Summary: Some excerpts from an article in Scribner Magazine that focus on life in Charity Hospital, the poorhouse hospital on Blackwell's Island (now Roosevelt Island), New York City.
Source: The Nineteenth Century in Print: Periodicals
The Training Of A Nurse
Scribner's magazine (Volume 8, Issue 5, November, 1890)
Following are some excerpts that focus on life in Charity Hospital, the poorhouse hospital located on Blackwell's Island, New York City (renamed Roosevelt Island in 1973).
The patients in Charity Hospital are the very poor of the city; some of them are only morally sick and needing a home; they puzzle the doctors to make a diagnosis. Most of their sickness, as we nurses know, has been brought on by over-work, poverty, drunkenness, laziness, and the like, but some are worthy and deserving persons.
Often when a patient comes into the hospital she enters a moral atmosphere which is new to her. She is cleaned and made fairly comfortable; she has to drop many of her old habits of speech, and be a decent member of the hospital for the time being. If she is not too degraded she can see what is expected of her at once. We seldom have any trouble with the patients and rarely hear an improper word. A nurse never need submit to insubordination; on her complaint the patient is dismissed, but a very sick patient is seldom beyond endurance. They are often very witty, and if we are in the mood we can get lots of fun out of them. They are also very religious. They thank God for everything; everything is the will of God -- their sickness, their troubles, their death; it never seems to occur to them that they might have a will of their own. In one way they have not much variety; they usually object to soap and water. As a rule the nurses are as good to the patients as they can be. Many of them remain in the hospital for a long time, and a nurse has the opportunity of showing them small kindnesses, perhaps writing a letter or giving them a garment or a few cents to pay their car fare. In those tedious cases of phthisis where the treatment is only palliative a nurse can be much to the patient.
The helpers spoken of in this sketch are women sentenced to the workhouse on Blackwell's Island for terms varying from three days to six months, and for such offences as drunkenness, vagrancy, and fighting in the streets. From the workhouse they are sent to do the scrubbing, laundry work, etc., in the institutions controlled by the Commissioners of Charities and Correction, who are obliged by law to use their labor.
We begin our duties in a large ward of Charity Hospital. The probationer will have charge of one side of the ward, with the care of from ten to fifteen patients and all belonging to them. The head or senior nurse will go round with her and work in with her for the first time. She is shown how to make the beds, to change all soiled linen; how to remove a very sick patient from one bed to another; how to cover a patient and save her from fatigue while sitting up to have her bed made; the best way for her to get in and out of bed ; to keep an eye on the beds that the patients are able to make themselves, and so on throughout the details of the mornings work. The latter part of the day is taken up with waiting on the patients and keeping her side in order all the time. The probation month is especially a time of learning something new; a good deal has to be got into that month; afterward things come more by degrees.
Should the probationer be accepted, she becomes a junior nurse and has the same kind of work for about three months.
She then goes on night duty; she is on the landing as we call it, that is, has charge of the two or three of the wards opening on to that landing. The junior nurse is feeling somewhat independent and consequential by this time. She does not have to act by herself; there is always an experienced nurse on the top floor to whom she can refer in case of emergency or otherwise. A nurse may never have been up all night in her life before, so the first night is rather exciting and anxious; she is very wide awake until about two or three o'clock in the morning when the effort to keep awake is really painful.
A night nurse does not sleep, that goes without saying, and should she doze when all is quiet she has always one ear open. Imagine a rather young nurse peering around the large ward with the aid of an antiquated lantern. Shall I ever forget that lantern? It would throw all shadow and the least possible ray of light and anywhere but where it was wanted. Sometimes its miserable little light would go out and the wick have to be pricked up and relit, then it would spit and splutter as though it meant to burn well, but somehow it never would, and the gas burnt low on the landing. When I think of that lantern I can go all through my night duty over again. We have a helper to fetch and carry for us, and she can be very useful in many ways. She may be as good as a nurse or she may have a fancy for gossiping with her friends during the day and so prefer to sleep at night, and such a lady is rather a trial. The patients have a way of dying at night, in spite of the very best efforts of the nurse to keep them alive until morning. Some helpers never could go anigh a dead body, but they don't mind fetching the things and standing outside of the screen. It requires considerable nerve on the part of the nurse to lay out a patient in the small hours of the morning; when the wards are silent and gloomy there is something uncanny about it; there is not much of the beauty of death in these cases, but we get used to it after a time.
Here follows the journal of an ordinary day at Charity Hospital, by one of the head-nurses:
Time: 7.30 A.M.
Scene: Ward 3, Medical.
Beds all unmade, a few patients up, these have faces washed and hair combed the majority in bed with this duty still to be performed for them. A part of the floor at the front of the ward has been scrubbed. Mary, one of my prison helpers, is washing dishes at the table, and Bridget, the other, is taking soiled clothes from a large can and sorting them for the wash.
The atmosphere contains none too much oxygen; this can be explained by saying that the night-nurse is finishing her work in one of the other wards, and the patients in her absence have taken the precaution to close all of the windows for fear of taking cold. After giving an order for the windows to be let down, I take up the night notes and read:
Murphy Died at 3 AM.
Ryan Temperature, 1080; pulse, 120; respiration, 30. Antifebrine, grains iii., and other medicines given as ordered. Poultice applied last at 6 AM.
Patient passed a very restless night.
And so on, through the other cases in the ward. These notes are signed by the night nurse, who now comes in with the keys, looking pretty well fagged.
"Good-morning; I am sorry I have kept you waiting for the keys, but I have been so busy I could not get down sooner. Had a death in Ward 4, as well as the one here, and a patient in Ward 6 suffering from delirium tremens, besides the ordinary work."
I now go over to where my assistants are putting on their caps and aprons and getting together the things necessary for work. Miss W. and Miss A. are here, but where is Miss H.?
Miss W. answers: "She was called up last night to go on the maternity service. The superintendent missed you, and asked me to tell you that another nurse could not be spared to-day."
Oh, dear, thirty-two patients in the ward, and five of them so helpless that they have to be fed and cared for like babies, two pneumonia cases, and the usual number of phthisical and rheumatic subjects. Well, well, grumbling won't do the work, so well have to make the best of it.
Each of my assistants, armed with a pile of clean sheets and pillow-cases, proceeds to the lower end of the ward and commences the task of getting beds made, while I go to write the list of clothes for the laundry. Bridget counts the clothes while I stand by and take down the number of each of the different articles. This done, they are tied in large bundles and sent to the wash-house.
Now the medicines are to be given out. I measure and prepare them, while a convalescent patient carries them round to those in bed. My list is a long one, and it takes fully thirty-five minutes before they are all distributed, the bottles wiped off, and the medicine closet put in order. My next move is to take a list of medicines which need to be renewed, and leave it ready for the doctors signature. It is now twenty- five minutes past eight, and Miss A. and Miss W. are making as good progress as possible at their respective sides; for it must be remembered that a nurse has often to stop what she is doing to attend to the wants of some particular patient, or to carry out an order if the time is due.
The "railroad beds"* are still unmade. Occasionally we have a convalescent patient who can do this part of the work very well. We had one in this ward last week, but alas, for the frailty of human nature, she showed a disposition to quarrel with the other patients on very small pretexts, so she was dismissed. With a rueful thought of what might have been, I go to work at the beds. A patient goes ahead and strips them for me. We work with all our might, and they are finished at ten minutes past nine. The side beds, too, are nearly finished. This part of the work necessarily takes much longer, as sick patients have to be placed in chairs and wrapped up in blankets, or, if they are too weak, lifted into other beds, so that their own can be made.
* A railroad bed is one that is unoccupied during the day, and therefore, as it were, "shunted" and rolled out at night. They stand close together in the middle of the ward.
My next work is to take morning temperatures; when I have finished this I see a large tin can standing near my table. It contains crackers, butter, eggs, and sugar. These have to be put away in their proper place, and the quantity noted. Now, I must write my diet-sheet, and order the supplies necessary for to-morrow. It is twenty-five minutes past nine, the beds are all made, the stands in order, the floor swept, and the table scrubbed. The junior nurses are about through with washing faces and combing heads, and it is now high time that I should make a round of the ward and find out if there is any change in the patients condition to which the doctors attention should be called.
While this has been going on the gruel and milk have been standing on the table, and the distribution of this falls to my share to-day also, as I have no senior nurse. Each bed-patient who cares for it is served with a portion on a tray; afterward the walking patients seat themselves at the table and take theirs. Now the doctors come in to make their morning visit, the house- doctor is told of any special complaints; he examines these patients, also any new ones who may not yet be under treatment, and leaves the new orders on my book.
While doing this work all morning, I have been trying to keep an eye on what my helpers are doing, and now take this time to make a thorough inspection of all parts of the ward, bathroom included. In the meantime the special diet has been divided among the patients needing it most. At eleven o'clock tonics are given out, afterward eggnogs and milk-punches are made and distributed.
We now begin to breathe freely, the worst pressure is over if we get no new patients. Our hopes along that line are doomed to disappointment, for the helpers from the women's bath-room now announce the arrival of two new patients, and Miss W. disappears to super- intend their bathing.
I am congratulating myself on not having a "stretcher case" at any rate, when two men come in with one. Miss A. quickly places screens round a bed, and a rubber sheet over the clean bedclothes. The woman is lifted on the bed, and her temperature, pulse, etc., taken. Her own clothes are soon removed, and a warm sponge-bath given and hair combed. These operations have effected a wonderful change in her appearance, and she now looks a little more like a Caucasian, whereas, before the bath, she might have belonged to one of the darker races of mankind.
The doctor is notified that there are three new patients in the ward. It is twelve o'clock ; Miss A. and I go to dinner, and leave Miss W. to superintend the patients noonday meal, and give out medicines afterward. We return at one o'clock, and Miss W. goes, with the right to remain off duty till four o'clock.
The ward is now to be swept again and put in order for the afternoon. This is hardly accomplished when two huge bundles of clothes are carried in, and in ten minutes time two more. These have to be sorted and counted. Before we proceed to the folding of them the afternoon milk and other extras are given out. That done and the table cleared, we fold the clothes as quickly as we can. In due time this is finished, Miss A. is making a poultice in the bath-room, and I am putting the clothes in the closet, when someone calls "Nurse, nurse!" I turn to see where the sound comes from, and notice several patients pointing to a bed in the far corner of the ward. I hurry down and find the patients clothes saturated with blood, a hemorrhage from the lungs. Screens are immediately placed around the bed, cracked ice given, and the doctor summoned. He comes at once, the flow of blood seems to have ceased, medicine is ordered, and the doctor goes. The patients clothes are now changed very carefully, and she is made as comfortable as possible. The screens are just put away when another stretcher is brought in, and Miss W., who has now returned, gives the usual treatment.
It is time for the afternoon tonics, and eggnogs and punches are again distributed; after this I take advantage of a few spare minutes to enter the names and addresses of patients in a book kept for the purpose. Discharged patients are also marked off.
The patients have supper between half- past four and five. At hall-past five Miss A. retires from the ward, the remaining time till half-past seven being hers to rest. In the meantime the doctor has been in and left a few orders.
The giving out of the evening medicines falls to me, while Miss W. attends to the patients needs in other ways. If I had a fourth nurse I might be relieved from duty; but it cannot be thought of now. This is the evening for carbolizing the side beds; the helpers do this, while we follow and restore things to order. The rest of the time till hall-past seven is spent in making patients comfortable for the night, and writing down new orders and notes on the patients condition for the night nurse. We are quite willing to deliver her the keys when she comes in, and bid her good-night, while we go home tired enough to sleep soundly.
At private nursing a woman receives from $15 to $25 a week, which would pay her well if she were always busy; but she is subject to be overworked for some months and idle for several more, and an excellent nurse said recently that she should be satisfied to be sure of making $600 a year.
There are signs that the market is beginning to be overstocked. The four large schools which I have already spoken of have already 911 graduates, and every hospital of whatever size must now have its training - school, so that each year brings a new crop of certificated nurses, more or less trained, according to their capacity and opportunities. Some of the schools announce that they have many more applicants than they can take