dean and the faculty of the college have been able to bring the college to its present state of excellence and to keep it there without the facilities which this building will afford.

"Unt i l resident under-graduate students can dine together in hall and until their other various organizations, social, literary and other, can be given aeeommodation on the campus, and in a building devoted to college purposes, the work and the influence of the college must be crippled and halted."

Another handicap in the development of the school has been the exceedingly long hours of duty. After one has been continuously on duty from 6:30 a. m. to 6:30 p. m., with only brief intervals for hurried meals, sometimes without change of environment, it is to be wondered at that there is any enthusiasm for study. Long hours spent in a limited environment have a deadening effect upon initiative and ambition.

Schools, everywhere today, reckon that at least one study hour should be allowed for every lesson. When that hour must come at the close of a long day, perhaps a very arduous day on the reception service or disturbed ward, when mind and body are fatigued, it is not surprising that study is so dittieult. Many nights when I made rounds I would find students fast asleep with their heads resting upon the open text book. When visiting one of the State hospitals not long ago we stopped at the country store to do an errand but the clerk was not there. She was allowed by the State to work only 8 hours a day, but the students in training in the hospital were actually on duty 11 hours that day. A young woman is really courageous to undertake a heavy educational program when she is required to spend such long hours on duty.

I am very glad to state that several of the superintendents have been able to make some adjustments so that study hours during the day are scheduled several times a week.

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Because of the incomplete organization of the State hospital schools, the preliminary course, as prescribed by the State Eduea tion Department is being ~ven in only two. The reasons given are : That the students cannot be off the wards so many hours, and that the physicians who carry so large a part of the instruetion required in the first semester are unable to give so much time because of the extreme pressure of their own work.

It has been a requirement of the State Education Department for many years that the minimum faculty of a school of nursing shall be a principal or director and three or more assistants, one of whom shall be qualified as a teacher. In 1925 I urged that a qualified instructor be secured for each school of nursing, thereby relieving the medical staff of the instruction in anatomy and physi- ology, drugs and solutions, elementary bacteriology, etc., in which the minimum hours required are nearly one hundred. There are so many subjects in which physicians only can give the instruction that they should be relieved from teaching those subjects which nurse instructors can teach when they are adequately prepared. Every general hospital school in the State is now meeting the requirement for a qualified teacher.

I have mentioned some of the outstanding difficulties which exist in the larger number of State hospitals and are handicaps to the progress of these schools. To correet these, the following sugges- tions are offered:

1. That a reclassification of employees be made to include stu- dent nurses, thereby emphasizing education.

2. That this group be paid on a different scale, perhaps a f rae tion of the attendants wage.

3. That a schedule of hours of duty be arranged so that time for study and cultural development may be available. (8-hour duty is suggested.)

4. That the student group be housed together, in a building devoted to school purposes so that a school atmosphere may prevail.

5. That the nursing school faculty meet the minimum require- ments prescribed by the Board of Regents for numbers and quali- fications.

I have not spoken of the attendant group. When one looks at tt~e OCT.--1929--B

494 T H E FUTURE OF THE SCHOOLS OF :NURSING I:N STATE HOSPITALS

figures of the students in training and realizes how very, very small is this number when compared with the total number of attendants, one is compelled to admit that, with exception of one hospital, the attendants are carrying the ward service. Yet, the most meagre course of formal instruction is given to this group--a course vary- ing from 16 to 30 hours only.

In order that the patients might receive more sympathetic and intelligent nursing I recommended in 1925 that a course covering nine months, or one academic year, be provided for selected mem- bers of this group, and that the assistant principal should be directly responsible for this instruction.

No group of patients in any other hospital is so much in need of good nursing as those in the State hospitals. Mental nursing can- not be taught apart from the patient. Therefore, there is needed on every ward a teacher or, teaching supervisor who at all times can interpret the patients' needs and symptoms to the students and attendants and help them to make the application of their instruc- tion. Nursing measures cannot always be prescribed in ~dvance, for symptoms and reactions are as variable as the individual make- up and the presenting situation. The well informed nurse can anticipate and oftentimes prevent or cut short unfavorable symp- toms while an uninformed or disinterested attendant may precipitate and aggravate symptoms.

And so I plead for the better education of the whole group of nurses and attendants, to the end that the more than 45,000 souls committed to the care of this great State may be ministered unto more intelligently.