BOOKS BY 
CHARLOTTE A. AIKENS 
Primary Studies for Nurses—i2mo of 545 pages, illus- 
trated. Fifth Edition. 
Clinical Studies for Nurses—i2mo of 577 pages, 
illustrated. Cloth, $3.25 net. Fourth Edition. 
Training School Methods for Institutional Nurses. 
12mo of 337 pages. Cloth, $2.25 net. 
Home Nurse's Hand-book—i2mo of 314 pages, 
illustrated. Cloth, $2.00 net. Third Edition. 
Studies in Ethics for Nurses—i2mo of 327 pages. 
Second Edition. STUDIES IN ETHICS 
FOR NURSES 
BY 
CHARLOTTE A. AIKENS 
Formerly Superintendent of Columbia liospital, Pittsburg, and of 
the Iowa Methodist Hospital, Des Moines; formerly Director of 
Sibley Memorial Hospital, Washington, D. C. 
SECOND EDITION, THOROUGHLY REVISED 
PHILADELPHIA AND LONDON 
W. B. SAUNDERS COMPANY 
1923 Copyright, 1916, by W. B. Saunders Company. Reprinted September, 1916, March 
and November, 1917, April and August, 1918, September, 1919, April, 1920, 
June, 1921, and July, 1922. Revised, reprinted, and recopy- 
righted July, 1923 
Copyright, 1923, by W. B. Saunders Company 
PRESS OF 
W. B. SAUNDERS COMPANY 
PHILADELPHIA 
MADE IN U. S. A. "Keep us. O (Bed. front pettiness; tet us be large In thought. In word. 
In deed. 
Tl.et us he hone with fault-finding, and leave off self-seehlng. 
yitat we put away all pretense and meet each other face to face 
without self-pity and without prejudice. 
3ttay we never he hasty In Judgment and always generous. 
~Tet us take time for all things; make us to grow calm, serene, gentle. 
'Ceach us to put Into action our better Impulses, straightforward and 
unafraid. 
©rant that we may realize It Is the little things that create differences: 
that In the big things of life we are at one. 
may we strive to touch and to know the great, common woman's 
beart of us all. and, 
O “Lord (Bod. let us forget not to be kind. 
■—5ttary Stuart. 
.llust stanb aaibe, anil matrij yourself go by; 
GJijink of yourself as “ijr” insfeab of “3.” 
|Krk flaws; fink fault; forget tlje wan is you, 
Anb atriue to make your estimate ring true. 
She faults of otljera ttjen mill iimarf anil aljrink, 
Slone’s rbain grow stronger by one migtjly link, 
3®ljen you mitlj as substitute for “3” 
Sjaue stooii asiiie anb watrlieb yourself go by. 
—g>trirklanb ®. (SiUUau PREFACE TO THE SECOND EDITION 
In this second edition the entire contents of the volume 
have been reviewed and some new matter added. The 
author is under obligation to several friends in hospital 
work who have furnished practical illustrations of ethical 
problems encountered in the daily routine. 
Detroit, Michigan 
July, 1923 
Charlotte A. Aikens FOREWORD 
The training of a nurse includes two distinct parts— 
distinct, yet inseparable. First, the technical instruc- 
tion and experience required in the practical care of the 
sick and the prevention of illness. Second, the training 
in conduct, in ideals of personal living. The question 
of personal living, the ideals of character and service 
which a nurse holds will greatly influence her practical 
work every day of her nursing career. 
It is easy in the pressure of training school life to 
devote all one’s time to the first, the technical, part 
of a nurse’s training—to subordinate the ethical to the 
technical, or to allow the ethical training to be crowded 
out entirely. Yet no amount of devotion to technical 
instruction will ever compensate for failure to give the 
nurse proper rules and principles of guidance in the 
moral realm; no amount of other classes which may be 
held will make up to a nurse what she loses, if the culture 
of character is forgotten during her training. 
No young woman can fail to be greatly influenced 
by the mental and moral atmosphere in which two or 
three highly impressionable years of her life are passed 
while in training, and by the ideals of life and conduct 
which are shaping during those years. The fact that 
pupil nurses are received at an earlier age than was the 
case twenty years ago, and that conditions make it 
impossible to make the careful selection of candidates 
that was possible in the earlier years of training schools, 
calls for more systematic and careful ethical teaching 
than has been customary. 
The purpose of this volume is to emphasize the 
importance of the ethical training of nurses, and to aid 
7 8 
FOREWORD 
teachers and students in the study of conduct and duty 
as it relates to nurses and nursing life. 
The plan of the book calls for a combination of the 
recitation and discussion method of ciass teaching. It 
is the author’s conviction, based on observation and 
experience, that ten minutes which nurses are obliged 
to spend quietly, out of class, in the careful weighing of 
ethical problems, and of the far-reaching consequences 
of certain matters of conduct—ten minutes of serious 
reflection on concrete problems in which ethical principles 
are involved, will accomplish more in impressing them 
with the importance of right decisions than hours of 
lectures on the abstract virtues—lectures in which the 
nurse is simply a passive agent who is expected to absorb 
a certain amount of the ethical instruction she is listen- 
ing to. What is most needed is that the nurse, while in 
training, should be obliged to meditate on the ethical 
questions likely to confront a nurse, to have those 
questions interpreted to her, and the lessons applied to 
her own life experiences. The lecture method of teach- 
ing has been tried, intermittently, for years, with ex- 
ceedingly unsatisfactory results to teacher, to pupil, 
and to the school. Lectures have been largely abandoned 
in other classes in the best schools, and lectures cannot 
too soon be abandoned in the teaching of ethics, if results 
worth while are to be expected. 
The requiring at intervals of written personal opinions 
on the methods which should be pursued in certain 
situations in which nurses are obliged to decide ethical 
questions is a valuable method in the teaching of ethics. 
Nurses should be trained to think things through to a 
logical conclusion, and to be able to give reasons why 
they reached the decisions at which they arrived. 
The teaching of ethics should begin when the pupil FOREWORD 
9 
enters the school, and should be carried through at regular 
intervals till the completion of the training period. It 
cannot be effectively handled by assigning a certain num- 
ber of classes to it at the beginning of the training, and 
forgetting all about it, till the pupil is about to graduate. 
For the sake of emphasis, repetition of important 
points has been made here and there throughout the 
book. There are many ethical truths which cannot be 
effectively taught by once telling. 
The illustrations and practical problems used in the 
book are drawn from life, and each teacher can add to 
them or substitute from her own experience. The author 
makes no apology for revealing certain ethical failures, 
believing that only by the frank recognition of existing 
weaknesses can the weak points be strengthened; only 
by bringing the results of ethical failures into an open 
forum for discussion can conditions be improved. The 
only way by which the common ethical failures com- 
plained of today in nurses can ever be corrected, is by 
instilling in the heart of every nurse a desire to be true 
to her own best self; by giving each individual nurse 
higher standards of life and conduct, and showing her 
how she may reach those standards. 
The author is under obligation to numerous friends in 
the United States and Canada who have contributed 
helpful suggestions from their own experience. Valuable 
hints have been gleaned from nursing magazines from 
a half dozen different countries. Three friends in the 
hospital and training school field have been kind enough 
to give critical reading to the manuscript. To name a 
few of these numerous friends, without naming all who 
have helped, would be to fail in expressing the deep 
appreciation felt for the counsel and very great assistance 
received from many different sources. 10 
FOREWORD 
During the preparation of the volume the text-books, 
Principles of Ethics, by Bowne, and Social Law of Service, 
by Ely, have been studied. Other books referred to 
have been “Constructive Ethics, by Courtney; Outlines 
of Ethics, by Dewey; The Ethics of Personal Life, by 
Griggs; and Nursing Ethics, by Robb. 
The author makes no claim to the production of a 
comprehensive treatise on the subject of Ethics for 
Nurses, and is fully conscious that the book has many 
defects. If it serves to call attention to the need of 
more careful ethical teaching, and more careful study 
by nurses of the ethical principles which should govern 
a life, if it helps in any measure toward bringing the 
ethical training and practice of nurses nearer to the 
ideals of life and conduct which Florence Nightingale 
has given to the world, it will have accomplished its 
mission. 
Charlotte A. Aikens. 
Detroit, Michigan. CONTENTS 
Page 
Chapter I.—The Nurse in Her New Environment 17 
Nursing and Ethics Inseparable, 17—Foundation Princi- 
ples, 17—Guiding Hints, 18—Government of Hospital, 
19—Departments and Department Heads, 20—Service, 
22—Individual Responsibility, 23—Spirit of Training- 
school, 24—Loyalty, 24—Hospital Atmosphere, 26—Sug- 
gestions for Written Work, 27—Questions for Discussion 
or Review, 27. 
Chapter II.—The Nurse Herself 29 
Psychology, 29—Self-analysis, 29—Faults, 30—Person- 
ality, 30—Good Breeding, 31—The Will, 32—Ambition, 
32—Temper, 33—Impatience, 34—Habit, 34—Conscience, 
35—Types of Nurse Students, 36—Questions for Discus- 
sion or Review, 39. 
Chapter III.—Expressions of Personality 40 
Poise of Soul, 40—Self-control, 40—Expression of Face, 
42—Voice, 42—Touch and Movement, 43—Carriage, 44— 
The Uniform, 45—Suggested Subject for Written Work, 
46—Questions for Discussion or Review, 46. 
Chapter IV.—Conduct and Duty 48 
Analyzing an Ideal, 48—Ethics Defined, 49—Nursing 
Habits, 49—Helps Toward Right Habits, 50—Roots of 
Ethical Teaching, 51—Conscience, 52—Ethics and Health, 
52—Where Special Precautions are Needed, 52—Nurse’s 
Duty to Herself, 54—Suggestions for Written Work, 55— 
Questions for Discussion or Review, 56. 
Chapter V.—Old-fashioned Virtues 57 
Test of Right Conduct, 57—Truthfulness, 57—Truth in 
Nursing Reports, 60—Discreetness of Speech, 60—The 
Talkative Nurse, 62—Telling One’s Friends, 62—Hasty 
Judgments, 63—Suggestions for Written Work, 63— 
Questions for Discussion or Review, 63. 
SECTION I 
11 12 
CONTENTS 
Pagh 
Chapter VI.—Old-fashioned Virtues (Continued) 65 
Sense of Duty, 65—Obedience, 66—Being Teachable, 
67— Attitude Under Reproof, 67—Respect for Authority, 
68— Discipline, 68—Rules and Regulations, 70—Credu- 
lity, 71—Loyalty, 71—Suggested Subjects for Written 
Work, 72—Questions for Discussion or Review, 72. 
Chapter VII.—Putting Principles Into Practice 74 
Honesty and Honor, 74—Questions of Honesty, 74— 
A Nurse’s Rights, 76—Integrity, 76—Taking Money 
from the Sick, 78—Confession of Accidents or Mistakes, 
80—The Rights of Others, 80—Borrowing Money, 81— 
Honesty in Records, 82—Suggested Subject for Written 
Work, 83—Questions for Discussion or Review, 83. 
Chapter VIII.—Ethics and Economy 84 
Economy Defined, 84—Handling of Hospital Property, 
85—Waste, 85—Free Service, 85—Extravagance, 86— 
Personal Responsibility, 87—Abuse of Supplies, 88—Mis- 
use of Appliances, 89—Prevention of Waste, 90—Thrift, 
90—Specimen Blanks from City Hospital, 91—Sug- 
gested Subject for Written Work, 93—Questions for 
Discussion or Review, 93. 
Chapter IX.—Tact and Imagination 100 
Tact Defined, 100—The Untactful Nurse, 101—Lack of 
Sympathy, 101—Seeing the Real Patient, 102—Imagina- 
tion, 104—The New Patient, 105—Standing Orders, 
105—The Patient’s Friends, 106—Visitors and Rules, 
107—Noise, 109—A Nurse’s Experience as a Patient, 
111—Suggested Subject for Written Work, 111—Ques- 
tions for Discussion or Review, 112. 
Chapter X.—Some Ethical Phases of Night Duty 113 
Night Duty a Test of Character, 113—Comfort of Patients, 
113—Good Judgment, 114—Observation, 115—Attire, 
117—Loyalty, 117—Honesty, 118—Accuracy, 119—Sys- 
tem, 120—The Nurse’s Health, 122—Avoidance of Fricton, 
123—Suggested Subjects for Written Work, 124—Ques- 
tions for Discussion or Review, 124. 
Chapter XI.—Ethics and the Every-day Routine 126 
Daily Conduct, 126—Permanent Records, 126—Disposi- 
tion, 127—Improvement, 128—Solitude, 129—Quality CONTENTS 
13 
Page 
of Work, 129—Reputation of Hospital, 130—Observing 
Powers, 131—Nursing Instinct, 132—Professional Re- 
lations, 132—Suggested Subject for Written Work, 134— 
Questions for Discussion or Review, 134. 
SECTION II 
Chapter XII.—The Cost of Training 136 
Taking Things for Granted, 136—Cost of College Train- 
ing, 137—Cost of Nurse’s Training, 137—Other Aspects 
of Cost, 141—Losing Ideals, 141—Fundamental Princi- 
ples, 142—Dangers which Beset, 142—Callousness or 
Routine Spirit, 142—Narrowness, 142—Th© Religious 
Spirit, 144—Suggested Subject for Written Work, 146— 
Questions for Discussion or Review, 146. 
Chapter XIII.—Good Tone in the Training-school 147 
Types of Schools, 147—Individual Nurse’s Responsibility, 
148—Treatment of Probationers, 150—Things to Avoid, 
152—Misunderstood Rules, 152—Hasty Judgments, 154— 
Suggested Subject for Written Work, 154—Questions for 
Discussion or Review, 155. \N 
Chapter XIV.—Ethical Aspects of Hospital Accidents. 156 
Kinds of Accidents, 156—Justice, 157—Carelessness, 
158—Bums, 158—Misunderstanding Orders, 160—Mis- 
takes in Use of Drugs, 161—Fatigue and Confusion, 161— 
General Precautions, 162—Infections, 163—Injuries to 
Delirious Patients, 164—Suicidal Patients, 164—Sug- 
gested Subject for Written Work, 165—Questions for 
Discussion or Review, 165. 
Chapter XV.—Developing a Symmetrical Life 167 
Nurse’s Fourfold Nature, 167—Ethics and Conversation, 
168—Influence of Mind Over Body, 168—Influence of 
Mind Over Mind, 169—Battle with the Blues, 170— 
Power of Thought, 171—New Interests, 171—Conver- 
sational Standards, 173—Suggested Subject for Written 
Work, 173—Questions for Discussion or Review, 174. 
Chapter XVI.—The Discipline of Daily Living 175 
Value of Hospital Discipline, 175—Reliability, 175— 
Honesty in Bedside Records, 175—Adaptability, 177— 14 
CONTENTS 
Pach 
Daily Routine, 178—Sympathy, 179—Reverence, 179— 
Faithfulness, 180—The Grumbling Nurse, 180—The 
Nurse with a Grievance, 181—Truth and Falsehood, 
181—Veracity, 183—Telling the Truth, 183—Why a Lie 
is Wrong, 184—Mental Therapeutics, 185—Placebos, 185— 
Suggested Subject for Written Work, 186—Questions for 
Discussion or Review, 186. 
Chapter XVII.—Manner and Temperament 188 
Self-training, 189—Types of Nurses, 189—Good Man- 
ners, 190—The Stony Manner, 191—Temperament, 193— 
The Head Nurse, 193—Special Nurses, 194—Tempera- 
ment and Private Duty, 194—Executive Ability, 196— 
The True Executive, 197—Carrying Responsibility, 198— 
Looking Ahead, 199—Suggested Subject for Written Work, 
199—Questions for Discussion or Review, 199. 
Chapter XVIII.—Health, Recreaton, and Friendship 201 
The Nurse’s Health an Asset, 201—Infections, 201—Diet, 
202—Overstrain, 202—Worry, 203—How to Be an Opti- 
mist, 204—Sensible Health Laws, 205—Recreation, 206— 
Annual Vacations, 207—Friendship, 207—What is a 
Friend, 209—Duty and Friendship, 209—Suggested 
Subject for Written Work, 210—Questions for Discussion 
or Review, 210. 
Chapter XIX.—Ethical Standards for Head Nurses 212 
Efficiency Records for Head Nurses, 213—Example, 214 
—Fairness, 215—Favoritism, 215—Finding Fault, 216— 
Loyalty, 216—Elbert Hubbard’s Philosophy, 217—Show- 
ing Appreciation, 217—Ambition, 218—Point of View, 
219—Professional Conduct, 220—Teaching Qualities, 222 
—Patience, 223—Suggested Subject for Written Work, 
224—Questions for Discussion or Review, 224—The Hip- 
pocratic Oath, 226. 
SECTION III 
Chapter XX.—After Graduation 227 
Nurse’s Aim, 227—Important Things, 227—Guiding Eth- 
ical Principles, 228—Value of a Life Purpose, 229—In- 
dustry, 232—Adaptability, 233—Making a Good First Im- 
pression, 234—Manner, 235—Carrying Responsibility, CONTENTS 
15 
Page 
236—Suggested Subject for Written Work, 238—Questions 
for Discussion or Review, 238. 
Chapter XXI.—The Wide Field 239 
Vocations for Nurses, 239—The Institutional Field, 240— 
Variety of Talent Needed, 240—Institutional Positions, 
240—Public Health Nursing, 243—Making a Choice, 244 
—A Right Start, 246—A Nurse’s Word of Honor, 247— 
Depending on One’s Alma Mater, 249—The Pioneer 
Spirit, 250—Need of Study, 251—Suggested Subject for 
Written Work, 252—Questions for Discussion or Review, 
252 
Chapter XXII—A Nurse and Her Monet 254 
What do You do with Your Savings? 254—Five Pertinent 
Questions, 254—Investing One’s Savings, 255—Rules 
Concerning Investment, 257—Bits of Advice, 258— 
Charities and Free Service, 258—Nursing in Homes of 
Moderate Means, 259—The New Psychology, 262—Sug- 
gested Subject for Written Work, 262—Questions for Dis- 
cussion or Review, 263. 
Chapter XXIII.—Ethical Problems in Private Nursing 265 
Variety of Problems, 265—Responses to Calls, 266— 
Charge of “Picking Cases,” 268—Specializing, 269— 
The Dilatory Nurse, 269—Economy and Nursing, 270— 
Suggested Subject for Written Work, 273—Questions for 
Discussion or Review, 274. 
Chapter XXIV.—Ethical Problems in Private Nursing 
(Continued) 276 
The Question of Dignity, 276—The Nurse’s Province, 277 
—Arrangements About Meals, 280—Domestic Problems, 
282— Tone and Manner, 283—Difficulties with Servants, 
283— Temperamental Difficulties, 283—Ethical Difficul- 
ties, 283—Practical Questions, 283. 
Chapter XXV.—Miscellaneous Problems rN Ethics 290 
Problems in Discipline, 290—Ethics and Visiting Nurs- 
ing, 295—Ethics and Private Nursing, 299. 
Chapter XXVI.—Cooperation for Wider Service 310 
The Alumna Association, 310—Its Advantages, 310— 
Objects of an Association, 311—Need of Patience, 313— 16 
CONTENTS 
Page 
Spirit of Intolerance, 313—Narrowness, 314—Variety of 
Interests, 315—Conferences with Social Workers, 316— 
Women’s Clubs, 316—Working with Men, 317—Sug- 
gested Subject for Written Work, 317—Questions for 
Discussion or Review, 317. 
Index 323 Studies in Ethics for Nurses 
SECTION I 
CHAPTER I 
The Nurse in Her New Environment 
The young woman who enters a training school for 
nurses finds, before proceeding far, that training in the 
science and art of nursing is inseparably bound up with 
the science and practice of moral conduct. She finds 
that the one phase of training influences the other at 
every step of the way. To attempt to teach nursing 
without reference to the general conduct of the indi- 
viduals concerned, is like building a costly structure 
on a base of sand. Lacking a solid foundation, the 
structure falls when a critical moment arrives. The 
chief element in the foundation required to make a good 
nurse is to be looked for in her character. A good nurse is 
first of all a good woman. No amount of ability which a 
nurse may display in other directions can possibly be 
accepted as a substitute for right conduct. There is 
no such substitute. Taking reasonable health and in- 
telligence for granted, the most important thing for a 
nurse to bring with her to the training school is a good 
conscience. 
Foundation Principles.—The entrance of a young 
woman into a hospital school is, practically, the entrance 
Into a new world—a world having laws and customs 
differing widely in many respects from those of the world 
17 18 
ETHICS FOR NURSES 
outside, yet which are based on the same fundamental 
principles which govern Christian society as a whole. 
These principles assume the existence in every individual 
of a human ideal, more or less clearly perceived, and the 
consciousness of an obligation to maintain right and just 
standards of moral conduct. Ideals and standards must 
change and grow as civilization advances and knowledge 
is increased, but the foundation principles do not change. 
These are based on the world-old law of good will, of love 
to one’s neighbor, of the duty to promote the general 
welfare of all concerned. The entrance of the nurse can- 
didate into this new world is a rather bewildering experi- 
ence, and the process of adjusting herself to these new 
conditions, laws, and customs is rarely easj''. It may 
be true that duties never conflict—it is also true that 
to decide between apparent duties and choose the real 
duty for each hour and each moment, is often most 
confusing. 
Guiding Hints.—1. An important duty for the nurse 
at this stage in her career is to meekly accept, as right and 
necessary, much that she cannot understand. 2. A 
second duty is to try to see every situation from the 
viewpoint of those in authority who have the responsibil- 
ity for, and the good of the whole institution in view; 
also, where a patient is concerned, it is necessary to 
endeavor to put oneself in his place. 3. A third duty is 
to analyze her own motives and be sure that they are pure 
and unselfish, that in all things and at all times she means 
to do the right, as right has been revealed to her. This 
duty is hers, not only at the beginning of her nursing 
career, but all through life. The hospital must have 
nurses who earnestly want to do right, and who will do 
right as far as they see and know that a thing is right. 
Account will be taken of human frailties, allowances IN HER NEW ENVIRONMENT 
19 
made for mistakes in understanding or poor judgment, 
but an institution for the care of the sick is no place for 
a girl who does not seriously want to do right—whose 
purpose is not fixed to do right, as far as human judg- 
ment can determine what is right under given circum- 
stances. 4. A fourth duty, which it is important to 
remember at this time, is to pay careful attention to 
what is said by those placed in authority over the school. 
The careful observance of this rule will help a nurse 
tremendously in adjusting herself comfortably to new 
conditions, and in measuring up to the just expectations 
of those responsible for the welfare of the institution and 
all concerned in it. 
CONCERNING GOVERNMENT 
The new world which she has entered has a governing 
body, which is responsible to the public and to those who 
contribute to the support of the institution, for its proper 
management. This governing body may be called the 
board of trustees, board of managers, board of governors, 
or some other term, but it is the highest authority, the 
final court of appeal in all important matters connected 
with the hospital. This governing body is itself bound 
by certain laws and rules, designed to protect all interests 
concerned and to promote the general well-being of all 
having dealings with the institution. While, apparently, 
this governing body is little in evidence in the daily rou- 
tine (being non-resident), it is responsible for the proper 
care of every patient who may be admitted, for fair 
and just treatment of all employed by the institution, for 
carrying out the purposes of the founders of the hospital, 
and for the wise expenditure of all money entrusted to the 
institution. 20 
ETHICS FOR NURSES 
If a nurse makes a blunder in caring for a patient and 
the patient is injured or wishes to appeal to a court of law 
for redress, the board of managers must bear the brunt of 
the defense, inasmuch as they or their representatives 
took the responsibility of admitting the nurse to the 
hospital training school. They may never have seen 
either the nurse or the patient concerned, but they carry 
the responsibility for the nurse’s mistakes while she is in 
training. 
If a saucy or flippant or discourteous reply is given by a 
nurse to a visitor, it may seem a small thing, yet it may 
prove a serious disadvantage to the board in its remote 
effects. Large gifts have been lost to hospitals because 
of the carelessness or discourtesy of nurses or employees, 
or because of their distorted stories relative to matters 
which they did not fully understand. Large gifts have 
often come to hospitals because of the courtesy and 
kindness of the nursing staff. 
The superintendent is the executive head of the hos- 
pital, the official representative of the board of managers 
in the institution, and in everyday dealings with the 
public. The rules and regulations pertaining to the gen- 
eral management and internal administration are usually 
arranged by him (or her) in conjunction with a committee 
appointed by the board for that purpose. 
While he (or she) may appear to have much freedom 
and authority, the superintendent is nevertheless subject 
to limitations and rules, just as is every other member of 
the hospital family. He exercises only such authority as 
is delegated to him by the governing body. 
Departments and Department Heads.—In all hospitals 
the work of the institutions is divided into departments, 
the number of departments depending somewhat on the 
size of the place, and the character of the work done. IN HER NEW ENVIRONMENT 
21 
The administration department is the center of the sys- 
tem. It may be compared to the hub of the wheel, with 
the various departments representing the spokes. The 
superintendent is the official head of the administration 
department. The assistant superintendent assumes such 
duties as are assigned by the superintendent. 
The departments found in most hospitals are: 
1. The medical department composed of the medical 
staff, visiting physicians, internes, and other medical 
assistants. It has to do with the medical and surgical 
care of patients. 
2. The nursing department or the training school, under 
which are grouped all nurses actively engaged in nursing, 
all probationers, the orderlies, and all other employees 
who are assisting in the work of this department. This 
department is usually the largest in point of numbers. 
3. The domestic or housekeeping department deals with 
matters relating to the housing of the hospital household, 
the cleaning and general care of the building, and the 
laundry. In most hospitals the feeding of the hospital 
family and of those connected with this work also 
comes under this department. In larger institutions 
this may be a separate department having its own 
separate head and staff of workers, and is known as the 
dietary department. 
4. The engineer’s department has to do with heating, 
lighting, and ventilation of the building, and with other 
related matters. Not all hospitals have their duties and 
responsibilities divided in the same manner. 
5. Other Departments.—The out-patient department 
usually includes the social service department. The 
pathological department and the drug department are 
other departments commonly found in larger hospitals. 
In smaller hospitals the superintendent is often obliged 22 
ETHICS FOR NURSES 
to assume responsibilities which in larger hospitals are 
divided among several people. 
While each of these departments has its own head, the 
administration department has to do with all depart- 
ments. There is no part of the building or grounds which 
should not be under the watchful eye of the superintend- 
ent; no part in which he (or she) is not and should not 
be actively interested; no department in which he is not 
entirely justified in making suggestions or giving direc- 
tions in regard to its management. He (or she) usually 
is superintendent of the whole institution, and is expected 
by the board of governors to oversee every part of it. 
His requests should have all the force of commands. 
Service.—All these departments working together 
spell SERVICE in a very real and vital meaning of 
the term. Service to our fellow-beings is the object of 
the institution. It is expected to be the object of every 
individual connected with it. If a nurse does not bring 
with her, when she enters the school, the spirit of helpful 
service, she has made a mistake in the step she has taken. 
She should choose some other occupation. 
The patient is the most important person in the entire 
institution. He is the reason for its existence. His wel- 
fare and his comfort are and should always be given first 
consideration. Without patients there is no need of these 
various departments, and, throughout a nurse’s whole 
career, the patient’s welfare while she is in charge should 
never be placed in the background of her thought or 
plans. 
While the new world which the probationer has entered 
may seem to be made up of a miscellaneous collection of 
people—engineers, firemen, laundresses, ambulance men, 
porters, ward maids, cooks, head nurses, doctors, 
internes, druggists, bookkeepers, clerks, etc.—each one IN HER NEW ENVIRONMENT 
23 
fits into his own department, is subject to the rules of 
that department, and is expected to do his part faithfully 
and well in the institutional plans. The carelessness or 
blunder of one member of these varied groups may 
easily upset the smooth running of the whole human 
machinery of the institution. 
For example, the failure of the kitchen workers to 
have breakfast ready on time may easily upset the 
smooth working of the whole institution. Failure in 
the laundry is quickly felt in the wards and operating 
rooms. Failure of nurses to attend to the sending back 
of soiled dishes at the proper time throws the plans of 
kitchen workers into confusion. Thus illustrations 
might be multiplied to show how dependent one depart- 
ment is on another, and how necessary it is for all to 
work harmoniously together. 
This explains the reason for the various rules and regu- 
lations which every hospital is obliged to enforce in order 
that negligence in one department shall not hinder the work 
of other departments. Not all the human units are equally 
important, but unless each person is of some importance, 
there is no reason for his being a part of the service. 
Individual Responsibility.—In this new world of the 
hospital, individuals are valued, largely, according to 
their ability to carry responsibility. This feeling of 
responsibility for faithful doing of her own tasks and also 
for faithfulness to the larger interests of the institution 
is something which a nurse should try to cultivate from 
her first probation day. It has more to do with her full 
and final success than she can possibly realize at the 
beginning of her career. The nurse who feels keenly 
her personal responsibility is the nurse who is trusted and 
depended on, and who, later, has larger responsibilities 
committed to her. 24 
ETHICS FOR NURSES 
The Spirit of the Training School.—It was previously 
stated that the patient was the most important part of 
the institution. He is also the reason for the existence 
of most of the rules and customs which have come into 
existence in hospitals. Most of these rules and customs 
are designed directly or indirectly to promote the pa- 
tient’s welfare and to guide those who have the responsi- 
bility for his care. For example, the rule requiring 
nurses to be in bed at a proper hour at night is designed 
primarily to safeguard the nurse’s own health, but in 
spirit it extends to the welfare of the patients, because it 
is well known that a nurse who has not had sufficient 
rest and sleep lowers her efficiency as a nurse, is more 
liable to mistakes, and the welfare of the patient suffers. 
Thus, when rule after rule is analyzed, each will be found, 
in most cases, to have its root in the safety and comfort 
of patients and the well-being of all concerned. 
Concerning Loyalty.—Loyalty to the institution on 
the part of nurses, employees, and all who form a part 
of its working staff, is one of its most valuable assets. 
It is also one of the most important essentials to the 
efficient service which the hospital owes to the public 
whom it serves. It is one of the working principles of 
all such institutions that acceptance of contracts for 
service, or to enter the institution as a student or in 
any other capacity, carries with it the spoken or unspoken 
pledge of loyalty to the institution. Whether the period 
of one’s connection with the hospital be long or short, 
it is better both for the hospital and for the workers 
themselves that all whose duty it is to interpret the spirit 
of the hospital to the public should be loyal rather than 
disloyal. 
Loyalty does not mean that one must shut one’s 
eyes to the shortcomings of the institution. No insti- IN HER NEW ENVIRONMENT 
25 
tution is perfect. Its work has to be done by very 
human individuals who are far from perfect. It does 
mean that one who is loyal will refrain from fault- 
finding or criticism except where criticism is made to 
those who are in a position to remedy it. It means 
that a nurse will not mention the failings or defects of 
her associates to the patients or to outside people. It 
means, where a patient or some one from outside the 
institution complains, that the loyal member of the 
hospital household will defend the interests of the in- 
stitution just as she would defend the interests of her 
own home. It is highly desirable for the good of the 
patient that his confidence in the hospital should not 
be shaken. Loyalty to the institution involves much 
more than this. It means that one who is loyal to an 
institution will be careful to observe its rules; that the 
property of the hospital will not be misused; that 
its officers will be treated with respect; that courtesy 
will be rendered to all; and that each worker will re- 
member that she has the reputation and welfare of the 
hospital to a certain extent in her keeping. 
Loyalty to the physician is one of the duties demanded 
of every nurse, not solely because the physician is her 
superior officer, but chiefly because the confidence of 
the patient in his physician is one of the important 
elements in the management of his illness, and nothing 
should be said or done that would weaken this faith or 
create doubts as to the character or ability or methods 
of the physician on whom he is depending. 
Loyalty to the patient’s welfare demands, first of all, 
that his rights be respected and that his private affairs 
shall not be discussed with other patients or with people 
outside the hospital. This includes refraining from 
discussing patients or hospital matters with outside 26 
ETHICS FOR NURSES 
nurses, with close friends, with members of one’s own 
family, or with any other individuals with whom a nurse 
associates, except those professionally concerned. 
The Hospital Atmosphere.—In all institutions there 
is present that subtle intangible thing called atmosphere, 
and the nurse, in common with all others, is affected 
by it, though often unconscious that she is being affected. 
The spirit or tone of the institution depends much on 
those in authority. It depends somewhat on the primary 
aims of the place. It depends greatly on the workers, 
the spirit which they put into their tasks, and their 
general mental attitude toward the work they have 
undertaken. 
While the nurse is passing through the wards or attend- 
ing classes, she is catching the influence of the per- 
sonalities with whom she is associated, but she is not a 
passive individual. From the time she enters the hos- 
pital, she herself is impressing her ideals and standards on 
others and is helping to create the moral atmosphere in 
which she and others move. The hospital will be made 
better or worse by her presence in it, by the way she 
does her work, by her daily conduct, on and off duty, 
by what she says, and by her general moral and spiritual 
influence. What she is counts for more than what she 
does. 
The spirit of the nurse as she reveals it, unconsciously, 
day by day in the wards, in the corridors, in her room, 
in the class room, at meals, and in off-duty times, is 
another of the important points in which she will be 
judged during her probation, and later by the public, 
as she takes her place in the busy world outside. It 
manifests itself in a thousand different ways. Some 
one has said that one of the first and hardest lessons 
a nurse has to learn is to spell SELF with a little s. IN HER NEW ENVIRONMENT 
27 
It is often difficult for her to realize that success and 
advancement in this work, as in many others, usually 
comes to the one who continually studies how he may 
give his fellow-beings a little more, a little better, 
service. 
Suggestions for Written Work.—In a paper of between 
200 and 300 words give an outline of your life since your 
fourteenth year, mentioning the responsibilities you 
have had, and your reasons for desiring a nurse’s train- 
ing. Have papers ready for class to be held— 
FOR DISCUSSION OR REVIEW 
1. Mention two fundamental principles that should 
govern in civilized and Christian society. 
2. What is an ideal? Of what value is it in life? 
3. State four guiding hints given in the preceding 
chapter to help a nurse in adjusting herself to the new 
world of the training school. 
4. In your estimation which of these guiding hints 
should be placed first in its importance to be observed 
during probation? Give reasons for your answer. 
5. State some of the important responsibilities which 
the governing board of a hospital carry. 
6. Mention several ways by which a nurse may seri- 
ously embarrass the governing body. 
7. By what term is the official head of the hospital 
usually known? Tell what you know of his relation 
to the various departments. 
8. For what do the various departments of the hospital 
exist? 
9. Whom do you consider the most important person 
in the hospital? Why? 
10. Mention one special quality in a nurse which 
largely determines her value as a worker. 28 
ETHICS FOR NURSES 
11. Show why it is necessary for the welfare of the 
patient that he have confidence in the institution and 
in those who are responsible for his care. 
12. What do you understand by the phrase “loyalty 
to an institution ?” 
13. State, briefly, several ways in which the spirit 
which a nurse manifests in everyday life may influence 
her success as a nurse. 
14. How may a nurse help in securing or maintaining 
the right moral atmosphere in a hospital? CHAPTER II 
The Nurse Herself 
The study of psychology has, within the past few 
years, been given a very definite place in the curriculum 
of the modern training-school. It deals “with the thoughts 
and feelings of human beings, and seeks to explain the 
facts of intellect, character, and personal life” (Thorn- 
dike). Such a study for a nurse should have as its first 
and most important result a better understanding of 
herself, her failings, her natural tendencies that are 
likely to prove a handicap in a nurse’s career. 
The nurse herself will have a large part in the training 
and developing her own powers, though she may not 
always be conscious of this responsibility. Her faults, 
her strong points, her ambition, her general make-up, 
decide her status in the school and, later, in the outside 
world. Therefore, anything that helps her to know her- 
self better is of real importance. 
The nurse who has never had to try to measure up to 
the responsibilities of a position for which she expected to 
be paid; the girl who has come from a sheltered home 
where her parents and friends were always ready to make 
allowances for her failures, who had an excuse ready when- 
ever she blundered or neglected a duty or obligation, 
wfill always have a more difficult time during her training 
than the girl who has been kept or has kept herself 
strictly up to the mark, and who is determined to so con- 
duct herself that excuses will not be called for. 
Self-analysis is one of the first steps to increased effi- 
ciency, and it has a definite bearing on the value placed 
29 30 
ETHICS FOR NURSES 
on your services, of which, later on, the salary paid will 
be an index. 
What Are Your Faultsf—Your friends who will write 
your recommendations will mention your ability and 
your good points. You yourself should be able to state 
with a fair degree of accuracy the other side of your case 
or character. Most people, even the best, will find 
that in some qualities of heart and mind there is much 
to be desired, though in other ways they may be nearly 
perfect. If you were given a score card and required to 
rate yourself on the following list with 10 as a perfect 
score for each, what would your rating be on each point? 
1. Fair in judgment. 
2. Self-reliant. 
3. Courteous. 
4. Honest. 
5. Tactful. 
6. Truthful. 
7. Discreet. 
8. Industrious. 
9. Conscientious. 
10. Teachable. 
11. Charitable. 
12. Ambitious. 
13. Obedient. 
14. Even-tempered. 
15. Oversensitive. 
16. Egotistic. 
17. A good loser. 
18. Kind. 
19. Dependable. 
20. Jealous. 
21. Accurate. 
22. Loyal. 
23. Respect for other’s 
rights. 
24. Punctuality. 
Few young women realize that learning how to per- 
form nursing duties is the smallest part of the training 
process, that the drilling and disciplining of the woman 
inside the nurse, the development of right character, 
a right attitude of mind, and habits of life, is the most 
difficult part in the making of a nurse. 
Personality, that intangible thing that distinguishes 
us from every other individual, exercises a powerful in- 
fluence over the sick for whom we care, and also over the 
well people with whom we associate. The development THE NURSE HERSELF 
31 
of those gifts and qualities which are good, the checking 
or correcting of tendencies that are detrimental, the 
strengthening of our weak points, the cultivation of a 
pleasing personality, or the reverse, depends more on the 
nurse herself than on anyone else. “The fundamental 
problem of the world,” said a college instructor to his 
class, “is the development of the personality of the in- 
dividual to the highest degree, and the organization of 
varied personalities into groups for efficient service. 
If we could develop each individual’s possibilities fully, 
and hit on a plan for making these highly developed per- 
sonalities work together, supplementing each other’s 
efforts, we could solve any problem in the world.” 
Good Breeding.—Whether or not we desire to be called 
“good,” most individuals desire to be classed as “well- 
bred.” Good breeding has to do with character, not 
with one’s ancestors. It refers to individual excellence, 
to the possession of, or the absence of, those qualities 
which are generally regarded as desirable. It pertains 
to the kind of human being you are, not to the money or 
position or fame of your parents. After rating yourself 
on the qualities enumerated on the list, try to answer the 
question “Am I well bred?” 
The period of training is a severe testing time for the 
nurse student. She is certain to come out of the school 
either better or worse; which it shall be depends much on 
herself. It is easy for a nurse to degenerate, etc. 
It is easy for a nurse to degenerate morally and spirit- 
ually while in training in spite of all the moral safeguards 
the school affords. In the important transition period 
of her life through which she is passing she needs to “hold 
fast to that which is good” and to watch that she does 
not retrograde, that she does not lose out of her heart 
life the things which no woman can afford to lose who 32 
ETHICS FOR NURSES 
desires to be “a good woman” in the highest, deepest, 
broadest and best sense of the term. 
The Will.—The nurse’s will, the faculty or endowment 
of the soul by which it is capable of making a choice, 
the power of the mind by which she decides to do or not 
to do, is the great test of character and life. The train- 
ing of the will until right habits are formed, and certain 
courses are taken, or things done unconsciously or with- 
out effort of will, is at the bottom of character building. 
Its results are shown in what a nurse does, not in what 
she thinks or intends. 
Inclination is sometimes confused with the will, but it 
is a less significant term, meaning simply a disposition 
more favorable to one thing than another. We may 
easily be inclined to do a thing, yet fail to do it. A 
nurse makes her record in a hospital by what she does, 
not by what she is inclined to do. 
Ambition.—An eager desire for the attainment of 
certain objects is an important element in the making of 
a nurse, yet it may easily become an inordinate desire 
for preferment, honor, position, or power of some kind. 
Ambition is a quality which every individual should 
cultivate, yet diligently keep under control. It should 
help to carry a nurse forward to greater achievements, 
yet not at the expense of others. The finest ambition 
is that which leads a nurse to overcome obstacles and 
difficulties, rather than to outreach competitors. The 
man or woman who wins is often the one who revels in 
working at, or working out, hard things which others 
are ready to give up. 
It is easy to be an average nurse; it costs to be the finest 
kind, in character, life and general attainments, along 
any line we may choose. 
One of the most wonderful pianists in America, one 
whose technic is marvelous, whose soul is full of har- THE NURSE HERSELF 
33 
monies, was asked how he came to be such a musician. 
‘‘I gave myself up to music,” he replied. “For three 
years I sat before my piano from morning until night. I 
rarely went anywrhere. I saw almost no friends. I lived 
for my music. I know I lost much in a social way, but 
I wanted above everything else to be a master musician.” 
And he is. But it cost. It meant giving up lesser things 
for something which he greatly desired. 
It is neither wise nor necessary for nurses to cut them- 
selves off from all social life. They need it, they need 
friends—friends and acquaintances who are not of 
the world of sickness in wdiich they live—but it is well to 
remember that it costs to be a high-grade nurse in 
character and habits and attainments. The nurse who 
is unwilling to study or sacrifice, who comes to the 
hospital “to see if she will like it,” who feels that social 
pleasures or her engagements should take precedence to 
duty, needs either to change her attitude of mind or to 
choose some other line of work that will leave her free 
to make social engagements and do as she pleases with 
her time. She does not desire to be a nurse strongly 
enough to pay the price cheerfully. The readiness or 
reluctance with which a sacrifice of personal feeling is 
made is a revelation of character which those who are 
training nurses are quick to observe in probationers. 
Think why this is so. 
Temper.—Early in the training course the nurse 
learns that she must never argue with a patient; that 
she must learn to get along sweetly with others; that she 
must learn to control her temper. She knows or should 
know that the nurse who flies off in anger at trifles must 
acquire self-control, must master her feelings, or she will 
always be under a handicap as a nurse or as a worker 
in any line of activity. Anger is usually looked on as a 
serious evil in life, yet anger has its place. The man or 34 
ETHICS FOR NURSES 
woman who can’t get angry when occasion arises, who 
can’t feel deeply indignant, is made of poor material. 
Yet it needs no argument to convince us that anger in- 
dulged in frequently or habitually is a sign of personal 
weakness, a sign that the individual has not learned to 
rule his own spirit, that he who indulges in anger hurts 
himself. 
Is it easier for some nurses to be sweet-tempered than 
others? Watch those with whom you associate and 
decide for yourself. What is the chief secret of a sweet 
sunny temper? How may it be cultivated? Think it 
over and try to give a satisfactory answer to yourself. 
Quite as disturbing sometimes as anger are the signs 
of irritability or impatience one sometimes sees in nurses. 
The well-controlled nurse will not often give way to 
outbursts of impatience. The provocation many times 
will be great, yet the temptation to give vent to one’s 
feeling in a snappy answer must be held in check. 
What would be the general atmosphere in a hospital if 
everyone followed the example of the nurse who, when 
busy with a bed patient, was asked by a patient in an 
adjoining bed to give her a glass of water? Without 
stopping to think how it sounded or what the effect on 
the patient or the ward would be the nurse snapped out: 
“Can’t you see I’m busy? I haven’t got three hands.” 
This sort of temptation nurses will have to meet every 
day, and the way in which they meet these everyday 
tests will show whether or not they have in them good 
nursing material. 
Habit.—When an act has been repeated so frequently 
that it is done almost spontaneously without much 
previous thought, it is spoken of as a habit. Scientists 
have stated that the current of thought moving in the 
same direction for a time has worn a groove in the plastic 
brain material, and that this groove is deepened as the THE NURSE HERSELF 
35 
act is repeated until it becomes almost automatic for the 
thought to take that course. It requires no conscious 
effort. 
Even superficial consideration of the matter will show 
how much of our lives is made up of habit, and how 
important it is to cultivate right habits in nursing and 
personal life. No course of action is trifling if it has in 
it the possibility of habit formation. 
We are influenced, partly unconsciously, to the for- 
mation of habits by the example and influence of those 
with whom we live in daily contact, and especially by 
the example of those in authority. Our attitude of 
mind is influenced by their attitude, but our wills are 
given to us to help keep us from forming wrong habits 
of body or of mind. We may love people without 
copying their faults. 
While these lines are being penned there lies before the 
writer a remarkable Gopy of a journal edited by the 
prisoners in one of the state penitentiaries.* It has a 
department known as “The Guide Post,” over which 
appears this inscription: “One turn to the Right, then 
Straight On.” The editor of the Guide Post department 
states the following truths which, perhaps, sound 
strangely coming from a man confined in a state’s prison, 
but they are some of the great truths of life which all 
need to remember. He says: “There is a word in the 
English language which has a peculiar power. It is 
Righteousness, and it seems to be at the very bottom of 
all things. Should it seem pleasing not to do so, it is 
not necessary to associate this word with any creed, 
orthodoxy or dogma. It is simply something thorough. 
But to find it, one must let truth illuminate the road. 
“Conscience is to the soul what health is to the body. 
* From Joliet Prison Post. 36 
ETHICS FOR NURSES 
No man knows what conscience is until he understands 
what solitude can teach him about it. 
“As to the future, let us cast new resolutions to the 
winds; they are too often shallow and meaningless. 
But let us hearken to that inner voice that requireth 
every man to mean well and to do his best in the world. 
“Let us cultivate those traits and habits which make 
for character, for character is the governing element of 
life. It cannot be constructed; it needs first of all a 
principle and an impulse, glowing and determined.” 
Think carefully over the quotations from the prisoner’s 
journal. Underline the sentences or phrases which you 
deem most important. Ask yourself why they seem 
important to you. Do you agree with the prisoner’s 
philosophy at every point? 
Types of Nurse Students.—The types of nurse students 
described here are all descriptions of real people, who have 
applied for and entered training-schools. Study each 
type carefully and try to decide the qualities mentioned 
that the nurse should try to correct—qualities that will 
hinder her success as a nurse. If you were the principal 
of the school, which of these types would you reject in 
the first year? Give reasons why you consider them unfit 
to graduate? 
1. Mary Plumb comes from a western farm home. 
Expert with sewing. Does any manual work well. A 
poor student. Dislikes to apply herself to theoretic 
work. Very jealous and secretive by nature, selfish. 
Inclined to think that she is never getting justice. Has 
very strong likes and dislikes. Not inclined to make 
friendships with girls, but very confidential with men. 
Fair, sallow complexion. Very narrow outlook on life. 
Given to magnifying trivial happenings and making 
herself unhappy without cause. Inclined to gossip. No 
experience outside of a small rural community. Accus- THE NURSE HERSELF 
37 
tomed to responsibility for getting work done. Not strictly 
truthful. 
2. Caroline Brant.—A college graduate. Unusually 
alert intellectually. Musical. Attractive in appearance. 
Tasteful and neat in dress. Inclined to gossip. Makes 
friends with people quickly and is overconfidential. 
Cannot keep a secret or be trusted with knowledge of the 
intimate affairs of people in general. Easily elated and 
depressed. Especially interested in poor people. Not 
much judgment about helping them. Very much given to 
hero worship. High ideals of life and service, but apt to 
be changeable as to vocation. Glories in sacrifice and 
wants people to know it. Takes special delight in appear- 
ing in different types of uniforms. Conscientious about 
her work, as a rule, but always has favorites. Will lavish 
attention on one patient and forget others for the time. 
Unselfish, but lacks poise. 
3. Ann Graham.—Comes from a Virginia town. Edu- 
cated to teach school, but changed plans before she was 
fully ready and entered a hospital instead. Tall, dark, 
and attractive in appearance. Capable and alert about 
grasping new ideas and methods, but is habitually un- 
truthful. Needs constant watching. Given to making 
indiscreet, rash statements about her associates and 
about doctors. Grumbles constantly about the ways of 
her superior officers and the management of the institu- 
tion in general. Criticizes food. Uses for herself fruit and 
delicacies belonging to patients if she thinks it will not be 
found out. Neat in appearance, and can do ward work 
quickly and well, but creates a feeling of uneasiness in her 
supervisors because she has proved unreliable in many 
ways, strong along technical lines, weak along character 
lines. 
4. Elizabeth Long.—Comes from a Michigan farm, 
Ancestors were natives of Georgia. Two years in high 38 
ETHICS FOR NURSES 
school. One year in a technical school. Refined, but 
lacking in neatness. Naturally indolent. Loves to read 
novels, though work is neglected. A persistent dawdler 
over tasks. Never does anything in the morning that 
she could put off till the afternoon. Easily flustered and 
excited. Habitually forgetful. Unduly influenced by 
her associates. Foolish about her expenditures of money. 
Cannot make up her mind about a doubtful procedure 
till she has consulted her companions. Lacks poise and 
makes mistakes when hurried. Absolutely truthful and 
honorable and dependable along moral lines, but not 
strong where technical skill is concerned. Liked by her 
associates. Overfree in criticizing head nurses and super- 
visors. Determined to “get through” the training-school, 
but shows no earnest desire or ambition to excel, or to 
study anything that is not likely to be required for exam- 
ination. Always ready with an excuse for her failures. 
5. Mildred Jones.—Comes from a Kansas farm. Lacks 
in refinement and table etiquette. Not neat about dress 
or habits. Lacks in respect for rights and belongings of 
others. Uses articles of wearing apparel of her associates 
without permission. Inclined to think she knows more 
than she does. Gives orders to associates freely and 
thereby creates friction where she works. Argues about 
orders constantly. Has been accustomed at home to 
talking freely about people and things, and carries this 
habit with her into the hospital. Is always making trouble 
with her tongue. Unselfish to the last degree where her 
patients are concerned. Capable along technical lines in 
general, and seems anxious to do her work well, but does 
not get along smoothly anywhere. 
6. Emma King.—Comes from an Indiana town. Was 
one of a large family. Capable about sewing and house- 
work. Limited in education. Makes people uncomfort- 
able by her self-consciousness. Narrow in views of life THE NURSE HERSELF 
39 
generally. Has never trained herself to think things 
through. Does fairly well the required tasks, but is 
careful to do nothing that is not required. Is not deeply 
interested in her patients, and wTould not go beyond 
what was ordered to make them comfortable. Has no 
special ambition to excel in any way. Reads short stories 
and novels freely, but is not interested in books or maga- 
zines concerned with nursing. Does not know what she 
wants to do. Not actually lazy, but will take the easiest 
task every time if she has to make a choice. Has few 
friends among nurses or patients. Dislikes to study and 
does as little as she can get along with. Truthful and 
honest, but selfish and mentally indolent. Reticent in 
speech and manner. 
1. Show why you believe that a nurse has a large 
part in the training of herself. What does it mean to be 
well-bred? 
2. What do you mean by the term “personality?” 
In what way does it influence a nurse’s success? Has a 
nurse any control over her personality? 
3. What is the difference between “will” and “in- 
clination?” 
4. What has ambition to do with the quality of nurs- 
ing service? What dangers may there be in having too 
great ambition? 
5. Is there such a thing as righteous anger? Give 
an example. What place has anger in dealing with 
patients? 
6. What is habit? How are habits formed? 
7. Mention some precautions which nurses should 
exercise in regard to habit. 
8. What is conscience? What effect does it have on 
the life and work of a nurse? 
FOR DISCUSSION OR REVIEW CHAPTER III 
Expressions of Personality 
When we speak of a well-poised woman we mean one 
who is physically, mentally and morally well balanced; 
one whose best powers have been developed symmet- 
rically in a proper way; one who avoids going to ex- 
tremes, and who has an innate sense of the proportionate 
value of things in general. 
Poise of soul comes from careful thinking, from medita- 
tion on the great principles which affect personal life 
and living. It manifests itself in numerous ways. It 
is a thing to be striven for by every nurse. The posses- 
sion of poise, or the lack of it, affects tremendously 
the estimation in which an individual is held by the 
people whose respect she desires to secure. It means 
more than self-control. A stoic may be self-controlled, 
but he may be absolutely without heart. He may be 
able to maintain a stoical demeanor because he is 
indifferent, absolutely unconcerned, as to the issues 
involved, even though they may be tremendously im- 
portant to others. 
Self-control.—It is soon recognized that nurses need 
to cultivate the habit of not being easily excited. They 
quickly learn that self-control is indispensable. They 
should also learn that it does not necessarily mean a 
lack of sympathy or a callous indifferent disposition, but 
a mind and body brought under the control of the will 
and trained to express sympathy in a very practical 
way. 
40 EXPRESSIONS OF PERSONALITY 
41 
An unknown writer in a city daily, writing on the 
subject of self-control, says: 
“Many an individual has seen fleeting opportunity 
elude his grasp because at the moment the self-control 
necessary to intelligent reaching was not his. 
“Self-control means precisely what it reads—the full 
command of yourself, the captaincy over your mind and 
body under military discipline. 
“It means to be able to hold yourself in check when 
natural inclination would overstep the bounds of common 
sense. It means quite as well to be able to speed your- 
self up when natural inclination unwisely lags. It is both 
brake and throttle under your hand. 
“It is more. It is steering wheel, too. It is the 
mental poise which enables you to scan guide posts and 
turns in the road without too much prejudice or predi- 
lection, but rather with an open-mindedness that invites 
and recognizes reason. 
“Self-control keeps you from fighting when peace is 
of greater moment, and from peace when fighting is 
needed. It keeps you from doing the unwise thing when 
emotion or lack of patience or momentary weakness or 
outside pressure would lead you into indiscretions of 
temper or speech or action. 
“Self-control wins many victories, but makes few 
enemies. And it is a great conserver of self-respect. It 
never cheapens its possessor. 
“Self-control—control of self. 
“It’s not easy. It’s hard. It's harder than con- 
trolling someone else. If you’re in a position to com- 
mand, the others must obey. But when it comes to 
commanding yourself—obedience is only a matter of 
experiment. If you can control yourself you are doubly 
strong.” 
Analyze this quotation. Show where you agree with 42 
ETHICS FOR NURSES 
the writer. How does one’s early training influence the 
matter of self-control? 
The expression of the face, the tone of voice, and the 
character of our touch all affect materially for good or 
ill the patient’s comfort and condition. The patient who 
is anxious about his condition will study carefully the 
expression of the face of doctor or nurse to see if he can 
discern from the face what the opinion is which they do 
not openly express in words. Therefore control of the 
expression of the face and of the voice, so that neither 
face nor voice expresses anxiety, alarm, or surprise, how- 
ever serious the occasion may be, is one of the important 
lessons a nurse must learn. Tone and manner often 
convey more than the spoken word. 
A sudden exclamation of surprise may so alarm a 
patient as to greatly hinder his chance of fighting a 
winning battle at a critical time, by giving rise to fear 
and mental anxiety; therefore the face must be trained 
not to tell tales, and the exclamation of surprise must 
often be repressed. 
It is, however, not necessary or desirable to always 
repress the expression of pleasure or gladness, either in 
face or voice, when all is going well. A happy quality 
of optimism in a nurse is an element much to be desired, 
and it can be cultivated. 
The Voice.—The quality of the voice may seem to a 
nurse something which she cannot control, something 
with which she was born and for which she is not re- 
sponsible, yet a little thought and study of herself will 
convince her that habit has much to do with it. A nurse 
may be habitually loud-voiced or gentle-voiced when 
she enters the school and may never have had attention 
called to it. She must train herself to realize that her 
habits of voice influence greatly the comfort of the EXPRESSIONS OF PERSONALITY 
43 
patients and also their appreciation of her value as a 
nurse. She must discipline her voice if she does not 
wish, many times, to be considered a nuisance. It is 
hard to imagine the amount of unnecessary discomfort 
that the sick are obliged to suffer because of the undis- 
ciplined voice in nurses, and because of the thoughtless 
chatter that is so often heard in corridors. Study your 
own voice. Do you speak distinctly, firmly, yet gently; 
or do you drawl your words out as if you had no energy 
behind them? Is your voice, or habit of speaking, harsh, 
discordant or unnecessarily loud? Is your tone quick, 
sharp, shrill; has it that piercing quality which jars sensi- 
tive nerves and often causes real pain? Do you mumble 
your words or speak in whispers? Do your tones indicate 
a cheerful, kindly disposition or the opposite ? Have your 
tones that quiet, gentle, firm note of authority and strength 
which inspires confidence? Have you ever tried to cul- 
tivate the habit of speaking gently, quietly, distinctly? 
When you read aloud have you ever tried to discover 
whether your voice was agreeable and pleasant, or dis- 
cordant or monotonous, or whether it had that sing- 
song quality which ought to be corrected? Nurses may 
help each other much by reminding each other of points 
at which they need to be especially careful. 
Touch and Movement.—Instinctively we feel that a 
nurse should be gentle, yet habitual gentleness requires 
a real effort and includes much. Few defects in a nurse 
are more quickly noted by patients or observers than 
the lack of gentleness. A nervous self-conscious nurse 
often jars the bed and the patient, slams doors, drops 
things, and unnecessarily causes suffering till the strange- 
ness of the new situation wears off. This is excusable 
at the beginning. It becomes a serious defect if it 
continues. ETHICS FOR NURSES 
44 
The size and shape of the hands are usually settled 
before we enter a training school. The quality of touch 
is under our control. By the touch we may convey to 
the patient our feeling of sympathy and tenderness, our 
appreciation of his weakened condition, our desire to 
be helpful. We reveal our character in our touch, to a 
considerable extent. 
The human hand has in it a wonderful power to soothe 
tired nerves; its subtle influence over the mind cannot 
easily be explained. It can easily be used in such a way 
as to indicate familiarity of manner, against which a 
nurse needs to guard with all patients. 
Three things especially to be studied in movement are: 
gentleness, deftness, quickness. 
Carriage.—Just as the voice and touch reveal char- 
acter, so the manner in which a nurse walks and carries 
herself will reveal the habits of the woman and will 
exert a very real if undefinable influence on the sick. 
“Stand straight” and “sit straight” are admonitions 
frequently needed by nurses. An erect carriage, an air 
of alertness, a keen attitude of attention are evidences 
of a well-disciplined body and of a certain general culture. 
These can be acquired, but not without effort. 
Habits to be avoided are a careless attitude in standing, 
as if the backbone were weak and needed support; a 
lounging posture in sitting; leaning against the bed or 
other support; sitting on the patient's bed. 
The character of the walk is a matter to be studied by 
every nurse. It also reveals to some extent the mental 
attitude of the woman. A quick, energetic nurse 
usually thinks and moves quickly. Others are slower in 
grasping ideas and usually slower in their walk and 
general movements. Women who are indolent by nature 
reveal it in their carriage, walk, and general movements. EXPRESSIONS OF PERSONALITY 
45 
Heavy, loud footsteps in a nurse are indications of a 
certain lack in the mental qualities desirable. Habits 
of walking to be avoided are the mincing gait; tip-toeing; 
the quick, nervous walk which is a half run and which 
betokens a nurse who is flurried; the dragging footstep 
and the heavy thud. 
A quiet, even, steady, firm walk which can be quick- 
ened on occasion is the least wearing on a nurse and 
most satisfactory for everybody concerned. A light 
footfall comes naturally to some people. Needless to 
say every nurse should wear a comfortable broad-soled 
shoe with rubber heels while on duty. 
The Uniform.—The uniform has been adopted as a 
necessary part of the nurse’s equipment. It announces 
to the little world in which the wearer lives and works 
the character of her duties in the institution. It carries 
with it a certain quality that helps to dignify the wearer 
and demands a certain respect. 
Does a nurse stop to consider that the manner in 
which she wears the uniform is an index of character? 
However carefully the school authorities may design a 
uniform, it can be worn so as to present a careless, untidy 
appearance. If there are pins where buttons were in- 
tended; if the skirt is bedraggled and frayed at the edges; 
if the nurse has so little sense of the fitness of things that 
she is found wearing rings or other unnecessary jewelry 
with a uniform dress that is designed for work; if her 
hair is untidy, her cap crooked, or perched in a fly-away 
fashion on her head, so that it attracts undue attention; 
if part of the uniform is always missing, may we not 
conclude that such a nurse is lacking in attention to 
details and apt to be as careless in her work as in her 
appearance? 
A proper uniform includes more than dress, apron, cap, 46 
ETHICS FOR NURSES 
collars and cuffs. It requires due attention to the 
amount of starch used in laundering. It should be so 
made as to allow freedom in movement to the wearer. 
It should be noiseless. There should be no cuffs with 
sharp edges that may be uncomfortable to the patient. 
Any elaborate style of hair dressing is out of place with 
the uniform. It calls for neatness and cleanliness from 
head to foot. It is limited to the details prescribed by 
the school. A well-trained nurse with her sense of what 
is proper duly developed will not be found wearing 
rings on fingers or in ears, bracelets, hair adornments, or 
conspicuous footgear, while on duty in hospital or home. 
It is entirely probable that the probationer has rarely, 
if ever, before entering the school, taken time to really 
think seriously on the subject of her own personality, 
and the thousand ways in which she is revealing it every 
day. She needs now to study herself, the failings and 
habits and tendencies which she should try to correct, as 
she never did before. Only a few of the ways in which 
character is revealed have been mentioned. Others will 
be discussed later on, but let it never be forgotten that 
the soul of the woman who wears the uniform will in- 
fluence the quality of her work, every day that she lives. 
Suggested Subject for Written Work.—Prepare a short 
paper on the question, “What is training as it relates to 
nursing?” stating your ideas of what training should 
accomplish in you, apart from learning to give practical 
bodily care to the sick. 
FOR DISCUSSION OR REVIEW 
1. When you speak of a well-poised woman, what do 
you mean? 
2. How may poise of soul be cultivated? EXPRESSIONS OF PERSONALITY 
47 
3. Show how poise may differ from self-control. 
4. In the practice of self-control, mention some things 
to be guarded against. 
5. State why you believe that self-control is indis- 
pensable to a nurse. 
6. Mention several ways in which the expression of a 
nurse’s face may affect the mental attitude of the patient. 
7. How may a nurse’s voice affect the comfort of 
patients? 
8. What qualities of voice should a nurse cultivate? 
What qualities avoid? 
9. Show how touch, movement and manner of walking 
may reveal character. 
10. Mention three qualities of movement which nurses 
should try especially to cultivate. 
11. Why do nurses wear uniforms? Mention some 
things that should be avoided in the wearing of the 
uniform. 
12. Give some reasons why rings and other jewelry 
are out of place on a nurse in uniform. 
13. What good results are likely to occur from an 
honest self-analysis? 
14. Make a list of the faults you know yourself to have. 
15. Mention three or four faults your friends have called 
your attention to. CHAPTER IV 
Conduct and Duty 
One of the main purposes of this text-book is to make 
nurses think, think hard and frequently, about questions 
of conduct and duty. In the long career, the nurse’s 
ideals of conduct and of duty are the biggest factors 
in her success, professionally and financially. It cannot 
be too deeply impressed on a nurse that her own ambi- 
tions and ideals, the spirit which she puts into her work, 
will be the chief determining factors in fixing her status 
in the great working world. 
Analyzing an Ideal.—It is well, then, at the beginning 
that a nurse should have a fairly clear idea of the kind 
of nurse she wishes to become. Her ideals will grow 
and change with the passing years, but, since she herself 
has a most important part in the training process, it is 
very desirable that she try to have a clear conception 
of the kind of nurse she is anxious to be. Let her think 
of the nurses she has known and read of, study the char- 
acteristics she admires in each, and also the characteristics 
which she thinks should be avoided. It is much better 
for the nurse to take a real person and try to analyze her 
habits and spirit than to frame a theoretical ideal which 
might not fit any woman v ho ever lived, on earth or in 
heaven. 
What do you know of the illustrious founder of modern 
nursing, Florence Nightingale, of the qualities that 
made her great? What did she do in order to fit herself 
48 CONDUCT AND DUTY 
49 
to improve nursing conditions? What difficulties did 
she encounter? What sort of woman was she, as a 
woman, apart from her nursing? What do you most 
admire in her character? What nurses have you met 
whom you admired greatly, whom you wished to be 
like, and what was it that you admired? What qualities 
have you seen expressed in a nurse’s life or conduct that 
you feel should be avoided or corrected? What qualities 
does Miss X, a senior nurse, possess, that caused the sur- 
geon to ask that she be assigned to care for Mrs. Brown, 
a young spoiled wealthy patient? Why is it that Miss 
B’s patients recommend their friends to try to secure her 
services? 
What qualities do these nurses possess that you lack? 
It is easy for any of us to sit down and write out a 
description of an abstract ideal for a nurse, but what 
we want are examples of real nurses, living or dead, who 
had to meet the every-day difficulties the nurse of today 
meets and yet made their lives in aims and habits safe 
examples to follow. 
Ethics Defined.—The nurse in her probation period 
and all through her career will hear much about “ethics”; 
therefore it is well that she try to understand what 
is included in the term. Dictionaries define ethics 
as the science which deals with moral conduct or with 
human duty. The meaning of the word covers custom, 
usage, habits, and in its application commonly refers 
to personal characteristics, or to the traditions of a 
community. As related to nursing, ethics has to do with 
the ideals, customs and habits which the members of 
the profession are by degrees accumulating around the 
name and character of the trained nurse. 
Nursing Habits.—The importance of correcting bad 
habits and forming good ones was mentioned in a pre- 
ceding chapter. While we speak and think of nursing 50 
ETHICS FOR NURSES 
habits as usually formed during training, it is a fact that 
the habits which we form during training are largely de- 
pendent on the habits we brought with us to the train- 
ing-school, the habits which were forming during child- 
hood, and which had become more or less fixed before 
coming to the training school. What are some of those 
habits? Are you energetic, alert, or inclined to be lazy 
and careless? Are you neat and gentle, or untidy and 
inclined to be noisy? Are you, as a rule, punctual in 
getting to church on time and in keeping appointments, 
or do you dawdle and act as if punctuality was of no 
special importance and you didn’t care whose time you 
wasted by being late? These are examples of some of 
the habits which a nurse brings with her to the training 
school. 
What is sympathy? How much place has in it a 
nurse’s life? Should it be repressed or cultivated? 
What sort of a heart and head should a nurse try to 
bring with her to the school? 
When you speak of an obliging disposition, just what 
do you mean? To what extent is a nurse responsible 
for the disposition she manifests? 
What is included in the term “a pleasing personality,” 
and how much does “a pleasing personality” have to 
do with nursing? Do you consider respect for authority 
a desirable quality for a nurse to cultivate? If so, why? 
Helps toward Right Habits.—In beginning the new life 
in the hospital, it is very necessary and desirable to cling 
to all the helps we can possibly get, which may aid in 
the formation of right habits. It has been stated that 
the thousands of new laws passed by state legislatures 
every year are all based to a degree on the ten com- 
mandments and the great commandment—“Thou shalt 
love the Lord thy God with all thy heart and with all 
thy soul and with all thy strength and with all thy mind, CONDUCT AND DUTY 
51 
and thy neighbor as thyself.” Since the Bible has 
given to most of us, either directly or indirectly, the 
highest and best laws and rules of life and conduct, it is 
very necessary that when we enter the training-school we 
bring our Bibles, or other devotional books with us, and 
that we do not allow any other study, or any number of 
them, to crowd the best things out of our lives. This is 
one mistake which nurses frequently make. There has 
probably never been a time in their lives when they 
needed, quite so much, the helps which religion affords, 
as when they are in the training period and in the transi- 
tion state, when new temptations, new problems of duty 
confront them on every side; and never a time in their 
lives when it will seem easier to grow careless about 
securing spiritual help, and find a reasonably good excuse 
for so doing. 
Next among the helps to right conduct and right living, 
let us place the old-fashioned habit of going to church— 
the church of our home training, or to synagogue, or 
to services, where we will get for ourselves the uplifting 
influences of public worship. Every nurse needs this 
to keep her from growing hard and callous, to help her 
to keep her mind from running always in the same 
channel, to help her to be sweet and sane, winning and 
optimistic, and to exert a wholesome influence in the 
little circle in which she moves. 
The Roots of Ethical Teaching.—When we get close 
enough to study beneath the surface we will probably 
discover that the subject of ethics in some respects 
resembles a tree, with roots deep down and with branches 
out in several directions. If we do not notice the roots 
of the tree we may expect to develop branches and fruit 
and have them flourish without roots. The roots of 
the tree we may designate as Religion which some writer 
has said is “the relation which an individual fixes 52 
ETHICS FOR NURSES 
between his soul and his God.” “The fruits of the spirit, 
love, joy, peace, long-suffering, gentleness, goodness, faith, 
meekness, temperance,” are fruits greatly to be desired 
in a nurse’s daily life, but it is hard for them to flourish 
without diligent cultivation. 
Concerning Conscience.—Among the fundamental re- 
quirements for the making of a good nurse we have placed 
the matter of conscience. It influences her work, at 
every turn of the way, both in the hospital and in the 
great world outside. Do nurses enter the training school 
with equally well-developed, sensitive consciences? If 
a good, healthy, sensitive conscience is a necessity for a 
good nurse, how can she acquire it if she did not have a 
well-developed conscience on entrance? This seems like 
a thoroughly important question for a nurse to consider. 
Did the ideal nurse whom you analyzed at the beginning 
of this chapter have a good active conscience, or not? 
Ethics and Health.—The subject of ethics enters into 
the secret places of one’s life. Ethics does not concern 
itself simply with abstract ideals and virtues. The 
subject is as broad and deep as life itself. It has a very 
close relation to a nurse’s own health, and her conception 
of her ethical obligations may have a very real bearing 
on the health of those committed to her care. Her care- 
lessness in health matters may easily create unnecessary 
burdens for those who are responsible for the nursing in 
the hospital 
The nurse who neglects the hygienic precautions which 
she knows should be observed may easily carry infection 
from one patient to another, may add to the burden of 
sickness which they are already carrying, and may en- 
danger life itself. There is a very real relation between 
a nurse’s conscience and infection, even though the 
subjects at first glance may seem wide apart. 
Where Special Precautions are Needed.—Two very CONDUCT AND DUTY 
53 
important parts of a nurse’s anatomy which need careful 
guarding to keep them in good condition are her hands 
and her feet. From the beginning of her career in the 
care of the sick, she should practice the habit of avoiding 
touching with her hands as far as possible dressings, 
basins or materials of any kind that are liable to contain 
disease-producing germs. Under the finger nails is a 
favorite lurking place for germs and the careless nurse, 
however good her intentions may be, may easily, by be- 
ing careless about her hands, carry infection into her 
own body as well as infect others. Careful cleansing of 
the hands before meals or before partaking of food of any 
kind is a rule that cannot be too closely observed. Soap 
and water applied to the hands freely and frequently are 
powerful safeguards to the health of a nurse. She has 
it in her own power to ward off much sickness. If she 
is careless and does not use the safeguards which are at 
her disposal, she must bear a considerable part of the 
blame when sickness overtakes her. As a rule, nurses 
are as happy and healthy a class of young women as 
are found in any school or college. Many nurses have 
gone through their entire course of training without 
missing one day on account of sickness. This is the 
ideal a nurse should have. Breaks in the skin of the 
hand, hang nails, minor cuts, etc., should be carefully 
attended to, as they afford an avenue for the entrance of 
infectious germs to the body. 
Since much of a nurse’s work requires standing or 
walking, the condition of the feet is of prime importance. 
Most schools require a nurse to bring with her a pair of 
comfortable well-fitting shoes with low heels, for ward 
duty. A few schools have the feet of all nurses examined 
and special shoes prescribed. Apart entirely from the 
matter of comfort, which is highly important, it is plain 
that no nurse is at her best, nor in condition to do her 54 
ETHICS FOR NURSES 
best for her patient, if she is suffering tortures from 
tight, badly fitting, or unsuitable shoes. 
The nurse’s duty to herself should never be overlooked. 
It is just as real as her duty to others. Neither should it 
be given undue prominence in our consideration. To 
have a proper sense of proportion, giving due importance 
to certain things and placing less important things where 
they belong in our plans, is highly necessary for effective 
service. In the classes in hygiene attention will be 
given to details which affect personal health. At the 
beginning it is very desirable that a nurse get a proper 
attitude of mind in regard to health, the relation of her 
health to the plans and management of the institution, 
and to the occupation which she has chosen. In every 
class of a dozen probationers there are likely to be found 
three types of nurses: 
1. Those who give up and go to bed for very slight, 
and sometimes fancied ailments. 
2. Those who will persistently assert that they are not 
ill and who remain on duty when their own common 
sense tells them they should be in bed. 
3. Those who take a sensible middle ground and, when 
they do not feel as well as usual, frankly come and report 
the matter to those in charge, realizing that slight in- 
disposition, if attended to promptly, may prevent 
suffering and loss of time to the nurse herself, and in- 
convenience to those who have to assume her duties if 
she has to be sent to bed. 
No training school can afford to carry through an 
extended period of training a nurse who is likely to disrupt 
the machinery every few weeks by reporting on the 
sick list. It is unfair to the other nurses who must as- 
sume her duties while she is laid aside, and unfair to 
those who will later on employ her. There are other CONDUCT AND DUTY 
55 
occupations which such women should take up, w’here 
less vital issues will depend on their uncertain health. 
On the other hand, it is well for nurses to remember 
that principals and head nurses much prefer to know that 
a nurse is not feeling well, so that prompt measures 
may be taken to correct what is wrong, and they cannot 
be expected to know of such things unless they are told. 
Experience quickly enables them, as a rule, to see 
whether the indisposition is trifling and likely to pass 
off soon, or whether it is something needing careful 
attention at once. Many nurses are subject to frequent 
attacks of sore throat. Hospital life occasionally seems 
to aggravate this trouble and special precautions should 
be practised. Especially should they be careful to 
mention to the principal of the school the first symptoms 
of the approach of this ailment. In spite of the emphasis 
which is placed on this matter of telling when the first 
symptoms of sore throat are felt, one frequently finds a 
nurse who will foolishly disobey or ignore the instruc- 
tions given her till she is forced to go to bed with ton- 
sillitis, and will give as her reason that she hesitated to 
trouble anyone. She neglects to look far enough ahead 
to see that if she is obliged to go off duty and be cared 
for, she will be causing much more trouble than if she 
had obeyed the instructions she received. 
Suggestions for Written Work.—A probationer was 
told to report for duty at the hospital on the morning 
of July 8. Instead, she came to the city with a friend, 
spent two days in sight-seeing and visiting, and reported 
at the hospital on the evening of July 9. What handi- 
caps did she place on herself at the beginning of her 
career? What estimate would the principal of the school 
be likely to place on her value as a student and worker? 
What important principle which she should have ob- 
served did she violate at the beginning of her training? 56 
ETHICS FOR NURSES 
QUESTIONS FOR DISCUSSION OR REVIEW 
1. Mention two factors which affect powerfully a 
nurse’s success, professionally and financially. 
2. Describe the nurse you have met who came nearest 
to your ideal. 
3. What do you understand by the phrase “ethics of 
nursing?” 
4. Make a list of things which are helpful to the for- 
mation of right habits. 
5. What book is the basis for most of the laws of the 
world and the ideals of right conduct? Explain what 
is meant by the Golden Rule. 
6. Mention some advantages of church going as a 
habit. 
7. What suggestions would you offer a nurse in regard 
to conscience building? 
8. Can you trace any relation between ethics and 
health as it relates to nurses and nursing? 
9. Outline some precautions which nurses should use 
in the care of their hands and their feet. 
10. Show how a nurse’s carelessness in matters of 
health may disrupt the plans of the nursing department. chapter v 
Old-fashioned Virtues 
The nurse who enters a hospital for training comes, 
or should come, with a conscious feeling that she must do 
right, that her purposes toward right conduct are fixed. It 
is expected that she has a fairly well-developed conscience 
which will help to guide her into right-doing. Why 
should she try to do right? What tests shall she apply 
to her conduct to see if it is right, when she is in doubt? 
The Real Test of Right Conduct is Social Welfare, the 
Good of All Concerned.—Social well-being is the great law 
under which our lives must be lived, if we would live 
rightly. If, when we are in doubt, we pause long enough 
to honestly ask ourselves what effect on general welfare 
would be produced if every one did this or that thing 
which we are doing, considering, or desiring, we will begin 
to get some light on the question that will show us how 
we should proceed. 
Truthfulness.—Is truthfulness an absolute duty? To 
this there can hardly be more than one answer; yet a nurse 
is seldom very long in a hospital before she learns that 
to tell the truth promiscuously to every one who chooses 
to pry into affairs, which often are really not his concern, 
would lead to disastrous results to herself and to others. 
Are we under obligation to tell the truth to any one who 
chooses to ask it? We quickly learn that there are in- 
dividual rights which should always be held precious. 
We learn that there is a field in which those inquiring 
57 58 
ETHICS FOR NURSES 
have a right to the truth, a field in which individuals re- 
pose mutual confidence in each other, and where nothing 
but truth should be considered, yet even in this field 
much judgment in telling the truth is required. Plain 
truth in many circumstances amounts to practical false- 
hood, since it often conveys a wrong impression. A well- 
known writer* states this point admirably in the following 
illustration: 
“ When a patient who has the earliest recognizable signs 
of phthisis in one lung, and tubercle bacilli in his sputum, 
asks, ‘Have I got consumption?’ it would be conveying 
a false impression to say, ‘Yes, you have/ and stop 
there. Ten to one his impression is that by consumption 
I mean a disease invariably and rapidly fatal. But this 
is not at all my impression of his case. To be true to 
the patient one must explain that what he means 
consumption is the later stages of a neglected or unrecog- 
nized disease; that some people have as much trouble 
as he now has and get over it without finding it out; that 
with climatic and hygienic treatment he has a good 
chance of recovery, etc. To tell him simply that he has 
consumption without adding any further explanation 
would convey an impression which in one sense is true, 
in the sense, namely, that to another physician it might 
sound approximately correct. What is sometimes called 
the simple truth, the ‘bald truth/ or the ‘naked truth/ 
is often practically false. It needs to be explained, 
supplemented, modified.” 
Is a Lie Ever Excusable f—A question that is sometimes 
asked is whether, in nursing, a lie is excusable when 
it is told solely for the patient’s benefit and without 
any selfish motive on your part. From time imme- 
morial this sort of lie has been cited as excusable when 
* Dr. Richard Cabot. OLD-FASIIIONED VIRTUES 
59 
dealing with the sick. This question will be discussed 
more fully later on. In the beginning of a nurse’s career, 
where there is any doubt as to whether the full truth 
should be told, there is always provided the protecting 
rule for the pupil, that the head nurse, or house doctor, 
visiting physician, or superintendent is the one who 
should give out information concerning the patient’s 
condition to his friends. It is clearly not the pupil 
nurse’s business or responsibility to deal with this matter, 
which she cannot fully understand. It would be folly, 
however, to prohibit a nurse from saying with gladness 
when occasion arises, “The patient is feeling much 
better.” When dealing with those outside the circle of 
the patient’s family or friends, a pupil nurse can always 
protect herself by the statement of the rule which gener- 
ally exists in hospitals: “We are not allowed to give 
out information about our patients.” The important 
question is not always, “Should I tell the truth or tell an 
untruth,” but very often it is, “Is it necessary to tell 
anything at all at this time?” There is an old saying that 
“You are rarely or never sorry for the things you did 
not say,” and it is well worth remembering by pupil 
nurses. It will be readily seen that truth-telling, even 
in the realm where others have right to the truth, is a 
matter that requires much judgment, and that the way 
the truth is told counts tremendously in its effects. 
In telling the truth in a hospital there is another side to 
the question which admits of little argument. It is 
clear that a nurse who attempts to keep back the truth 
from the doctor or from those in charge in the hospital 
is a dangerous element and an unfit person to have charge 
of the sick. The medical treatment of a patient depends 
verv largely on the statements of the nurse as to his 
condition. The doctor sees his patient but a few minutes 60 
ETHICS FOR NURSES 
each day and naturally and properly depends on those 
who have the patient under their observation and care 
constantly to give him an exact and true report of things 
as they are. Omitting to tell the whole truth, or sup- 
pressing important facts or happenings, which should 
be told, is deceiving those who have a right to know, 
and is inexcusable. No hospital can afford to tolerate 
such practices. 
Truth in Nursing Reports.—Similarly, a nurse’s reports 
to the head nurse or house physician, and her written 
records, should be as free from exaggeration, from evasion 
or deceit in any form, as she can possibly make them. 
Proper nursing, proper medical treatment, can be built 
only on a foundation of absolute truth as far as truth is 
known. Mistakes may occur, but should be promptly 
and honestly confessed to those who have a right to 
know, and who are in a position to correct them or to 
lessen the bad results of mistakes. Inexactness in speech, 
half truths, the covering up accidents or mistakes, all, 
in course of time, react on the nurse in ways she does 
not understand. How can a nurse expect a hospital 
to recommend her for any important position, if she 
leaves in the institution a record of deceit, or of at- 
tempts to deceive those in authority? No nurse ever 
does deceive those in authority very long, though she 
may think she does. 
Discreetness of Speech.—Many centuries ago an ancient 
writer spoke of the tongue as an unruly member, and 
time has not changed its habits. A large part of the 
training for which a nurse must be responsible in herself 
is the training of her tongue, the cultivation in herself 
of habits of reticence, habits of refraining from discussing 
the affairs of patients with people who have no right to 
be told anything about them, of refraining from discuss- OLD-FASHIONED VIRTUES 
61 
ing with patients matters with which they have no 
concern and which she often does not fully understand. 
Endless trouble, untold hours of agony have been 
caused by the thoughtless habit of some nurse talking 
with patients about things of which she herself has little 
real knowledge. 
A doctor leaves an order for a patient to be prepared 
for an important operation. The nurse while making 
the preparations remarks that “most of the patients 
who have had this operation have had cancer.” The 
patient immediately and naturally wonders if she too has 
cancer and if the doctor has deceived her. Her anxiety 
is quickly communicated to her friends and to the doctor. 
He comes to the principal to know who told his patient 
she had cancer, and a general fuss follows this apparently 
innocent but terribly unwise and wholly unnecessary 
remark which the nurse made. This is one illustration 
of thousands which most hospitals can furnish of the 
trouble caused by nurses who allow their tongues to 
run wild, who talk at random about vital matters of 
which they know very little that is definite and on 
subjects which are better avoided. 
A patient asks a nurse if she knows what was done in 
the operation she has just undergone. The nurse has 
seen stated on the operating-room records that the 
appendix was removed, and she states just what she had 
read on the records. She tells the truth. The patient 
had convinced herself that she would never be well till 
appendix and some other parts of her anatomy were 
removed, and she begins to worry. She censures the 
surgeon when he comes for not doing all that she was 
sure was needed. The doctor inquires how she knows 
what was done, and here follows another general dis- 
turbance, wholly unnecessary. 62 
ETHICS FOR NURSES 
The Talkative Nurse.—The nurse who has brought 
with her a predisposition to “tell things” which are 
better untold is one of the great problems of hospital 
life. How to deal with her, whether such nurses should 
ever be allowed to finish a nursing course, is one of the 
great unsettled questions. It rests entirely with the 
nurse herself whether she becomes this sort of problem 
in a hospital or not. She herself is the one who must 
learn to control her tongue. No one else can do it. 
Does a nurse really desire to be recommended as “a safe 
woman to be admitted into one’s confidence?” Let her 
learn to manage the little unruly member. Let her 
cultivate every day the habit of not telling things which 
need not be told, however great the temptation may be. 
Telling One’s Friends.—Nurses frequently think that 
they may tell anything they choose about their patients 
to their own personal friends or members of their own 
family, or to other nurses. Are they right or wrong in so 
interpreting their duties? Should a nurse in training 
who gossips with her friends outside the hospital about 
hospital patients ever be allowed to graduate? A well- 
known, wealthy lady entered a hospital for her first 
confinement. One foot of the baby was slightly bent, 
requiring only a little manipulation to straighten it. 
One of the nurses on duty told a married nurse friend of 
hers that the baby had a club-foot. Of course she 
thought her nurse friend would not tell, but the people 
concerned were prominent and the story was quickly 
told. It spread to the circle of the patient’s friends 
and lost nothing in the telling. Several friends came to 
the doctor to inquire if anything could be done for the 
club-feet of Mrs. Blank’s baby. The story wras traced 
back to the home of the married nurse who encouraged 
pupils to bring all the gossip of the hospital to her. OLD-FASHIONED VIRTUES 
63 
What course should training-school authorities follow to 
try to stamp out this habit of gossiping about patients’ 
affairs outside the hospital? 
Rash accusations and hasty judgments are failings that 
are not confined to nurses, but against which nurses 
should guard. A nurse on night duty misses her watch 
and immediately, when a general search fails to bring 
it to light, concludes that it has been stolen. She 
suspects that one of the men servants took it. Before 
reporting the matter to the principal she informs the 
police. The suspected servant is placed under surveil- 
lance. A few days later the nurse finds the watch under 
the mattress on her bed where she herself had placed it. 
What harm has been done by her hasty judgment, her 
readiness to cast suspicion? What can be done to undo 
the results of her mistake? How will this mistake affect 
the estimate of other people regarding the nurse in 
question? What, in your judgment, should the authori- 
ties of the hospital do in regard to such an occurrence? 
Suggestions for Written Work.—Prepare a series of 
not less than ten Do’s and Don’ts for nurses in regard 
to truthfulness and to the wise use of the tongue as it 
relates to nursing. 
QUESTIONS FOR DISCUSSION OR REVIEW 
1. What tests may a nurse apply to her conduct to 
be sure that it is right? 
2. How far should we speak the truth concerning our 
patients ? 
3. What limitations should a nurse place on herself 
when asked for information concerning a patient’s 
condition? 
4. What ethical principle does a nurse violate when 64 
ETHICS FOR NURSES 
she gives to others information which has come to her 
because of her work as a nurse? 
5. Mention some reasons why an untruthful nurse 
should not be retained in a hospital school. 
6. How does the fact of inexactness or deceit in speech 
affect the estimate which others place on a nurse? 
7. How may inexactness in speech affect a nurse’s 
success professionally? Financially? 
8. In what way may a nurse’s records affect the gen- 
eral course of treatment prescribed for a patient? CHAPTER VI 
Old-fashioned Virtues 0Continued) 
The conception which an individual holds as to his duty 
is an important index to his character. What does duty 
mean? Webster defines duty as “that which a person is 
bound by moral obligation to do or refrain from doing; 
that which one ought to do; service that is morally 
obligatory.” Duty is a graver term than obligation. It 
implies, in some cases, obedience or submission to 
superiors in authority. 
Duty to God implies reverence, worship and loving 
obedience. Duty to ourselves implies temperance, cour- 
age, self-respect, and due attention to our own health 
and well-being. Duty to others implies absolute justice, 
charitable judgment, and helpful service as we have 
opportunity and they have need. 
The Sense of Duty.—Even a very superficial study of 
a group of people will show that the sense of duty is 
much stronger in some individuals than others. One 
person sees what seems to be a duty of common hu- 
manity, and is impelled to perform it. Another sees 
the same thing, but has no feeling that he has any moral 
obligation to concern himself in any way about it. 
Ability to help plays a large part in determining our 
duty. Does our sense of duty depend to any extent on 
our early training and environment? Is it true that in 
the performance of that which has been generally 
agreed to be a duty there is often a curious mixture of 
65 66 
ETHICS FOR NURSES 
motives such as pride, sympathy, love of approval 
or applause, regard for public opinion, fear of external 
consequences, or hope of material reward? Give an 
example from your own experience that illustrates 
this point. Is our sense of duty strengthened or 
weakened according to the ideals of life which we have 
before us? 
Obedience.—One of the first lessons a child learns in 
the home is the lesson of obedience to those who naturally 
have authority over him. When he goes to school he 
has the duty of obdience still further impressed upon him, 
until, when he reaches the age when he can reason things 
out for himself, he should be able to see that obedience 
and respect for authority are fundamental to real success 
in practically any field of activity he may choose to 
enter. In the hospital these virtues assume an impor- 
tance that cannot be overestimated. Does obedience 
in the hospital and obedience in the home mean exactly 
the same thing? Not altogether. In the home there 
is less necessity for the strict enforcement of obedience 
in matters of time, and in various other ways. Time- 
liness and punctuality are closely related to obedience 
in the hospital. 
To learn to do the thing ordered punctually, when 
she is busy, when her own judgment opposes it or 
when she feels it to be unnecessary; to refrain from 
arguing the case when she feels she has a strong 
side to present; to make no grumbling comments 
about the order; to grasp the thought that the thing 
ordered is to be done even if it be inconvenient and so 
difficult as to be well-nigh impossible—these are qualities 
to be coveted and cultivated in every nurse. To make 
for herself a reputation for being faithful and dependable 
is possible for every nurse, even in her probation period, OLD-FASHIONED VIRTUES 
67 
and this sort of reputation means much all through the 
training. It means still more in the years to come. 
Be a probationer never so clever in examinations, 
alert, and skilful, she will be a failure as a nurse if she 
fails to observe the rules of those in authority, and if 
she omits or neglects things ordered which she did not 
find it convenient to do. Every hospital wants nurses 
who will do the thing ordered, at the proper time if at 
all possible, and if they find it impossible to carry out 
an order they will at once report it to those responsible 
for having that duty done. Exceptions to this rule may 
be necessary if a patient’s condition changes so that the 
reason for the order being given has passed or there is 
need of some modification. Even then these matters 
should be reported to those in charge. 
The quality of being teachable is one of the most im- 
portant that a nurse has to cultivate, not only at the 
beginning but all through her nursing career. No one 
admires an unteachable nurse, or a nurse who is con- 
fident that she knows more than she really does. In 
the beginning it is not of material consequence that a 
nurse know anything about nursing; the important 
thing is whether she is capable of learning and eager to 
do so. She will probably have to unlearn much that 
she already knows or thinks she knows, and to be taught 
many duties in which she already feels proficient. This 
is a part of the daily discipline which goes on unconsci- 
ously and which has such a large part in the real training 
process. 
Attitude under Reproof.—The attitude assumed by 
nurses under reproof affects greatly their own happiness 
and the harmony of the school. Nurses are mistaken 
when they regard themselves as isolated units or when 
they try to deceive themselves into thinking that their 68 
ETHICS FOR NURSES 
manners or methods affect only themselves. The 
nurse who is sullen or defiant when she is shown her mis- 
takes and what she must do to correct them constitutes 
a real problem in every school. Too often, instead of 
accepting rebuke and caution with meekness and with 
singleness of heart deciding that she will give no further 
occasion for correction on that point, she goes about 
clamoring for sympathy, proclaiming to other nurses 
“that she is tired of being scolded,” or that someone 
“has a pick on her,” and indulges in self-pity that is 
always unwholesome. 
Minor offenses can easily become major offenses in a 
training school, by the attitude of the nurse concerned 
when she is rebuked. It is a minor offense if a nurse 
leaves certain utensils, for which she is responsible, 
in a soiled condition when she goes off duty. If, how- 
ever, when the nurse is recalled to properly care for those 
utensils she refuses to do it, the offense assumes an 
entirely different aspect. A major offense has been 
created by the nurse out of a minor offense, and the 
major offense strikes at the very foundations of the 
discipline in the school. The first offense is readily 
understood and is excusable. The larger offense grow- 
ing out of it is inexcusable. 
Lack of respect for authority is a distinctive mark of 
bad breeding and stamps a nurse as undisciplined and 
defective in her conception of her real place in the in- 
stitution. Lack of respect is frequently shown in the 
use of slang terms when applied to doctors or to those in 
authority. The use of slang shows that the nurse is 
lacking in true culture and in her sense of what is right 
and proper; it reflects on the home training wrhich she 
has received. 
Discipline is a term of which a nurse hears much, and OLD-FASHIONED VIRTUES 
69 
in a general way she learns a good deal about it without 
trying to. To the young nurse the need for strict dis- 
cipline is not always apparent. Quite often she resents 
it because she has a wrong idea of its value. Discipline 
has been defined as “the difference between an army and 
a mob.” One writing on this subject has said: “Dis- 
cipline in its best sense means to educate, and to educate 
is to bring out of yourself your very best abilities in 
orderly fashion. There is no lost motion in the action 
of a well-disciplined army. Every move counts. The 
wonder of any of our great modern business enterprises 
is its smooth-working discipline. Maximum power de- 
mands maximum discipline. To discipline your will, 
your emotions, your desires is no easy job. To some it 
is a tremendous task, but to the man who through patient 
and determined effort finally brings his every ability 
into control and harmony, there is created a momentum 
that makes the greatest works come easy, all of which is 
the result of discipline.” 
In a hospital a system of semi-military discipline 
prevails. The rules, regulations and orders are as a 
rule passed to nurses through officers or workers higher 
in rank. The nurse is expected to observe the orders 
and rules given to those to whom authority has been 
delegated, whatever her personal feeling toward the indi- 
vidual may be. Each worker is expected to be in his 
own place until relieved from duty; to attend to the 
responsibilities assigned to him and not to interfere with 
the duties or affairs of others. Only thus can a general 
hope to command an army successfully. Only thus can 
an institution achieve its highest success. These rules do 
not prevent a spirit of helpfulness to each other; they do 
not hinder, for instance, one nurse in the same ward or 
corridor whose work is finished helping another who is 70 
ETHICS FOR NURSES 
delayed in getting through; they do prevent nurses from 
assuming responsibilities promiscuously and, perhaps with 
the best of intentions, doing harm. It may seem a small 
thing for a nurse or probationer to give a patient not 
in her charge, who calls to her, a glass of water, yet 
there are occasions when to give even a glass of water 
may be harmful to a patient, and for that reason she 
must go to those in charge of the patient and ask about 
it before doing it. 
Laxity in discipline in a training school is always a 
detriment to the nurses, even though they may think it 
a desirable thing. A free and easy manner among 
nurses while on duty, a failure on the part of those in 
charge of the departments to properly enforce rules 
made for the good of all concerned, is an indication of 
slip-shod work, and an attitude of carelessness that bodes 
no good to the institution or to the nurses in training. 
No one, as a rule, is thankful for strict discipline while 
undergoing it. It is only appreciated when, after ex- 
perience is gained, we are in a position to contrast a 
well-disciplined school with the other kind, and to com- 
pare the results as shown in nurses’ habits, spirit and 
ideals. 
Rules and regulations in a hospital are the outgrowth 
of experience and conditions. They are at once a means 
of education and of promoting the comfort and general 
welfare of all connected with the hospital. Without 
rules, any individual is at liberty to impose on others, 
and disorder, discomfort and lack of harmony are the 
result. Not every nurse in a hospital needs all the 
existing rules, but it is safe to say that unless conditions 
had arisen to make each rule necessary, it would not 
have been made. It may seem irksome at first to have 
a rule specifying the time that lights must be out and OLD-FASHIONED VIRTUES 
71 
nurses in bed, but experience clearly proves the 
necessity for it. To have a rule that nurses must clean 
the bath tub after using it seems trivial, even humiliat- 
ing—one feels like apologizing for it—yet a little observa- 
tion shows that even girls from good homes have neglected 
this homely and necessary duty, until they were re- 
minded that it -was a rule. In their final effect rules 
are educative, and the keeping of them an important 
part of one’s training. Instead of thinking of rules as 
irksome, they should be regarded as guide posts on the 
path of duty, necessary measures designed to promote 
the general good. 
Credulity is defined as readiness to believe on slight 
evidence. Because many pupils enter hospital schools 
with an overstock of credulity, most schools have taken 
some steps to protect such nurses from dangers which 
are well understood in every hospital. It is because of 
this that rules are sometimes made regarding nurses going 
out with men patients who have been in the hospital. 
Restrictions or rules in this matter should be regarded as 
safeguards to a nurse. They are a part of the moral 
safety movement in which many of the best men and 
women are engaged. It is surely no kindness to a nurse 
to allow her to be imposed on by men of uncertain 
character. 
It is well for nurses to remember that superintendents 
of hospitals and principals of training schools really 
desire pupil nurses to have all the legitimate pleasures 
that are compatible with their own best interests and 
the highest good of the school. Many years of experience 
are behind each rule. 
Loyalty, that indefinable quality which every institu- 
tion desires in the members of its working force, is in no 
way better shown than by careful observance of the 72 
ETHICS FOR NURSES 
rules and regulations. It is, of course, shown in numerous 
other ways, some of which will be discussed later, but 
loyalty begins with careful observance of rules, even if 
the nurse does not understand the reason for them. If 
a nurse ever expects to reach a position where she will 
command and instruct others, she must show her fitness 
for such responsibility by loyalty to the school and its 
rules, and to those in authority. 
The question of loyalty to another nurse, or loyalty 
to the patient and the institution, is one which a nurse 
frequently has to decide. What should a nurse do 
when a patient complains in her presence about some 
other nurse who is assisting in nursing the complaining 
patient? 
Suggested Subjects for Written Work.—A nurse on 
night duty leaves the bed of a paralytic patient in a soiled 
condition when she goes off duty. Her attention is 
called to it, but a few days later the same thing occurs. 
She is sent for to change the bed and leave the patient 
in proper condition but refuses to come. In what 
necessary qualities is this nurse deficient? What dis- 
ciplinary measures should the authorities of the school 
assume toward a nurse who manifests this defiant 
attitude? 
FOR DISCUSSION OR REVIEW 
1. Explain what you mean by the term “duty.” 
2. Outline briefly what you conceive to be one’s duty 
to God, to one’s own self, to others. 
3. Show that in performing one’s duty one may have 
a curious mixture of motives. 
4. In what way does the matter of punctuality enter 
into the question of obedience? OLD-FASHIONED VIRTUES 
73 
5. Mention several ways in which a nurse’s attitude 
under reproof may affect the happiness of others and 
the harmony of the school. 
6. Show how major offenses may grow from very small 
causes in a hospital. 
7. Write a short paper on discipline in a hospital show- 
ing why you believe it is important to the happiness and 
welfare of the hospital household. 
8. What should a nurse do when a male patient, of 
whose character she knows practically nothing, begins 
to flatter her and assert his undying devotion to her? CHAPTER VII 
Putting Principles into Practice 
A college president, on assuming the duties of a new 
position, in discussing the subject of educational ideals 
expressed himself as follows, and the remarks apply 
equally well to hospital students: “Nomatter how many 
courses you may give a student, no matter how many sub- 
jects he may study, no matter how many years he may go 
to school and college, or what degrees he may earn, unless 
you make a Christian gentleman out of him, unless he is 
trained to honesty, to honor, to love of truth and hatred 
of a lie, his education is a failure. We have been in 
danger of paying so much attention to the curriculum 
that we have lost sight of the importance of character.” 
In a hospital many questions of honesty and honor will 
present themselves to nurses—matters which they have 
never before had to consider. It is probable that in every 
life the keeping of the ten commandments and the great 
commandment at times presents difficulties, and nurses 
are no exceptions. What are the commandments from 
which a nurse in a hospital is most likely to be tempted to 
deviate? Think the matter over. Thou shalt not steal. 
Thou shalt not bear false witness. Thou shalt remember 
the Sabbath day to keep it holy. Does the keeping of 
any of these commandments present any special difficulty 
to nurses in a hospital? If so, how? 
Common Honesty.—One of the difficult points for 
many nurses to grasp is that there is an ethical principle, 
74 PRINCIPLES INTO PRACTICE 
75 
a question of honor, a principle of right or wrong, in- 
volved in the smallest transaction. It is not always pos- 
sible, nor should it be necessary for a nurse to have this 
pointed out to her by others, and it devolves upon herself 
to pause long enough before indulging in something ques- 
tionable to ask herself whether she can justify herself in 
doing it, whether she is being true to her best self in pur- 
suing a certain course, whether she will lessen her own 
self-respect by so doing. Strange as it may seem, the 
practice of common everyday honesty is the point at 
which many nurses fail. They apparently do not mean 
to be dishonest, but their consciences are either too un- 
developed to perceive when a thing is honest and when 
it is dishonest, or they deliberately violate clearly ac- 
cepted ethical principles of guidance that a child of ten 
ought to know should be observed for the common good 
of all. 
Is it honest or is it not for nurses on duty to use sugar 
supplied to the wards for the use of patients in making 
fudge for their own use? Is it honest or not for nurses 
to look into letters belonging to others? Is it honest or 
not for nurses to write letters to friends on temperature 
charts or record blanks belonging to the hospital? Is 
it honest or not for a nurse to nibble at the fruit in the ice- 
box which has been brought to some patient by his 
friends? Is it honest or not for a nurse to use for her- 
self delicacies provided by the hospital especially for 
patients? Is it honest or not for a nurse to say on her 
application blank that she will, if admitted, observe the 
rules of the institution, then violate them deliberately 
and say nothing about it to those in charge? Thus illus- 
trations might be multiplied, of practical ethical ques- 
tions which a nurse will have presented to her in the daily 
routine, questions in which there is an important ethical 76 
ETHICS FOR NURSES 
principle involved. The way in which she decides such 
questions affects not only herself but the whole tone of 
the school, and often the reputation of the hospital. 
Few more humiliating experiences come to a principal 
or head nurse than to have to confess to a patient that 
fruit or delicacies brought to him which he could not 
use at the time have mysteriously disappeared; yet such 
an occurrence is not so unusual as one might wish, and 
drastic measures have had to be taken in some hospitals 
to prevent this very thing occurring. Petty dishonesty 
is contagious, so is high-principled, through-and-through 
honesty. It remains for every nurse to decide which 
sort of influence she will exert. 
The question of her rights may be suggested. A nurse’s 
rights are those which may freely be accorded to every 
other nurse in the institution, those and no more. No 
hospital can afford to have favorites, to grant certain 
nurses privileges to indulge in practices which it would 
forbid in others. The harmony and good feeling so de- 
sirable in a hospital must be based on equal justice to all. 
A Nurse’s Honor.—A high sense of honor is one of 
the best things which a nurse can bring with her to any 
school or to any work in which she may, later on, engage. 
It is difficult to analyze the elements of this intangible 
thing called honor, but every nurse understands to a 
greater or less degree what it means. It is defined as 
“a keen sense of what is right, just, and true, with the 
course of life corresponding thereto; or as strict con- 
formity to the duty imposed by conscience, position or 
privilege; or as a scrupulous regard for integrity and 
reputation.” 
Integrity, that spirit of whole-hearted honesty, which 
excludes all forms of injustice that might favor one’s 
self, has special reference to uprightness in mutual deal- PRINCIPLES INTO PRACTICE 
77 
ings, to the carrying out of trusts for others, and to those 
matters which rules and laws cannot reach or enforce. 
It is especially in matters which cannot well be reached 
by laws or rules that a nurse’s sense of honor will be 
tested, in the carrying out of obligations in the right way, 
even though no one but the nurse herself may ever know 
of the matter which involved the question of honor. 
To be true to one’s self, to one’s own best ideals, is the 
hardest task a nurse will ever undertake. 
“To thine own self be true. 
And it must follow as the night the day, 
Thou canst not then be false to any man.” 
might fittingly be chosen as a motto for a school, a class, 
or a life. 
Carrying out the letter of a law or rule, but deliberately 
violating the spirit of it, is a temptation which comes to 
every nurse at some time. It is one which involves, 
directly, the nurse’s personal sense of honor. To do a 
thing or to refrain from doing it, simply because one is 
trusted, is a real test of character. The thing in itself 
may seem unimportant but the principle involved is 
tremendously important to every nurse. 
This fine sense of honor which a nurse possesses, or 
fails to possess, is one of the great factors in her success 
after graduation. Where it is absent, where the nurse 
has shown herself lacking in this characteristic, recom- 
mendations, if given at all, are often given reluctantly. 
The one from whom the recommendation is sought is 
not quite confident how the nurse will meet the character 
tests of the new position which she seeks, though tech- 
nically she may be fully qualified. The recommendation 
is therefore given, if at all, with reservations. The 
sense of honor is frequently the intangible quantity 
which decides the question between two candidates, 78 
ETHICS FOR NURSES 
who otherwise seem equally well qualified. The sense 
of honor exhibited in a thousand small ways stamps its 
possessor as a woman of distinctly higher grade. It is 
frequently in small ways where questions of honor are 
involved that nurses unconsciously determine their own 
status in nursing affairs. 
The custom of nurses taking money from the sick in 
return for extra service rendered to them was one of 
the intolerable abuses in the days before trained nursing 
began. One of the important and sweeping reforms 
that followed as a result of Florence Nightingale’s 
work and ideals for nurses was the abolition of this 
custom. Nurses of today occasionally are confronted 
with this old temptation to accept money from patients, 
while all reputable training schools have stringent rules 
against the practice. To illustrate: A young Jewess, 
who had been operated on, suffered most severely from 
thirst following operation. She had grown up with the 
idea that money could procure practically any sort of 
service that she desired for herself. She saw no reason 
why she might not bribe the nurse into giving her a 
drink of ice-water, so offered the nurse a dollar for a 
drink. The nurse hesitated, but finally took the money. 
After taking it she became afraid of it being found out 
that she had given the drink, kept delaying the giving 
of it, and finally went off duty without doing it. The 
patient was angry and told the head nurse of the affair. 
How should such an occurrence be dealt with by train- 
ing school authorities, in order to impress other nurses 
with the seriousness of the offense? If the money had 
been offered for special attention instead of for the drink, 
would the offense have been less serious? 
A young husband whose wife is to be operated on wishes 
as much attention as possible, without the expense of a PRINCIPLES INTO PRACTICE 
79 
special nurse for his wife. The head nurse in charge is 
young and inexperienced and he approaches her, telling her 
that he will “make it worth her while” to devote special 
attention to his wife. He begins by offering theatre 
tickets to the head nurse, and the day nurse in charge 
of his wife. Should the tickets be accepted? How 
should this situation be handled with the nurses? 
With the young husband ? 
In a certain school there were rigid rules against nurses 
taking money from patients, but small gifts from 
“grateful patients” were permitted. One certain nurse 
seemed to be extremely popular and received many 
more gifts than other nurses. It finally became known 
to other nurses that she was in the habit of dropping 
hints to patients as to things which she especially 
desired. She would proceed in some such manner as 
the following: After a trip to the shopping district she 
would remark, “I saw just the loveliest pair of dancing 
slippers today, just my size, number four, and only 
$3.50. Blank and company are having a sale. They 
were beauties, regular $5.00 slippers, but I hadn’t 
enough money with me to get them; I couldn’t afford 
them anyway, but I wanted them so much.” Forth- 
with a pair of the bargain sale dancing slippers are 
secured for the nurse by the “grateful patient.” Or 
she would remark, “I’ll be so glad when I am earning 
something. I’m just crazy to have one of those new 
shopping bags; my old one is so shabby; but of course a 
nurse in training has to go without such luxuries. Three 
years seems an awful long time not to be earning any- 
thing,” and the shopping bag would be presented by 
the next patient. What should nurses do who discover 
that one of the pupil nurses is inviting gifts to herself 
in this manner? What effect would the general prac- 80 
ETHICS FOR NURSES 
tice of this custom by all nurses have on the tone and 
general reputation of the school? How would it be 
likely to affect a graduate nurse’s methods later in life; 
in private or institutional work? What measures should 
be used in regard to it? 
Honest confession of accidents or mistakes made or 
of neglect, whether intentional or unintentional, is one 
of the finest indications that a nurse can give that she is 
possessed of those high principles of conduct that should 
characterize a nurse. Honest confession creates in the 
minds of those in charge of the school a feeling of con- 
fidence in a nurse and respect for her character, that 
will linger in their memories long after training days are 
past. 
This principle is probably nowhere so frequently vio- 
lated in a school as in the matter of breakage of hospital 
appliances. The cost of the article concerned may be 
small, but the principle involved is far from small. 
It seems difficult to understand the habit of concealment 
or denial of knowledge of how the article came to be 
broken or destroyed, which many nurses show in their 
daily life. It is difficult to understand how they regard 
the whole matter, or why they are willing to violate their 
conscientious principles for the sake of the small sums 
involved. What can one high-principled nurse do to 
quicken the consciences of her associates who are given 
to denial or concealment in such matters? 
The Rights of Others.—Occasionally a nurse is found 
whose home training has been so defective that she has 
little or no regard for the rights and property of others. 
Such nurses will borrow, without asking, articles of 
clothing belonging to other nurses and wear them and be 
deeply indignant when they are complained of, or are 
taken to task for such breaches of conduct. They will PRINCIPLES INTO PRACTICE 
81 
loudly insist on the innocence of their intentions when 
called to account, yet seem utterly unable to see that 
because another nurse is a friend, or is sharing the same 
room, it does not give them the right to appropriate 
her property. They would scorn to take money, but 
have no scruples about taking such articles as stockings 
or gloves, wearing them out, and never replacing them. 
Borrowing money from other nurses with no prospect 
of paying for years is another questionable proceeding 
frequently indulged in by nurses in training. Many 
college students are obliged to borrow money to tide 
them through their period of training, and the same is 
true of hospital students. But borrowing small sums of 
money promiscuously from other nurses is certain to 
create difficulties for the one who borrows and for the 
one who loans. It is no disgrace to have to borrow 
money, but the way in which the borrowing is managed 
may be disgraceful, and the things for which nurses 
borrow money are often exceedingly ridiculous. The 
judgment of the nurse who borrows money in order that 
she may give Christmas presents to her friends is 
certainly open to question, and many nurses have done 
this ridiculous thing. A nurse, known to the author, 
borrowed five dollars from another nurse saying she 
needed it to buy clothing. Instead, she used the money 
to secure a pretty frame for a large photograph of the 
gentleman who for the moment occupied the center of 
her affections, and with the remainder she purchased 
some elaborate lingerie which she certainly could have 
done without. Ten years after, the borrowed money was 
still unpaid. The nurse who needs a loan of money to 
tide her over till she becomes an earner should frankly 
go to the principal of the school and talk matters over. 
There are dignified and proper ways of securing such 82 
ETHICS FOR NURSES 
loans without embarrassing one’s associates by asking 
for the loan of money which they themselves need. 
The practice of honesty enters every day into such 
matters as the taking of temperatures and of making 
records and the most severe tests of character often 
come in the doing of routine duties. 
A nurse who was on night duty had the care of the 
patients on one floor. Most of these patients were 
children who were undergoing orthopedic treatment. 
As a rule none of the orthopedic patients were kept in 
this ward for more than two weeks to a month. A part 
of her duty was to take the temperatures of the children 
in this ward every morning. This became a tedious duty. 
In many of the children there was little or no change in 
temperature from morning to morning, so she decided to 
omit taking the temperatures of children who showed 
little variation, and simply mark the charts each morning 
as though she had taken the temperatures. What 
ethical principles did she violate in so doing? How 
would you characterize this offense? 
A nurse hated sponging typhoid fever patients. There 
was a standing order that all such patients should be 
sponged if the temperature went above 102°F. It 
became known that when this certain nurse was on duty 
the temperatures of fever patients were rarely recorded 
above 102°F. She either did not leave the thermometer 
with the patient long enough to secure a proper record, 
or she deliberately falsified the records of the tempera- 
tures and marked the charts always below the sponging 
point. What effect would this practice have on the 
work of the hospital if commonly indulged in? How 
can a principal prevent such breaches of trust on the 
part of nurses? What disciplinary measures should be 
used with nurses who fall under this temptation? PRINCIPLES INTO PRACTICE 
83 
Suggested Subject for Written Work.—A nurse is in 
charge of a patient with a very poor appetite. The 
doctor allows the patient to have ice cream whenever 
she wishes, and a small freezer containing a quart is 
ordered daily to be sent to the diet kitchen to be used 
especially for this patient. Soon after the first supply 
is sent to the diet kitchen, the nurse in charge is seen 
secretly treating two other nurses to ice cream from this 
patient’s supply. What qualities of character are 
shown in this transaction, by the nurse in charge of the 
patient, by the other two nurses? How would this and 
similar practices affect the hospital, the nurse herself, 
and the tone of the school? What measures should be 
taken to check such practices? What attitude should 
the authorities assume toward nurses who persistently 
indulge in such practices in spite of admonition? 
FOR DISCUSSION OR REVIEW 
1. Mention those parts of the ten commandments 
which seem to furnish special difficulties to nurses. 
2. What do you mean by “a sense of honor?” 
3. Show how the possession of a keen sense of honor 
may be a help to a nurse when seeking a position. 
4. Give some reasons why the custom of nurses taking 
money from patients should not be tolerated in a hospital. 
5. What is the difference in principle between taking 
money and taking other gifts? 
6. Should the accepting from patients of small favors 
or other gifts be permitted among nurses in a hospital? 
Give reasons for your answer. 
7. What method should be followed when every 
nurse on a floor denies breaking an article, which one 
nurse must have broken? 
8. Show how the principle of honesty enters into the 
taking of temperatures and the keeping of records. CHAPTER VIII 
Ethics and Economy 
Economy and efficiency are two important goals which 
hospitals try to keep before them in their management. 
Economy without efficiency in the care of the sick is 
hardly creditable. Efficiency without economy is indi- 
cative of ignorance and poor management. 
“Economy,” says Webster, “is management without 
loss or waste; prudence, with a disposition to save. 
Economy avoids waste and extravagance and applies 
money to the best advantage. Frugality cuts off 
ordinary indulgences, and insists on systematic saving. 
The latter conveys the idea of not using or spending 
superfluously, and is opposed to lavishness or profusion. 
Parsimony is frugality carried to extremes, involving 
meanness of spirit and a sordid mode of living. Economy 
is a virtue, and parsimony a vice.” It will thus be seen 
that a virtue when carried to extremes may become a 
vice, and that wise judgment is needed in a hospital to 
know where to draw the dividing line. 
Most hospitals have some rules of guidance for nurses 
in these matters. The rule that commonly exists, that 
worn linen or defective appliances are not to be cast 
aside, but should be brought in exchange for new articles 
of the same kind, is a wise rule that tends to economy 
and relieves nurses of the necessity of deciding when a 
thing is of no further use. 
Another rule that should be unnecessary is that towels, 
pillow covers, and such things shall be used for the pur- 
poses for which they are intended and for no other; this 
84 ETHICS AND ECONOMY 
85 
has prevented some careless nurses from using them as 
dusters or cleaning cloths. Rules that ice-caps or hot- 
water bottles must not be placed in coverings which are 
pinned with common pins have saved such articles from 
being promptly punctured by heedless nurses. But with 
all the safeguards that hospital workers have been able 
to devise to prevent thoughtless damage and waste by 
nurses, there is still much room for the individual nurse 
to exercise her judgment and to help or hinder the hos- 
pital in using the money entrusted to it to the very best 
advantage. 
The Handling of Hospital Property.—Many nurses who 
have been accustomed to the freedom of a home find it 
exceedingly difficult to get the thought fixed in their 
‘'inner consciences” that the hospital supplies and 
property which they are handling do not belong to them, 
that their rightful use is limited to that which is actually 
needed for those persons for whom the supplies were 
intended. 
Is it Wrong to be Wastefulf—This question admits of 
little argument. Waste, as a general rule, indicates 
either ignorance or lack of conscience in the person re- 
sponsible. Yet wilful extravagance on the part of nurses 
is not unusual. Many nurses have the mistaken idea 
that because the property belongs to the city or to a 
corporation it makes little or no difference to anyone 
whether they are careless or extravagant or not in the way 
they handle supplies in their department. “Use all you 
want to, the city pays for it,” or “we don’t have to pay 
for it” are remarks frequently heard that are indicative 
of the attitude of some nurses, especially in larger 
institutions. 
Free Service.—Two important sides to this question 
should be carefully considered by every nurse. Whether 
the hospital is supported from taxpayers’ money as a 86 
ETHICS FOR NURSES 
municipal institution, or whether from funds entrusted 
to the board of managers by private individuals to be used 
for the benefit of the sick, the fact remains that the work 
of every hospital is affected in quality or quantity by 
the amount of money it has to spend, and this is especially 
true in relation to its charity. Most hospitals have as 
many free beds as possible with the money at their dis- 
posal. The cost of keeping up a free bed in an average 
American hospital will probably be found to be some- 
where between $2.75 and $4.75 a day, the higher figure 
depending on a variety of things—proportion of ward 
patients, a busy accident service, expensive laboratory 
and research departments, and other items, the cost 
varying each year with the general cost of living. 
What is meant by a free bed is that it is free to the occu- 
pant, that someone else pays the cost. Most hospitals 
desire to provide for the sick poor as much free care as 
possible with limited funds. Thus it is easily seen that 
waste, just small waste, of milk, soap, gauze, absorbent 
cotton, electric light, gas, breakage which should have 
been prevented, each nurse wasting a little of these and 
other articles every day, mounts up in a year to much 
larger sums than nurses are aware of. It lessens con- 
siderably the service the hospital is able to render to the 
sick poor. This is one serious side to the matter of 
waste, or carelessness, in the use and care of hospital 
supplies and appliances. 
Extravagance in nurses has another serious side which 
relates to the nurse herself. Habits of waste or care- 
lessness, of extravagance, are a decided hindrance to a 
nurse’s success as a private or institutional nurse. They 
are defects of character which quickly show up and make 
her undesirable as a worker. A wasteful, extravagant or 
careless head nurse is not a safe example for pupil nurses; 
therefore few institutions desire to keep such nurses in ETHICS AND ECONOMY 
87 
positions of responsibility. An extravagant or careless 
private nurse is too expensive a commodity for most 
private households, and her reputation for these habits 
soon spreads. 
“We could have paid the trained nurse her regular 
charges by going in debt, but we found after a few days 
that she was so extravagant in different ways that we 
couldn’t afford to keep her, so we let her go and got an 
untrained woman who could get along with less and who 
knew something about economy.” This bit of real con- 
versation shows how the habits which a nurse forms while 
in training may quickly affect her professional reputation 
and her financial success as an independent worker. 
How does a nurse acquire such habits? To some extent 
they are acquired before she comes to the training school. 
Nurses are inclined to be either careful or careless, to be 
economical or the opposite, before they ever see inside a 
training school. Part of the practice of carelessness or 
extravagance is due to sheer thoughtlessness; part is 
due to a wrong attitude of mind toward the whole prob- 
lem; part is due to not knowing the cost of various 
articles and how the waste or carelessness of one nurse, 
when multiplied by tens or hundreds, really affects to a 
great degree the good work which a hospital is able to 
do for those who most need its help. 
Personal Responsibility.—It was stated in the opening 
chapter that one of the important points on which a 
nurse is judged is in her ability to be trusted with re- 
sponsibility. Every nurse, in the way she uses or 
misuses hospital supplies, appliances and property, is 
showing whether she can be trusted with larger re- 
sponsibility or not. Every nurse is, to a certain extent, 
a steward of hospital supplies; whether she is a trust- 
worthy or untrustworthy steward is for her to decide. 
If she carried a placard around her neck saying “I am 88 
ETHICS FOR NURSES 
wasteful; I am careless about hospital property and 
expense,” she would not reveal her character and habits 
more plainly than they are revealed in the everyday 
routine. 
Bed Linen and Bedding.—In the care and use of bed linen 
and blankets there is much need for the exercise of good 
judgment, if waste and misuse of these supplies are to 
be avoided. It is easily possible to go to extremes in 
this matter, to not change the bed linen as often as is 
really needed, or to be extravagant in the use of bed linen 
and needlessly increase the work in the laundry, as well 
as add unnecessarily to the wear and tear of linen as it 
goes through the laundry process. An investigation 
as to the constant shortage of linen in a certain depart- 
ment of a hospital revealed the fact that some nurses 
changed the sheets every time they gave the patient a 
bath. Nurses on special duty in that department gave 
daily baths, as a rule, and changed the sheets daily 
whether they were soiled or not. Clean folded sheets 
were used as draw sheets, or used as pads under bed 
pans, and the same sort of carelessness was observed 
in regard to towels and other articles. 
Good judgment is needed in using linen in cases where 
extensive wet dressings are used or in cases of burns or 
certain forms of skin diseases where the remedies used 
are of an oily nature, liable to leave an indelible stain 
on new linen or blankets. Likewise, also, special care 
is needed in regard to blankets used for baths, or for 
wrapping convalescents. 
Common examples of the abuse of everyday appli- 
ances may serve to furnish the beginning of a list, which 
every nurse can add to from her own observation. 
1. Scissors are used to remove corks from bottles 
and the points are broken. 
2. Boiling drinks are poured into glass tumblers, ETHICS AND ECONOMY 
89 
3. Hypodermic needles are left without wires and 
quickly rendered useless. 
4. Thermometers are placed in the mouths of delirious 
patients or children and forgotten. 
5. Utensil sterilizers are allowed to boil dry. 
6. Glass barrel syringes are left on tables or window 
sills and roll off. 
An excellent object lesson in what not to do with 
hospital appliances was shown at one of the conventions 
of the American Hospital Association. It consisted of 
a collection of articles ruined by misuse,* the articles 
being arranged in flat, square, cardboard boxes. The 
collection illustrated the following evidences of waste or 
misuse: 
Destruction of polished woodwork by hot water, 
soap and alcohol. 
Result of nurse splashing gown with Labarraque’s 
solution. 
Destruction of rubber by oil. 
Sling used to clean ink bottles. 
Burnt rectal tube. 
Burning of bedding, blankets, sheets, spread, mattress, 
etc., by leaving 16-candle-power lamp with shade on 
bed for one-half hour. 
Broken glass syringe. 
Result of uncovered hot-water bag lying on glass-top 
table. 
Result of boiling an infant’s woolen stocking. 
Result of putting rubber tubing away with clamp 
down. 
Destruction of rubber cap by ether. 
Result of using towel to wipe up tincture of iron. 
* Collection arranged by Miss Lauder Sutherland, Hartford 
Hospital, Hartford, Conn. 90 
ETHICS FOR NURSES 
Result of 16-candle-power drop-light left in contact 
with mirror in a dresser. 
Result of steam sterilization of celluloid combs. 
Result of placing silver teapot over gas flame. 
Child’s leather shoes spoiled by steam sterilization. 
Bathroom rug with olive-oil stains. 
How is Waste to be Prevented?—There is no one remedy 
which can be depended on to prevent waste, but much 
may be accomplished in this direction by systematic 
instruction, and by creating in the heart of each nurse a 
genuine desire to avoid waste. Theoretically, at least, 
most nurses profess to abhor waste. They will say 
emphatically “If there is one thing I hate it is waste,” 
and sometimes immediately proceed to use four times the 
amount of gauze needed for a pad, thereby making it 
cost the hospital four times what it should, or they cut a 
bandage instead of patiently unwinding it, or they do 
something else diametrically opposite to wise use or 
economy. 
Thrift.—The very first step in the promotion of thrifty 
habits is the taking account of the items handled in the 
daily routine, and their cost. A good method which is 
practised in some hospitals is to tabulate for each de- 
partment each month the name and cost of each article 
broken or destroyed by misuse. These lists are dis- 
tributed to the head nurses, to be by them presented to the 
pupils. This has the advantage of not only bringing to 
them the total cost of breakage each month, but of giving 
an opportunity for comparison between different wards 
or departments. The carelessness of workers in one 
department is often best appreciated when contrasted 
with those in a different department, where more care 
is exercised. 
In teaching the cost of hospital supplies various methods 
are in use. In one hospital a collection of the common ETHICS AND ECONOMY 
91 
CITY HOSPITAL. 
Ward Requisition, 92 
ETHICS FOR NURSES 
CITY HOSPITAL 
GROCERY REQUISITION ETHICS AND ECONOMY 
93 
ward supplies most likely to be broken or destroyed is 
arranged on heavy cardboards for object teaching, the 
articles being fastened to the board by narrow tape. 
This list would include rectal nozzles and tubes, catheters, 
thermometers, medicine glasses, small syringes, babies’ 
bottles, etc. The price of each article singly and by the 
dozen is marked. These object lessons constitute the 
nurse’s first lessons in hospital economy. A similar 
method is used in another hospital where pictures of the 
common articles, clipped from catalogues or magazines, 
are mounted on sheets of cardboard with prices listed 
under each article. These cost demonstration boards are 
hung in the class room for reference and for use in teach- 
ing. Another method consists in having a price list 
of articles used in the wards or departments typewritten 
and placed in a loose-leaf book belonging to every ward. 
This latter system is in use in many hospitals, and the 
system is further developed by having on every requisi- 
tion blank a column for costs. Specimens of these 
requisition blanks are shown. It should be understood 
that the cost of any of these articles is likely to vary 
from year to year and in different parts of the country. 
Suggested Subject for Written Work.—Prepare a list 
of not less than a dozen suggestions which, if observed 
by nurses, would reduce cost without lowering efficiency 
in a hospital. 
DISCUSSION OR REVIEW 
1. State briefly how the question of right or wrong is 
related to hospital economy. 
2. Give reasons why more care should be exercised 
in regard to hospital property than if the same were 
personally owned. 94 
ETHICS FOR NURSES 
3. Mention several ways in which a reputation for 
extravagance may hinder a nurse’s financial success. 
4. Explain what is meant by the terms “true economy” 
and “false economy.” Give examples of misuse or ex- 
travagance in the use of hospital linen that you have 
observed. 
5. Mention several ways by which nurses may reduce 
or increase the cost of rubber goods in a hospital. 
6. If one electric bulb, while burning, costs one cent 
for each hour, estimate the waste produced by five 
careless night nurses who each allowed on an average of 
five bulbs to burn unnecessarily for ten hours each night 
for a month. 
7. In a certain hospital breakage is charged to the 
nurse responsible. Where the breakage is not admitted 
and the responsible person not known, the cost of the 
destroyed article is divided among all the nurses in the 
department. Is this a fair rule? Should the innocent 
suffer for the guilty? How should such a condition be 
dealt with? 
8. In a surgical pavilion accommodating seventy 
patients, estimate the cost per patient, per day, of the 
gauze and cotton used in dressings. 
9. State the total cost to the hospital per year of 
wasting an average of four inches of gauze on each 
patient every day, considering that the hospital had a 
daily average of 160 patients. 
10. What should it cost to properly pad a splint 
eighteen inches in length and four in width? 
11. Mention several examples that you have person- 
ally observed of how waste occurs in regard to surgical 
supplies. 
12. In your own ward or department jot down the ex- 
amples of waste that have come to your notice in one day. ETHICS AND ECONOMY 
95 
GRACE HOSPITAL, DETROIT 
Price List of Articles Used on Wards (1923). 
A 
Applicators, wood, per box.$. 30 
Atomizer 90 
B 
Bags, hot-water 70 
Bags, paper T.B., per M... 2.25 
Bandage, Esmarch 06 
Bandage, gauze 06 
Bands, elastic per lb 1.30 
Basin, dressing 35 
Basin, pus 35 
Basket, waste 90 
Beater, egg 50 
Bell : 75 
Blotter, desk 03 
Blotter, small, per C 30 
Board, chart 80 
Boiler, catheter ..2.00 
Boiler, inst 2.25. 
Book, day order 50 
Book, Dr.’s order 25 
Book, patient’s clothes.. . .25 
Book, temperature 20 
Bottle, baby’s 04 
Bowl, bath 2.25 
Bowl, cereal 30 
Bowl, finger 15 
Brush, bed-pan 18 
Brush, bottle 05 
Brush, camel-hair 05. 
Brush, floor 90 
Brush, hair 75 
Brush, hand 021 
Brush, high duster 1.25 
Brush, radiator 25 
Brush, shaving $ .25 
Box, large red 25 
Box, paper sputum, per C.. .60 
Box, pasteboard T.B 02 
Box, sputum, tin 10 
Broom, floor corn 65 
Broom, oil 2.00 
Broom, whisk 35 
Buckles, gross 50 
Bulb, electric 30 
C 
Can, clothes 2.00 
Can, garbage 1.10 
Can, irrigation 60 
Can, sprinkling 50 
Candle 02 
Cap, ice 70 
Cap, rubber 50 
Caps, baby’s bottle, gross.. . .20 
Cards, colored 01 
Cards, morgue, per C 35 
Catheters, rubber 10 
Catheters, silk 75 
Catheters, silver 1.00 
Clips, small box 04 
Comb, fine tooth 25 
Comb, large 50 
Cots, finger, gross 2.67 
Cotton, absorbent 30 
Cotton, common 30 
Cradle, bed 2.00 
Cup, drinking 12 
Cup, enamel 15 
Cup, feeding 20 
Cushion, air 2.00 96 
ETHICS FOR NURSES 
Price List of Articles Used on Wards.—(Continued) 
GRACE HOSPITAL 
D 
Depressors, tongue, per M.$l. 10 
Director, grooved 30 
Dish, sauce 10 
Dish, soap, china 10 
Dish, soap, enamel 15 
Dish, square, enamel 15 
Duster, feather 75 
F 
File, nail 10 
Forceps, hemostatic 1.10 
Forceps, sponge 1.50 
Forceps, tissue 75 
Forks, silver, dozen 5.40 
Forks, steel 75 
Funnel, enamel 15 
Funnel, glass 20 
Funnel, hard rubber 25 
G 
Gas heater 2.50 
Gauze, per roll 3.25 
Glass, drinking 05 
Glass for thermometer 05 
Glass graduate, 1 dram 25 
1 ounce 25 
1 pint 85 
Glass, medicine 03 
Glasses, eye, blue 10 
Gloves, rubber, per pair... .35 
Graduate, enamel 75 
H 
Hamper, clothes 4.50 
Handle, mop 50 
Holder, match $ .40 
Holder, pen 03 
I 
Ink well 25 
J 
Jar, glass, large 2.00 
Jar, surgical carriage 2.50 
K 
Knife, carving 1.00 
Knife, silver, dozen 4.65 
Knife, vegetable •. .15 
L 
Ladle, soup 15 
Lamp, alcohol 25 
M 
Mask, eye 25 
Medicine dropper 02 
Mits, bath 50 
Mop, dish 10 
Mop, dish, wire 15 
Mop, floor 35 
Mugs, large and small 15 
N 
Napkins, paper, per M 90 
Needle, hypodermic, dozen .75 
Nipple, baby welcome, grs.. 4.00 
Nipple, simplex, gross 2.95 
Nozzle, douche 10 ETHICS AND ECONOMY 
97 
Price List of Articles Used on Wards.—0Continued0 
GRACE HOSPITAL 
P 
Pad, Kelly $5.00 
Pad, scratch, pound 08 
Pail, enamel 1.50 
Pan, bed, china 1.75 
Pan, bed, granite 2.25 
Pan, douche, granite 1.50 
Pan, dust 20 
Pan, sauce 1.00 
Pan, saute 75 
Paper, toilet 10 
Paper, wrapping, pound... .06 
Pencils 03 
Pens, gross 95 
Pins, common, pound 1.05 
Pins, safety-, gross 25 
Pitcher, enamel 80 
Pitcher, glass 50 
Plaster, adhesive, 5 x 12... .85 
Plates, breakfast 10 
Plates, dinner 12 
Plates, soup 15 
Points, enema 10 
Points, irrigating 10 
Polisher, floor 1.75 
Pot, cocoa 30 
Pot, tea, P.R. tray 30 
Probe, silver 75 
Pump, breast 50 
R 
Racks, baby bottle 25 
Razor 
Ring, napkin 10 
Ring, rubber 2.00 
Ruler 15 
S 
Saucer $ .08 
Scissors 1.00 
Screen, fourleaf 9.00 
Shade, light 30 
Shaker, milk 50 
Shaker, powder 10 
Shaker, salt 10 
Shaker, soap 10 
Shield, nipple 25 
Spatula 25 
Sponge, bath 75 
Sponge, desk 10 
Spoons, serving, dozen 4.80 
Spoons, table, dozen 4.80 
Spoons, tea, dozen 2.70 
Squeezer, glass 10 
Stick, orange 02 
Strainer, dish 50 
Strainer, sink 40 
Strainer, tea 20 
Strap, razor 2.00 
Syringe, aural 50 
Syringe, Davidson 75 
Syringe, glass, 1-ounce 35 
Syringe, hard rubber 1.25 
Syringe, hypodermic 55 
Syringe, Sub. Q 1.00 
Syringe, urethral 25 
T 
Tacks, thumb, gross 1.50 
Tags, baby bottle, per M.. .50 
Tags of all kinds, per C... .35 
Thermometer, bath 50 
Thermometer, clinical 65 98 
ETHICS FOR NURSES 
Price List of Articles Used on Wards.—(Continued) 
GRACE HOSPITAL 
Thermometer, dairy $ .50 
Toothpicks 10 
Tray, enamel, large 75 
Tray, enamel, small 50 
Tray, papier mache 75 
Tray, pen, enamel 50 
Tub, foot 3.00 
Tube, connect., glass 10 
Tube, drinking, glass, gross. 1.25 
Tube, drinking straw, M... .25 
Tube, rectal 10 
Tube, stomach 1.75 
Tubing, rubber, pound 80 
Twine, ball 20 
U 
Urinal, enamel 60 
Urinal, glass 50 
V 
Vase 20 
W 
Wicks, alcohol lamp 03 
Wires, hypodermic, bunch. . 10 
Wringer, mop 2.25 
Charts 
Anesthesia 40 
Bedside notes, per C 23 
History, per C 40 
Laboratory report, per C. . .22 
Medicine, per C 30 
Physical examination, per C . 35 
Standing order, per C 30 
Temperature, per C 25 
Weight, per C 24 
Pads 
Daily ward report, per C. $ .22 
Death notice 20 
Deposit check, per C 25 
Diet requisition, per C 08 
D. K. requisition, per C. . . .09 
Discharge slip, per C 10 
Drug requisition, per G 05 
Emergency requisition, per 
C 09 
Grocery 09 
Linen 13 
Nurse report, per C 21 
Pathological chart, per C. . .22 
Repair requisition, per C... .12 
Short memo., pound 15 
Transfer slip, per C 11 
x-Ray chart, per C 50 
Groceries 
Barley flour, box 25 
Bon ami, cake 05 
Brass polish, pound 48 
Butter, varies 35-45 
Cereals, dry pkg 10 
Chlorid lime, pound 05 
Chocolate, pound 40 
Cocoa, pound 35 
Coffee, pound 23 
Condensed milk, can (gal.). .70 
Crackers, pound 14 
Dust down, pound 08 
Eggs, dozen, vary 35 
Flaxseed, pound 10 
Floor wax, pound 30 ETHICS AND ECONOMY 
99 
Price List of Articles Used on Wards.—(Continued) 
GRACE HOSPITAL 
Flour, pound, varies $ .03 
Lemons, dozen, varies 27 
Matches, dozen boxes 10 
Milk, quart, varies 10 
Mustard, pound 22 
Oranges, dozen, varies 30 
Pepper, pound 25 
Salt, pound 01 
Sapolio, cake 05 
Soap chips, pound $ ,07-£ 
Soap, laundry, cake 03 \ 
Soap, toilet, cake 03 
Soda, washing, pound 02 
Starch 02 
Sugar, granulated, pound, 
varies 05 
Tea, pound 30 
Vinegar, gallon 32 CHAPTER IX 
Tact and Imagination 
It is hard for a nurse to realize the importance of the 
daily happenings which go to make up life while in the 
training school. It is hard for her to realize that the 
ethics of her personal life affect the very center of all 
efforts for the improvement of nurses and nursing, that 
what she does and is, and the influence that she is exert- 
ing, affects the whole nursing structure. Only as a 
school can improve the individual members of that 
school, can it accomplish anything in improving condi- 
tions—ethical conditions, which exist, and which rightly 
cause serious concern to those who have the welfare of 
the sick and of nurses themselves really at heart. Ethical 
questions are practical problems. They are questions 
dealing with the personal life and conduct of each nurse, 
with her way of looking at situations and of dealing with 
them as they present themselves in a more or less monot- 
onous routine day after day. Two elements which 
mean much in securing the comfort of patients and the 
general success of the nurse are tact and imagination. 
Tact is defined as the ready power of appreciating 
a situation, and of doing or saying that which is most 
suitable under the circumstances. It suggests the 
keenness of perception or discernment which enables a 
nurse to prevent awkward situations, or to avoid diffi- 
culties arising from temperamental differences. The 
word brings to our mind the nurse or the individual who 
100 TACT AND IMAGINATION 
101 
has the happy art of keeping things running without 
friction, of smoothing out ruffled dispositions by a few 
well-chosen remarks, or by an adroit turn in the con- 
versation. 
The untactful nurse always has a difficult time. She 
does not get along smoothly with people. There are 
sharp edges to her disposition. She may be conscientious 
and faithful but her lack of tact prevents her from getting 
or keeping good positions or from making friends gener- 
ally. She is very often what is called “self-opinionated,” 
disposed to argue points when it really makes no differ- 
ence, confident that she is right and that the patient or 
his friends, or somebody else, was wrong. She creates 
trouble for people in authority by her inability to smooth 
out minor grievances of patients and prevent them 
assuming larger proportions in the patient’s mind. 
She is apt to feel that patient’s likes or dislikes are of 
small importance. Every training school knows the 
untactful nurse. It is a part of the training school aim 
to transform untactful nurses into tactful ones, an aim 
not always reached. How may an untactful nurse cor- 
rect this grave defect in herself? There is no one way 
of doing it. Two of the best methods to use are to 
continually and honestly try to get the viewpoint of 
the other person, to try to see how he looks at the matter, 
and to practice thinking before speaking. 
A lack of sympathy with the other person is often at 
the bottom of a difficult situation which arises from lack 
of tact. A spirit of genuine everyday kindness in a 
nurse is quickly felt by most patients, and one does not 
often find troubles arising from lack of tact, where the 
patient is convinced of the nurse’s real desire and effort 
to be kind. Occasionally there is encountered a grouchy 
person who is at odds with the world in general, and on 102 
ETHICS FOR NURSES 
whom kindness seems to be thrown away, but these 
people are exceptions. The nurse who is really kind, 
and who takes pains to express her kindness in such little 
ways as are possible to every nurse, will have compara- 
tively little trouble in keeping her patient’s dispositions 
from becoming seriously ruffled on her account. 
Is kindness a natural or acquired gift? Can it be 
cultivated? If so, how? Study yourself in this matter 
of everyday kindness. What does it consist in? 
Seeing the Real Patient.—To see the real patient we 
must, in most cases, try to see him or imagine him in his 
natural environment; we must see him in relation to his 
family or relatives, or, lacking these, his associates, 
those with whom he mingles in everyday life. We see 
the patient in a free bed, or we think we see him. We 
think he should be profoundly grateful for all that is 
done for him. But we frequently fail wholly in ap- 
preciating how it must feel to some natures to become 
dependent on the bounty of others; how it must gall and 
fret a man or woman of independent spirit to be obliged 
to occupy a free bed. 
We forget that in many cases an enforced stay, even 
a short one, in a hospital, means loss of wages, fre- 
quently debt, worry from fear of losing a job, anxiety 
over family problems, perhaps overdue rent, perhaps 
hungry children, all these and more; yet in our short- 
sightedness, we see none of these things in the background, 
as we move in and out among the patients. We need 
not only good judgment but we need a kind heart, 
and a mind that desires keenly to understand the 
whole man, we need to learn to see beyond the standing 
orders and general routine. 
In one ward we may see a man who has struggled to 
save to make a small payment on a little home, which will TACT AND IMAGINATION 
103 
be his some day many years hence, providing he keeps 
up the monthly payments as stipulated in the contract. 
We can faintly imagine what loss of work, what a stay 
in a hospital, means in such a case. 
Close to this patient lies a foreigner who has been 
injured in a mining accident, with broken arm and leg. 
He has scant knowledge of English. Understands but 
little of the conversation in the ward. Has been saving 
his money to send to Italy to bring his wife and family 
to him. All his savings are likely to be swept away by 
this accident. 
At the far end of a ward we see a woman who was 
hurried to the hospital for an emergency operation. She 
left a baby and three other small children behind. Is 
worried greatly about her children. Husband is inclined 
to neglect home and family, and absent himself for weeks 
without letting her know where he is. 
In another bed we may see a woman for whom the 
joy of life has been killed because of a wayward son or 
daughter, or husband; in another we may see one whose 
whole life has been one long struggle with adversity, 
for whom troubles have followed fast on each other, and 
who looks out into the future with dread and apprehen- 
sion of what it may hold for her. In a small private 
room, we may see a patient whose furniture has been 
mortgaged to secure money to tide over the illness, 
because she was too proud to occupy a free bed, or a bed 
in a general ward. We may, if we look farther, see a 
boy or a girl in this family who has had to give up his 
cherished ambition of high school or college because of 
the drain on the family treasury made by illness. There 
are so many things about our patients that we never 
see because we do not try to really understand them. 
A clear understanding of people is rarely reached until 104 
ETHICS FOR NURSES 
we have learned something of what constitutes pleasure 
to them and what their ambitions and disappointments 
have been. Would we be a little more patient, a little 
more kind, a little more attentive to their requests, 
would our service be a little less mechanical, if we could 
see back into their lives more clearly, see each patient in 
his own setting, surrounded by the people and the things 
which make up his life? Is it part of our duty to try to 
see these things; to nurse the individual, not simply his 
disease? If so, how may we become proficient? 
Imagination, the power to call up mental images, to 
modify our conceptions of things seen or felt, to combine 
different ideas so as to form new ideas in our minds, has 
a large place in nursing. The lack of imagination is the 
cause of a very great deal of dissatisfaction where nurses 
are concerned. The nurse who has trained her imagina- 
tion and her sympathy so that she can at least dimly see 
things from the patient’s viewpoint, will not come glibly 
into a patient’s room and remark, “I attended my first 
autopsy last night,” and proceed to dilate on her feelings 
during the autopsy and to describe the situation. 
She will not come briskly into the presence of a pa- 
tient with a history of pain of long standing which she 
fears she will have to endure till death, and inquire, “Is 
the pain gone this morning?” She will never tell a 
patient that the troubles of which he complains are im- 
aginary, that there is nothing the matter with him if he 
only thought so. 
She will avoid using the rocking chair when she sees 
it jars sensitive nerves. She will try to remember the 
thousand and one little things that she would like done 
for herself if she occupied the patient’s bed. She will try 
to keep from a patient depressing, harrowing stories, or ex- 
periences, and to bring to him all the brightness possible. TACT AND IMAGINATION 
105 
The nurse whose imagination is developed as it should 
be will not permit herself to smile or to grow impatient 
where religious rites, ceremonies, or beliefs are concerned 
or mentioned. Few things are more appreciated by- 
patients than a practical expression of sympathy with 
a patient in his religious belief, when he knew the nurse 
was not of the same belief, yet it is not uncommon to 
find nurses giggling or making frivolous remarks about 
religious observances that were tremendously important 
to the patient and to his friends. They did not imagine 
how the patient felt about it. We cannot be expected 
to fully understand the deep meaning embodied in all 
religious observances; yet we can appreciate the fact that 
it is an effort of the soul to link itself to the Infinite One 
in some way, and we can be kind, whether we understand 
the meaning of the symbolic rites or not. 
The New Patient.—Nowhere is the lack of tact or 
imagination likely to cause keener suffering than in the 
manner shown toward new patients. To the nurse the 
new patient may be simply one more in the never ceasing 
procession of suffering or ailing individuals through the 
halls of pain, one more bed or room occupied, one more 
to carry out standing orders for, one more name to go on 
the diet lists. To the patient it is often a momentous 
experience in life, nearly always protested against and 
dreaded to some extent, nearly always fraught with 
anxiety, and more or less risk. 
Standing Orders.—Apart from the standing orders for 
new patients which include the orders to list his clothing 
and put them away; send money and valuables to the 
office, properly marked; take temperature, pulse and 
respiration; give bath; make out a chart, etc., may each 
nurse not make out for herself a set of standing rules of 
ethics for new patients which might read somewhat 
as follows: 106 
ETHICS FOR NURSES 
1. Give prompt and special attention to latest arrival 
in ward or department; always remember that nurses are 
hostesses in departments or wards, and same courtesy 
is required as in well-ordered home. 
2. Meet friends of patient if possible and impress them 
with personal interest in patient. 
3. Be sure to speak a few reassuring words of comfort 
and sympathy to patient as soon as possible after arrival. 
Let him know that he is going to like the hospital. 
4. Find out when food was last taken. Give light 
nourishment if needed and permitted, and if meal is not 
near. 
5. Inquire sympathetically about length of illness. 
Inquire as to whether he feels comfortable at present. 
6. Find out if patient has dread of hospital, and is 
suffering from needless terrors, and try to remove 
dread. 
7. Study to interpret to patient the real spirit of the 
institution. 
8. Never ignore existence of new patient till something 
has to be done for him. 
9. Cultivate habit of showing helpful interest, and 
study how to be kind as needed in each case. Try to 
remember likes and dislikes when special points are 
mentioned. 
10. Remember that we are dealing with afflicted souls, 
hungry souls, as well as afflicted bodies. 
The Patient’s Friends.—In many cases the friends of 
patients make larger demands on us than the patients 
themselves. We are ready to make allowances for 
patients, because of illness, but are often unwilling to 
make allowances for the mental suffering which a patient’s 
friends are undergoing because of his illness. Quite often 
the father, mother, wife or husband of a much loved TACT AND IMAGINATION 
107 
patient is suffering more deeply than the patient. Soul 
grief, soul suffering, cuts deeper than physical suffering. 
For instance, a young man of good family is wounded 
in a quarrel, while under the influence of liquor. His 
father and mother and wife have worried keenly over his 
habits. The illness or wound may be slight or serious, 
but is it not entirely likely that their suffering is deeper, 
more acute than that of the patient? 
If we have ever had a relative seriously ill we can 
perhaps recall our own feelings, and thus be better able 
to appreciate the feelings of our patient’s friends. 
It is never possible to make rules regarding patient’s 
friends that will fit all occasions that may arise, but many 
difficulties will be avoided if a right attitude is exhibited 
toward, and pleasant relations established with the 
friends in the beginning. First let us rid ourselves of 
the feeling that is far too common, that “visitors are 
nuisances.” Let us remember that relatives and friends 
have some rights which we should never forget. 
It is well to be guided to some extent in our dealings, 
not by the impression the friends make on us, but by 
the effect they have on the patient. A visitor may 
appear to us as a most unattractive and undesirable 
person. Her voice may be shrill, her habits noisy, and 
her appearance untidy. Yet to the patient she repre- 
sents a familiar figure whose habits are unnoticed 
because of long familiarity with them, and the effect on 
the patient may be decidedly good; his loneliness is 
banished, he feels better. The visit from this most 
unattractive person often means more than anything we 
can do for him. 
Visitors and Rules.—Perhaps the most difficult part 
of the nurse’s dealings with friends of patients comes 
when rules have to be enforced, regarding hours when 108 
ETHICS FOR NURSES 
they may come, or must leave, regarding delicacies or 
foods forbidden, and similar necessary prohibitions. 
This is a point at which nurses need tact and judgment 
and also a good stiff spinal column. To keep one 
patient’s visitor from annoying other patients is a highly 
important duty, but when tactfully done it rarely 
offends. To weakly yield when in charge of a ward or 
corridor, and entrusted with the enforcement of rules 
regarding hours at which visitors should leave, and allow 
them to overstay their time, is no real kindness to a 
patient. It is a sign of lack of ability, of moral courage 
in a nurse. If she ever wishes to be trusted with larger 
responsibilities she must show herself equal to dealing 
with such situations. 
A discerning nurse will be able to see when some 
visitor who has gained admittance to the patient’s 
room is tiring the patient, and will contrive to get rid of 
him whether the visitor’s time limit has expired or not. 
A difference must be recognized in dealing with the close 
family relatives, and with ordinary acquaintances. A 
great many people have a morbid desire to visit people in 
hospitals, who have never visited in the patient’s home, 
and this kind of visitor is likely to prove both tiring and 
troublesome to deal with. 
It is through the imagination that it is possible for us 
to put ourselves on the same plane as a child and, 
sympathizing with him, see things as he does, and under- 
stand in his way. Similarly we can try to put ourselves 
on the plane of thought and feeling which the patient 
occupies. We need to do this to keep from becoming 
mechanical in our habits of service to patients. 
How shall a nurse cultivate her imagination? Think 
of the ways in which muscle is developed, by which skill 
is acquired. TACT AND IMAGINATION 
109 
Noise.—What is the relation between a nurse’s imagi- 
nation and the noise that disturbs the sick so seriously. 
A very close relation indeed! If a nurse had her imagi- 
nation so trained that she could appreciate how noise 
jarred on sensitive nerves, would she be more careful, 
would she try to correct her noisy habits? What are the 
chief causes of hospital noise in your hospital? Con- 
structive difficulties may have something to do with 
them. Elevators may be too close to patients. Diet 
kitchens may be too close to wards. These defects are 
not for pupil nurses to remedy. 
If the question were, “ what is the chief cause of noise 
due to nurses in hospitals?” it might be clearer. Study 
carefully your own department for one day and night, 
and note every kind of noise that disturbs, day noises 
and night noises, and how they might be prevented. In 
nine cases out of ten, the chief cause of noise, apart from 
crying babies, and the noise from delirious or suffering 
patients, will be found to be the human voice, though 
not always of nurses. Staff doctors are often heard 
talking in the corridors in the same tone they would use 
if going through a factory. Internes are frequent 
offenders also in this respect. But since nurses are 
more numerous than either of these other offenders and 
since they are very directly and constantly concerned 
with the comfort of the patient, they should be keenly 
alive to the necessity of maintaining quietness in the 
sick room. They are alive to the need of quietness when 
they enter. Instinctively, people in general speak in 
hushed tones and subdue their movements when they are 
in the presence of sickness. When does this feeling of 
the necessity for quietness for the sick leave nurses? 
Can it be regained? A list of the causes of preventable 
noises in hospitals would include: Banging of doors, 110 
ETHICS FOR NURSES 
rattling of basins, creaking of hinges, flapping of window- 
shades, sometimes, noisy handling of chart files, moving 
of furniture, collecting of trays; the list might be con- 
tinued indefinitely. These causes should be made a 
subject for real study by every class. 
Can your imagination help you to answer this question ? 
If you were a really ill typhoid fever patient, how would 
it feel to be placed in a bed near the door of a ward 
through which doctors, internes, nurses, visitors must 
pass every few minutes in the day? If your temperature 
were hovering up around 104°F, would it enliven you 
and help you to combat the fever by having this constant 
stream of people on different errands, passing your bed? 
Would a little more imagination help us to place really 
ill patients where they would not have to endure this? 
Would it make us a little more thoughtful? 
The husband of a patient who had been in the hospital 
two weeks, marched into a hospital office one evening 
with high indignation written on his face. He had come, 
he said, to make a protest about the way his wife was 
being treated in the hospital. He was angry clear 
through, he said. Inquiry revealed that the sole cause 
of this outburst was that the doctor had said his wife 
might sit up in bed and the nurse hadn’t attended to it. 
The nurse told his wife that she couldn’t find a back- 
rest. In reality she had made no serious attempt to find 
one, had not reported to the head nurse that she 
couldn’t find one. She didn’t think it made any 
special difference. She did not imagine how it felt 
to have been on one’s back in bed for two weeks. 
She did not realize that “sitting up” may be, and 
often is, a red-letter event in an unusual chapter in 
a life history. She realized it only after a patient had 
grown indignant and complained, a husband had become TACT AND IMAGINATION 
111 
irate, and a general ill-feeling toward the hospital had 
been created. 
A Nurse’s Experience as a Patient.—A nurse who was 
twice a patient in the same hospital writes thus of some 
of her experiences while a patient: “The surgical treat- 
ment I received was excellent, but the nursing left much 
to be desired. The first night I heard the day nurse 
telling the night nurse ‘No. 13 was a new patient, 
another nurse, and she was sick of nurses.’ I had no 
sleep at all the first night, as my bed was facing the 
kitchen door, which was left wide open, with the light 
streaming directly on my face, and the night nurses 
constantly resorted thither for audible chatter. The 
second night I was given chloral, and hoped for some 
sleep; but the day nurse started my preparation for 
operation before she went off duty at 9 P.M., and left 
it for the night nurse to finish when convenient, which 
seemed to be about 1 A.M. Three enemas during the 
night at two-hourly intervals did not add to the possi- 
bility of sleep. The night nurse used to go from one 
patient to another with the same syringe without any 
sterilizing, and thought screens for douching, enemas, etc., 
quite superfluous.” 
If the imagination of the nurses on duty had been a 
little more fully developed, would these discomforts have 
been created for this nurse? Have the patients now in 
your care any reason to complain of you in the matters 
this nurse complains of? 
Suggested Subject for Written Work.—Make a list 
of the causes of noise that you have observed in your 
department with suggestions for their prevention. 112 
ETHICS FOR NURSES 
FOR DISCUSSION OR REVIEW 
1. Explain the term “tact.” How can it be cul- 
tivated ? 
2. How may an untactful nurse train herself to be 
tactful? 
3. Show how the quality of imagination in a nurse 
may affect the comfort of her patients. 
4. Apart from standing orders make a list of rules 
which nurses should observe in connection with new 
patients. 
5. What attitude should a nurse manifest to a patient’s 
friends? 
6. Give some suggestions for a nurse in regard to the 
management of visitors, mentioning things to be avoided. 
7. From your own observation in the hospital what 
reason have patients had to complain of their treatment 
by nurses? 
8. Apart from the standing and special orders, what 
does a nurse owe to a patient? chapter x 
Some Ethical Phases of Night Duty 
A nurse’s first term of night duty is one of the ex- 
periences in her life which lives long in her memory. 
Years later, she will usually be able to recall the names 
of some of the patients assigned to her- care, her own 
emotions on the first night on duty, and the little hap- 
penings that were a part of her initiation into the realities 
of night service. 
Like many other of her life experiences, this one will 
not come to her labeled “Important.” It will come as 
an ordinary step in her training, but it means for her 
more real responsibility than she has had to carry 
heretofore. It means that her character, her moral nature 
will be tested more severely than when on day duty. 
Supervision over her is not so close or so constant as 
she has been accustomed to. To have the care of a 
number of sick people entrusted to her, as a night nurse 
has, is not a small responsibility. What are some of the 
tests of character she will have to meet? 
1. The comfort of the patients will be more entirely in 
her hands than on day duty. This is not alone a test 
of nursing ability but of character. There are numer- 
ous things which she might do to add to their comfort 
which she may leave undone, and no one in authority 
will be the wiser. There is nothing in the orders con- 
cerning many things which she should do, to be true to 
her best self. Turning a pillow and shaking it for a 
113 114 
ETHICS FOR NURSES 
restless patient; a gentle rub of the back or limbs; 
straightening wrinkles from sheets; bathing face and 
hands; slipping a small pillow here and there to give 
support to a part; adjusting a larger pillow till it is 
really comfortable; moistening parched lips; snipping 
the edge of a roller bandage on an extremity, thus easing 
pressure on the wounded part; elevating a wounded limb 
till it is supported gradually and evenly and is com- 
fortable; supporting the knees and thighs by a pillow; 
careful adjustment of light and arrangement for proper 
ventilation; a bit of extra covering as needed—these are 
suggestions of “comfort” methods which need to be 
adapted to the individual patient, few if any of which 
will be included in the orders. 
What qualities of a nurse’s character will be tested 
by these opportunities for real genuine service to the sick? 
How far may she excuse herself for neglecting them? 
What effect will continued neglect of such opportunities 
have on a nurse’s habits? How will indifference to a 
patient’s comfort, even when combined with rigid ad- 
herence to orders, influence her desirability as a nurse? 
2. Her good judgment will be tested more severely than 
on day duty. Conditional orders are often given as to 
whether to give or withhold certain medicines. A 
patient’s condition may seem to be growing more crit- 
ical. She must decide as to whether she shall report the 
matter. 
A sudden serious change may develop which may make 
it necessary to call the resident physician or the friends 
of the patient. She does not want to make herself a 
nuisance by raising unnecessary alarms, or by making 
too frequent demands on the night supervisor; she does 
want to have everything possible done for the patient. 
In a small hospital there may be no night supervisor. ETHICAL PHASES OF NIGHT DUTY 
115 
The day supervisors need their rest. Shall she disturb 
any one or not? These are tests of the make-up and 
development of the nurse. 
3. Her powers of observation will be tested. Serious 
complications or emergencies may occur which she 
should have noted and perhaps did not. A dressing may 
accidentally become displaced, leaving the wound ex- 
posed to infection. She should notice it. She may often 
have to judge of the severity of a symptom of which the 
patient complains. Many patients are highly emotional 
and make a fuss out of all proportion to the gravity of 
their condition. She will be open to the charge of harsh- 
ness and indifference, if she refuses to believe they are 
suffering and does not apparently try to relieve them. 
She may give such patients so much attention, because 
they are noisy and troublesome, that she neglects some 
silent sufferer who needs special attention. 
A practice far too common among night nurses is to 
spend time in preparing suppers or lunches for nurse 
associates or interns, and to neglect patients’ calls, or to 
fail to watch carefully seriously ill patients while this 
apparently harmless practice is being indulged in. 
A patient who was well advanced in pregnancy devel- 
oped pneumonia and was taken to the hospital. A special 
duty nurse, a graduate, was engaged to care for her at 
night. The patient was given a sedative so that she 
might secure sleep. After giving the sedative the special 
nurse prepared a lunch for herself and two or three others. 
They lingered over the table. Several hours later the 
night intern visited the patient’s room. A miscarriage 
had taken place. Mother and baby were both dead. 
The special nurse thought she was sleeping. She was so 
busy with her supper party that she neglected to observe 
carefully. What course should have been followed by the 116 
ETHICS FOR NURSES 
principal of the school in regard to this nurse? What 
qualities of heart and mind did she lack that contributed 
to the deplorable result just described? 
Hysteria is a term which nurses often use too freely. 
Nurses who would not think of transgressing the rule in 
regard to other diseases that a well-trained nurse does 
not make or announce a diagnosis, and does not pre- 
scribe, outside of simple nursing measures for comfort 
or relief, nurses who have only a glimmering of under- 
standing of what hysteria is, will glibly announce that 
this or that patient is suffering from hysteria. They do 
not know that the ablest physicians are often perplexed 
and deceived in regard to such cases, and unwilling to 
venture a positive opinion, while frequently with the 
recklessness of inexperience and ignorance, a nurse after 
being one night with a patient, will freely pass judgment 
and announce that her patient has hysteria. Even if 
it be true, it is never wise for a nurse to announce it. 
Few things will give greater offense to the patient or his 
family than such an announcement, and when it has to 
be made, it should come from the doctor in charge of the 
case, and not the nurse. 
It is no part of a nurse’s business to diagnose disease, 
yet every day one may find nurses doing it. Guesses in 
many cases will necessarily be made. The patient will 
often announce his own diagnosis of his case, but every 
nurse should study to avoid expressing her opinions as 
to the disease a patient is suffering from. To do so 
shows a lack of training, a lack of that fine sense of pro- 
priety which nurses should try to possess. 
This rule holds just as good in regard to the ailments 
of nurses as in regard to patients. A nurse in announcing 
that her roommate or next door neighbor in the nurses’ 
home is ill, adds perhaps the statement, “Her throat is ETHICAL PHASES OF NIGHT DUTY 
117 
dreadfully sore. I think she has diphtheria/’ and the 
story grows, as it is passed around. Some nurses seem 
to feel that if a nurse is ill they may freely express their 
own opinions as to the disease, even if a doctor has not 
examined her, or if he is withholding a diagnosis till he 
feels more certain. 
Think over some of the bad results which may follow 
a nurse going out of her province and announcing her 
diagnosis of an illness. What results may such a habit 
lead to in a hospital, in a nurse’s home, also when engaged 
as a private nurse? 
4. There will come to a night nurse the temptation to 
spend too much time with a patient who is congenial 
to her and to neglect others less congenial. This temp- 
tation is not peculiar to night duty, but with less close 
supervision of her methods the night nurse is the more 
likely to yield to it. 
5. Attire.—A night nurse on special duty is frequently 
tempted to be careless in regard to the attire in which 
she appears in corridors, before doctors, internes, and 
orderlies. Make a note of the things to be avoided in 
this respect. 
6. Loyalty to the institution and its rules will be tested 
in various ways while on night duty. She will often find 
it inconvenient to enforce rules regarding hours when 
visitors must leave, and lights must be out; she will 
perhaps be tempted to gossip with internes and doctors 
and to forget the proper limitations placed on duty in 
regard to professional relations with men, of whatever 
class. She may easily become the subject of unpleasant 
gossip by some indiscretion of this kind, which is usually 
noted by some patient or fellow-worker. 
Is a night nurse on duty at liberty to provide lunches 
for internes who happen to make late rounds, using the 118 
ETHICS FOR NURSES 
food supplies provided for her, or for the use of patients, 
for that purpose? What bad results are liable to follow 
if a nurse begins this practice? 
7. Her Honesty will be Tested.—Much may be done that 
should not be done and the matter covered up. 
She may be tempted to absent herself from her ward 
or department for some time, leaving no one in her place. 
She may neglect to make rounds as frequently as ordered 
to make sure that all is well. 
She may permit herself to fall asleep while on duty 
and neglect to carry out certain orders, or neglect her 
patients. 
She may try to cover up her failures by making false 
entries on her records. 
She may wilfully waste hospital money by allowing 
unnecessary lights to burn, and this is a form of un- 
trustworthiness. 
She may neglect to “own up” to the head nurse 
or principal of the school that certain things occurred 
or were not attended to. The nurse who “owns up” 
is the nurse who inspires confidence. She shows she 
has that fine sense of honor so essential in a good nurse. 
It is not always an easy thing to do. It requires courage. 
Sometimes the warring impulses in a nurse’s heart will 
suggest to her “why say anything about it? It prob- 
ably will never be known; why bother about a little 
matter that is not important?” Every nurse knows 
by experience this war with one’s own conscience. How 
she meets these apparently simple and unimportant 
tests is a matter that is going to count tremendously 
in the moral influence she exerts on others, on the moral 
atmosphere of the school, and these tests leave their own 
indelible mark on her personal character. 
Principles are inconvenient things, sometimes. Matters ETHICAL PHASES OF NIGHT DUTY 
119 
of expediency suggest one course; duty and conscience, 
another, but there is no question as to the ultimate 
reward of putting what is right before the thing which 
at the time seems more convenient, expedient, or to be 
preferred. 
8. Accuracy is closely related to truthfulness. It is 
an important quality for a nurse to cultivate, and night 
duty is an especially good time for her to put forth special 
effort to develop this quality. It is her business to be 
able to state facts accurately, definitely, in regard to 
every patient under her care. Under average conditions, 
a nurse will have some patients sleeping most of the 
night; others who are restless and easily disturbed; 
others who are unable to sleep because of pain or dis- 
comfort. Her reports should never consist of vague 
generalities such as “slept pretty well” or “had a good 
night.” A patient who did not bother the nurse very 
much or make many demands on her may easily be 
said to have “had a good night,” when in reality the 
night nurse did not know whether he slept at all, or 
how much. Her reports should state definitely the 
approximate number of hours each patient slept, except, 
perhaps, those who are convalescent and whose general 
condition needs no special watching at night. A 
patient’s record may state that he “slept pretty well,” 
while he complains tha', he got little or no sleep at all. 
Quite often a patient who lies awake for an hour or 
two (the night hours often seem to be more than sixty 
minutes in length) will complain that he was awake 
all night. The nurse should visit each patient often 
enough to know how many hours, approximately, he 
slept or was awake. 
What is true of accuracy as it relates to sleep is just 
as true in other details. An inaccurate nurse guesses 120 
ETHICS FOR NURSES 
about much which she should know and be able to 
speak definitely and positively. She often carries her 
guesses into the realm of medicines and does not bother 
to measure drugs of various kinds. She records guesses 
as exact facts. 
A night nurse was seen pouring whiskey into an or- 
dinary drinking glass. “How much whiskey is the patient 
supposed to have that you are preparing that dose for?” 
she was asked by the night supervisor who was passing. 
“A half ounce” was the nurse’s reply. “You have 
nearer two ounces than a half ounce in that glass,” the 
supervisor replied. The nurse argued that she knew a 
half ounce without measuring it. On measuring the 
dose which the nurse had poured out, it was found that 
she was giving the patient an ounce and a half of whiskey 
instead of a half ounce. She had been carefully taught 
to measure drugs, but she did not class whiskey as a 
drug. She did not do as she was taught. She thought 
it did not make any difference if he did get a little more 
than was ordered. She was willing to guess and take 
chances instead of giving medicines as she had been 
taught. Especially she was given to guessing on night 
duty when she thought it would not be noticed. She 
was reporting on her records that the patient had been 
given a half-ounce dose of whiskey when in reality he 
had been given three times that amount. What moral 
principle did she violate? 
Apart from the moral principle involved in this trans- 
action, what bad effects might accrue to patients as a 
result of this kind of ethical failure in a nurse? 
System.—While on day duty a first year nurse’s work 
is largely planned for her by head nurses, or by nurses 
with more experience. On night duty she has the plan- 
ning of the details of her work herself to a great extent. ETHICAL PHASES OF NIGHT DUTY 
121 
The comfort of the patients will be influenced to a 
considerable extent by her systematic habits or the lack 
of them. 
It is usual to try to have the wards quiet and lights 
shaded or turned out by nine o’clock so that sick people 
can settle down to sleep. Most duties which would 
interfere with the patient’s sleeping will probably be 
attended to before that time. Patients who are likely 
to need constant watchfulness and attention will have 
screens adjusted; night lights will be in readiness. 
Causes of noise will be studied and measures taken to 
prevent. The nurse herself will wear soft-soled shoes 
and cultivate gentle footsteps and movements. 
The orders will be studied and plans made for carrying 
out the duties with quietness and “despatch.” Basins, 
glasses, and appliances will be cleaned up as she goes 
along, and not allowed to accumulate and add to the 
morning work. She will be told the earliest hour when 
morning temperatures should be taken, and will be care- 
ful not to wake patients at unnecessarily early hours to 
carry out a routine duty. She will try to study how to 
systematize her work so that she gets through without 
being “rushed” in the last half hour. All the time she is 
arranging her work she will be developing that quality 
called “Executive Ability, ” which is so much in demand. 
Ten nurses can follow orders, can do routine work well, 
if planned and directed by someone else, where one will 
be found who has developed the qualities of planning for 
others, of getting work done without needless fuss and 
friction. It is the one nurse who has cultivated this 
quality before and during training who finds positions 
seeking her; she is in demand. Her services are worth 
more than those of the other ten who have not this 
quality. 122 
ETHICS FOR NURSES 
The Nurse’s Health.—The turning of night into day, 
of working hours into sleeping hours, is never or rarely 
accomplished without some difficulty in regard to sleep 
and general health. The general experience of night 
duty is that it causes physical depression in a greater or 
less degree. For this reason a nurse needs to guard her 
health even more carefully than when on day duty. 
Out-of-door recreation, taken some time during the hours 
of sunshine, is imperative if general vitality is to be 
kept up to the ordinary mark. Sunshine is a great 
yitalizer and restorer. There is a wonderful power in 
“God’s out-of-doors” to minister to our minds which 
exercise their subtle influence over our bodies; to in- 
crease our power to resist disease and the depressing in- 
fluence of the sick room; to quiet irritated nerves, to 
keep us sweet tempered and at our best. 
The temptation to violate the rule which requires 
night nurses to be in bed between certain hours of the 
day comes to most nurses, yet both she and the patients 
suffer if a nurse fails to get the sleep required. It 
takes a few days to get accustomed to sleeping during 
the daytime. If a nurse is unable to sleep after she has 
used all the measures she knows of to procure sleep, the 
matter should be reported to the principal of the school. 
Experience teaches much in regard to this matter. 
Perhaps a nurse is indulging in strong tea or coffee just 
before retiring; perhaps the room she sleeps in is not well 
ventilated or darkened; perhaps there are house noises, 
noise made by other nurses, which the principal could 
quietly and promptly check if she knew of their occur- 
rence. In any case, since a nurse cannot do her best 
work without a reasonable amount of sleep, it is im- 
portant that everything possible be done to help her 
secure it. ETHICAL PHASES OF NIGHT DUTY 
123 
The Avoidance of Friction.—The dividing line between 
a day nurse’s responsibility and that which properly 
belongs to night nurses is not always as clearly drawn as 
we might desire. There are numerous opportunities for 
friction and unpleasantness, which may react unfavor- 
ably on the patients. Such friction often renders 
nurses unhappy, and the cause is usually so trivial that 
one grows impatient with nurses who yield to it. 
Let it be understood clearly that since nurses are in 
training and forming habits, it is no real kindness in a 
nurse to cover up laxity or neglect in some other nurse 
who is being trained. Training should be helping every 
nurse to overcome such habits, and by covering up the 
results of careless habits we help a nurse to become more 
careless. 
The manner in which acts of neglect or carelessness are 
brought to a nurse’s attention has much to do with the 
way she accepts reproof or reminder. If the lapse is 
apparently accidental we can overlook it in a nurse 
who is usually careful. If it seems to occur so often as 
to be habitual with her it has a different aspect. Motive 
and habit need to be considered. 
A badly soiled basin was found one morning by the 
day nurse in charge of the corridor. She called the 
night nurse’s attention to it. The night nurse declared 
it was there when she went on duty, that she had not 
touched the basin but had left it where she found it. 
The next morning the night nurse’s attention was again 
called to the basin; it had been carefully left for her to 
clean up. She refused; sharp words followed. Other 
nurses were called in to bear witness in the case. The 
tempest grew. Much ill-feeling was created. Finally, 
each nurse determined to carry the matter of her inno- 
cence to the principal. They came, unhappy, crying and 124 
ETHICS FOR NURSES 
angry, with their stories. Two or three days had 
elapsed. What course should the principal have pur- 
sued in the matter? How might such unhappiness have 
been prevented by each nurse? Was the cause of the 
difficulty enough to have caused the nurses such un- 
happiness? After the unhappiness and trouble caused 
by the incident, what should the nurses involved do 
to minimize the bad effects of the quarrel? 
Suggested Subject for Written Work.—Prepare a list 
of ten suggestions which you would give to a young nurse 
about to begin her first term of night duty, things to do, 
things to avoid. 
FOR DISCUSSION OR REVIEW 
1. Mention at least a dozen “comfort methods” 
which a night nurse may use, which are not likely to be 
in the standing orders. 
2. State why or how a nurse’s character is likely to be 
more severely tested on night duty than on day duty. 
3. What effect will continued neglect of small things, 
by which she might add to a patient’s comfort, have on 
her own character and the general quality of the service 
she renders? 
4. Give reasons why nurses should be careful not to 
announce that a certain patient has hysteria. 
5. Is the temptation for a nurse to administer seda- 
tives or sleep-producing drugs to noisy or troublesome 
patients, without orders, one that is likely to present 
itself to night nurses especially? State your own ob- 
servations on this point. In case a nurse yields to this 
temptation, what should be the policy of the principal 
of the school toward her? 
6. If a night nurse discovers that another night nurse ETHICAL PHASES OF NIGHT DUTY 
125 
is administering sedative drugs without orders, what 
course should she pursue? Has she any responsibility 
in the matter? 
7. What points should a nurse on special duty at 
night be careful to observe in regard to her attire? 
8. Mention some of the special problems that present 
themselves to night nurses. 
9. At what hour in the morning should a nurse begin 
to wake patients for temperature taking and the morn- 
ing work? 
10. What suggestions would you give a nurse in man- 
aging her morning work? 
11. Show how night nurses have special opportunities 
for developing systematic habits. 
12. Outline some important rules of hygiene which 
night nurses should be careful to observe. CHAPTER XI 
Ethics and the Everyday Routine 
Nothing so tests character as the daily routine. We 
may be able to rise to sublime heights of courage and 
resourcefulness in times of emergency, and yet easily 
fail to show the patience, tolerance, faithfulness and good 
judgment needed in the everyday routine of the ward or 
department. Here ethical principles have to be weighed 
quickly and acted on, or the opportunity is gone. Habits 
assert themselves. The record which we are making 
every day as practical workers and as high- or low-prin- 
cipled women will probably count for or against us years 
hence. It may be a hindrance or a help in getting some 
greatly desired position. This truth is one which nurses 
should never forget, for probably no class of workers is 
more dependent on recommendations than are nurses. 
There is a close relation between recommendations and 
the daily record of conduct and deportment which a nurse 
leaves in the hospital. 
Permanent Records.—In the efficiency records of a 
well-organized school there will be found, concerning 
every nurse, her grade on such points as the following: 
Personality 
disposition. 
neatness. 
Quality of work. 
Agreeableness to patients. 
Conscientiousness in details. 
Obedience. 
Power of observation. 
Reliability. 
126 ETHICS AND EVERYDAY ROUTINE 
127 
Systematic habits. 
Executive ability. 
Health. 
Nursing instinct. 
The nurse makes these records, the principal keeps 
them for future reference, when inquiry comes to the 
hospital in regard to her. 
Disposition.—The nurse’s general disposition mani- 
fested in a thousand ways carries tremendous weight 
when fitness for different positions has to be considered. 
A recommendation which states that “Miss Blank is a 
capable nurse, but—” is not a very desirable recommenda- 
tion, yet it is the only kind which many principals can 
conscientiously give to some nurses. It means often that 
the nurse knows how to nurse, that her technical ability is 
creditable, but that in disposition or general conduct 
as a woman there is doubt as to her desirability. A 
nurse may be a success considered from the standpoint 
of technic, and a brilliant failure from the standpoint of 
ethics. The great majority of failures on the part of 
nurses to measure up to the reasonable expectations 
of the public are failures in disposition or conduct; they 
are ethical failures. 
Is a nurse inclined to be sullen or sulky under reproof? 
It becomes a part of her record if she is. 
Does she give way to anger easily? 
Has she the quiet dignity of manner so desirable in a 
nurse? 
Is she inclined to make confidential friends of her 
patients on very brief acquaintance? 
Is she careful in her habits of speech? 
Is she addicted to slang, or does she indulge in vulgar 
expletives and coarse jests? 128 
ETHICS FOR NURSES 
Is she always alert to observe the niceties of conduct 
in her relation to her patients? 
Is she faithful in small details? 
Is she inclined to criticize the management? 
Does she openly discuss the methods and failings of 
physicians? 
Is she careful in all her dealings with men—doctors, 
patients, orderlies, patients’ friends, other men—or is her 
conduct such that she becomes a subject for gossip or 
criticism because of indiscretion in this respect? 
Is she a chronic grumbler? 
Does she act as if she were a much-maligned mortal, 
whose misfortunes were always due to someone else? 
Does she cherish the foolish notion that someone in 
authority has a secret grudge against her and that she 
can never expect to be dealt with justly? 
Is she able to get along sweetly with her associates, or 
are there liable to be signs of friction wherever she hap- 
pens to be on duty? 
Is she afraid of doing too much for her patients? Does 
she carry with her the spirit of glad, willing service? Is 
her spirit selfish or unselfish? 
Is she careful to observe rules, or does she need con- 
stant watching? 
Is she earnest in her desire and efforts to improve and 
to correct her own faults of disposition or habit? 
Improvement.—These are some of the points at which 
every nurse is being tested in the everyday routine. 
Perfection is not expected of her. Improvement is 
rightly expected. Training should be improving her. 
It is the nurse who, after having her attention repeatedly 
called to the need of improvement in some particular 
yet shows no sign of improvement, no effort to correct 
the fault or weakness, who is the big problem in many a ETHICS AND EVERYDAY ROUTINE 
129 
school. Her technical work may be good, her disposition 
most deplorable. She may be tolerated and allowed to 
finish her course, because she commits no open or flagrant 
misdemeanor that has been discovered, that seems to 
justify her dismissal; but how can a nurse who has proven 
an ethical failure hope for her training school to recom- 
mend her for positions where she will have an opportunity 
to set an example of unethical conduct and unworthy 
disposition to others? 
During the first year, before habits are too firmly fixed, 
there is excellent opportunity for any nurse who earnestly 
desires it to “mend her ways,” to reform her habits, and 
to constantly endeavor to live up to the personal ideal 
she should keep before her. Her ideal should change as 
she sees a little deeper into the meaning and end of life 
and of nursing, but it should never descend to a lower 
plane. 
The Need of Solitude.— Every individual needs her 
seasons of solitude when, apart from the distractions of 
life and away from the influence of other minds, she can 
look into her own soul, take a square look at the record 
she is making, and see as in a mirror the points where 
effort at readjustment, at strengthening weak places in 
character, should be made. This time of solitude a nurse 
will rarely get unless she insists on it. Much time is 
wasted by nurses in off-duty hours by aimless gossiping 
about the incidents of the day, gossip which may be 
harmful to the nurse, even if not malicious, because of 
the habit of gossip which she is forming. 
Quality of Work.—How is the quality of work es- 
timated? Chiefly in regard to thoroughness; partly in 
relation to what has been taught; partly in relation to 
improvement in regard to details; partly by the spirit 
which pervades the work. Is a nurse thoughtful in 130 
ETHICS FOR NURSES 
seeing little things to be done for the comfort of the 
patients, or the reverse? Does her work have that 
finished appearance that is so desirable? Is she neat in 
her personal habits? Is she in the habit of tidying up 
as she goes along, or does she leave a trail of soiled basins, 
glasses, dishes, appliances, which she means to put in 
order “ when she gets around to them? ” Just a few such 
nurses who never learn to put things in order as they go 
along may easily make for a hospital the undesirable 
reputation of lack of neatness and cleanliness. 
The reputation of the hospital rests more on the quality 
of its nursing than on any other single thing connected 
with its management. Good nursing consists in atten- 
tion to small details, and the nurses are adding to, or 
marring, the good reputation of the hospital every day 
of their lives. 
One of the common failings of pupil nurses is to neglect 
answering a call from one patient because they happen 
to be busy with another. There are perhaps few things 
more frequently complained of in regard to hospitals 
than the neglect to answer calls promptly. Nurses in 
general are altogether too prone to excuse themselves 
on plea of being “busy.” It is an important part of a 
nurse’s training to develop the ability to attend properly 
to the wants of several patients and keep them all 
happy and satisfied, with no reasonable ground for feeling 
neglected. A nurse in a very short time should be able 
to show that she can be busy with one patient and not 
neglect another for whom she is equally responsible. 
This calls for system, and even more for the manifesta- 
tion of the spirit of cheerful readiness to do, which is 
quickly felt by patients and helps immensely in making 
them more willing to wait. A nurse who tries and suc- 
ceeds in making her patients happy, and inspiring them ETHICS AND EVERYDAY ROUTINE 
131 
with the feeling that she has a real solicitude for their 
comfort, has done much for the reputation of the hospital 
so far as her patients and his friends are concerned. 
The old time-worn complaint of the patient who sig- 
nalled for half an hour for a nurse to bring him a drink 
of water and then had to go without it is based on a 
foundation of fact in most hospitals. Even as small a 
thing as that helps to mar the reputation of the hospital 
so far as its nursing is concerned. 
Would you consider a nurse a success who was able to 
satisfy one patient, when she could give him her whole 
attention, but a failure in attending satisfactorily to the 
wants of three or four? How may a nurse develop 
the ability to so plan her work, and so manage herself, 
that she can keep several patients comfortable and well 
cared for with no reasonable ground for feeling neglected? 
Powers of Observation.—A nurse’s efficiency is 
judged to a large degree by the extent to which she 
cultivates her power of observation and uses it in the 
daily routine. A physician states that “the whole 
science of medicine rests on the power of observation. 
The modern conception that many diseases are due to 
micro-organisms we owe to this quality being born in 
men like Pollender, Davaine, Pasteur and Koch.” 
It is so easy to get into ruts in making records—noting 
only the routine things and failing to notice various im- 
portant matters concerning patients that are readily seen 
when pointed out—that many nurses follow the course 
of least resistance. If Florence Nightingale had done 
this the world today would practically have forgotten 
that she lived. It was that quality of keenness, that 
insistent habit of note-taking regarding the care of the 
sick that helped her to lay the foundation for nursing 
education as we have it today. If she had waited, as 132 
ETHICS FOR NURSES 
so many nurses do, to have every bit of knowledge duly 
administered by some one appointed for the purpose, if 
she had failed to see things all around her which bore on 
the thing she was anxious to learn, she could never have 
accomplished the work she did. It should be the 
ambition of every pupil to gather up scattered bits of 
nursing knowledge and to cultivate to the fullest extent 
her observing powers concerning her patients and her 
work. The nurse who has this quality of keenness well 
developed has usually a fine enthusiasm regarding her 
work and is likely to find positions waiting for her when 
she is ready to leave the school. 
The Nursing Instinct.—What is it? Is it that acute 
perception of the importance of small things in the com- 
fort of a patient—that sense that prompts a nurse to 
see a hundred small things that would make him more 
comfortable and do them, while another nurse contents 
herself with doing what she considers important, and 
sees nothing further which she might have done? 
If a nurse seems to be lacking in nursing instinct, can 
it be cultivated during training? If so, how? 
Professional versus Confidential Relations.—From 
the entrance of a nurse to the training school, she hears 
that her relations with patients must be “strictly pro- 
fessional, ” and she well knows the necessity of this rule. 
Yet there are nurses, many of them, who never seem 
to be able to keep their relations with patients within 
professional limits. They have a “confiding” way with 
them, and in spite of positive prohibitions will, before 
they have known their patients twenty-four hours, be 
found relating to them their own private affairs which, 
certainly, sick people should not be bothered with. 
Even “love affairs” are often unfolded to patients on 
a few hours’ acquaintance. ETHICS AND EVERYDAY ROUTINE 
133 
A bright, attractive, young woman was deserted by her 
husband and left with two children to be cared for. The 
children were placed with relatives, and through the 
influence of friends she was admitted to a training 
school. On entrance she was admonished privately and 
positively that her disappointment in marriage must 
not be made known to patients, neither were her children 
to be discussed with them. In spite of repeated admoni- 
tions, in spite of all that anyone could do, she continued 
to tell patients of her disappointment, of the needs of 
her children for whom she had to provide clothing, until 
in justice to the reputation of the school and to the other 
nurses she had to be dismissed. Patients were sorry 
for her and gave her gifts of money for her children, and 
the discipline of the school in this respect was made 
exceedingly difficult while she remained. Knowing the 
necessity she was under to become able to earn a living 
for herself and her children, it was hard to say to her 
that she could not continue in training, but whose fault 
was it that it had to be done? 
She had many other good qualities—was unselfish, 
faithful to the needs of her patients, quick to grasp the 
technical part of her training. Should her good qualities 
have enabled her to complete her course, in spite of this 
serious failing? How was this failing likely to affect 
the other nurses and the school generally? 
A nurse who was exceptionally capable along technical 
lines had the habit of establishing confidential or semi- 
confidential relations with men patients in particular, 
especially private-room patients, but frequently with 
ward patients. It became known that she was in the 
habit of receiving letters from many of the men she 
nursed, after they had left the hospital. Quite often 
the correspondence died out in a few weeks or months, 134 
ETHICS FOR NURSES 
through its intensity, but new correspondents took the 
place of those who dropped out, and the habit became a 
standing joke among other nurses. Also, it became a 
problem to know where to place her on duty. In the 
women’s departments or women’s wards she proved 
most capable. In the men’s wards she was inclined to 
be “confiding” and familiar in her manner in dealing 
with men in general, yet nothing of a really scandalous 
nature was discovered. Should such a nurse have been 
allowed to graduate? Is the failure to maintain strictly 
professional relations with men sufficient to justify 
dismissal? How many nurses do you know personally 
who have failed in this respect? 
Suggested Subject for Written Work.—In what ways 
may a nurse’s disposition interfere with her success as 
a nurse? Mention some methods which a nurse may use 
to correct faults in her own disposition. 
FOR DISCUSSION OR REVIEW 
1. Make a list of the points in a nurse’s history in 
the school which should become part of the permanent 
records. 
2. How is the quality of a nurse’s work estimated? 
3. Show how the quality of a nurse’s work affects 
the reputation of the hospital and its standing with the 
public. 
4. When a nurse is in charge of several private patients, 
mention some points which she should be careful to 
observe in order that none may feel neglected. 
5. Give reasons why a nurse should not discuss her 
private affairs with patients. 
6. What do you understand by the term “professional 
relations?” ETHICS AND EVERYDAY ROUTINE 
135 
7. If a nurse is given to having favorites among her 
patients, giving special attention to one and “visiting” 
with him while neglecting others, how should she be 
dealt with? 
8. Show how the vice of favoritism may affect the 
happiness and welfare of patients and the reputation of 
the hospital. 
9. What do you understand by the phrase “nursing 
instinct?” SECTION II 
CHAPTER XII 
The Cost of Training 
Apart from the natural blessings which we enjoy— 
fresh air, sun, rain, etc., few things in this world that are 
worth having are secured without some one paying the 
cost. Yet it is one of the commonest human failings 
to take for granted much of great value that comes to 
us, and to unconsciously but utterly fail in appreciating, 
at anything like their real cost, many of the blessings 
that we receive. 
Not many children are able to appreciate until many 
years of life have passed, the cost in dollars and cents of 
their maintenance and education—apart entirely from 
other aspects of their life which cannot be reckoned in 
terms of money. 
Few college students who do not pay their own way 
through college are able to estimate, at anything like its 
real value, the cost of their education. Few nurses take 
time to consider that the board, room, heat, light, in- 
struction and supervision and all the other things which 
come to them while in training have all to be paid for by 
somebody. None of these things are to be had without 
cost. 
At different times the suggestion has been made that 
nurses should pay for their tuition, and be able to exercise 
more choice in regard to the various details of their 
training than is now the rule. But serious attention has 
seldom been given to the matter of such cost to the 
136 THE COST OF TRAINING 
137 
nurse, should such a change be made, nor to the fact 
that many of the best nurses now in the field would 
have been barred from being nurses, had they been re- 
quired to have sufficient capital to pay in money for their 
training. 
The cost of a year in college for a young woman varies 
from about $800 to $1500 a year. 
A Smith college graduate of 1922 reports her expenses 
as amounting to $1500, not including clothing. A grad- 
uate of a smaller college in Ohio reports her expenses for 
1922 at about $800. Estimate what a four years’ college 
course costs a young woman at the rates quoted above, 
including clothing and incidental expenses, also travel- 
ing expenses, if she lived three hundred miles from the 
college. 
What advantages or disadvantages does she have as 
compared with a nurse graduating from a hospital, from 
the standpoint of a woman worker? 
Compare her opportunities with the opportunities of 
the graduate nurse as to service to humanity, and possible 
financial reward for her labors. 
The cost of a nurse’s training is not easily estimated, 
and many hospitals do not attempt to keep the cost of 
the training school separate from general administration 
expenses. As is the case with colleges, the cost varies 
greatly in different localities and in different hospitals 
in the same locality. In some hospitals a monthly money 
allowance is paid to pupil nurses. In others, books, 
uniforms, etc., are provided, but no allowance. All such 
items enter into the cost of the maintenance of a pupil 
nurse. The number of paid nurse supervisors is de- 
termined by each institution, and this number may vary 
from one to fifty or more. In estimating the cost of 138 
ETHICS FOR NURSES 
head nurses and supervisors, apart from their salaries, 
must be reckoned the items of their housing accommoda- 
tion, board, laundry, books and materials for teaching, 
care in sickness, and other incidental expenses. The cost 
of the supervisor’s room or suite in an average hospital 
would range from $25 to $75 a month, or more, depending 
on the number of rooms, their furnishings and the various 
items and privileges which go with the room, and which 
a worker living in an ordinaiy apartment house would 
have to pay for. Calculate the annual cost of a suite of 
rooms consisting of a sitting room, bed-room, and private 
bath which is heated, furnished, and lighted, if such were 
in an apartment house or family hotel. 
Throughout the United States and Canada, millions 
of dollars are invested in training school buildings or 
homes for nurses, and large sums of money are expended 
every year in the heating, lighting, furnishing and general 
maintenance and management of those homes. In 
estimating the cost of training nurses all these expenses 
must be included, and the amount of capital invested in 
such buildings should not be left out of consideration. 
For purposes of illustration the cost of supporting a 
pupil nurse has been secured from several representative 
hospitals in different cities and different parts of the 
country. 
In the City Hospital, Worcester, Mass., the cost of 
maintaining a pupil nurse is stated to be $3.13 per day for 
1922 and $3.28 per day for the previous year. For the 
three years’ course the cost amounts to about $3500. 
This includes room, board, laundry, tuition, supervision, 
care in sickness, etc. 
In New York Hospital, New York City, the cost of 
maintaining and training a nurse in 1922 was $3.36 per THE COST OF TRAINING 
139 
day. The items of expense furnished by the New York 
Hospital are, prorated per day, as follows: 
Training-school office $ .2975 
Superintendent’s office 21 
Instructor 05 
Lectures 03 
Lodging 40 
Heat, power, and light 47 
Physician training-school 0175 
Matron 0250 
Commencement 0350 
Laundry 2275 
Kitchen 15 
Nurses’ food 68 
Help’s food 39 
Maids and waitresses 38 
$3.3625 
Miss Anna C. Jamme, Director, Bureau of Registration 
of Nurses, California, estimates the cost of training a 
pupil nurse as follows: 
FIGURES SHOWING COST OF MAINTENANCE 
AND INSTRUCTION FOR STUDENT NURSES 
These are based on cost of room and board for college 
girl under average conditions. 
For laundry when student may have facilities to do 
some articles and send out large pieces, as nightgowns, 
uniforms, aprons. 
Uniforms and upkeep of uniforms based on figures from 
hospital supplying uniforms. 
Breakage and drugs are arbitrary figures. Allowance 
is average. 
Figures on instruction based on salaries of faculty— 
Based on a School of Fifty Students 140 
ETHICS FOR NURSES 
allowing a proportion of one-half for superintendent, for 
administration of school, and one-third for other officers. 
Full salary and maintenance of instructor is apportioned 
to school. 
Per month. 
Room $10.00 
Board 30.00 
Laundry 8.00 
Uniforms and upkeep 4.00 
Breakage and drugs 3.00 
Allowance 10.00 
$65.00 
MAINTENANCE 
Per month. 
Salaries of Faculty. Pio rata per school. 
Superintendent of nurses $200.00 $100.00 
Assistant superintendent of nurses 150.00 75.00 
Night superintendent 125.00 50.00 
Operating-room superintendent 150.00 60.00 
Head nurses (2) 200.00 50.00 
$335.00 
Proportion for each student $6.70 
Instructor’s salary $150.00 
Instructor’s maintenance 50.00 
$200.00 
Proportion for each student 4.00 
Use of library and equipment, including de- 
preciation 1.00 
$11.70 
INSTRUCTION 
A great many nurses feel that the nursing duties which 
they perform reimburse the hospital for the outlay of 
money for maintenance, and, to a degree, this holds true. 
It should be remembered, however, that the cost of room, THE COST OF TRAINING 
141 
board, laundry, and other expenses begins the day the 
pupil enters—long before she is capable of real nursing 
service. It continues, should she be laid aside through 
illness, and is often unduly increased because of waste, 
breakage, and for other causes. Many students are glad 
to pay for the opportunity to do “real work” that will 
afford some practical experience with every-day respon- 
sibilities, that will help to give the confidence in one’s 
powers needed for effective work, and that will add to the 
chances for securing the kind of work desired. The cost 
of training has many angles which should be discussed, 
but one point to be emphasized is that a hospital training- 
school offers advantages over almost all other schools, for 
a nurse with ambition and without capital, to secure an 
education that will fit her at once on graduation to earn 
an independent livelihood. It fits her for a vocation 
that affords unusual opportunities for advancement and 
for satisfying service to humanity. 
Other Aspects of the Cost of Training.—The cost of 
an education cannot always be reckoned in terms of 
money. Not infrequently a student enters college with 
high purposes and the noblest ideals of life, and leaves 
it with his ideals gone, his life purpose thrown to the 
winds, his character seared, his influence changed from 
good to bad. Many never recover the ground lost. 
What influences are responsible for this change? Men- 
tion some ways by which it might come to pass? To 
what extent is a student responsible for this retrograde 
condition? 
A nurse may pay the cost of training in lost ideals, in 
changed purposes, in impaired character and influence, 
but she does not need to. It is rare, if ever, that an 
individual is placed in a position in which he cannot do 
right, and live right, if he is determined to do so. 142 
ETHICS FOR NURSES 
A Fundamental Ethical Principle.—Analyze the fol- 
lowing statement of ethical principles showing whether 
the writer is wrong or right in affirming what he be- 
lieves to be a fundamental truth. 
“The center of character is found in the will to do 
right, and it cannot be too much emphasized that where 
it is present, other lacks may be excused; and where 
it is absent nothing else can take its place. The will 
to do right is also possible to every one, and in all circum- 
stances. With it every one can make a beginning and 
all may meet on the plane of a common faithfulness. 
The ignorant, the poor, the savage, may be faithful to 
their ideal of right and thereby win the approval of all 
moral beings. This does not imply their perfection in 
any sense, but only a right attitude of will toward 
righteousness. This furnishes the indispensable con- 
dition of all moral development. So much is possible 
to every one; less than this can be accepted from none.”* 
Some writer has said that “It is good to have money 
and the things that money can buy; but it’s good, too, 
to check up once in awhile, and make sure you haven’t 
lost the thing that money can’t buy.” This bit of 
wisdom might be slightly changed in its wording and 
applied to nurses and a nursing education. There is a 
danger of losing something out of our lives and out of 
nursing that we cannot afford to lose or to value lightly. 
Dangers which Beset.—In an address to pupil nursesf 
Dr. Richard Cabot has called attention to three great 
dangers which beset nurses. 
1. Callousness, or the routine spirit. 
2. Narrowness. 
3. Dissipation of energy. 
* Principles of Ethics. Bowne. 
f Massachusetts General Hospital. THE COST OF TRAINING 
143 
Discussing the subject of callousness or the routine 
spirit, Dr. Cabot expresses himself thus: “Our profession, 
the profession to which you as nurses and we as physicians 
contribute what we can, brings us constantly into the 
closest contact with human souls. We are with our 
fellow-creatures in their hours of storm and stress when 
what is deepest and truest in them comes to light. Such 
contact is sure to affect us in one of two ways. It can 
ennoble us or it can make us callous. There is no other 
alternative. Familiarity with the great spiritual ex- 
periences that attend birth, death, and bereavement, 
with the awful perplexity of choosing between one life 
and another, and the awful desolation of the sufferer who 
learns for the first time his malady is incurable, drives 
us all either to shut our ears to the poignant message of 
our work, hopeless of understanding its meaning, or else 
opens every sense and every faculty to meet the world’s 
revelations, with a faith that is the essence of religion.” 
Continuing, Dr. Cabot says: “I have watched nurses 
become coarsened, hardened by their work. It is in- 
evitable when nursing is only a means of winning a liveli- 
hood. You cannot pass through such an ordeal without 
showing the scars. We must pass through a fire that con- 
sumes if it does not purify. A man can deal with leather 
or with hemp and be but little changed by it; but he 
cannot deal with human suffering, terror, and temptation, 
with the desperate struggle of the fallen to get upon his 
feet again, and utter despair of passionate love confronted 
with vacancy, without being forced to meet, and as 
best he can, answer the great problems of human life 
and destiny. By a well-known process all but the finest 
types of prison chaplain soon begin to show the deaden- 
ing effect of meeting familiarly the great and sacred crises 
of human life over and over again until they become 
commonplace. Unconsciously and inevitably we are all 144 
ETHICS FOR NURSES 
of us infected with the same smug and business-like view 
of death, sin and suffering, unless the spirit of religion 
defends us. 
“Our Profession Cannot Remain Secular.—If it at- 
tempts to do so, it becomes a trade and a low one. What 
do I mean by the spirit of religion in the work of nurse or 
physician? I mean the missionary, not the proselyting 
spirit, but the spirit of service, the sense of working for 
a cause that is absolutely and infinitely worth while, 
in which we can spend ourselves without stint, without 
restraint, without reserve. The Greek doctrine of the 
golden mean, of moderation in all things, is the full 
opposite of the spirit of religion as I understand it. It is 
impossible for the world to get, or for us to give, too much 
of the kind of service I am speaking of. It is its own re- 
ward, and the more of it you give, the richer you become. 
Absolute loyalty to the world’s needs, wherever found, 
is the sum and substance of it all. Wherever there is the 
greatest need of me, there is my home, and paradise can 
offer no greater blessing. It is the soldier’s creed; it is 
the creed of the devotee, the world over, and it must be 
our creed if we are to face the facts, the plain everyday 
facts of our work. Most of us don’t face them. Most of 
our training has the effect of blinding and deafening us 
to one-half (and that the most vital half) of the facts be- 
fore us. To concentrate attention day in and day out on 
physical processes, without any attempt to go deeper 
into their meaning, or into the life of the being to whom 
they belong, is to kill out our sensitiveness to the other 
manifestations of that life. 
“We deal with human life, not with human bodies alone, 
and yet we are trained exclusively in the care of bodies. 
No wonder that the souls in those bodies rebel, now and 
then, and demand someone who recognizes their ex- 
istence; or else, what is worse, catch from the nurse the THE COST OF TRAINING 
145 
materialistic and mechanical view of things toward 
which all the nurse’s training tends. When our training 
schools admit that to minister to a human being we must 
know the whole thing, and not only half of him, then it 
will be impossible any longer to keep them secular, and 
the spirit of religion will bring about a reorganization of 
the training there given, and of the type of nurse that 
graduates. Such nurses will prove the following: 
1. “ The religious spirit is one that can’t be discouraged, 
for there’s no uncertainty about our venture as we see it. 
The road may turn either way, to life or to death; in 
any case it must be full of opportunity that we want, 
the opportunity for service, for sacrifice, for courage and 
cheerfulness under strain, for education and experience, 
and for knitting closer the bonds of friendship with all 
sorts and conditions of men. 
2. “The religious spirit is one that can’t be hurt, 
shocked or wounded. It is invulnerable to insult, 
taunt, annoyance—so small, so puny they seem, as we 
look through and behind them to the prize of our high 
calling. 
3. “Failure does not seem to touch the religious man, 
for to fail in the ordinary sense is to be taught the weak 
point in his armor, what he needed most to discover, 
and so to strengthen. 
4. “Such a person is like a united army, his powers 
all dominated by a single motive, his eye single. This 
gives the great calm, the deep, all-pervasive happiness 
which shines in such people’s faces. We all know such 
and marvel at it. 
5. “Such a person can’t but be enthusiastic, because 
he is always finding what is surprising and fresh; fresh 
meaning, fresh value in the old, fresh opportunity and 
experience in the new. 146 
ETHICS FOR NURSES 
6. “Such a person is everybody’s friend because he 
finds everybody interesting. 
“With this spirit in our work we cannot help see- 
ing and fighting against the dangers that beset our 
profession.” 
Suggested Subject for Written Work.—What is 
mechanical service? How may a nurse guard against 
mechanical service while in training? 
QUESTIONS FOR DISCUSSION OR REVIEW 
1. What do you regard as the center of character? 
2. Show how one’s attitude of mind and ideals of 
right conduct may influence such duties as, giving medi- 
cines, giving baths, keeping records, taking temperatures. 
3. What is faith? Show how a steady firm faith in 
the Infinite is necessary for a nurse’s peace of mind and 
how it helps her to become a better nurse. 
4. What is callousness in nursing? What daily pre- 
ventive measures would you recommend a nurse to use? 
5. To what extent is a nurse in training responsible 
for losing her highest ideals of life? To what extent is 
she the product of her environment? 
6. Are we ever placed in situations where it is impos- 
sible to do right, if we honestly want to do right? Give 
illustrations to prove that this is, or is not, so. 
7. What general measures may one use to help her to 
retain interest in the things of eternal value, while in 
the pressure of daily studies and duties in a training 
school? 
8. Show how a nurse may maintain a proper interest 
in the spiritual side of her patient’s nature, and be en- 
tirely free from “the proselyting spirit” which is men- 
tioned in the quotation from Dr. Cabot. 
9. What is the missionary spirit which Dr. Cabot 
insists is essential to the highest type of nurse? CHAPTER XIII 
Good Tone in the Training School 
What is meant by “tone” in a school is, briefly, the 
general or prevailing character of the school as it relates 
to morals, manners, or sentiment. It should be re- 
membered that the spirit and tone of the school has a 
tremendous influence on the general reputation of the 
hospital in any community. It is reflected by the nurses 
in a thousand ways every day. One who is accustomed 
to hospitals can, even in a brief tour through a hospital, 
determine to some degree the prevailing tone of the 
school. 
Two Types of Schools.—In one hospital, one notices 
nurses neatly attired going about their work with a 
serious quiet demeanor. Professional courtesies are 
exchanged with doctors in a dignified way as they come 
and go. Patients’ calls are responded to quickly and 
quietly. Doors are opened and closed noiselessly. 
No chattering is heard in corridors. There is an air of 
alertness and consideration for the patients’ needs, and 
of quiet dignity about the place that gives a feeling of 
confidence in the general management, and in the 
personnel of the nursing staff. 
In another hospital, one notes the absence of these 
things. Nurses and doctors greet each other with a 
boisterous “Hullo.” In one place, one even notices a 
doctor standing with his hand on a nurse’s shoulder as 
she sits at the chart table. One hears nurses calling to 
each other in corridors, and notes that they fail to use 
147 148 
ETHICS FOR NURSES 
the title “Miss” frequently as they address each other. 
A Miss Shepherd is given the nickname “Sheppy,” 
Miss Jackson is “Jackie.” Others have similar dis- 
tinguishing titles—nicknames used without malice, no 
doubt, but showing the lack of that sense of propriety 
which is so desirable. As one goes through the corridor, 
one sees a nurse catheterizing a patient in a ward of four 
beds without screens, and in full view of the corridor. 
Flippant remarks about patients are overheard. Nurses 
and internes laugh and joke with each other as they meet, 
and act as if they never have heard the rule that, “Con- 
versations with doctors and internes while on duty must 
be limited to professional matters.” There is a free 
and easy air about the place that is the result of lack of 
training, lack of discipline, lack of a proper conception 
of what hospital etiquette is, or what a hospital atmos- 
phere should be. From which school would a well-bred 
refined nurse prefer to graduate? 
The Individual Nurse’s Responsibility.—It has been 
stated before, and is repeated for the sake of emphasis, 
that from the day a probationer arrives in a school she is 
helping to create the moral atmosphere in which she and 
other nurses are to live. The hospital and the training 
school will be either better or worse because she has been 
a member of the training school family. She does not 
come to the school as a blank sheet of paper to receive 
impressions She brings with her, her own personality, 
her own standards, her own habits. She contributes 
something to the moral atmosphere of the school every 
day she is in it. It is for each individual nurse to decide 
whether she will hold fast to those things which are 
highest and best and most enduring, whether she will 
add to the spirit of reverence, of truth, of faith, of 
courage, of tenderness, thq,t she brought with her to the GOOD TONE IN TRAINING SCHOOL 
149 
school—whether these shall be the predominating habits 
in her nursing life, and whether her influence will help or 
hinder the formation of right habits in those with whom 
she associates. 
It may be asked, “ What can one nurse do to improve 
conditions such as exist in the latter of the two training 
schools mentioned ?” There are certain to be differences 
of opinion as to this question, but it is worth thinking 
over, and worth discussing in class. It will hardly be 
questioned that a nurse can be a ladylike woman under 
all circumstances, and the good example of the one nurse 
will help some other nurse to hold to her highest ideals 
of conduct. A nurse who is interested in the tone and 
reputation of the school can call the attention of other 
nurses to undignified actions which should be corrected. 
She can refuse to belong to that class of people known as 
“the quiescent good.” 
“Eleven apostles, working men, and a twelfth added 
in a later season, took up the Master’s work, and made 
the world over new” says a popular writer. “If they 
had belonged to 1 the quiescent good ’ nothing would have 
happened.” Continuing, this writer asks, “What can 
you and I do to make our world a better place than it is? 
Merely good intentions will not overcome bad practices 
nor improve conditions. Conditions grow worse, fre- 
quently, because good people do nothing.” The 
“quiescent good” members of a school can often be 
roused to work for better moral standards, if one nurse 
musters courage to quietly protest against practices 
which are lowering the whole tone of the school. 
The responsibility for maintaining a proper tone in the 
schools falls much more heavily on the members of the 
intermediate and senior classes of a school than on the 
juniors. Probationers and juniors are very apt to copy 150 
ETHICS FOR NURSES 
the bad as well as the good habits of their seniors. Every 
nurse who indulges in habits or practices which are 
undignified or vulgar, or in remarks which are flippant 
“slangy” or coarse, is helping to lower the moral tone 
of the school, and making it harder for younger nurses 
to live up to the best that they know. 
Two probationers, who entered a church hospital 
school for training about the same time, were greatly 
shocked at the prevalence of profane language among the 
pupils of the school. If they had ever heard of the com- 
mandment “Thou shalt not take the name of the Lord 
thy God in vain” they were evidently failing to apply 
it in their daily conversation. Such expletives as 
“Good Lord,” or “My God,” and others of similar type, 
were disgracefully common. When the nurses were 
asked what the principal thought of the profanity, the 
probationers were told they had better not let her hear 
them using it. They decided that they would use 
their influence to stop this pernicious habit which they, 
later, found had begun with the entrance of one attract- 
ive, popular, but rather reckless nurse, now in her senior 
year. The course they decided on was to quietly ask 
every girl they heard using such language to please not 
take the name of the Lord in vain. The simple fact of 
calling attention to this evil was sufficient to check the 
habit in most of the nurses who indulged, and within a 
year the use of such language had died out in that school. 
This kind of influence quietly and tactfully exerted will 
accomplish what no principal could hope to accomplish 
by many lectures and reprimands. 
Treatment of Probationers.—One of the tests of char- 
acter which comes to every nurse, comes in the attitude 
or manner which she assumes toward probationers and 
juniors. It is natural that seniors should feel just a GOOD TONE IN TRAINING SCHOOL 
151 
little above the juniors, and that the juniors should take 
on little airs of superiority because they happened to 
enter for training a few months before the probationers, 
but it is not necessary that these airs of superiority 
should develop into harshness. It is not necessary that 
probationers endure the snubbing that was so common 
years ago. It is essential for the highest good of the 
school that every nurse radiate that spirit of helpfulness 
and kindness which should permeate every institution 
for the care of the sick. 
There are numerous little methods which a kind- 
hearted thoughtful nurse may use who has not forgotten 
the bewilderment and depression of the first few weeks 
of her probation period, that will do much to lessen 
that horrible feeling of loneliness and timidity which a 
probationer feels, in a strange place, where she is on 
trial, and under close observation. Even the experience 
of going to the first meal in a nurse’s dining room, where 
the probationer is keenly conscious that she is being 
“sized up” and commented on by the assembled nurses 
is an ordeal to most probationers. This experience can 
easily be rendered a more pleasant memory if nurses 
will only take the trouble to be kind. To call for the 
probationer, conduct her to the dining room, and see 
that she is treated with the courtesy due to any stranger 
and that she finds her way back to her room again, is 
a small service but one which will surely be gratefully 
remembered. Most people intend to be kind, and are 
willing to be kind, provided they happen to think about 
it, but the trouble with nurses as with many other people 
is that they often fail to perceive in such circumstances 
as the one just described, an opportunity to show personal 
kindness to a stranger. If we have within us the spirit 
of the Great Teacher, and are keenly desirous of helping 152 
ETHICS FOR NURSES 
all with whom we come into contact, we will not neglect 
these small courtesies to the stranger who has entered 
the training school household. If we study His wonder- 
ful life we will find that many of His wonderful deeds 
of healing were done “as he passed by” on some other 
errand. The opportunity to do this deed of kindness 
came, and He did not neglect it. 
Things to Avoid.—Pages might be written by nurses 
as to things to be avoided by intermediates and seniors 
in their treatment of probationer and junior nurses, and 
the writing of some of them should prove a wholesome 
exercise for every class. A few “don’ts” are suggested 
here as illustrations of what to avoid. Every nurse of a 
year’s experience should be able to make her own list. 
Don’t forget how awkward and strange you felt during 
the first few days in a training school. 
Don’t think it is clever to “scare” the new proba- 
tioners by telling them all the weird and gruesome stories 
of hospital life you can think of. 
Don’t regard the presence of a probationer in your 
ward as an unmitigated nuisance. Every trained nurse 
was once a probationer. 
Don’t impose on probationers by asking them to run 
errands for you and do unattractive duties which jrnu 
yourself are responsible for. 
Don’t forget that the spirit of loyalty to an institution, 
its methods and rules is contagious, and that your atti- 
tude toward these things will help greatly toward main- 
taining the desired tone in the school. Try to add a 
dozen additional “don’ts” to this list. 
Misunderstood Rules.—In every school there are 
rules the reason for which is not understood at the be- 
ginning of the training period. One rule which gener- 
ally prevails is the rule which forbids pupil nurses from GOOD TONE IN TRAINING SCHOOL 
153 
visiting doctors in their offices, or from consulting with 
physicians about personal ailments without first consult- 
ing the principal of the school about the indisposition. 
This rule is often resented as a curtailment of personal 
liberty. Give reasons why such a rule is a necessity for 
a well-ordered school. 
A young principal of a small hospital school neglected 
to announce or enforce such a rule. A probationer 
arrived, and before the principal was aware of it she had 
consulted three different physicians who visited the ward 
she was in about a gynecological ailment which she had. 
This nurse regarded her presence in a hospital as an 
excellent opportunity to get all the medicine and medical 
advice she wanted gratis. When the principal dis- 
covered this tendency in the nurse, she talked seriously 
with her about it. The nurse persisted in the practice 
when she thought she would not be discovered, and of 
talking over her personal ailments with doctors whenever 
and wherever she chose. In other respects she proved 
an acceptable candidate. Was this proclivity in this 
probationer a sufficient reason for rejecting her? 
A principal on assuming charge of a school found that 
one of the visiting doctors was in the habit of making 
visits after ten o’clock at night, and of spending an hour 
or more in “visiting” with the senior night nurse who 
was serving as night supervisor. After this nurse came 
off night duty, she paid frequent evening calls to this 
same physician in his office. When asked the reason for 
these visits, she stated that the doctor was treating her 
for headache and throat trouble. The nurse had com- 
pleted all but about five months in a three-year term of 
training. What effect on the tone and reputation of 
the school will this nurse’s conduct have? What should 
the principal of the school do in regard to this matter? 154 
ETHICS FOR NURSES 
Hasty Judgments.—There is perhaps no more com- 
mon failing among pupil nurses than their tendency to 
criticize the motives and decisions of the principal of a 
school, to proclaim that she has been harsh and unjust 
in dealing with certain pupils, when they have but a 
half knowledge of the real facts in the case. Tempests 
in schools are often worked up, serious issues are created 
out of mistaken sympathy for some pupil who is sus- 
pended or dismissed and deserved to be, but who 
protests her absolute innocence and purity of motive. 
The pupils often fail to take the larger view of the good 
of the school as a whole, and perhaps after keeping up a 
seething discussion of the principal’s actions come in a 
group to the training-school office, asking that the dis- 
missed pupil be reinstated. 
It is well never to lose sight of the plain rule of justice 
that if a privilege could not wisely be allowed to forty or 
one hundred nurses, it should not be allowed to one 
pupil. Keeping this rule in view helps wonderfully to 
steady conditions in turbulent times. 
A certain third-year nurse in a small hospital was 
placed in general charge on night duty. Two junior 
nurses were on duty on the second and third floors, the 
charge nurse being on the main floor. She developed a 
flirtation with the policeman in that district, and was in 
the habit of entertaining him for a longer or shorter time 
each night in the hospital, frequently serving refresh- 
ments. The junior nurses were cautioned to say nothing 
about it. However, the offense was discovered and the 
nurse was dismissed. Was the dismissal justifiable? 
What would be the effect on the reputation of the 
school and the welfare of the patients if all pupil nurses 
were allowed to do as this nurse did? 
Suggested Subject for Written Work.—What are some GOOD TONE IN TRAINING SCHOOL 
155 
of the reasons why a nurse’s conversation with doctors 
and internes should be limited to professional affairs 
while on duty? 
1. What should a nurse do when a middle-aged 
respected member of the visiting staff is inclined to be 
just a little too familiar, not shockingly improper, but 
indiscreet? 
2. What should a nurse do when a doctor tells in her 
presence a story which is intended to be a joke, but 
which is coarse, vulgar and decidedly “off color?” 
3. How may a nurse keep to a sensible middle course 
and avoid being prudish on the one side, or on the other 
side drift into loose habits of conversation with profes- 
sional people? How shall she avoid the criticism of 
being “gay” on the wrong subjects? 
4. To what extent does a woman set the pace for a 
man in maintaining proper relations, or to what extent 
does she control the situation? 
5. Explain what is meant by the phrase “tone of the 
school.” 
6. What responsibility has the individual nurse regard- 
ing the tone of the school? 
7. Mention some things which intermediates and senior 
nurses should avoid in their treatment of probationers. 
8. What bad effects in a school are liable to grow out 
of hasty judgment on the part of pupils in regard to the 
principal or head nurse? 
9. Show how the rule requiring pupils to report their 
ailments to the principal before seeking medical advice 
is a safeguard to every nurse. 
10. Outline briefly some points which nurses should 
be careful to observe in dealing with male patients. 
QUESTIONS FOR DISCUSSION OR REVIEW CHAPTER XIV 
Ethical Aspects of Hospital Accidents 
When Florence Nightingale, after her return from the 
Crimean war, began to call attention to the need of reform 
in the care of the sick, she announced that one of the very 
first requirements in a hospital is that it should do the 
sick no harm. 
It is still necessary to call attention to that funda- 
mental requirement in the hospitals of today, and to 
emphasize it still further by saying that the first require- 
ment in a nurse is that she also should do the sick no 
harm. 
From the very nature of their work, hospitals are 
places where accidents are liable to occur. They are 
devoted to the care of individuals who are not normal 
and who, in many cases, are not accountable for injury 
which they may inflict on themselves. Nurses, in com- 
mon with other hospital workers, have to do their work 
under these conditions. They have to accustom them- 
selves to the constant thought that an important part 
of their work is to prevent accidents, to prevent patients 
injuring themselves or each other, and also to see to it 
that no patient receives bodily harm through their inad- 
vertence or neglect. 
The term “accident” in hospitals, as ordinarily used by 
the public, suggests the idea of an injury caused by the 
recklessness, carelessness, ignorance, or negligence of 
some individual. While accidents of many kinds occur 
in hospitals, there are four classes which stand out con- 
spicuously because of their frequent occurrence: 
156 HOSPITAL ACCIDENTS 
157 
1. Burns due to hot-water bottles or other articles used 
for the external application of heat. 
2. Mistakes in the use of drugs. 
3. Delirious patients jumping from hospital windows. 
4. Accidents connected with hospital elevators. 
Every accident has both a legal and an ethical aspect. 
The legal aspect relates especially to the existing laws 
dealing with such accidents, and the extent to which the 
person responsible for the accident is liable for damages 
should the injured patient go to the courts for redress. 
The ethical phase concerns itself chiefly with questions 
of neglect of duty, and the responsibilities which should 
voluntarily be assumed by an individual whose negligence 
or ignorance has resulted in injury to another. 
Because a hospital exists as a result of the altruistic 
motives of its founders, and because it is engaged in 
benevolent work designed to promote the comfort and 
general welfare of the public, it is less liable to suits for 
damages than institutions or concerns promoted for 
commercial purposes. It is only in comparatively rare 
instances that injured patients are able to collect dam- 
ages from hospitals, yet the publicity resulting from 
accidents which are followed by court proceedings dam- 
ages the hospital itself in the minds of the public. It 
has reacted to the disadvantage of many institutions by 
creating prejudice or distrust as to its management in the 
minds of people who are contributing to its maintenance 
or who were planning to make bequests in favor of the 
institution. 
Justice requires for every pupil nurse that early in her 
career her attention be called by those responsible for 
her instruction to the need of extreme caution, the 
necessity of always being on the watch to prevent mis- 
takes and accidents, and to the places where accidents 158 
ETHICS FOR NURSES 
are most likely to occur. She should be warned, but it 
depends on the nurse herself whether she heeds the warn- 
ing, whether she pays careful attention to what is said 
to her and governs herself accordingly. 
Carelessness is a term having many shades of meaning. 
Webster defines “careless” as “heedless; inattentive; 
unconcerned; unmindful; without thought or purpose; 
incautious; inconsiderate; remiss; not taking ordinary or 
proper care.” There are degrees of carelessness. Most 
accidents occur not because the nurse is wilfully careless, 
but because she is not sufficiently careful. She is willing 
to take a risk. It is this willingness to take risks, this 
neglect to use the precautions which have been taught, 
that results in many accidents for which nurses are 
responsible. Occasionally a serious accident occurs be- 
cause a nurse did not understand the order, and this 
emphasizes the necessity of every nurse making sure, 
before doing a thing, that she understands what she is 
expected to do and how to do it. But it must be ad- 
mitted that too many accidents occur not because nurses 
cannot understand orders, but because they do not care- 
fully read the orders, or because while they were reading 
the order they were thinking of something else. 
Failure to report at once to the head nurse or principal 
that a mistake has been made or an accident has oc- 
curred is an ethical failure that is often exceedingly se- 
rious both for patient and nurse. An accident or blunder 
may be excusable, but the attempt to cover it up shows 
a serious weakness in a nurse’s character. The ill effects 
of an accident or mistake can often be overcome if the 
matter is promptly reported and energetic treatment 
given at once. 
Bums occurring in newly operated patients while 
unconscious from anesthetics, by nurses failing to exer- HOSPITAL ACCIDENTS 
159 
cise due precaution in regard to hot-water bottles, have 
occurred probably more frequently than any other kind 
of hospital accident. The ethical aspects of this accident 
are far too little considered. The nurse is reprimanded or 
disciplined in some way, but that does not undo the fact 
that damage has been done, or that patients frequently 
suffer other injuries when such burns are inflicted. 
A patient, a railway mail clerk earning $80 a month, 
entered a hospital for a minor operation several years ago. 
The doctor told him he would be able to leave the hospital 
in a week or less, and able to be at his work in ten days or 
two weeks. The patient paid a substitute to take his work 
and expected to pay his doctor. He paid $15 a week in 
the hospital. The wound healed promptly, but he re- 
ceived a severe burn while unconscious from ether, a 
burn which was very slow in healing. The nurse respon- 
sible for the burn decided to say nothing about it when 
she discovered it. Through lack of care the wound 
became infected, and the patient had to remain in the 
hospital over four weeks. Instead of his hospital ex- 
pense being $20 to $30, it was $70. His doctor’s bill was 
correspondingly increased. He was obliged to pay a 
substitute for more than five weeks instead of one or two 
weeks and, in addition, he had to pay the rent of his 
room in a rooming house during the whole period he was 
in the hospital. Thus it will be seen that the carelessness 
of the nurse was directly responsible for the young man’s 
loss of over $100, besides the bodily injury inflicted. 
What reparation should the nurse make, or the hospital 
make, for this violation by the nurse of the fundamental 
ethical principle emphasized by Florence Nightingale 
that a hospital should do the sick no harm? Thus 
ethical problems growing out of hospital accidents might 
be enumerated indefinitely. 160 
ETHICS FOR NURSES 
An illustration of accidents which result from pupils 
not understanding orders occurred in an English hospital. 
The details were as follows: A probationer of a few weeks’ 
experience was told to cleanse the heads of two patients, 
and if necessary to rub in carbolic oil. The oil which was 
commonly used for such purposes was a mixture of nine 
parts of olive oil to one part of carbolic acid. The pro- 
bationer, instead of using the mixture, rubbed pure car- 
bolic acid into the hair of a child of thirteen years who 
was waiting an operation for adenoids. The child died 
shortly after, before a doctor could be secured. The jury 
blamed the probationer for not using proper care, the 
head nurse for laxity in supervision of the probationer’s 
work, and the superintendent of the hospital for allow- 
ing pure carbolic acid and strongly poisonous drugs to be 
kept in the same cupboard with common medicines. 
Who was most to blame? 
An illustration of an accident of a different kind 
recently reported from a Berlin hospital shows the tragic 
consequence to the nurse herself, because of a mistake in 
the use of drugs the dangerous nature of which she fully 
understood. This also shows how long familiarity with 
the use of drugs may cause one to grow less cautious in 
handling them. 
A schoolboy of fourteen was about to undergo a 
minor operation. Cocaine was used to deaden the pain. 
The nurse, whose duty it was to administer the anes- 
thetic, dipping the hypodermic syringe by misadventure 
into the wrong bottle, injected a cocaine solution of 
20 per cent, instead of 2 per cent. The lad expired 
almost immediately, and the nurse took the tragic con- 
sequences of her error so much to heart that she imme- 
diately injected into herself the fatal mixture, and died 
so suddenly that it was at first thought that she had sue- HOSPITAL ACCIDENTS 
161 
eumbed to a heart attack. She had been employed at 
the hospital for fifteen years, and was regarded as one of 
the most trustworthy assistants on the staff. It is said 
that the two cocaine solutions were kept in precisely 
similar bottles, which stood quite close to one another. 
Who was to blame for this double tragedy? What pre- 
cautionary measures might have prevented it? 
Accidents with drugs have frequently happened during 
the progress of building or alterations when the general 
order of things was disturbed and there was more or less 
confusion in regard to where solutions or medicines were 
to be placed. In a hospital in one of the central states, 
during alterations in the building, a nurse gave two 
patients on the same morning a half glass of a solution of 
bichloride of mercury, instead of a solution of magnesium 
sulphate. Both patients died. The solution bottles 
were exactly the same size and stood side by side, the 
labels being turned to the wall. Under ordinary condi- 
tions the bottles were kept on separate shelves. 
The psychological effect on a patient who has had a 
wrong dose of medicine administered, even when the 
medicine was simple and harmless, is often most dis- 
astrous. Patients frequently refuse to believe that 
serious damage has not been done, and court proceedings 
have frequently been begun to recover damages from a 
hospital because of supposed damage to the “lining of 
the stomach” or to other internal organs, due to the 
mistake of the nurse in administering a medicine in- 
tended for some other patient. 
A dim light where medicines are kept or measured, a 
blurred or indistinct label, and a careless method of 
labeling are all contributing causes to mistakes in the 
handling of drugs. 
Fatigue and Confusion.—Experience has shown that 162 
ETHICS FOR NURSES 
many accidents in the handling of drugs occur during the 
busiest hours when nurses are hurrying to get through 
and off duty at a given time. Experience has also taught 
that a nurse needs to be especially on guard at those 
hours. 
Quite frequently one very troublesome patient, who is 
making incessant calls on the nurse while she is trying to 
attend to other patients, will so confuse her mind that 
she neither thinks nor sees clearly. Excessive fatigue 
has the same effect. Fatigue itself is one of the laws 
of growth, but excessive fatigue is unwholesome and 
dangerous. A tired mind affects working efficiency. It 
is not possible always to guard against excessive fatigue, 
but it is well to know that it exposes a worker to real 
danger. This condition of confusion and exhaustion at 
the end of a day often results because a nurse “dawdled” 
over duties at the beginning, because she left till the end 
of the day duties which might have been done with ease 
several hours earlier. 
General Precautions.—In the handling of drugs there 
are several general precautions which experience has 
shown to be necessary to be shown to all nurses, which 
if generally observed would go far to prevent accidents. 
1. Remember that there is an element of danger in 
every drug. 
2. Read your orders carefully and be sure you fully 
understand the order and the method to be used before 
you carry it out. 
3. Never give or use a drug of any kind that is not 
plainly labeled. 
4. Never give a drug in the dark or in a dim light. 
5. Always read the label twice before pouring out the 
drug. Read it again before giving it. 
6. Keep your mind on the work in which you are 
engaged. HOSPITAL ACCIDENTS 
163 
7. Measure the dose carefully. Never guess at 
quantities. 
8. Never give a pill, capsule or tablet which has acci- 
dently escaped from its container. 
9. Never jump at conclusions in regard to fractional 
doses. Mistakes in the arithmetic of drugs may be 
fatal. 
10. Never give a dose of medicine that you have a 
shadow of doubt about. Omit the dose if you are not 
sure. Always remember that it is better to be sure than 
sorry. 
Infections.—In the operating room and all through the 
hospital the nurse is peculiarly responsible for the 
prevention of infection. Frequently, while apparently 
exercising all due precaution in the operating room, she 
may err through ignorance or carelessness, or from failing 
fully to grasp the extent of her responsibility. 
A patient entered a hospital for an operation for 
double hernia. The operating room supervisor was 
away and a senior nurse was in charge of the operating 
room, handling dressings, etc. Gloves were not then as 
commonly used as now. The nurse in charge had 
neglected to use the healing hand lotions provided by the 
hospital, and the ordinary precautions for keeping her 
hands in good condition, and her hands had become 
exceedingly sore. 
The hernia wounds suppurated, and for a time it looked 
as if the results of the operation would be completely 
undone by the infection of the wounds. Every avenue 
by which a clean wound could have become infected was 
investigated, and in the investigation it developed that 
the nurse’s hands, because they were sore, had not been 
properly scrubbed or disinfected. She said nothing 
about them because she was afraid of being taken from 164 
ETHICS FOR NURSES 
the operating room where she was most eager to stay. 
The patient’s stay in the hospital was more than twice 
as long as it would have been if the wounds had not 
become infected, and the expense was correspondingly 
increased. 
This is a case where a nurse allows her own eagerness 
to be in the operating room to imperil the safety of the 
patient, and is a distinct violation of ethical principles 
and the Golden Rule. The subject of infection as it 
relates to nursing practice is one which affords ample 
scope for ethical as well as technical failures. 
Injuries to delirious patients who escape from hos- 
pital windows are not always the result of carelessness 
on the part of the nurse. They are as frequently the 
result of the management of the hospital which neglects 
to provide safety screens for windows of rooms in which 
such patients are confined. The nurse’s responsibility 
in the tragedy which results comes frequently because of 
her disobedience to orders. She is told that she is not 
to leave the patient alone, even for a minute, that he is 
liable to injure himself, and that she must call another 
nurse to watch whenever she is obliged to leave the room. 
She intends to do this, but perhaps the other nurse does 
not respond promptly to her call; she disobeys orders and 
takes a risk, and the death of the patient results. 
Should a nurse be punished for her part in this tragedy? 
If so, how? 
Patients with suicidal intent are frequently admitted 
to hospitals and the nurse in charge of such carries 
more than ordinary responsibilities. In order that 
nurses may realize their personal responsibility more 
fully in regard to such patients, some institutions issue 
a card with a form somewhat like this: HOSPITAL ACCIDENTS 
165 
(Name of Institution). 
You are asked to take notice that patient, John Doe, 
Room No. —, is suicidal. 
He has threatened suicide frequently by poisoning 
He has attempted to drown himself. 
He must be kept under observation constantly. 
Signed, A. B., Superintendent. 
I have read the above warning and understand my 
responsibility. 
Signed by all nurses who will have him in charge. 
Another safety system in dealing with such cases is 
to issue a small disc or tag, on which is written the 
patient’s name. The nurse who has possession of this 
disc is held responsible for the patient’s life. If the 
nurse has to leave the patient even for a moment she 
surrenders the disc to another nurse who is responsible 
in her absence. The carrying of such responsibility is 
a severe test of the makeup of the nurse, and of her 
ability to be trusted with other large responsibilities. 
Suggested Subject for Written Work.—Mention four 
or more kinds of accidents that commonly happen in 
hospitals, with rules or suggestions for their prevention 
which nurses should observe. 
FOR DISCUSSION OR REVIEW 
1. Mention an important requirement in the care of the 
sick that was emphasized by Florence Nightingale. 
2. Give reasons why accidents are very liable to 
happen in hospitals and why eternal vigilance is needed 
to prevent their occurrence. 
3. Describe three kinds of accidents to patients that 166 
ETHICS FOR NURSES 
you have observed in a hospital, telling how each might 
have been prevented. 
4. Differentiate between the legal and the ethical 
aspects of hospital accidents. 
5. What course should a nurse pursue who discovers 
that she has given a wrong dose of medicine to a 
patient? 
6. If she believed the medicine given was simple and 
harmless, what should she do about it ? Should the patient 
be told? If so, who should tell him if he didn’t know of 
the mistake? How is a nurse to know that a medicine is 
harmless? 
7. Show how accidents in the handling of drugs fre- 
quently occur. 
8. What suggestions would you make in regard to 
methods of labeling or placing drugs that would lessen 
the liability of mistakes occurring? 
9. Show how a nurse’s mistake in arithmetic may 
cause the death of a patient. 
10. Why is it a principle of safety to pour medicine 
from the side of the bottle opposite the label? 
11. State the precautions which you observe in giving 
medicines. 
12. Outline the ethical responsibility of the nurse in 
the operating room. 
13. Of what value is a good conscience in a surgical 
nurse to the hospital? To the patient? To the nurse 
herself? 
14. Is a nurse responsible for accidents occurring 
through her ignorance if she had been told of necessary 
precautions but had not heeded what was taught her? CHAPTER xv 
Developing a Symmetrical Life 
The purpose of these studies from the beginning has 
been to help nurses to study the nature and laws of 
personal life, the moral or ethical life of each individual 
nurse, and its relation to nursing and nursing problems; 
to help nurses to see, in well-balanced relation, the things 
that are true and right in personal life; to help them to 
steer their course along safe moral lines, amid the diffi- 
culties and perplexities that beset them in a nursing 
career. 
Fourfold Nature.—A fact which should never be for- 
gotten is that, apart entirely from obtaining a nursing 
education and experience, every nurse while in training 
is developing a life. To direct and develop this life 
so that she emerges from the training school a symmet- 
rical well-balanced woman with a wholesome outlook on 
the world in general, and with right ideas as to the part 
she is to play in the world, is an important part of the 
training process. It depends to a considerable extent 
on the nurse herself whether she accomplishes this or 
not. Every nurse has a fourfold nature to be culti- 
vated and developed. She has a physical, mental, spir- 
itual, and social side to her make-up, all needing due 
care and cultivation, and the possibilities of becoming 
warped and stunted in growth, of becoming one-sided 
and narrow, are present in every nurse’s life. 
In a previous chapter a quotation from an address by 
Dr. Richard Cabot is made, in which he calls attention 
to the danger of narrowness as one of the great dangers 
167 168 
ETHICS FOR NURSES 
which beset the profession, and all who know anything 
of nurses and nursing today are likely to agree with 
him as to the seriousness of this peril. 
Ethics and Conversation.—By far the most frequent 
complaints about the trained nurse, in general, after 
graduation are these: 
1. She requires too much waiting on. 
2. She does not keep sacred her patient’s affairs. 
3. She talks “shop” incessantly. 
In too many cases her conversation is devoted largely 
to discussing her previous “cases” or things relating 
to the world of sickness. It rests with each nurse to 
decide whether the public whom she serves can justly 
make such complaints about her. If a nurse stopped to 
ask herself the question: “What effect is my conversa- 
tion likely to have on the mind of my patient,” is it 
not probable that many things she talks about would 
be omitted? If she asked herself the question: “Will 
this bit of gossip, or this incident I am going to relate, 
have a tendency to brighten the day for my patient, to 
relieve the depression of sickness, to take his mind away 
from the realm of sickness and give him new and helpful 
interests, or will it help him to see the seamy side of life, 
will it add to the depressing state of mind which he al- 
ready has to combat,” is it not possible that many 
things which nurses talk about in the presence of 
their patients would be barred from a nurse’s list of 
topics? 
The influence of mind over body is generally recog- 
nized. We all have seen its results, and have had some 
degree of experience that has taught us the simple lesson 
that the state of mind, the things one thinks about do 
exercise a powerful influence over the bodily functions. DEVELOPING SYMMETRICAL LIFE 
169 
An individual hears something that surprises or offends 
and the color of his skin changes; he blushes. The 
capillary vessels in the face and neck dilate and a hyper- 
emia results. The physical change has been directly 
due to the thought that came to his mind. 
We have seen people ready with a splendid appetite 
to partake of a meal, when a disturbing bit of news 
arrives, news of the illness or death of a relative perhaps, 
and at once the body loses its keen desire for food; the 
appetite has vanished. 
A meal is eaten under the influence of distressing con- 
ditions, with anxiety filling the mind, and the glands that 
furnish the digestive fluid refuse to pour out their secre- 
tion; the food ferments, toxins are formed, and a train 
of miserable physical symptoms arise, if the anxiety and 
worry continue. 
We see a child who is hurt run to its mother, crying 
with pain. The mother kisses the spot, says a few com- 
forting words; the mental state of the child has changed 
and the pain has gone. Thus illustrations might be 
multiplied to show what we all know to be true, that 
mental conditions powerfully affect the bodily functions. 
The influence of mind over mind is quite as real as 
the influence of mind over body. We may not fathom 
the deep secrets of psychology, but we do know that our 
own mental state is actively influenced by the people that 
we associate with. A friend with a happy optimistic 
temperament meets us, and he radiates the same feeling. 
He refuses to cherish gloomy forebodings, sees much 
that is good and beautiful in the world, maintains a 
quiet confidence in the Infinite One, and in some in- 
explicable way his attitude of mind is communicated 
to us. A fussy, nervous individual makes it impossible 
to get into a tranquil, restful state of mind while in his 170 
ETHICS FOR NURSES 
presence. Those who are well and active in the affairs 
of life are able to better resist such influences than are 
invalids who are shut in by the four walls of a sick-room, 
and nurses should constantly remember that a good 
nurse ministers helpfully to the whole individual. 
If it were possible for nurses to separate the minds and 
souls of their patients from their bodies and nurse only 
the bodies, it would matter little what a nurse talked 
about in the presence of the sick, but since she is ex- 
pected to minister to the whole patient, his mind as 
well as his body, it does matter a great deal whether 
the thoughts the nurse arouses in him are constructive or 
destructive in their influence over the bodily functions. 
A Battle with the Blues.—A gentleman who was about 
to employ a special nurse for his wife while she was in the 
hospital, requested especially to be given a nurse who 
would not discuss operations, or hospital affairs, or pa- 
tients that she had previously nursed. The principal 
assured him that the nurse he would have would not 
inflict any of her experiences with operations, or patients, 
or in hospitals, on his wife, who was suffering from the 
mental depression following a long illness. The nurse 
was warned, and did not dwell on these topics to any 
great extent, but she had had some unfortunate expe- 
riences with men; she firmly believed that men in general 
were bad, and she tried to make her patient believe the 
same thing. All men she said were unchaste and impure 
in their personal lives, only their wives refused to believe 
it in many cases. She was simply obsessed with the idea 
of the iniquities of all individuals of the masculine gender; 
there were none good, no, not one! and this fixed idea 
injected itself into her conversation at every opportunity. 
It is unlikely that the nurse herself was conscious that 
she was allowing herself to dwell on this phase of life DEVELOPING SYMMETRICAL LIFE 
171 
to such an unwise extent, or that she knew that her 
influence over her patient’s mind was morbid and un- 
wholesome, but a nurse should think and should know 
whether the thoughts that she thinks and expresses, are 
likely to fill her patient’s mind with the joy of living, to 
help her to look out on a sunnier world, to deepen her 
faith in God and man, to add to her happiness or whether 
they will have the opposite effect. 
The possibilities of the power of thought are tremen- 
dous, and no nurse can afford to let this potent force in 
the sick-room run riot. It is entirely within a nurse’s 
power to refuse to harbor unpleasant thoughts, or to dwell 
on the sad and painful experiences of life. She can 
deliberately determine that her business in life is to 
exercise a constructive influence on her patient’s mind, 
rather than a depressing destructive influence. She cer- 
tainly can refrain, if she wills to do it, from inflicting the 
story of her own unpleasant or harrowing experiences 
on a helpless patient who cannot escape from her 
presence. 
The Value of New Interests.—The best way to combat 
the tendency to form habits of gossiping about matters 
relating to the world of sickness, is to keep up a whole- 
some interest in the world outside, and, from time to 
time, to acquire new interests in life. Time for reading 
is limited while in training, but fifteen minutes a day or 
less spent in scanning the chief events chronicled in the 
daily papers, will serve to keep a nurse posted as to the 
progress of the important developments in her own com- 
munity and country. An hour a week with magazines 
which give a review of world progress, will wonderfully 
widen a nurse’s outlook on life. Then there are numer- 
ous great movements for social and moral uplift in our 
own land, which touch the nursing field at many points, 172 
ETHICS FOR NURSES 
movements which are opening new doors of opportunity 
for nurses every year, movements which nurses in train- 
ing should know something about, such as the child 
labor movement, the playground movement, the great 
public health movement, the various forms of social 
service which are being carried on in the interests of 
immigrants, etc. 
One of the easiest and most natural ways that a nurse 
can use to keep out of the ruts of monotony in thought 
and conversation is to maintain her relationship with 
some church, attend its services as regularly as possible 
and try to keep in touch with what her own church is 
doing at home and on foreign fields. No study that a 
nurse can engage in will do more to broaden her horizon 
and quicken her sympathies than a study of the modern 
acts of the apostles who are at work in foreign fields or in 
difficult parts of the home land. The nurse who desires 
this kind of culture can (for a dollar or less a year) have 
any one of a dozen magazines come to her monthly 
that will bring to her stories of heroism and achievement 
in other lands, that will lead her out into new lines of 
thought and endeavor, and that will wonderfully enrich 
her personal life. From such a magazine one catches 
glimpses of the manners and customs of people in non- 
Christian lands, of their social and sanitary condition, 
their educational methods, of the great need for trained 
women in those lands, of what women from the western 
lands are doing to lift the burdens from women in oriental 
lands, and free them from the bondage of pernicious 
ancient customs. Nurses are having a wonderful part 
in this great movement. They are teachers of sanitary 
science, of home economics; they are bringing to the 
oppressed and down-trodden women, who, in many lands 
are considered simply as chattel property or as slaves, DEVELOPING SYMMETRICAL LIFE 
173 
the inspiration, instruction and nursing care they have 
so long needed, and are helping to create in those countries 
a higher idea of the value of woman, and of her place in 
national life. No nurse who wishes to be known as a 
well-informed or cultured woman can afford to be 
ignorant as to progress in this great movement for the 
uplift of women that is going on all over the world, a 
movement in which the nurses of the future are destined 
to play a still more important part. 
It was said of a certain group of women that “ they knew 
of no great events to talk about, so they talked of small 
things as if they were great.” The same could truthfully 
be written about many groups of nurses, who, during 
training, indulge in gossiping, endlessly, about their pa- 
tients, at meals, in bedrooms, on street cars, and in public 
places, simply because they refuse to make the effort to 
direct their conversation into other channels of thought. 
Conversational Standards.—Is it worth while to try 
to keep out of ruts in one’s thinking and conversation? 
Is it worth while for a nurse to try to improve her con- 
versational standards? If so, how shall she begin to do 
it? A good rule to start with is the following: “What- 
soever things are true, whatsoever things are honest, 
whatsoever things are just, whatsoever things are pure, 
whatsoever things are lovely, whatsoever things are of 
good report; if there be any virtue, and if there be any 
praise, think on these things.” 
Suggested Subject for Written Work.—What should a 
nurse do who does not desire to become a gossip, but who 
finds this pernicious habit of gossiping about patients’ 
affairs, the short-comings of head nurses, habits of 
physicians, etc., prevalent among the nurses that she 
associates with? Can such a habit be stamped out 
among nurses? If so, how? 174 
ETHICS FOR NURSES 
1. What is meant by a nurse’s fourfold nature? 
2. Mention three common complaints which the 
public make about graduate nurses. 
3. Is it true that nurses cannot be trusted to keep their 
patient’s affairs sacred? Give reasons for your answer. 
Can you be trusted? 
4. Mention several ways in which a nurse may help- 
fully influence the mind of her patient and help her to 
combat the depression of illness; also subjects which she 
should avoid. 
5. Write a brief paper on the influence of mind over 
body. 
6. Can a nurse fix conversational standards for herself 
and adhere to them? Explain your answer. 
7. Of what value to nurses are varied interests in life? 
8. Show how a variety of interests tends to strength of 
character and is a safeguard to a nurse. 
9. Prepare a list of books you would consider suitable 
to be read to the adult sick. Mention some kinds of 
books which should be avoided. 
10. Can you think of any reason why a nurse should 
hesitate to attempt to read dialect stories aloud to her 
patients? 
11. What sort of books would you consider suitable 
to be read to a sick child and give some precautions in 
regard to the reading which you would think necessary? 
12. If a nurse desires to become proficient in story- 
telling, how shall she go about it? Are there any general 
rules to be observed that will contribute to the success 
of the story-telling effort? If so, what are such rules? 
FOR DISCUSSION OR REVIEW CHAPTER XVI 
The Discipline of Daily Living 
It is probable that no nurse ever appreciates the value 
of hospital discipline till years of experience with life and 
people have come to her. She does not appreciate how 
much it means in the building of her character that she is 
required and expected to be faithful, true, honest, fair to 
others; that her tendencies to grumble or criticize or 
gossip were repressed; that she was obliged to stick to her 
tasks, whether agreeable or not, till they were finished; 
that she had to be punctual; that she had to repress the 
hasty word she was about to speak; that she was given 
responsibility and expected to measure up to it. 
Reliability.—The work of the world depends upon 
reliable people, and this is especially true of hospital 
work, where life and death issues often hinge upon some 
apparently small thing. “ A reputation for being reliable 
is the key to most of life’s successes. Friends, work, 
honor, all gravitate to the reliable person. Being reliable 
is not easy, surface work. It takes day after day and 
year after year of patient acceptance of responsibility, 
of picking up the threads that the careless drop, of being 
ready in emergencies where others fail, of doing unin- 
teresting faithful work that others tire of and slight— 
it takes all this to make the dependable man and woman 
known and valued.” 
Honesty in Bedside Records.—In a previous chapter 
reference was made to the subject of honesty or reliability 
in a nurse’s records. A nurse’s bedside records are an 
index to her real character, an everyday test of her 
175 176 
ETHICS FOR NURSES 
honesty. It is of small comfort to know that the records 
look well, are free from blots and erasures, etc., if they lie. 
The principal of a certain school relates the following 
experience in her school, an experience which is probably 
not confined to any one school. 
On making rounds, unexpectedly, shortly before mid- 
night she found that all the patient’s records in a large 
ward were completed up till 7 A.M., with a few exceptions. 
Various patients were recorded as having had “a good 
night.” Six ounces of milk had been taken by several 
at 2:30 and 6:30 A.M. and several had voided twelve 
ounces of urine at a certain morning hour. Digitalis 
had been given to one at 3 A.M. and whiskey to another 
at 5 A.M. Temperature, pulse, and respiration were 
charted at 6 A.M. 
On another occasion a certain nurse in the same school 
had recorded a douche given to each of three patients 
for three successive nights, all of which douches were 
reported to have “returned clear.” One of the patients 
complained of not having had her douche for several 
nights, and on inquiry the other patients stated that 
theirs, too, had not been given. 
Another nurse in the same school recorded special tab- 
lets which were ordered for a patient each four hours, as 
given at 8 and 12, and that the patient was asleep at 
4 A.M. when the tablet was not given. The facts were 
that the supply of these tablets had been exhausted and 
the head nurse had failed to have the stock renewed, and 
none had been given. This nurse was suspended for 
two weeks, and warned that if further dishonesty were 
discovered, she would be dismissed. In an inspection 
of her room, articles belonging to several other nurses 
were found in her possession. 
How far can a nurse who is dishonest in her records be DISCIPLINE OF DAILY LIVING 
177 
trusted? What is her word worth? Will a nurse who 
will lie in her records be likely to be guilty of stealing 
also? 
Adaptability, that quality so essential to a nurse’s suc- 
cess, is being cultivated all through training. Whether 
a nurse learns the lesson, or develops this most desirable 
quality, depends greatly on her own attitude of mind, 
and her own temperament. She has the opportunity 
to acquire this quality of adaptability, if she really 
desires it. 
One of the first tests that nurses have to meet, one 
which contributes considerably to the development of the 
quality of adaptability to varying circumstances, comes 
to her when she becomes a part of community life. She 
learns that there are regular hours for doing things, and 
that whether she is inclined to attend to them at the 
time ordered or not, she must do it. She realizes for 
the first time the importance of trifles. She protests 
at first against the existence of so many rules—rules as 
to what she must bring with her; rules about rising and 
retiring, about the condition in which she leaves her room 
in the morning, about when she must go to meals, about 
hair and clothing, about the shoes she wears; rules about 
when to stand and how to stand, and when to sit; 
about what subjects are proper to be discussed with 
doctors when on duty, when to speak and when to be si- 
lent; about what articles she may and may not put in the 
laundry; about a thousand things which she has exercised 
free choice about before she entered. 
She learns that her tastes in food are not likely to be 
consulted, that she need not expect favors to be shown 
her, and that no one is likely to ask for her opinion about 
a multitude of regulations to which she is expected to 
conform, but she does not dream that she is cultivating 178 
ETHICS FOR NURSES 
adaptability through these conditions and restrictions. 
She learns meanwhile to submit herself to the will of 
others, to accept sweetly the restrictions of institutional 
living, to consider the rights and comfort and welfare 
of others of the same household, as of equal importance 
with her own. 
Daily Discipline.—There is also the discipline that 
comes from carrying out, day by day, a more or less 
monotonous routine, which must often seem like drudg- 
ery. She needs to remember that no education is ever 
secured without drudgery, and that all work at times 
seems to the doer of it as real drudgery. Contact with 
suffering brings to a nurse a different sort of discipline 
from that which most workers receive and every nurse 
needs to guard against allowing firmness to degenerate 
into hard heartedness; to be careful in developing endur- 
ance, and self-control, that she does not lose some of the 
finer qualities which no nurse can afford to lose. 
Some one has said that “there is such a thing as the 
prose of this world’s work, even good work, eating like 
rust into the life; there is such a thing as the little daily 
cares rasping and fretting the womanliness and the 
godlikeness away until there is scarcely a sweet word left 
on the lips, or a noble thought in the heart. Every 
nurse has to guard against this. It is true she has to 
stand in the shadows with those who are in trouble, but 
her face can always be turned toward the sun, so that 
the true light may not only enable her to see her duty, 
but may beautify and ennoble it.” 
When a nurse has passed her first year of training, 
she should have grasped the principles that underlie 
the discipline which she perhaps protested against in 
the beginning, and should be capable of applying the 
best principles to her own character and conduct and life DISCIPLINE OF DAILY LIVING 
179 
If she will try to keep always in mind Florence Night- 
ingale’s idea that “nursing is God’s business” she will 
find many duties made lighter; and she will find, what 
every nurse should try to find, a real joy in service. 
Sympathy, that indefinable quality which is so much 
needed, and so quickly felt by patients and their friends, 
is better shown in deeds than in words. It has been de- 
fined as a fellow-feeling with others in their varied con- 
ditions of joy or grief. Sympathy is not a weak yielding 
to the whims of patients when such yielding will do harm. 
It is frequently shown in “humoring” a patient when it 
is quite permissible, but often not fully convenient to do 
so. While, as a general rule, sympathy is shown much 
better in deeds than words, yet there are occasions when 
nothing more remains to be done for the patient. All 
that one can do has to be done with the sorrowing 
relatives and friends who are feeling the first shock of 
their loss. 
What can or should a nurse do or say under such cir- 
cumstances that will impress the friends that she has a 
real feeling of sympathy with them in their loss? What 
can she do that will give them a crumb of comfort or 
satisfaction at such a time? What can she do, or should 
she do to interpret to those friends and relatives, the real 
feelings of compassion and human kindness that animated 
the founders of the hospital? 
Reverence.—A nurse reveals her true character to a 
considerable extent, by her reverence or lack of reverence 
for sacred things, or for the solemnities of life and death. 
It is unfortunate that familiarity with death should so 
frequently rob nurses of that awe which should be felt in 
the presence of death. 
What responsibility has a senior nurse who assists a 
junior for the first time in caring for a dead body? If 180 
ETHICS FOR NURSES 
your mother or sister or a near relative were about to die 
in a hospital, mention three things you would rightly 
expect of the nurse in charge, before death occurred, and 
three qualities you would expect her to manifest in her 
care of the body after death. 
Faithfulness.—All nurses cannot be quick or brilliant. 
All cannot take the highest grade in examination, but 
all can be faithful, and there is no quality which means 
more to a nurse in meeting the stern tests of life, than the 
simple quality of being faithful to the trust reposed in one. 
A nurse can receive no higher commendation than “Thou 
hast been faithful.” 
The grumbling nurse is found at some time in all 
schools. She may be capable, and of more than average 
intelligence, but she is unable to adapt herself sweetly to 
the rules and restrictions necessary to the life and routine 
of an institutional household. She frequently is found, 
often before her probation period is passed, freely criticiz- 
ing the methods and rules of the institution to other 
nurses. In the blind confidence born of inexperience and 
ignorance, she imagines she could manage the hospital 
or training school or department far better than those 
who have had years of experience. Such nurses grumble 
about rules, about work, about food, about duty hours, 
about one thing one day and another the next, till they 
succeed in keeping all with whom they associate uncom- 
fortable. There is only one thing to be done in regard to 
a nurse of this type, who persists in grumbling and criti- 
cizing and stirring up discord that poisons the atmosphere 
of the place, and that is to get rid of her. The habit of 
grumbling in some people is chronic, and usually it is 
to a greater or less degree contagious. 
It is well for nurses to remember that few if any prin- 
cipals are fully satisfied with the results of their manage- DISCIPLINE OF DAILY LIVING 
181 
ment; that they are fully conscious of many conditions 
which should be improved, and are patiently waiting for 
the right moment to make some needed adjustment. 
They are not half so blind as some pupils suspect, but 
they have to depend on very human machinery for the 
working out of plans for improvements, which are often 
delayed from causes difficult to control. Very often the 
grumbling nurse, apart from her undesirable disposition, 
is an inferior, unreliable worker, one whom the principal 
would be very glad to be relieved of. The grumbling 
nurse sees a variety of things which she wants changed to 
suit her tastes; the principal sees perhaps a very inferior 
nurse who may not commit any flagrant crimes or misde- 
meanors, but who will never be a credit to the school, and 
who is likely to prove a disturbing element wherever she 
goes. 
The nurse with a real grievance belongs to a different 
class. That, even in this twentieth century, nurses 
sometimes suffer from unnecessary and preventable dis- 
comfort, cannot be denied. Quite often the principal 
may be so overwhelmed with pressure of other duties, 
that she has not had the existence of the grievance 
impressed on her. There is too, a possibility of knowing 
a thing without having its full importance brought to 
one’s attention. 
What to do with a Grievance.—Very rarely is any- 
thing gained by airing one’s grievances in corridors and 
bedrooms, with those who are in no position to correct 
the conditions complained of. There are two or three 
things which may safely be advised in dealing with 
grievances in general. First, be sure it is a real grievance 
and not a fancied one. Second, write a statement of the 
grievance on paper, and let it cool for a few days, or 
longer. Be sure it is not exaggerated. If it still seems a 182 
ETHICS FOR NURSES 
real grievance that can be and should be remedied, go in 
a quiet, ladylike, dignified way to the person in authority, 
who is in a position to correct the conditions complained 
of, and ask if something not be done to improve 
matters. 
It is well always to remember that the narrow outlook 
which a pupil nurse necessarily has as a result of working 
in one corner of an institution, and being unable to see 
the problems of the hospital or school as a whole, in- 
variably has a tendency to lead her to magnify small 
grievances into large ones, to become irritated at trifles, 
which in later years will appear ridiculous. 
If, after having done this, the grievance continues, 
what course should a nurse pursue? The old adage, 
“Better endure the ills you have, than fly to those you 
know not of,” is a good one to remember. The coura- 
geous acceptance of such disagreeable conditions as 
nurses could not remedy, has had a large part in the 
making of the best nurses the world knows today. 
Truth and Falsehood.—There is probably no ethical 
question which seems to a serious minded nurse more 
puzzling than the matter of telling the truth. From 
the beginning of her career she is impressed with the idea 
that in the eyes of many members of the medical pro- 
fession, it is an unpardonable sin to lie to a doctor about a 
patient, but perfectly pardonable, and frequently very 
desirable, to lie to a patient about his own condition. 
Thus this “double standard” as to truth in medical 
affairs confronts a nurse and adds to the confusion of her 
own ideas of duty, all along the way. 
“The great bulk of medical work, public and private, 
is still done by men, high-minded men, who believe that 
it is impossible to deal frankly and openly with patients,”* 
* Social Service and the Art of Healing. DISCIPLINE OF DAILY LIVING 
183 
says Dr. Richard Cabot, in discussing the questions, 
“How far should we speak the truth in dealing with our 
patients, our colleagues, or anyone else? Are lies ever in 
place? If so, under what conditions?” 
The substance of the teaching given in medical schools 
on the question of truth-telling in medical matters is 
summarized by Dr. Cabot as follows: “‘When you are 
thinking of telling a lie/ said the teacher, ‘ask yourself 
whether it is simply and solely for the patient’s benefit 
that you are going to tell it. If you are sure that you are 
acting for his good and not for your own profit, you can 
go ahead with a clear conscience.’ The lies which the 
medical profession agree in condemning are those told for 
personal and private gain.” 
Veracity is defined by the same writer as “doing one’s 
best to convey to another person the impression that one 
has about the matter in hand.” One may do one’s best 
and yet fail, but that is not lying. A true impression, 
not certain words literally true, is what we must try to 
convey. By lying is meant an intentional deception, 
however brought about. 
The Technic of Telling the Truth.—In answering the 
question as to whether the truth should be told when it 
may kill the patient, the writer quoted suggests that it 
is in very extraordinary and rare cases that a life could 
be saved by a lie, and that the nervous systems of 
patients and friends on whom the experiment has been 
tried of telling the truth about their condition when a lie 
would have been easier, have shown an amazing im- 
munity from depressing effects. “ It seems as if, when the 
pinch comes and the individual has to face stern realities, 
some species of antitoxin is spontaneously and rapidly 
developed whereby the individual is rendered immune to 
the effects of the expected shock.” 184 
ETHICS FOR NURSES 
The way in which a thing is told has so much to do with 
the way in which it is received that all nurses need to 
study carefully the best way of putting disagreeable 
facts before a patient or his friends when asked for them, 
or when it is desirable for the facts to be known. See 
page 58. Is there such a thing as “a lie of necessity”? 
If so, give an illustration of such necessity. 
Why is a Lie Wrong?—“There is a very general belief 
that American common education is lacking in one 
important aspect, namely, the inculcation of a sound moral 
element,” says a modern writer. “This is not to say, of 
course, that the trend of education is immoral, nor even 
unmoral. There is a certain moral element in the very 
nature of study, in the very act of imparting knowledge. 
There is a sense of honor which makes itself felt at every 
examination, and there is also an atmosphere of clean 
competition in both studies and sports.” . . . 
“It is possible to teach morals in a way to fix in the 
youthful mind the truth that ‘being good’ is not merely 
obedience to an arbitrary rule, but is a scientific observ- 
ance of some of the deepest laws of nature. Every child 
is told, for example, that ‘it is wrong to tell a lie.’ It is 
right that the child should so be told. But why is a lie 
wrong?—the child is seldom told that. A lie is morally, 
socially, and economically wrong, it is morally, socially, and 
economically dangerous and disruptive, and if this idea 
were firmly planted in the mind, the truth itself would rest 
on a sounder basis. Speech is the coin of confidence. Men 
rest on each other’s word, just as they take at full face value 
the coined money which is handed them. When the truth- 
fulness of a man’s word becomes vitiated, he is an agent 
in hindering the exchange of human confidence, and all 
the operations based on confidence, just as if he were 
instrumental in diluting the monetary currency and coin- DISCIPLINE OF DAILY LIVING 
185 
age of the country with counterfeit pieces. A lie is a 
broken bearing in the wheels of social life, not to speak 
of the disintegrating power which it exerts upon the life 
in which it originates. 
“We live in a universe of moral laws which are as 
unsafely violated as are the natural laws. Indeed, morality 
is a natural law.” 
Mental Therapeutics.—The wise use of “persuasion” 
and “suggestion” as therapeutic measures is advocated 
today by the best and most successful physicians. To 
many, the giving of placebos is simply a form of sugges- 
tion which they feel is perfectly justifiable. Instead of 
trying to persuade a patient or of using time and effort 
to impress a patient’s mind with the idea that he will 
sleep tonight, thus creating in his mind the right mental 
conditions for sleep, they give a bread pill or a sugar of 
milk tablet and say, “This medicine will put you to sleep.” 
Placebos with or without lies, Dr. Cabot believes,* 
are unnecessary, unless in the very exceptional cases in 
which one is dealing with a foreigner or an individual who 
cannot understand the explanations given. He claims 
that the giving of placebos is fostering the patent medi- 
cine habit, and helping to educate the patient, and the 
public, to a harmful dependence on drugs, to a wrong 
idea of the way in which disease is produced and avoided, 
is helping to perpetuate false ideas about how health is 
to be secured and maintained. Do you agree with this 
opinion? If not, why not? 
In the use of placebos, does the value of the suggestion 
depend on the patient not finding out that he has been 
deceived? Is it a good thing to have a patient’s con- 
fidence rest on such a flimsy foundation as “not being 
found out?” 
* Social Service and the Art of Healing. 186 
ETHICS FOR NURSES 
In what way might the use of placebos help a patient 
to an unwholesome dependence on drugs, and induce a 
habit of drugging for every ailment? 
What is meant by the use of “persuasion” and “sug- 
gestion” as therapeutic measures? 
To what extent and in what ways may a nurse use 
these methods in her everyday practice? 
Suggested Subject for Written Work.—Is it possible 
for every nurse to be a living demonstration to those 
who know her, that she is capable of doing the work of a 
true nurse in the world without losing any of the sweet 
and beautiful qualities we covet for all women. If you 
believe it is, show how it can be done. 
1. What is reliability? How is it shown? 
2. Of what value to a nurse is a reputation for 
reliability? 
3. What value should be attached to dishonest bedside 
records? 
4. What responsibility has a nurse who discovers that 
one of her associates is practising dishonesty in her 
records? 
5. Is it dishonest to record a duty as done before it is 
done, when a nurse simply thinks she will do it? 
6. Show how adaptability is cultivated in the every- 
day routine of a hospital. 
7. Mention several ways by which a nurse may sho.w 
her sympathy with a patient or his friends, and several 
methods of showing sympathy which she should avoid. 
8. Explain in detail what is meant by reverent care 
for the dead. 
9. When a nurse finds one of her associates inclined to 
grumble constantly, what should she do? 
FOR DISCUSSION OR REVIEW DISCIPLINE OF DAILY LIVING 
187 
10. What is the best course for nurses to pursue who 
believe that they have a real grievance? 
11. In a certain hospital there is a rule posted in the 
nurse’s dining room requiring all complaints about food 
or the way it is served to be repressed while in the 
dining room, and submitted in writing to the superin- 
tendent. Would such a rule tend to greater comfort or 
discomfort during meal hours? Would it tend to lessen 
or increase grumbling about food? Why? 
12. Prepare a list of suggestions by which the variety 
in institutional food might be increased without increas- 
ing the cost. 
13. If you had to cater for fifty or a hundred nurses, 
what rules would you adopt in order to satisfy them all? 
14. What is the best way to deal with a nurse who is a 
chronic grumbler and never satisfied? 
15. Mention some examples of the successful use of 
“suggestion” used as a therapeutic measure by nurses. 
16. Why is a lie wrong? CHAPTER XVII 
Manner and Temperament 
It is a common mistake in nurses to feel that in the 
first few months or a year they have acquired a good 
deal more knowledge than they really have, and to fail 
to realize how much there is yet for them to learn be- 
fore they should be sent forth as trained women. They 
have not learned to distinguish between knowledge and 
wisdom. 
Good judgment comes only as the result of experience 
and of a wider knowledge than any nurse can hope to 
acquire in a short time. Many nurses fail to remember 
that the self-control, the power of wise decision, the re- 
sourcefulness, the quickening of the powers of observa- 
tion and perception, the complete reliability which makes 
a good nurse a tower of strength to an institution or 
household have to be patiently acquired; they cannot be 
learned from books, cannot be put on with the uniform, 
they cannot be purchased. 
Many nurses bring with them certain mannerisms— 
ways of speaking or acting—which are more or less crude. 
They have sharp edges to their make-up, which training 
should help them to eradicate. Many “ diamonds in the 
rough” are admitted for training in the hope that, 
through training, the fine qualities that are believed to 
be in them may be developed and the rough edges 
smoothed away. This process takes time and patience, 
not only on the part of the nurse herself, but probably a 
greater degree of patience on the part of those responsible 
for her training, who must meanwhile put up with the 
188 MANNER AND TEMPERAMENT 
189 
results of her crudeness, her lack of judgment, her foolish 
weaknesses, or her unfaithfulness. There are perhaps 
few failings in nurses that are more exasperating than the 
quality of self-complacency which so often develops after 
the first year’s training has been finished. 
Self-training.—It is hard for a nurse to comprehend 
that the acquisition of technical knowledge and the 
passing of examinations are but one phase of training, 
and that the change which she needs to have wrought 
in her is often much farther from being accomplished than 
she is able to realize. Nurses frequently come asking for 
a course of training when they do not desire training. 
They rebel against it. They would be satisfied with a 
certain very moderate amount of instruction. They act 
as if they expected to have technical knowledge poured 
into them as though they were empty vessels, with no 
inherent qualities that would prevent their retaining all 
that was taught. That they bring with them bad habits 
that must, if possible, be trained out of them, that they 
have weak points that need to be strengthened, and latent 
good qualities developed, all of which takes time, is a 
thought rarely grasped by a pupil on entrance. 
Types of Nurses.—In every school there will be found 
nurses who seem to have no higher motive than simply to 
secure a diploma, and who wish to do as little as possible 
and study as little as they can possibly manage to get 
through with; who seem to be in no way desirous of 
correcting glaring defects in character, even when atten- 
tion is called to them. Others are quick but superficial, 
content to slight their duties whenever it seems conven- 
ient, and have no aspiration toward thoroughness. 
Another type is slow in grasping new ideas and methods, 
but make up for this in their faithfulness to details and 
their general loyalty to the welfare of patients and the 190 
ETHICS FOR NURSES 
institution. They quickly develop the quality of being 
“dependable” and impart a feeling of security and 
confidence wherever they are at work. Still another 
group of nurses demonstrate quickly their power of con- 
structive thinking and planning. They manifest that 
quality known as “initiative.” They see things to be 
done and do not have to be told every slight detail. 
They see things out of place and put them where they 
belong, without waiting to be told. They show a proper 
regard for hospital property and try to keep it in good 
condition. They are not given to wasting time in 
gossip, and get along well with their associates. 
Describe some other types of nurses whom you know— 
nurses who will not fit into any of the classes mentioned. 
Good Manners.—Of what value is a refined manner to 
a nurse? How will courtesy and good manners affect 
her success in life? How much responsibility have the 
training-school authorities to correct defects in table eti- 
quette in nurses? In what ways can nurses help each 
other to acquire good habits and correct bad habits in 
the dining room and elsewhere? 
Mention some common lapses in table etiquette which 
you have observed among nurses. 
Is the habit of using slang likely to be a hindrance to a 
nurse? Mention common examples of slang or expletives 
which you have noticed nurses indulging in that you 
think might be a hindrance to a nurse in her professional 
life? 
Two nurses who were friends before they entered for 
training persisted, in spite of orders to the contrary, in 
calling each other by their Christian names, and occa- 
sionally by such terms as “Dearie” and “Honey,” while 
on duty. What are the chief reasons for objecting to 
this practice? MANNER AND TEMPERAMENT 
191 
The stony manner so frequently used by fiction writers 
in portraying nurse characters is unfortunately not 
entirely an imaginary quality. It exists in far too many 
nurses, and the term “ stony lady ” used by a little girl 
patient in speaking of her nurse is far too apt a charac- 
terization of some nurses. 
A writer in an English journal,* in commenting on 
this subject, says some plain things which are worthy 
of reflection by every nurse: 
“ The ‘ hospital manner ’ has become a by-word, and the 
profession which should be a model of gentle kindliness 
is often held up to just reproach on account of the abrupt 
discourtesy of its speech, the stiff aloofness of its manner, 
its want of sympathy and politeness as displayed to 
strangers or to subordinates. 
“Constant daily association with strangers tends to 
make some natures silent, unresponsive, unsympathetic. 
Because they are strangers such people do not find it 
worth while to be pleasant, courteous, or genial. They 
go about their business self-contained and indifferent to 
others. When spoken to they are monosyllabic, abrupt, 
curt to the verge of rudeness. They ask but little of 
others and never go out of their way to do an unasked 
kindness to anyone. They may be of sterling worth 
under this hard crust, but their better qualities seldom 
find their way to the surface because of what the kind- 
hearted describe as their ‘unfortunate manner.’ These 
people sometimes become embittered because their good 
qualities and real ability remain unrecognized, while 
others, less reliable and not half as clever, secure some 
coveted post or easily win promotion or praise. They 
will not allow that the same good things might have 
fallen to their own share also had they only possessed 
* Nursing Mirror. 192 
ETHICS FOR NURSES 
equally gracious and pleasant manners. They pride 
themselves upon that very abruptness which hinders 
their advancement. They hug their curtness and call it 
sincerity; their rudeness and christen it truth. 
“Surely, if any members of the community ought to 
cultivate good manners, nurses should do so. To them, 
rather more than to most, they mean success. At the 
very commencement of her career a well-mannered girl 
stands on a different footing from her more uncouth 
companion. Her fellow-nurses like her, the patients 
take to her, the head nurse of the ward sees in her a 
promising pupil, the principal is favorably impressed. 
As she goes on she finds difficulties smoothed by her 
invariable courtesy; she can bend patients, juniors, ser- 
vants to her wishes; even members of committees yield 
to her charm of manner. 
“Good manners ensure the immediate success of the 
head nurse, the superintendent, the private nurse, in all 
those countless intricacies of daily life which call for 
tact and courtesy. If they are indeed the ‘fruit of a loyal 
nature and of noble mind,’ then, when combined writh 
ability and professional skill, it is safe to prophesy that 
the nurse possessing them will go far. 
“True, it is difficult in the daily ‘hussel and busseH— 
as a little maid once spelled it—of hospital life to remem- 
ber and practise always the grace of courtesy. The time 
goes so fast, interruptions are so numerous, and there 
are so many duties to claim our attention that almost 
before we know it the staccato note has crept into our 
voice, and we are nothing if not abrupt. People are deaf, 
people are stupid, and we are compelled to suffer fools, 
though not gladly. Thronging duties hem us in on every 
side until sometimes the common courtesies of life are 
allowed to slip from us unheeded. Yet some of the MANNER AND TEMPERAMENT 
193 
busiest of people have been noted for their good manners, 
while those possessed of ample leisure are not always the 
most courteous. 
“The best manners have their origin in a kind, unsel- 
fish nature, a sympathetic mind, a feeling heart. They 
are the outcome of a spirit of reverence toward God and 
man, the expression of true benevolence, and, as Lord 
Rosebery has put it, ‘ a sign of charity toward your fellow- 
man, a part of your duty to your neighbor; they are also 
a sign of self-respect.’ 
“Good manners are not incompatible with sincerity. 
Nearly always there is something pleasant to say if we 
will only say it, just as true as, and infinitely more accept- 
able than, the abrupt word and unsmiling look. Cour- 
tesy establishes friendly relations at once and goes far 
to oil the wheels of daily life.” 
Temperament and Institutional Work.—The author 
receives numerous inquiries regarding nurses for insti- 
tutional positions and always the matter of temperament 
is mentioned as one of special importance. If you were 
seeking for a principal or supervisor for a hospital school 
in which you were interested, what temperamental 
qualities would you desire to find ? What other qualities ? 
The following description of a head nurse was written 
by a Turkish patient after an experience in a hospital 
in New York City. Analyze his description and compare 
it with your own ideal for a head nurse. What points 
did the Turkish patient overlook that should be embodied 
in the ideal you have in mind of what a head nurse should 
be temperamentally? 
“I wish to speak especially for the head nurse. She 
seems so simple, so even, so obliging, so sympathetic 
and so kind a woman as I have ever seen. She creates 
a smile even if she had none. She makes a sympathy 194 
ETHTCS FOR NURSES 
with every little complaint to her. She answers short 
and simple. She walks around scattering grace and 
peace everywhere. She gives one smile to a sufferer and 
to another a sympathetic nod. She is very kind to her 
nurses. She speaks obligingly (kindly, he means), but 
yet commands. She asks yieldingly, yet demands. She 
inquires beseechingly, yet compels. She is medium 
aged, modest looking, bright, fair complexioned, has a 
forehead which could show her intellect, a modest nose 
that may betray her great patience, a pair of eye-glasses 
behind which two glittering eyes which could tell that 
their owner had shaken hands sometimes with the mes- 
sengers of every kind of misery and disappointment. 
Anyhow I must not go further for an American lady which 
is your national sister and my human friend. The other 
nurses I do not care for; they seem very greenhorns yet.” 
Special nurses for private patients in hospitals can 
be either a real help or a real detriment to a training 
school. Analyze the most nearly perfect “special duty” 
nurse whom you know, and try to decide what qualities 
she seems to possess that other nurses lack. What are 
the reasons why doctors and patients seem to prefer her, 
and why the hospital calls her in preference to some 
others? 
Temperament and Private Duty.—If manner and 
temperament are important in filling a hospital position, 
they are even more so in private homes. Two types of 
nurses will illustrate this point. The nurse whose 
management of her cases is so plainly in evidence that 
everyone in the home is made uncomfortable is a type 
not infrequently met with. Such a nurse is described 
thus by a nurse writer:* “Miss H. is mentally alert and 
neatness personified. She was the valedictorian of her 
* Helen Wilson in The Trained Nurse and Hospital Review. MANNER AND TEMPERAMENT 
195 
class, but alas for her patients! She rules them as rigidly 
as if they were prisoners. She has what is called ‘a 
commanding presence/ Everyone gets out of the way 
when she arrives. The poor miserable patient feels the 
shock of her arrival most of all. While she takes the 
temperature, pulse and respiration on the minute, she 
wears an air of stern seriousness. 
“She takes a quick survey of her surroundings and 
plans her attack. The position of the bed is changed, 
and before she has been in the house half an hour, the 
hall is filled with articles considered superfluous and un- 
hygienic. Her commanding presence is quickly felt in 
the kitchen, where the cook is given freely a course in 
domestic science. The doctor’s orders are carried out 
to the letter; not one medicine or treatment is omitted.” 
No one can call her lazy, but somehow every one heaves 
a sigh of relief when the door closes behind her. Can 
you tell why? Why is such a nurse not kept busy? 
Wherein was her failure? How far is it wise to try to 
discipline a patient when in a private home? 
Another case in which manner causes the nurse’s fail- 
ure occurs somewhat as follows: 
Dr. Blank calls a registry and asks for a nurse whom he 
knows for a mild case of nervous exhaustion. The nurse 
he asks for is busy, but the registrar sends another nurse, 
the one whose name is at the top of the registry list. 
The doctor expects the case to last at least two months, 
possibly longer. He wishes the patient to have complete 
rest in bed and to gain in weight. The remainder of 
the story is thus told by the writer quoted. 
“The nurse arrives. She is the picture of health, 
tall, a perfect physique, and very pretty. She is dressed 
in the height of fashion, of a certain type. Her hat, 
the largest money could buy, is trimmed—it surely must 196 
ETHICS FOR NURSES 
have resembled David Harum’s wife’s bonnet, so nearly 
did it come to having ‘glass beads and garden truck’ 
upon it. It did have two very weather-beaten peaches 
and a bunch of grapes on one side and a willow plume 
on the other. Her flimsy black dress would have passed 
for an evening gown, so ‘dutched’ was the neck. She 
wore a gaudy necklace and numerous rings. 
“When greeted by her patient’s husband she exclaimed: 
‘Well, say, I would have came out by the ten o’clock, 
but I just missed it. Say, ain’t this a peach of a place 
though?’ 
“When she appeared later in her pretty pink uniform 
and kerchief she was indeed a picture as she stood in 
her patient’s door.” 
She greeted the patient with a volume of the latest 
slang, which at once settled her grade as a nurse in the 
patient’s mind. In just two days she departed and an- 
other nurse was called. Technically there was no com- 
plaint about her work—she was willing to do anything 
she saw needed to be done for the patient’s comfort. 
Which of the two nurses just described would you wish 
to have hovering over you if you were really ill? To 
what extent was each nurse to blame for her manner? 
Would it be possible for either to change her manner? 
How would you convince either nurse that her manner 
was a hindrance to her? Can you see why such nurses 
are likely to swell the discontented class that is always 
complaining that there are too many nurses? 
Executive Ability.—There is no one quality or com- 
bination of qualities so much in demand in nurses as 
that known as executive ability. Institutions are always 
seeking for nurses with executive ability and the “right 
temperament” to take charge of training schools and 
departments. MANNER AND TEMPERAMENT 
197 
What is this thing which is so much in demand in 
nurses and how can it be cultivated? Is it a natural 
gift or must it be acquired? These are questions of real 
importance to nurses who desire institutional positions 
or other positions of responsibility in the nursing field. 
Is the following a satisfactory definition of executive 
ability; the power to think and plan and do, with a fair 
measure of success, without the supporting help and 
direction of others? 
How far, and in what ways, may a nurse acquire this 
power or ability while in training? How can she 
demonstrate that she has this ability? 
An analysis of the qualities that go to make up executive 
ability will show practically always these two striking 
and important traits of character—moral courage and 
self-reliance. These two might be combined in the well- 
understood quality known as back-bone. 
The true executive must make his own decision—act 
on his own responsibility, irrespective of what others may 
suggest. He must be able to overcome obstacles and not 
sit down supinely and wait till someone else takes them 
out of the way. He must be able to organize others and 
fit them into needed places. Clear vision, quick thinking, 
resourcefulness, knowledge of human nature, and good 
judgment are nearly always to be found in the successful 
executive, though not always in the same degree. Behind 
and underneath all other qualities, however, there must 
be the moral courage and self-reliance that will demon- 
strate themselves in the “handling of situations.” Con- 
fidence in oneself and one’s own decisions will inspire 
confidence in others, and enlist assistance in the accom- 
plishment of undertakings that without self-reliance in 
the leader would be impossible. 
In the nursing world as in other walks of life there 198 
ETHICS FOR NURSES 
will be found many who are “half-executives” or “near 
executives.” They may get along well so long as they are 
in contact with a really capable, forceful, and resourceful 
executive, but require constantly, like inferior storage 
batteries, to come back to the chief to be recharged with 
self-assurance and energy. Fortunately, there is a place 
for this type, but they are rarely found at the head of 
affairs. Tell why this is so? 
The Carrying of Responsibility.—In the opening 
chapter of this book it was stated that the most impor- 
tant thing for a probationer to demonstrate in the trial 
period was her ability and willingness to measure up to 
such responsibilities as came to her. All through her 
life she will be judged and valued largely according to her 
ability wisely to assume responsibility and easily and 
effectively to carry it. This ability comes largely 
through experience, though many never acquire it to any 
great degree. The tendency in the age in which we live 
is to centralize responsibility, and to make it the chief 
characteristic of leadership. The importance of a place 
and the remuneration attached to it depend very greatly 
upon the amount of responsibility to be borne. 
The failure of many nurses who have had excellent 
training and splendid opportunities can be traced either 
to the question of disposition or temperament, or to their 
inability to think systematically and clearly, to act 
independently, and to carry responsibility effectively. 
Lack of courage to stand alone, to meet opposition or 
difficulties without being crushed, is another common 
cause of failure in otherwise well-equipped women. 
They always seem to need someone to make up their 
mind for them on important questions, or to go ahead of 
them and prepare the way. They are afraid to have real 
convictions on any subject for fear of being disapproved MANNER AND TEMPERAMENT 
199 
of or misjudged, or of meeting opposition. Such nurses 
may fill a niche in the world; without doubt there is a 
place for them, but it is not a large or important place. 
Can you think of any other quality which is a substitute 
for courage? How is courage acquired? 
Why Some Executives Fail.—After considering the fore- 
going reason for failure, there are two other outstanding 
reasons which should not be overlooked. An experienced 
executive who had had large opportunities to observe, 
states these reasons thus: “They get ‘too much ego in 
their cosmos,’ which defect is commonly known as ‘the 
swelled head.’ The other reason is that they can’t stand 
criticism. Some individuals with ‘swelled heads’ can stand 
criticism, but usually these two defects are found to- 
gether.” 
Looking Ahead.—During a nurse’s second year she 
should be able to take stock of her own character, tem- 
perament, and ability to fill some certain position in the 
nursing field. From your present knowledge of nursing 
conditions, which line of nursing service most appeals to 
you ? Give reasons for your answer. 
Suggested Subject for Written Work.—Prepare a 
description of the qualities you think a nurse who desires 
to have charge of a surgical department should possess. 
Mention the three qualities which to you seem most 
important. 
FOR DISCUSSION OR REVIEW 
1. Which of the four types of nurses mentioned in the 
early part of this chapter would you consider best 
adapted for institutional work? Give reasons for your 
answer. 
2. Write a short paper telling how a nurse reveals in a 200 
ETHICS FOR NURSES 
hospital whether she has the grace of good manners, and 
of what value good manners will be to her in institutional 
work, in private work, in visiting nursing. 
3. Show how good manners may be a help to a nurse 
whose work is chiefly with dispensary patients in the 
dispensary and in their homes. 
4. How may a nurse guard against “the hospital 
manner” described in this chapter? 
5. What temperamental and other qualities would you 
expect a successful visiting nurse to possess? 
6. Make a list of the faults you have observed in 
special nurses which you think all nurses should avoid. 
7. Explain the term “executive ability.” How may 
it be acquired? How is it demonstrated? What are its 
two most important ingredients? 
8. Mention one important point by which a nurse’s 
value in dollars and cents is rated. 
9. Mention any quality which seems to you a substi- 
tute for courage. 
10. What is the difference between having convictions 
and having opinions? 
11. What is meant by the phrase “the courage of one’s 
convictions?” 
12. Why is it that some nurses have convictions and 
others do not? How much does one’s early training have 
to do with convictions? CHAPTER XVIII 
Health, Recreation and Friendship 
A nurse’s health is her most important asset. How- 
ever skillful she may be in her profession, she cannot hope 
to attain her highest success in any line of nursing activi- 
ties if she is in a debilitated uncertain condition of health, 
liable to be incapacitated for the performance of her 
work every little while. Granted that she entered 
training with a sound physique and average normal 
resistive power, her health during training is, to a very 
considerable degree, in her own keeping. Many nurses 
forget that the subject of personal hygiene is not a 
theory simply to be studied in order to pass an examina- 
tion. It is a practical thing to be applied in a hundred 
ways every day in the year. 
Nearly every nurse, in common with other individuals, 
has some point in her constitution which is weaker than 
other points and liable to be easily affected; when she 
knows where her weakness is, it behooves her to govern 
herself accordingly. It seems to be self-evident that 
those who aspire to nurse the sick should themselves be 
healthy, and the desire to keep at one’s maximum phys- 
ically should be strong enough in every nurse to keep her 
on her guard constantly against the things which would 
undermine her health. 
Infections.—It has been abundantly proven that most 
infections which occur in hospitals are the result of con- 
tact, this in opposition to the older theory that infections 
were chiefly air-borne. In many cases infections are the 
direct result of the neglect of necessary and well-under- 
201 202 
ETHICS FOR NURSES 
stood precautions which nurses have been taught they 
should be careful to observe. 
Mention several instances of such neglect which you 
have observed in nurses. 
Diet.—It is along dietary lines that nurses err more 
frequently than anywhere else in matters of health. Too 
free indulgence in tea or coffee, or indulgence at wrong 
hours, nibbling at candy, cake, nuts, etc., in off-duty 
hours, night suppers in rooms are common causes of ill 
health among nurses in training, causes which they 
should have learned to guard against long before they 
entered for training. Any nurse who has lived twenty 
or more years with herself should know what she can eat 
with safety, and what she ought to avoid eating. 
A nurse who was ill in bed with some gastric disturb- 
ance had a mild fever, and was ordered to be kept on a 
milk diet till the fever subsided. A friend, hearing of her 
illness, sent her a two-pound box of candy which she 
surreptitiously ate in less than two days, while she was 
supposed to be making an effort to get well. 
Another nurse had been out for a walk and was caught 
in a heavy shower. She returned just in time to go on 
duty at night and donned her uniform without changing 
her wet shoes, stockings and skirts, working all night in 
these wet garments. She was subject to frequent at- 
tacks of sore throat, and next day was so ill that she was 
unable to be out of bed. A severe attack of tonsillitis 
followed, and later a heart complication developed. As 
a result of this illness she was obliged to be off duty three 
months. 
These are common illustrations of violations of the 
simple rules of health which nurses fully understand. 
Overstrain in nurses, with the resultant loss of 
equilibrium and disturbance of nerve balance, is usually HEALTH, RECREATION, ETC. 
203 
due to a combination of causes. Loss of sleep which is 
long continued, insufficient exercise in the open air, 
digestive difficulties—these, combined with worry, are 
found to a greater or less degree in most cases. All 
nurses suffer from overstrain in the early weeks of their 
training, due to the mental and physical effort required 
in getting accustomed to new surroundings and duties, 
in trying to remember the multiplicity of new things 
that need to be grasped in the very beginning; due also 
to the needless expenditure of strength and energy, the 
lost motions and wasted steps in doing tasks that are 
unfamiliar. This period of overstrain passes away in a 
short time, and the nurse develops a higher degree of 
resistive power and endurance, in much the same way 
that an athlete develops muscular strength and skill. 
Worry plays a much greater part in sapping the vitality 
than, probably, any other one cause. It is a veritable 
demon that robs life and work of its joys, poisons the 
nervous organism at its very centers, and affects the 
smooth harmonious working of the machinery of the body 
in a variety of ways. If diligent efforts are not made to 
combat it, worry soon becomes a habit of mind that 
lessens efficiency and reacts adversely on the nurse in 
more ways than can readily be mentioned. 
Is worry a habit which a nurse can correct? If so, how 
is she to successfully combat this habit? A well-known 
American psychologist, Professor James, says: “The 
sovereign cure for worry is religious faith. The turbulent 
billows of the fretful surface leave the deep parts of the 
ocean undisturbed, and to him who has a hold of vaster 
and more permanent realities, the hourly vicissitudes of 
his personal destiny seem relatively insignificant things.” 
If one would avoid worry it is important to avoid doing 
things which are liable to lead to keen regrets or over- 204 
ETHICS FOR NURSES 
anxiety, and a nurse cannot too early learn this important 
lesson. This rule can be applied in a nurse’s life in a 
thousand ways. When it comes to matters as to the 
wisdom of which there is room for doubt, it behooves a 
nurse to walk cautiously, if she is not to invite worry. 
Another wise rule is never to make an important decision 
when one is physically or mentally weary or depressed, 
or not in good condition physically. Many causes of 
worry are preventable if one uses reasonably good 
judgment. 
How to be an Optimist*—Dr. J. H. Kellogg gives the 
following rules for those who would cure themselves of 
habits of worry: 
“To cure worry you must cultivate hope; to cure pessi- 
mism you must deliberately cultivate optimism. You 
must force your mind into optimistic channels of thought. 
This can best be accomplished by reading optimistic 
authors and talking with optimistic people. A very 
excellent plan is to set yourself the task of curing some 
pessimistic person by deluging him with optimistic ideas 
and expressions. If the physical causes which were 
originally responsible for the morbid condition have been 
corrected, this habit of making mental sunshine for 
others will in the end produce an optimistic habit of 
thinking, and will become permanent, thus eradicating 
pessimistic thought habits by substitution. 
“It is a well-known fact that the best actors often 
actually experience the emotions which they depict in 
their acting—when counterfeiting laughter, for instance, 
they often actually experience the thrill of good cheer 
which normally accompanies the act of laughing. There 
is, indeed, the most substantial ground for believing that 
one may not only form but reform his habits by deliber- 
* Good Health Magazine. HEALTH, RECREATION, ETC. 
205 
ately producing through the will such mental and physical 
activities as are normally associated with mental and 
physical acts, the opposite of those of which it is desirable 
to rid oneself. 
“ If one feels reticent, disagreeable, and sullen, he may 
dissipate the evil spell by assuming an air of cheerful 
amiability and sociability quite different from the inward 
feeling, with the result that the mask of geniality will 
soon permeate the mind and character, and develop 
kindred habits of thought and action, and thus effect a 
cure. 
“ Remember, too, that fatigue has an important effect 
on the channels along which our impulses travel, with the 
natural result of weakening the resistance of the will 
against the undesirable contacts that result in wrong and 
unwise acts. A prolonged condition of fatigue is thus a 
source of great danger. 
“A countless number of physical, mental, and moral 
disasters result from this weakening of the will resistance 
and the opening of the doors of impulse. To the tired 
brain, facts appear distorted. Values are displaced, 
sanctions are ignored, resolutions are forgotten, good in- 
tentions fly to the winds, impulse is in the ascendency, 
the senses predominate.” A good holiday is often the 
best antidote for worry. 
A few sensible health laws which a group of club 
women worked out for themselves, and which apply 
equally well to nurses are these: “ To eat well, neither too 
much nor too little and of proper food; not to worry; 
to govern one’s nerves, and maintain a steady faith in 
God; to play often; to laugh; to think much of others 
and little of one’s self; to spend a part of every day in 
the open air; to be hopeful; to love both God and man; 
to look on the bright side of life; to have always some 206 
ETHICS FOR NURSES 
congenial work to do, some responsibility to carry, and 
whatever happens, to be good-natured.” 
Recreation.—Inseparably interwoven with the matter 
of health is the subject of recreation. The most splendid 
energy will flag, enthusiasm for one’s work will wane, 
and the best balanced person will become irritable, unless 
there enters into one’s life reasonable recreation. The 
human system demands change as well as rest, if it is to 
remain in good condition. 
The choice of recreation, so that it really recreates, 
and gives new strength and enthusiasm, requires much 
judgment. Nurses in training, and after training, often 
show a woeful lack of good sense in regard to how they 
spend their off-duty periods and holidays. Many of 
them do not seem to know where recreation ends, and 
dissipation begins. 
True recreation is best secured by a combination of 
three things; change of air, getting completely away from 
the hospital and training school, or the sick room, or 
one’s work; change of thought, the banishing for the time 
everything connected with the care of the sick or nursing 
affairs; and change of exercise and habits. It is just as 
much a nurse’s duty to learn to rest properly and wisely 
as it is to learn right methods of work. A proper amount 
of sleep and rest are a necessary part of recreation. In 
her efforts to secure what she thinks is recreation, a 
nurse too often becomes unnecessarily and unwisely 
fatigued, and returns to her work and studies worn out 
rather than refreshed. Long walks are taken; tiresome 
shopping expeditions are planned; errands are under- 
taken for other people; exhausting excursions are taken; 
late hours are indulged in; or perhaps, week after week, 
the nurse frequents moving picture shows in her after- 
noon off duty, instead of securing the variety in pleasure HEALTH, RECREATION, ETC. 
207 
that she really needs. Every nurse with ordinary ob- 
serving powers should be able to make out a list of things 
to be avoided in matters of recreation. 
The annual vacation presents a different sort of problem 
from the short off-duty periods, and one which requires 
wise management by the nurse herself if she is to get 
the rest and benefit from it that every nurse needs. 
A mistaken idea of duty and values often prompts a 
nurse to ask to be allowed to use her vacation in nursing 
friends or relatives, or in making up time lost by illness. 
Both of these plans have been found to be against the 
best interests of the nurse, and of the hospital. In many 
schools, rigid rules exist which require a nurse to spend 
her holidays in freedom from nursing of any kind, in 
real recreation, so that she can bring to the work of 
the year to follow a rested body, a clear mind, strength- 
ened nerves, and fresh courage and enthusiasm. 
Equally unwise has it been found in actual practice 
to allow nurses to take two years’ vacation in one year. 
Shorter and more frequent periods of rest yield better 
results as a rule than longer vacations at longer intervals, 
but it is often difficult to make a nurse believe that what 
she wants in regard to her vacation is not always best. 
Quite often it will be found that the nurse whose health 
breaks down before her training is finished, or who fin- 
ishes it in an utterly exhausted condition of body, has 
been most unwise in regard to the management of her 
sleeping hours, her off-duty periods and her annual 
vacations, or has been worrying over matters in no way 
connected with her work, while she poses as a martyr 
whose debilitated health is entirely due to her devotion 
to duty and to overwork. 
Friendship.—The nurse who desires to maintain a 
true balance in her life, to avoid the danger of mechan- 208 
ETHICS FOR NURSES 
ical service, of narrowness, and numerous other dangers 
that are common to institutional life, will find that the 
friendships she forms during training will have much to 
do with the progress that she makes in various directions. 
Friends have much to do with the making or marring of 
both a nurse’s happiness and reputation. They both 
reflect her character and profoundly affect it. The 
ancient proverb still is true that “a man is known by the 
company he keeps.” A nurse’s choice of friends will 
affect materially the confidence that other people im- 
pose in her and their general estimate of her as a woman. 
Violent Friendships.—A mistake which many nurses 
make is in the formation of violent friendships on very 
short acquaintance, and with people of whose character 
they have but a superficial knowledge. Another mistake 
is that of allowing the feeling to develop that one’s 
friend is an absolute necessity to one’s happiness. It is 
only by sad experience that many nurses learn that 
friendship has its perils, very real perils, that sudden 
and violent friendships usually result disastrously, and 
that it is a mistake to attach one’s self to one person so 
exclusively that one neglects to make other friends who 
might mean much in one’s life. 
The realization that there are people in life who will 
pose as friends, because in some way an individual is 
useful to them, and who will drop him as soon as the 
novelty wears off and they meet another who seems 
for the moment more attractive or useful, is one that 
comes to many nurses as one of the bitter experiences of 
life; but it is by such experience that one learns to be cau- 
tious in the choice of one’s friends, and to be chary about 
becoming too intimate with those whose character and 
loyalty are open to question. Under the influence of 
so-called friends, a nurse is often led into going to places HEALTH, RECREATION, ETC. 
209 
the character of which is open to question, and to doing 
unwise things which her own judgment condemns, and 
which lessens the confidence that others repose in her. 
This constitutes one of the commonest perils of friend- 
ship. 
What is a Friendf—What are the chief things which 
a friend may rightly expect of us? 
It is never desirable for a nurse to restrict her circle 
of friends to nurses or other workers in the same field. 
She needs the stimulus of new lines of thought. She 
needs a point of contact with people, both men and 
women, who are not of the world of sickness, who do not 
look out on life and its problems through the windows of 
a hospital, or of a sick room, or of a doctor’s office. 
The elements of friendship are hard to analyze, but one 
thing is certain, that real friendship is always unselfish. 
It will not prevent one from maintaining a kindly interest 
in other workers, and kindly pleasant relations with other 
friends. 
For a nurse in training her most wholesome friendships 
will usually be made with those of her own class. Close 
friendships between pupil nurses and head nurses are 
rarely conducive to the best interests of the school. 
When such a friendship develops, charges of favoritism 
are frequently made, and the feeling that favoritism 
exists, reacts adversely both on the pupil and head nurse. 
Similarly, it is seldom an unmixed blessing to find 
senior nurses choosing their closest friends from among 
the probationers or juniors. It is hard to keep one’s 
affections always within the safest limits, yet it is just 
as well to know that friendship has its dangers, and to 
guard against these dangers when possible. 
Will a Real Friendship ever Lead an Individual to do 
WrongP—Is it possible to love the friend, and yet, at 210 
ETHICS FOR NURSES 
times, hate, or refuse to uphold the friend’s actions? 
We know that all sorts of crimes are excused under the 
plea of “shielding a friend” and nurses will often have 
to meet the question as to how far one’s duty to one’s 
friend extends. 
A nurse in her second year was dismissed because of 
her entanglement with one of the orderlies. In her 
junior year she had been severely reprimanded and 
warned because of a violent flirtation which developed 
between her and one of the porters. It was known that 
she was meeting the orderly secretly outside the hospital, 
and there were numerous evidences of unprofessional 
relations while both were on night duty. Finally the 
climax came and both she and the orderly were dismissed. 
The dismissed nurse wrote to her closest friend asking her 
to persuade the members of her class to sign a petition 
that she be reinstated as a member of the school? What 
is the friend’s duty in this matter? 
Suggested Subject for Written Work.—Prepare a 
short paper, giving your idea as to how a nurse in training 
may wisely plan to spend a two week’s summer vacation, 
so that she may get the best possible results in renewed 
health and enthusiasm. 
FOR DISCUSSION OR REVIEW 
1. To what extent is a nurse’s health while in a hos- 
pital in her own keeping? 
2. What suggestions would you give to a nurse who 
wished to keep at her maximum health while in training? 
3. Make a list of the rules of health which you have 
seen nurses violate since your entrance to the school. 
4. Mention some causes of overstrain in nurses in the 
early months of training. HEALTH, RECREATION, ETC. 
211 
5. What is the effect of worry on the digestion, on the 
power to sleep, on the general health? 
6. When worry seems to be settling into a habit, what 
can or should an individual do to combat it? 
7. What is the best antidote for worry that has thus 
far been discovered? 
8. Prepare a synopsis of the suggestions in this chapter 
on “How to be an optimist.” 
9. What additions would you make to the health laws 
mentioned in this chapter? 
10. Mention several ways in which you have observed 
that nurses do not use good judgment in regard to 
recreation. 
11. In the matter of recreation in off-duty periods, 
what three things would you suggest that a nurse try to 
secure; what three things try to avoid? 
12. Which do you think is most likely to result in 
health failure—hard, but congenial work, or worry? 
Give reasons for your answer. 
13. How many close true friends is an individual likely 
to have at one time? 
14. Mention some things which a nurse must do if she 
desires to have a circle of congenial friends. 
15. What are some of the perils of friendship in hospital 
life, and later on? 
16. Give several reasons why a nurse needs to cultivate 
friendships among people who are not of the hospital 
household or in any way connected with the world of 
sickness. 
17. Will a true friend ever lead a nurse into wrong- 
doing? CHAPTER XIX 
Ethical Standards for Head Nurses 
The head nurse’s position is one of increasing impor- 
tance in hospital and nursing life. She comes into closer 
contact with physicians, patients and pupil nurses than 
it is possible for a principal or superintendent to come, 
and the tone and atmosphere of the ward or department 
is determined to a considerable extent by her standards 
of conduct and duty, and by her manner and tempera- 
ment. The nurse who has proven successful as a head 
nurse of a department will find many other doors of 
opportunity awaiting her. The position is an important 
part of the preparation which many superintendents and 
principals have had for their work. It offers the young 
graduate opportunities of no mean order to secure execu- 
tive experience. 
Thus far little attempt has been made to provide a 
special course for head nurses in hospitals that would help 
them to better understand their place in the whole plan 
of the hospital activities, but this no doubt will be reached 
in time. There is not and probably there never can be a 
fixed code of ethics for her. She will always have to 
learn much by experience and observation; but there are 
certain fundamental principles in ethics which pertain 
especially to the head nurse—principles which affect 
so vitally the harmony and tone and comfort of the 
whole institution that some time may wisely be spent 
in considering them. 
212 STANDARDS FOR HEAD NURSES 
213 
The Head Nurse’s Efficiency Record.—In a previous 
chapter reference was made to the efficiency record kept 
for pupil nurses, and the point was made that the pupil 
GENERAL HOSPITAL 
Efficiency Record for Head Nurses 
Name 
Home address 
Religion 
Position held 
Length of service. . . 
Salary 
Vacation 
Illness 
Absences, reasons.. 
Personality: 
Courtesy 
Kindness 
Enthusiasm 
Ability to inspire these 
Executive ability 
Initiative 
System 
Organizing powers 
General control 
Progressiveness: 
Study of nursing literature. . . 
Current literature 
Notetaking on newer 
methods 
Originality in plans of work. 
Improvements made or sug- 
gested , .. . 
Ambition to excel 
Lack of 
Teaching qualities: 
Theoretical work 
Practical work 
Example to pupils: 
Good Bad 
General interest in work of 
school 
Loyalty: 
To Institution 
To Superintendent and prin- 
cipal 
To physicians 
Respect for authority 
Observance of rules 
Manner to subordinates 
“ Patients 
Professional manner toward: 
Internes 
Visiting physicians 
Visitors 
Temperament 
Judgment 
Tact and resourcefulness 
Economy 
Effectiveness in carrying re- 
sponsibility 214 
ETHICS FOR NURSES 
made these records herself—the principal of the school 
wrote down for future reference the record made in the 
everyday work. This is true also of head nurses and 
their records. What should an efficiency record for a 
head nurse contain? Opinions will differ on this point, 
but the specimen record will serve as an illustration 
for this chapter. 
It will be seen from the foregoing form of record that 
there is abundant scope for the best powers of a graduate 
nurse in filling well such a position. The old conception of 
the head nurse’s work was that of a supervisor whose duty 
it was to see that orders were carried out and the patients 
well cared for—and to this limited conception many 
aspirants for head nurse positions still tenaciously cling, 
seeing nothing beyond the getting of routine work done. 
The new conception which is being forced on nurses by 
the demands of the age is that she is not only a super- 
visor and executive, but a teacher who has exceptional 
opportunities to teach much of practical value which will 
never be taught, unless she measures up to her opportun- 
ity. While this new conception makes more demands 
on the nurse it has in it great possibilities for the develop- 
ment of the head nurse’s own powers. 
The Head Nurse’s Example.—It is said of Emerson 
that he once wrote a young girl in whom he was much 
interested that he cared little concerning the name of the 
school which she had decided to attend, but that he 
cared much about the teachers under whose direction she 
worked and studied. A prominent educator, in speaking 
of the character of the instructors of the youth of our 
land, said that if he had his way there would be over the 
door of every school in the land a motto embodying this 
sentiment: “No teacher shall be employed in this school, 
whose character we would not desire reproduced, or STANDARDS FOR HEAD NURSES 
215 
whose example we would not wish every child in the land 
to copy.” There are many in the hospital and training 
school field who have equally high standards for head 
nurses in hospital schools. Certainly the head nurse 
should be satisfied with nothing but the highest standard 
of life and conduct for herself. Next to experience the 
best of all teachers for nurses as well as other pupils is 
a good example. No head nurse can hope to attain to the 
best standards for her class unless she is willing to sacrifice. 
This is where many nurses fail when the crucial test 
comes. 
Granted that a head nurse sincerely desires to become 
the best sort of example to pupils and to measure up as 
nearly as possible to the opportunities which her position 
affords her, what are some of the things which she should 
do and avoid doing? 
The quality of fairness is one which every successful 
head nurse should try to possess. It must be one of the 
foundation stones in her system of management in her 
department, to be lived up to whether it be easy or diffi- 
cult. This rule of fairness must extend throughout her 
whole department—to patients, to pupils, to doctors, to 
all who are associated with her. It is but natural to like 
some patients, doctors or pupils better than others, but 
justice should keep an executive from allowing her likes 
and dislikes to influence her management. Favoritism 
in any way usually leads to trouble. 
Favoritism in regard to doctors frequently develops 
insiduously. A certain doctor has numerous patients 
in the hospital, and is anxious for favors to be shown to 
them. He perhaps boasts to his patients that he can 
secure such favors. It gives the patient the impression 
that he stands higher in the esteem of the hospital than 
his medical associates. He perhaps begins by flattering 216 
ETHICS FOR NURSES 
the young head nurse, and suggests some special reason 
why she should give special attention to one of his 
patients. She tries to do this, and later he presents a 
box of candy which, he remarks, is for “favors shown/’ 
The practice of showing favors grows. The other doc- 
tors, in course of time, learn that this certain doctor can 
get “anything he wants for his patients,” and gradually, 
ripples of dissatisfaction arise which react adversely on 
the hospital, and the blame for which is often laid on the 
superintendent or principal who are unconscious of the 
real conditions which exist. 
The fine art of finding fault pleasantly is one which 
every head nurse must cultivate. Much of her work 
must of necessity consist of correction or reproof, and 
the way in which this is done will have much to do with 
the good-feeling and harmony of the school. No really 
successful head nurse will allow herself to administer re- 
proofs in the presence of others. This is always resented. 
To be able to administer rebuke without arousing antag- 
onism is a quality which must be given diligent cultiva- 
tion, and there is plenty of opportunity to practise this 
particular virtue. 
Loyalty.—The head nurse who would inspire loyalty 
in pupils must herself be loyal. We like to think of some 
of the head nurses whom we have known who were towers 
of strength to the institution of which they were a part. 
Everything which affected its interest was to them a 
matter of deep concern. Without meddling in other 
departments, they frequently had knowledge of matters 
which affected the institution adversely, and a quiet 
word was spoken to the principal or superintendent. To 
the nurses they were never familiar yet never unapproach- 
able. Every pupil felt that when she had personal mat- 
ters of real importance under consideration she could STANDARDS FOR HEAD NURSES 
217 
talk them over with the head nurse, sure of her sympathy 
and wise counsel, and sure that her confidence would be 
respected. Loyalty is such a big intangible thing that 
it is difficult to go into details about it, but the following 
quotation from one of the well-known philosophers of 
this age, is worthy of consideration. Elbert Hubbard’s 
voice was stilled when the Lusitania sank, but he left 
behind many bits of practical wisdom of which this on 
loyalty is one. He said: 
“If you work for a man, in Heaven’s name work for 
him. If he pays wages that supply you your bread and 
butter, work for him, speak well of him, stand by him, 
and by the institution which he represents. I think if 
I worked for a man I would work for him. I would not 
work for him part of his time, but all of his time. I 
would give him hearty, undivided service or none. If 
put to the pinch, an ounce of loyalty is worth a pound 
of cleverness. 
“ If you must vilify, condemn, and eternally disparage, 
why resign your position, and when you are outside 
criticize and “knock” to your heart’s content. But, 
I pray you, so long as you are a part of an institution, 
do not condemn it. Not that you will injure the insti- 
tution—not that—but when you disparage the concern 
of which you are a part, you disparage yourself.” 
Was Elbert Hubbard right or wrong in his conception 
of the duty of any individual who is a part of an institu- 
tion ? Show how his advice if followed would be helpful to 
an institution, and also to the individuals employed in it. 
Appreciation of work well done and of general im- 
provement is an important habit, for a head nurse to 
cultivate. There are but few individuals who will keep 
up sustained effort to improve, if nobody cares or seems 218 
ETHICS FOR NURSES 
to notice. Careless thinking and practice in pupils can 
often be traced to lack of appreciation of their best 
efforts. 
Seeing beneath the surface is another quality which 
head nurses need to develop. Minor failures and errors 
are to be expected of pupil nurses, and while they are not 
to be overlooked, it is necessary that an effort be made to 
look beneath the surface and appreciate the spirit which 
was behind the failure. It takes no special amount of 
genius or skill to find fault. It does take skill to know 
when it is wise to overlook a failure, or how best to call 
attention to it, so that it will not occur again. It takes 
skill to be able to give constructive suggestions that will 
help to correct known faults. 
Progressiveness and ambition are always found in the 
successful head nurse. She is constantly looking about 
for methods which will add to the efficiency of her de- 
partment, yet careful before introducing them to talk 
them over with the principal. This latter point needs 
special emphasis because much trouble is caused by head 
nurses trying to institute new methods or teach them 
to nurses, while the head nurse in the next department 
to which the nurses go may disparage the method and 
refuse to have it used. There must be harmony in 
methods or much confusion is sure to result. 
A superintendent’s policy regarding head nurses was 
once stated to the author in this way. He said: “I like 
to hold out to our graduates the opportunity of head 
nurse positions in our hospital, but I have about decided 
to insist on every graduate securing at least six months 
in one or more institutions, before she begins her work 
with us. I have found that graduates who have done 
this, have brought back to us a freshness and enthusiasm STANDARDS FOR HEAD NURSES 
219 
that is worth much. They have gotten rid of the self- 
complacent spirit so common among nurses; and are 
able to bring to us many little practical points which 
have proven of great value to us. They find that other 
hospitals have difficulties quite as hard to meet as any 
we have, and they are able to take a much broader view 
of their work.” 
What do you think of this superintendent’s policy 
regarding head nurses? Show where it is wise or unwise. 
The head nurse’s point of view has much to do with 
the smooth running of the hospital machinery. To be 
successful she must be able to see, to some extent at least, 
the needs of the institution as a whole, and to adapt 
herself to those needs without grumbling or unwise com- 
ment on particular situations. Failure to do this is a 
sign of unfitness for the work, or for greater responsibili- 
ties. A pupil nurse fails to report for duty on account 
of illness or several unusually sick patients come into one 
department, while in another there may be very few 
seriously ill patients. The principal decides to take a 
nurse from the department where the work is lighter, and 
place her where she is more needed. This has to be done 
for the good of the service, and it should be accepted 
without comment or question just as a good soldier ac- 
cepts his orders. 
Should this spirit of hearty cooperation be lacking in 
an institution, what can be done to create it? 
Is it possible for a head nurse whose energies have to be 
largely if not wholly confined to one department of a 
hospital, to appreciate the needs of the institution as a 
whole? How far does selfishness enter into this par- 
ticular problem? 
A certain head nurse makes no secret of the fact that 220 
ETHICS FOR NURSES 
she wishes to secure a position as principal of a training 
school. She seems singularly lacking in resourcefulness 
and managing ability. For example, should a nurse be 
reported as ill, the head nurse invariably telephones the 
principal’s office asking for another nurse to be sent to 
take the place of the one who is ill. It seems to never 
occur to her that she should try to adjust her plans so 
as to tide over the emergency without extra help. She 
acts as if she imagined that the principal kept nurses 
sitting in rows in her office ready at once to be sent to 
her relief. 
Should such a head nurse expect a hospital to recom- 
mend her for the position she desired? What other 
qualities than those mentioned does she seem to lack? 
Professional Conduct.—What is it? Try to write 
down a definition which would convey to the uninitiated 
the phases of conduct the term is intended to cover. It 
is far too wide a subject to be fully discussed here, but 
one or two phases of it which especially concern the dis- 
cipline of the school may be considered. An illustration 
will perhaps explain more clearly one of the points that 
needs to be emphasized by the head nurse who desires 
to be counted successful, and who wishes to secure some 
position of greater responsibility. 
Dr. B., a young practitioner, makes frequent visits to 
a hospital in which graduate nurses are in charge of de- 
partments. There are also always a number of graduate 
nurses on special duty. Dr. B. is genial and pleasant. 
His patients are not so numerous but that he has plenty 
of time to waste. Wherever he goes in the hospital, the 
head nurses and graduates on special duty gather about 
him for a “jolly good time.” “He is so jolly” they say. 
All sorts of frivolous subjects are discussed. Jokes and STANDARDS FOR HEAD NURSES 
221 
stories are interchanged. The patients are disturbed by 
the talking and laughter. The special duty nurses 
should be with their patients. The head nurse should 
be attending to her duties. Treatments are delayed or 
neglected. Patients’ calls are unanswered; just com- 
plaints arise. The efficiency of the service is lowered— 
all because of thoughtless but unprofessional conduct. 
Should this condition be corrected? If so, who should 
do the correcting? Suggest ways and means to control 
this sort of situation. 
The worst thing about this phase of unprofessional 
conduct is that it is apt to be contagious. Others are led 
into doing things which they would not think of doing, 
had they not seen some one else doing it. The example 
of the head nurse is perhaps followed in some such fashion 
as this. A pupil nurse begins to gossip with an interne 
when he comes to her ward. To do this she has to neglect 
her work, many times. Occasionally she may even tele- 
phone that he “is wanted” in her ward, when she has 
some particularly delectable bit of “fudge” or other 
confection to distribute—such things do sometimes hap- 
pen in twentieth century hospitals. Other nurses follow 
the example of this nurse, and so the undesirable practice 
extends. Show how this practice affects hospital effi- 
ciency. How does it affect a nurse’s ideals of conduct? 
How the tone of the school? 
Another phase of unprofessional conduct is shown in 
lack of respect for authority shown by some nurses. No 
one is fitted to command who has not learned to obey with- 
out grumbling, or questioning. This was one of the prin- 
ciples laid down by Florence Nightingale, and the years 
that have passed have proven the soundness of her con- 
tention that a well-trained nurse—a nurse who is fitted 222 
ETHICS FOR NURSES 
for the responsibility of directing others—must observe 
rules made for the good of all and must respect the wishes 
of those in authority over her. No nurse who is really 
fitted for head nurse responsibility will wish or try to 
be “a law unto herself.” 
Teaching Qualities.—In the efficiency record for the 
head nurse occurs the item of “teaching qualities.” 
This is a point at which many good head nurses seem 
singularly timid, and there is no one who has not faced 
a class of nurses for the first time, who cannot under- 
stand to some degree the feeling of hesitation about 
assuming this responsibility. It is one thing to have a 
certain kind of knowledge, and a different thing to impart 
it effectively. There is a current belief that the teaching 
instinct is born with an individual—in other words that 
teachers as well as nurses “are born, not made.” To 
some extent this may be true, but it would surprise 
most people if they really knew how much of thought 
and study and effort the supposed “born teacher”had 
put forth to reach a stage of proficiency that even ap- 
proached her own ideals of teaching. There is usually 
a vast difference between what the individual was by 
native endowment, and what she has become by the 
study of the art of imparting knowledge. We did not 
know that we could walk till we tried, and we cannot 
know whether or not we can teach until we have really 
tried. 
What mental picture have you of a successful teacher 
of nurses? 
How may a head nurse develop her latent teaching 
ability? 
First among the teaching qualities which the head nurse 
should cultivate is how to utilize to the fullest extent the STANDARDS FOR HEAD NURSES 
223 
teaching opportunities of her ward or department, so 
that pupil nurses really get the benefit of the clinical 
material before them. She needs to study how to tie up 
the theoretical teaching which a nurse has received to 
the ward work. A lesson in bacteriology that seemed 
very dry or uninteresting may be given a practical applica- 
tion that the nurse will never forget, by reference to some 
patient in the ward. And this holds true throughout 
the course. 
The art of questioning occupies a most important place 
in teaching. In fact a well-known educator has said 
that “the success and efficiency of our teaching depends 
more on the skill and judgment with which we put ques- 
tions than on any other single method used in theoretical 
teaching.” 
Mention several kinds of questions which may be used 
to advantage—also kinds of questions which should be 
avoided. 
What are the elements of a good answer? 
Repetition is everywhere an important element in suc- 
cessful teaching. There is so much in hospital life to 
distract that few lessons are learned by “once telling.” 
By degrees we learn that the pupil is not always to blame 
because she did not retain the thing we thought we 
had taught her. Perhaps we ourselves did not make 
the point quite clear, and did not properly empha- 
size it. 
Patience with the slow pupil is another quality which 
head nurses need to cultivate. What methods have you 
seen used, or would you recommend to help the nurse 
who is slow in getting through her tasks, if she is other- 
wise qualified for nursing responsibilities? 
These are just a few of the points which a nurse who 224 
ETHICS FOR NURSES 
aspires to become a really successful head nurse needs to 
consider—one who earnestly desires to do her duty and 
fill her place in the best manner possible. 
Suggested Subject for Written Work.—Prepare a 
description of the head nurse whom you have met who 
most nearly approached your ideal. Tell what qualities 
you most admired in her. 
FOR DISCUSSION OR REVIEW 
1. Show why the head nurse is such an important 
factor in hospital life. 
2. Explain what is meant by “professional conduct” 
in a nurse. 
3. Tell why you think nursing is a profession and not 
a trade. 
4. Why does the public seem to expect higher stand- 
ards of conduct from professional people than from 
tradespeople? 
5. Give some examples of conduct in institutional 
nurses that you considered unprofessional conduct. 
6. To what extent do you consider it permissible in 
nurses to discuss affairs relating to the hospital, its work- 
ing staff, or the patients, with their personal friends or 
the people of their own family? 
7. If a nurse transgressed this rule, would you con- 
sider that she had been guilty of “unprofessional con- 
duct?” 
8. What is loyalty? Of what value to a nurse is a 
reputation for loyalty? 
9. If a nurse is lacking in ambition to measure up to 
the responsibilities or demands of a position what can 
be done to make her a success? , STANDARDS FOR HEAD NURSES 
225 
10. What is the difference between “holding a posi- 
tion” and “filling a position”? 
11. Should a nurse expect to hold a position which she 
does not try to fill wisely and well? 
12. What is the difference between the old conception 
of a head nurse’s responsibility and the new, as mentioned 
in this chapter? Which offers the greater possibilities of 
development to the nurse herself? THE HIPPOCRATIC OATH* 
“You do solemnly swear, each one by whatever she 
holds most sacred— 
1. “That you will be loyal to the physicians under 
whom you shall serve, as a good soldier is loyal to his 
officers; 
2. “That you will be just and generous to all worthy 
members of your profession, aiding them when it shall be 
in your power so to do; 
3. “That you will lead your lives and practise your 
profession in uprightness and honor; 
4. “That into whatsoever house you enter, it shall be 
for the good of the sick to the utmost of your power, and 
that you will hold yourselves aloof from all temptation; 
5. “That whatsoever you shall see or hear of the lives 
of men and women, whether they be your patients or 
members of their households, you will keep inviolably 
secret, whether you are in other households or among 
your own friends. 
“If you accept these obligations, let each one bow the 
head in sign of acquiescence. 
“And now, if you shall be true to your word, may 
prosperity and good repute be ever yours; the opposite, 
if you shall prove yourselves forsworn.” 
* Note.—This pledge is a modification of the Hippocratic Oath 
used by some medical schools and, so far as is known, was first used 
in the New York City Training School for Nurses. 
226 SECTION 111 
CHAPTER XX 
After Graduation 
What shall I do after graduation? How and where 
shall I use the training I have acquired? These are 
questions that press insistently on a nurse during her 
final year of training. Where does duty lie, when one 
ventures beyond the training school? What should the 
individual nurse’s aim be as she leaves the school? 
It is well for a nurse to have a dual aim in view, an im- 
mediate or present aim and an ultimate aim, something 
ahead to strive to reach. It is not well for her to be too 
positive at first about what she will or will not do. The 
path of duty is rarely clearly marked out very far ahead. 
We advance step by step. We live one day at a time. 
We do not need to see tomorrow’s duty. We do not 
know what opportunity is going to offer us. We do 
know that experience as an independent worker is nec- 
essary, and a valuable asset. The opportunity most 
coveted will rarely be waiting for a nurse as she leaves 
the school, but the lesser opportunity which may prove 
the first step toward 'it will probably present itself in 
due time. 
The most important thing for a nurse to examine herself 
in, when she faces the wide field of nursing, is regarding 
her own attitude of mind toward nursing, her own ideals 
of service. Is she conscious of a sincere desire to be 
broadly helpful in her own sphere, to go where she is 
needed most, to play well her part in the drama of life? 
Does she recognize any obligations of service to humanity 
227 228 
ETHICS FOR NURSES 
because of the opportunity which has been hers to become 
a skilled workman? Has she adopted for herself any 
guiding principles which, if followed, will help her to 
make the most of life and yield the greatest possible sum 
of happiness to herself and others? 
If a nurse desires a life that is abundant, rich, and 
satisfying, yielding a full measure of happiness, she will 
find it through service, and in no other way. The law 
of happiness is based on social service, or service to 
society, service to others. Happiness comes to us in- 
directly, and refuses to come if sought as an end in it- 
self. There can be no service in the real sense of the 
term without some degree of sacrifice, though the sacri- 
fice is usually unconscious and its chief element is 
self-forgetfulness. 
Guiding Ethical Principles.—“For whosoever will save 
his life shall lose it; and whosoever will lose his life for 
my sake shall find it.” “All things whatsoever ye would 
that men should do to you, do ye even so to them.” 
These two guiding principles, if applied by every nurse 
in her own life, will solve many of the perplexing ques- 
tions that beset the young nurse. The nursing body will 
be lifted to a higher level only as the life of the individual 
nurse is improved, and only as she brings herself into 
conformity with these great laws of human welfare. 
Had Florence Nightingale sought her own happiness and 
convenience, had she planned for herself a life of ease, 
she would never have carved for herself a niche in the 
most enduring of all temples of fame—the hearts of the 
people. 
Had Jane Addams lost sight of the two great guiding 
principles of life just quoted, she would never have been 
known as one of the greatest women of her time. Thus 
examples might be quoted indefinitely which go to prove AFTER GRADUATION 
229 
the enduring truths expressed, truths which are as vital 
today as when first uttered, fundamental truths which 
have but begun to do their work, truths which need to be 
personally applied by every nurse. 
Are your ideals of service copied from some other 
nurse who may be far from successful in the best sense 
of the word, or are they the ideals of service given by 
the Great Teacher? 
To what extent is an individual responsible for the 
actions of others? 
How does a private nurse act who puts self first in 
her plans and purposes? 
How does putting self first affect the comfort and 
well-being of an institutional worker and the institu- 
tion? What effect is it likely to have on real success as 
a nurse? 
What is the power of a vision? 
What is the best way for a nurse to set about making 
her dreams of service come true? 
How should success be measured in a nurse’s life? 
What had a vision of the world’s needs to do with 
Florence Nightingale’s work? How did she set about 
making her dreams a reality? 
What are your highest ideals? What is involved in 
being loyal to those ideals? 
The Value of a Life Purpose.—The most practical 
people do more or less dreaming about the things they 
are going to make happen, or at least are going to try to 
make happen. Before effective action there must come 
thinking, and thinking till a purpose is reached. Every 
nurse has opportunities to make the world better if she 
cares to use them. They are everywhere, and great 
movements often begin with the doing of some concrete 
thing that was badly needing to be done at the moment. 
The life story of Jacob Riis as told in “The Making of an 230 
ETHICS FOR NURSES 
American ” is an apt illustration of the power of a vision 
and the force of a life purpose in our own day. He died 
in 1913, but before he died he dreamed dreams of a 
better New York, and made his dreams come true in 
large measure. He struggled with poverty, loneliness, 
the disadvantages of having to acquire a new language 
in the land of his adoption, but the power of a vision of 
better conditions which he could help bring about held 
him steady in times of despondency. He was far too 
busy in his early years in this country trying to keep 
himself and family clothed and fed to plan any very big 
programs of constructive philanthropy, but he saw the 
things that were not right, and persistently told of them 
by tongue and pen and kodak. He presented not prob- 
lems, but people who needed to he helped to decent living 
conditions. He set himself the task of making people see— 
a big task that can be worked at anywhere. He set up 
new standards of life for the poor, and did what he could 
to have those standards accepted. It is a long story, 
but wonderfully captivating. It has many lessons for 
nurses. 
The established order of things sometimes has to be upset 
before much progress can be made. There are conditions 
that are not right in regard to nursing which should be 
worked at till better conditions are assured. In the 
private nursing field especially, nurses are most unequally 
distributed—patients who sadly need their skill are un- 
able to secure it; nurses who seriously need work are held 
back from accepting calls to nurse where their help is 
sorely needed. To illustrate: A widow who was left 
with a little girl of five, and dependent on her own efforts 
for a living for both, was advised by her family doctor to 
“take up nursing” as a practical nurse, promising that 
he and a few of his medical associates would keep her 
busy. His first call on her was to care for a maternity AFTER GRADUATION 
231 
patient, which she did for two weeks—the only experience 
she had had in nursing outside of her own family. The 
morning after she returned from her first case, a doctor 
called on her to go to a patient of his whom he said had 
some “stomach trouble.” She went and found a very 
serious case of gastric ulcer, with hemorrhages, persistent 
vomiting, severe pain, and with a serious heart complica- 
tion besides. There were two little children in the home. 
The husband had to keep at work to earn their daily 
bread. This practical nurse was ordered to feed the 
patient entirely by rectum, and on the doctor’s next visit 
all medicine by mouth was stopped and ordered to be 
given by hypodermic. The practical nurse, after strug- 
gling with the case for two days, filled with dread every 
moment that the patient would die after one of the severe 
vomiting attacks, gave up the case and went home, say- 
ing to the family that a trained nurse was needed. They 
begged her to stay—the doctor did the same—the family 
said they were unable to pay the price for a trained nurse 
and a servant to do the work besides, but she refused to 
remain longer in charge of such a serious case. Did she 
do right? What should have been done? This kind of 
problem could be duplicated hundreds of times every 
year in every community. What should be the attitude 
of the young graduate toward this sort of problem? Can 
she do anything to change the existing order of things? 
What attitude would Florence Nightingale have taken 
toward such cases? What can or should one nurse do 
toward meeting the responsibility presented in this 
problem? 
Some one has said that “Every great advance in 
science has had as its beginning and first cause a new 
point of view. Every epoch-making discovery has 
implied a way of looking at things different from that 
which has previously prevailed. Civilization advances 232 
ETHICS FOR NURSES 
as new points of view prevail. The great lights in the 
world’s history give us new points of view.”* The im- 
portance of getting a correct viewpoint, one which will 
enable her to see the needs of the world and what the 
individual nurse could or should do to meet them, cannot 
be too strongly emphasized. 
Industry.—Next in importance to getting the right 
viewpoint and securing right guiding principles of con- 
duct and life is that of cultivating right habits. When 
one leaves the training school and new conditions have 
to be met, habits are more or less disturbed and discipline 
is relaxed. This is a time in which a nurse especially 
needs to be on her guard, lest the good habits she has 
formed slip away and bad habits take their place. 
One of the essentials to success in any branch of nursing 
is industry—willingness to work. It makes little differ- 
ence how capable and skilled a nurse may have become 
during her training, if she is not willing to work; if she is 
continually looking out for the easiest cases and places 
and refusing those which would probably mean serious 
or hard work, she can never be a successful nurse. Quite 
frequently a nurse who is a habitual shirker may be able 
to get through a training school because someone con- 
stantly supervised her and kept her up to the mark, 
but when she becomes an independent worker, her 
habitually lazy habits reassert themselves. This type 
of nurse does more to create prejudice against trained 
nurses than any other type. A train of complaints follow 
such nurses wherever they go. They are unaccommodat- 
ing in private homes, and always fearful lest they will be 
imposed on by being asked to do something which is 
not directly connected with the patient. They apply 
for hospital positions and often secure them, but fail to 
measure up to the opportunity that is theirs. They 
* Richard T. Ely, in Social Law of Service. AFTER GRADUATION 
233 
make frequent changes, and usually have nothing good 
to say of those who have employed them. Their habitual 
unwillingness to work shows up more plainly in private 
homes than anywhere else, for under those conditions there 
is no one whose duty it is to keep them up to the mark. 
A young graduate of a large training school when filling 
out an application for a place on the school registry stated 
that she would not go to the country; would not do night 
work; would not nurse nervous or mental patients; would 
not take tuberculosis cases or the acute contagious dis- 
eases; would not nurse obstetrical patients or children. 
In what qualities essential for success in nursing was this 
nurse lacking? Who was responsible for this lack, the 
nurse or her training school? What sort of service might 
reasonably be expected of such a nurse on the cases to 
which she agreed to go? 
What general results would follow so far as the nursing 
body is concerned if all graduate nurses went out with 
the spirit shown by this nurse and followed her example? 
How would the welfare of the sick be affected? What 
should be the attitude of other graduates of the same 
school toward this nurse? Can they do anything to 
change her attitude? 
Adaptability.—Closely related to industry is the 
quality of adaptability, and both of them have their 
roots in unselfishness. Lack of adaptability does not 
always mean selfishness pure and simple, but there is 
nearly always an element of selfishness in it. The nurse 
who lacks adaptability “fusses” when she cannot have 
her own way, is unable to see a situation from the view- 
point of others, is unable or unwilling to concede to others 
the rights which she demands for herself. Her own con- 
venience and comfort are usually uppermost in her mind, 
though she would be the last to admit it. 
To a certain extent lack of adaptability may be due to 234 
ETHICS FOR NURSES 
training, but not wholly. No nurse is wholly the product 
of her school; she can correct defects in character if she 
really desires to. The chief difficulty lies in the un- 
willingness to recognize her own defects and limitations 
or the reasons for her failures. She too frequently suffers 
from what Florence Nightingale termed “the vice of 
self-sufficiency.’' She wants people who employ her 
to bend to her ways. She does not make a real effort to 
“fit into” the varying situations in which she finds her- 
self, so there is constant friction. She may be a capable 
nurse but “hard to get along with.” She does not realize 
that “pleasing the patient” is one of the most important 
elements in her success as an independent worker. In 
the hospital it is always a detriment to a nurse if it can be 
said of her: “Her patients do not like her;” in private 
nursing it is always a calamity. 
A nurse trained in a large city hospital enters the 
private nursing field. She had practically always done 
her work in a large ward. Her patients have been of the 
very poorest class. She can manage her share of the 
nursing in a large ward well, but has never during her 
training had the time to devote herself to caring for but 
one patient at a time. Her patients did not demand -a 
lot of fussy attention, and had to be satisfied with having 
their actual needs attended to. How is this nurse to so 
change her habits that she will be a successful nurse to one 
private patient in her home surrounded by family and 
friends? What are the chief things against which she 
must guard? What suggestions would you offer such a 
nurse that might be helpful to her in meeting the diffi- 
culties of such a situation in a home in which the patient 
was a young wife who had been accustomed to the re- 
finements and luxuries of life? 
Making a good first impression is important whatever 
line of nursing may be chosen. It is especially important AFTER GRADUATION 
235 
for the private nurse. The patients who furnish the 
demand for her services are ill, and usually abnormally 
sensitive in mind and body; their friends and relatives 
are, frequently, even more sensitive than the patient him- 
self. Impressions made at such times are more vivid 
than usual. Many invalids, especially those of a nervous 
type, are unusually influenced by certain personalities; 
they often take violent likes or dislikes without knowing 
why. They are “easily rubbed the wrong way”—easily 
irritated. Very often, where a nurse makes a wrong 
impression at the start, the doctor disposes of the problem 
by promptly sending the nurse away. He refuses to 
add to the physical strain which his patient has to endure, 
the unnecessary mental strain of having either to conquer 
a dislike or endure it. By failing to make the right im- 
pression in such a case, the nurse creates a prejudice 
against herself which will react adversely on her where 
future calls are concerned. Granted that a nurse 
earnestly desires to make a good impression, how shall 
she manage it? It is well to remember that first impres- 
sions are gained from superficial things, from appear- 
ances, largely from dress and manner. A nurse who is 
dressed like a walking fashion plate, with an elaborate 
style of hairdressing or much jewelry, is apt to give the 
impression that she is likely to be more interested in her 
personal appearance than in her work or the care of the 
patient. Neatness in dress and a sense of the fitness of 
things is expected of her. 
A nurse’s manner reflects to a degree her inner qualities. 
Two things which go far toward making a good impression 
are a sincere interest in the patient to be served, not a 
feigned interest or a “case” interest, and a spirit of genu- 
ine kindness that finds its expression in numerous inde- 
finable ways. A nurse who is genuinely kind will find 
that that virtue covers up a multitude of other defects. 236 
ETHICS FOR NURSES 
“Another important constituent of a good impression 
is self-confidence. This must be guarded that it shall 
not become conceit, which always offends and antago- 
nizes. This quality is a necessary one. If you have 
not a good opinion of yourself, how are you going to 
impress others that you are worthy of their good opinion ? 
If you are not reasonably sure that you can do a thing, 
how are you to get a chance to do it? If you seem not 
to be mistress of the situation, how are you going to 
make people willing to let you undertake their affairs? 
A man who respects himself is bound to be respected. 
A woman who is willing and knows that she can do good 
work is likely to be given an opportunity to do it.” 
Practically all that has been said about the value of 
first impressions to the private nurse applies with equal 
force to institutional nursing and to other lines of work. 
The wearing of much jewelry and a lingerie blouse 
cut indecently low in the neck has prevented a nurse 
from securing a coveted position in an institution. The 
superintendent decided that the jewelry was unneces- 
sary for nurses and indicated personal vanity, and the 
indecently low-cut blouse suggested that its wTearer would 
not be a good example to pupil nurses. 
The failure to keep an appointment made for a certain 
hour has often settled the question of the desirability of 
a nurse for some desired position. She was unbusiness- 
like and was likely to fail in various other directions. 
The best positions come to those who are willing to 
pay the price of prolonged study and training. As a 
rule, such positions require women of sterling character 
and a wholesome ambition to excel in their chosen line. 
Success is not a matter of chance. 
The Carrying of Responsibility.—The ease and effective- 
ness with which a nurse is able to assume responsibility 
determines her value in large measure. This fact cannot AFTER GRADUATION 
237 
be too strongly emphasized. The nurse who habitually 
shirks responsibility, or fails to measure up to it, is not 
worth as much in dollars and cents to an institution, 
organization, or family as the nurse who quietly takes 
on burdens of responsibility and faithfully carries them. 
A nurse determines her own value very soon by her atti- 
tude toward responsibility, and toward human needs in 
home, hospital, or elsewhere. 
Earnest effort to measure up to the responsibilities that 
come all along the way, combined with industry and adapt- 
ability, will do more to pave the way to better positions 
with greater responsibilities than any other thing. It is 
as true today as ever it was that he who has been faithful 
in a few things, in lesser responsibilities, is the one who is 
going to be given greater responsibilities. Friends may 
recommend and help to secure a desired position for a 
nurse, but it rests with herself whether she fills the posi- 
tion satisfactorily. Friends cannot make good her char- 
acter deficiencies. Training alone will not bring success. 
The world cares but little how many degrees a nurse 
has, or how many diplomas. These serve as certificates 
of a certain amount of preparatory attainment, but they 
will not save the unfit from failure. The world that is 
represented in the great wide field now open to nurses is 
looking always for the nurse who has shown herself 
capable of bearing real burdens, of carrying responsi- 
bilities, of exercising the right influence on others, of 
doing things, of directing others, of getting results. A 
reputation for measuring up to responsibilities wherever 
her work has called her is worth more to the average nurse 
than a university degree. The latter is a good thing to 
have, but unless a nurse manifests the three qualities 
named—industry, adaptability, and the ability to easily 
and effectively assume responsibility—her university 238 
ETHICS FOR NURSES 
degree will not make her a success in any line of nursing 
endeavor. 
Suggested Subject for Written Work.—How may a 
nurse cultivate the quality of seeing a given situation 
from the viewpoint of those who employ her? 
QUESTIONS FOR DISCUSSION OR REVIEW 
1. How much does one’s mental attitude toward nurs- 
ing have to do in influencing the success of any worker? 
2. Outline what you consider is the right mental 
attitude of the nurse at graduation toward the needs of 
the world and the problems that confront her. 
3. Is it possible for a nurse to really be true to section 
5 of the pledge found on page 226 ? How many nurses 
do you know who have violated that pledge? Is it more 
difficult to keep than the other clauses in the pledge? 
If so, why? 
4. Mention three important qualities for a nurse to 
possess who desires to be entrusted with large responsi- 
bilities. 
5. What do you understand by adaptability and how 
is it cultivated? Show why it is important in a nurse’s 
success. 
6. How is a nurse who is not adaptable liable to act 
in a private home? 
7. How far is a nurse to be blamed for her lack of 
adaptability? Could she overcome it if she desired to? 
8. How does a nurse show while in a training school 
that she is fitted for a position of responsibility? 
9. Give some suggestions to a nurse who desires to 
make a good first impression. 
10. Mention two qualities which help a nurse to make 
a good impression. CHAPTER XXI 
The Wide Field 
The nursing field, into which the young graduate 
enters, widens from year to year, as new ways are dis- 
covered of bringing the skill and training of a nurse to 
bear on the needs of the w'orld. From the training school 
one may find over twenty different lines radiating, each 
leading to a somewhat different kind of service in which 
nurses may engage. 
Vocations for Nurses.—In a training-school announce- 
ment, recently received, the following list of “vocations' 
appears* 
Superintendent of hospital. 
Assistant superintendent of hospital. 
Principal of training school. 
Assistant principal of training school. 
Head nurses of departments. 
Instructors in training schools. 
Hospital social service nurse. 
Dietitian. 
Hospital office assistant. 
Anesthetist. 
Resident nurse in schools and colleges. 
Private duty nurse. 
Army and Navy nurse. 
Red Cross nurse. 
Rural nursing service. 
District nurse. 
Office nurse. 
School nurse. 
239 240 
ETHICS FOR NURSES 
Social welfare workers. 
Foreign missionary workers. 
Tuberculosis nurse. 
Infant welfare nurse. 
Almshouse nurse. 
Sanitary inspectors. 
Department store nurse. 
If the number of vocations which mean opportunity 
for service seems bewildering, the problem of choice may 
be simplified if one remembers that the great majority 
of nurses will naturally come in one of the three great 
divisions of nursing: 
Institutional work. 
Private nursing in homes. 
Visiting nursing and public health work. 
The institutional field each year demands more and 
more workers, as higher standards of service in insti- 
tutional work and additional buildings create the de- 
mand. Hospitals are living growing things, constantly 
enlarging, and each year new institutions come into 
existence. The regular hours, freedom from outside ex- 
penses, generally good accommodation, and the spirit of 
comradeship in service found in hospitals all combine 
to make this form of nursing attractive. Where a few 
years ago one found one or two paid graduate workers in 
a hospital, one may today find ten or more in the same 
institution. 
The great variety of positions in institutional work calls 
for a variety of talent. At the door of many hospitals 
one finds a nurse who serves as an admitting officer— 
receiving patients, meeting their friends, and answering 
the multitude of questions that come to one in such a 
position. What temperament and qualifications should 
a nurse have for such a position? THE WIDE FIELD 
241 
In another, one may find a nurse in charge of the 
bookkeeping and clerical work with other assistants 
provided. 
In another, one finds a nurse in charge of the dietary 
department and also acting as matron of the nurse’s 
home, capable assistants being provided who work under 
her direction. 
In another, one finds a nurse who has special qualifica- 
tions as a teacher, visiting several hospitals weekly as 
instructor in certain subjects. 
In another, one finds a nurse in charge of the nurse's 
home—having the responsibility of managing about their 
uniforms, arranging for social events for them, caring 
for sick nurses not ill enough to be in the hospital, 
serving as housemother, and with the office of assistant 
to the principal. 
In another hospital one finds not one, but several 
nurses regularly employed as anesthetists. 
A hospital starts a social service department with one 
nurse, and a little later it gives her one or two or more 
assistants, as the work grows, and results are seen that 
justify the expense. 
In another institution one finds a nurse in charge of 
the entire instruction of probationers, carrying one class 
at a time through for perhaps two, three, or six months, 
and then admitting another. She specializes in this 
kind of work. 
The increase in surgical work that is going on all over 
the country is requiring an army of skilled operating 
room nurses, and the demand for this class of worker 
grows each year. 
Dispensary work is becoming every year a more im- 
portant part of the hospital activities, and here and there 
dispensaries, independent of hospitals, are being started. 242 
ETHICS FOR NURSES 
These all require one or more nurses for the most effective 
service, and to the nurse whose sympathies go out to the 
struggling poor, the dispensary offers a field of service 
of wonderful opportunity. 
There is found, besides, a great increase in the number 
of head nurses and assistants to the principal or superin- 
tendent, and such work has many attractions.* One 
writing on the opportunities of the head nurse 
“The head nurse touches life on many sides. If she is 
interested in science, she may see in the ward the very 
latest application of it for the benefit of humanity. She 
may herself take part in the work, and by her knowledge 
and skill, help to make these new discoveries successful 
in the treatment of disease. She works side by side 
with physicians and surgeons whose work other men may 
cross continents to see. This is a constant stimulus to 
further study and effort. 
“If it is sociology that fascinates her, the material for 
its study is all around her, for at one time or another all 
the great problems that social workers are grappling 
with, are encountered in the hospital ward. 
“If it is humanity that calls to her, just elemental 
human nature with its comedy and pathos, its courage 
and its despair, its divinity, its degradation—all phases 
of it are revealed in the flashes of quaint humor, the 
patiently endured trouble, the little comedies and the 
stern tragedies of the hospital ward. Life never lacks 
interest here. 
“Finally, if the maternal instinct is strong in her, and 
I believe that is the fundamental thing in all women who 
are good nurses, it may find a wholesome field for its ex- 
pression in the care given to the sick, and in the very 
important part she takes in the professional education 
* Marion G. Parsons. THE WIDE FIELD 
243 
of the young women who are to be the nurses of the 
future.” 
In the field of public health nursing, so-called, one 
finds a still greater development going on, and opportu- 
nity is provided for a wonderful variety of talent to find 
scope. Apart from the regularly organized forms of 
visiting nursing, now well understood, one finds nurses 
each year filling some new need. In one place one may 
find a nurse doing a sort of inspection duty in a neighbor- 
hood in which a number of cases of contagious disease 
exists. She not only instructs, advises and assists the 
families in which such diseases are present, but she is 
there to see that quarantine laws are observed. 
Another nurse may be engaged solely in giving instruc- 
tion to the school children of a city on how to prevent 
tuberculosis. She goes from school to school and tells 
her story, and even if the children sometimes call her 
“the spit nurse” they love her none the less. 
Another nurse may be the only one of her class in a 
whole county—sent there by the State Board of Health 
to discover cases of tuberculosis and help to secure for 
them the help they need. 
Nurses in a southern state have won the admiration of 
all who know of their work among the mountaineers, 
in fighting the spread of trachoma, and preventing many 
cases of blindness. 
In other cities one finds “little mother’s leagues” 
organized, with nurses in charge, giving instruction to 
school girls on how to care for their baby brothers and 
sisters. 
As the infant welfare work becomes more fully organ- 
ized, increased demands for nurses for this form of service 
will be made on those now in training. For the nurse 
who is able to give health lectures to mothers, and create 244 
ETHICS FOR NURSES 
interest in health matters in a community, there is a 
fine field of service. 
The school nurse has made for herself a place of in- 
creasing importance in the country, while factories and 
department stores in greater numbers are finding need 
for a nurse’s services. 
The foreign field is calling loudly each year for nurses 
from America to come to take charge of hospitals and 
dispensaries in foreign fields where health work is so 
badly needed. 
For many of these positions the nurse who is wise will 
take time to secure special training if she expects to 
render effective service. However complete a hospital 
training may be, it can constitute only the foundation 
for most of the forms of service mentioned. 
Making a Choice.—In attempting to decide which one 
of these divisions to enter, it is well to take stock so far 
as one may, of one’s own capabilities. To do good work 
in any of these fields requires that a nurse must have, 
besides her technical training, some enthusiasm, adapt- 
ability, and liking for the work. Occasionally one meets 
the unusual nurse, the nurse who apparently can follow 
any one of several different lines of work and appear to 
do well in all of them. Such nurses have probably ac- 
quired before and after coming to the training school 
a variety of experience and education along different 
lines, that serves to supplement their nurse training; 
and they have, besides, that important qualification 
known as executive ability. But the majority of nurses 
cannot do two or three kinds of work equally well. 
The difficulty with many nurses is that they become 
hopeless drifters, rarely staying at any one thing long 
enough to become really proficient, never being able to 
say of any one kind of work, “this is where I feel I can do THE WIDE FIELD 
245 
the best work,” or “ I have found my work.” Very often, 
a certain form of nursing has been idealized in the pupil 
nurse’s mind. She sees it from a distance, and it appears 
to have a halo of glory around it. She may be honestly 
convinced that such work is the work of all others in the 
world for her. A bit of experience is then her greatest 
necessity. To illustrate: A young nurse full of ambition, 
after graduating from one hospital, immediately entered 
for further training in another. She was determined to 
leave nothing undone to secure the best preparation pos- 
sible for her life’s work. While taking the post-graduate 
course she became convinced that visiting nursing was the 
work she wanted above anything else. To “ go about doing 
good ” among the poor—could anything be more beauti- 
ful? It seemed from a distance to be the “ideal occu- 
pation” for her. Fortunately, the opportunity came to 
her soon after leaving the post-graduate school to substi- 
tute for a nurse who was doing visiting nursing under the 
auspices of a church organization. There was no one 
really to direct her work, or to give her a word of prac- 
tical advice about it. A large part of the work consisted 
in visiting patients suffering from chronic disease, where 
her nursing duties were of the simplest sort. Long 
tedious hours were spent, in one or two cases, in combing 
long matted hair which had been badly neglected; at 
other times in giving baths to patients who protested 
against having them; other patients spent their money 
for stimulants and patent medicines that did not cure, 
but would not listen to her advice; much time was spent 
in carrying special delicacies to patients who were just as 
needy the next day, and would be till the end. Visiting 
nursing was then unorganized. Each center was an iso- 
lated unit. This nurse could not feel that she was part of 
a vast social movement for human betterment. She was 246 
ETHICS FOR NURSES 
simply an isolated worker doing tasks most of which she felt 
she could as easily have accomplished after a few months 
training. The halo around the work began to fade. 
When the time she had agreed to substitute had expired, 
she took an institutional position, became an efficient 
principal of a training school, and later superintendent 
of a hospital. She still “went about doing good" but 
in a hospital, for which work she was unusually well fitted. 
Other nurses have similarly idealized other lines of work. 
A nurse who had bubbled over with enthusiasm about 
“public health work” found her enthusiasm waning with 
the first prolonged period of rainy weather. She lacked 
imagination and stick-to-it-iveness. 
There are disagreeable features in all branches of work, 
including nursing, and each has its compensations. There 
is such a thing, however, as “working against the grain,” 
working in conditions which are singularly distasteful, and 
it is certain that one’s best work will not be accomplished 
in such circumstances. There is an excess of nervous 
energy expended, where one is working against one’s natu- 
ral bent, where there is friction, and where one feels that 
there is not scope for the best use of one’s powers, that 
in time reacts adversely on the health of the worker. 
Two practical questions which a nurse may well ask 
herself in considering an occupation, therefore, are: 
Have I within myself the possibility of measuring up to 
the demands of this situation? Would I be happy in 
this particular line of work? 
Making a Right Start.—There are several important 
ethical considerations which a nurse should especially 
try to keep in mind when she goes forth as an independent 
worker. 
1. The public will judge trained nurses in general, by 
the conduct and spirit of individual nurses in their work. THE WIDE FIELD 
247 
2. A nurse’s honor is at stake in many of the problems 
that will confront her. 
3. In her dealings with the sick, or with the public, 
there are always at least two sides to every question that 
arises, and sometimes three or four sides. She must try 
to see these other sides. 
A nurse’s word should mean something if she ever 
hopes to attain to any position of trust. If she agrees 
to go to a certain place at a certain time, she should be 
there unless some accident befalls her, or she should 
notify in time those who are depending on her or expecting 
her that she cannot keep the engagement. To make 
such a reputation that people will say, “If Miss Blank 
said she’d be there, you can surely depend on her, she 
always keeps her word,” is worth more to a nurse than 
she can readily estimate. If a nurse has no sense of 
honor, nothing within herself that will keep her from 
doing small contemptible things, the greatest benefit 
that she can confer on the nursing profession is to 
leave it. 
A nurse who had graduated about four years before 
applied to her superintendent to help her to find a posi- 
tion. She had had a discouraging experience, and was 
both out of work and out of money. The only vacancy 
that the superintendent had to suggest at the time was 
with a visiting nurse association some distance away 
which was then in need of a worker. This was just the 
kind of work the nurse wanted, she said; so her applica- 
tion went at once. The nurse had committed no flagrant 
misdemeanors during her training; she had done “pass- 
ably good” work, and the superintendent recommended 
her in a somewhat restrained non-committal manner. 
The nurse had had some few months of experience in 
visiting nursing, and it seemed as if she might give satis- 248 
ETHICS FOR NURSES 
faction if she really tried. On the strength of the sup- 
erintendent’s recommendation, the application was 
promptly accepted, and the day was set, about four weeks 
hence, on which she was to report for duty, to take the 
place of another nurse who was leaving to go to another 
position. 
A few days before the date set for the nurse to begin 
service with the visiting nursing organization, the super- 
intendent received a letter from a hospital to which this 
nurse had applied for a position as night superintendent, 
and shortly after another letter was received from a tuber- 
culosis hospital to which the same nurse had applied for 
a position. It developed that after the arrangements 
with the visiting nurse society had been made, the nurse 
heard of the vacancy as night superintendent, and also 
saw an advertisement for nurses for the tuberculosis 
hospital. She could see no reason why the superin- 
tendent would not recommend her for any or all of them, 
though she had been under contract for weeks with 
another organization. There, apparently, was no ques- 
tion in her own mind as to her fitness to fill any of these 
positions. The obligations which she incurred when 
she accepted the position with the visiting nurse society 
were as nothing to her. It meant nothing to her that 
the visiting nurse work would be thrown into confusion, 
or that the welfare of the patients in the district that was 
to have been hers was to a degree dependent on her 
keeping her word. She thought the superintendent was 
most hard-hearted that she did not promptly write 
recommendations for her for all these positions, and as 
many more as she chose to apply for. In fact she thought 
only of her own side of the case. What ethical failures 
was this nurse guilty of? If this were an isolated case, 
it need not be given serious consideration, but it illus- THE WIDE FIELD 
249 
trates an ethical problem of no small magnitude, and 
one that is far too common. Engagements for service 
are accepted by nurses and broken with an indifference 
that is appalling. It is such nurses who drift aimlessly 
from place to place, never holding any position long 
enough to really make good, and often spending several 
months of the year idle. 
How many positions may a nurse properly apply for at 
one time? If she has applied for more than one position, 
what course should she pursue when she finds one appli- 
cation accepted? Having accepted a position which 
proves distasteful to her, after a few weeks’ experience, 
what should she do? 
Depending on one's alma mater or on the hospital in 
which one has been trained, to keep one supplied with 
work, is a failing which is common in the nurse of today. 
Twenty years ago, or less, no nurse on graduation ex- 
pected that she was to get her calls for nursing from the 
hospital in which she trained. Today one may find, in 
many places, that a whole class of nurses, instead of 
looking around to find out where their services are most 
needed, are inclined to settle down a few blocks from the 
hospital, to look to the hospital to send them special 
cases, to cast jealous eyes on the cases on which pupil 
nurses are given special nursing experience, and to 
find fault with the principal if she calls in some other 
nurse while they are idle. This unwholesome and 
dependent attitude of mind in regard to nursing, and 
to one’s life work, is detrimental to the whole nursing 
body. It helps to keep nurses crowded in cities, while 
not far away there may be whole counties without a 
nurse. 
The pioneer spirit is not dead in the nurses of today, 
but it is badly in need of better cultivation. It is 250 
ETHICS FOR NURSES 
true that most nurses will have to follow the pioneer, 
yet the spirit of the pioneer should be in every nurse. 
She should cultivate the courage to advance beyond 
the well-populated districts—confident that there is 
nothing in the “regions beyond” which a brave, healthy, 
well-trained nurse need fear to meet. 
What is the pioneer spirit? What qualities do pioneers 
possess that many nurses of today seem to lack? What 
is the price of pioneering? 
It depends on how far the pioneer spirit leads us, 
what the price is that we pay for it, and on how com- 
pletely that spirit takes possession of us. If we study 
the life stories of the pioneers in nursing we will find 
that they seemed to scorn the cost—left it entirely out 
of consideration. If they had been afraid to venture 
outside of the city for fear they would not have hot 
and cold water always at hand, electric light, tele- 
phone service, someone to wait on them, etc., the world 
would never have heard much about them. 
The Price of Pioneering is often Unpopularity.— 
There are those who will try to make the pioneer’s 
plans seem ridiculous, who will raise obstacles, and 
who will hinder by their constant criticism of motives. 
The real pioneer must be able to go on in spite of these 
difficulties if he expects to accomplish anything worth 
while. Most great causes have at first been unpopular, 
and there will always be those who -will urge the life of 
ease, and urge a nurse not to venture far away. How 
shall she cultivate the courage to go? How shall she 
discover where she is most needed? 
The development of tuberculosis hospitals and nursing 
has put before the nurses of today a challenge which 
some nurses have met with wonderful bravery and suc- 
cess. Others have failed. The following form of ethical THE WIDE FIELD 
251 
failure is not unusual. In a certain tuberculosis hospital, 
graduate nurses are employed for the general nursing 
of the patients. During the absence of the superintend- 
ent there was a certain amount of relaxation in regard 
to enforcement of rules, etc., and when the superin- 
tendent, on her return, endeavored to correct certain 
undesirable practices several graduate nurses promptly 
resigned, on a day’s notice, and left the patients to the 
care of whomever the superintendent could pick up. 
This ethical failing of graduate nurses is not confined 
to tuberculosis hospitals, but can be readily illustrated 
in other institutions and places. 
Even if a contract for service calls for no definite term 
of notice before leaving, should a nurse’s sense of honor 
cause her to give ample notice? What considerations 
should guide her in cases of this kind? What can one 
nurse do to correct this condition? 
The Need of Study.—Florence Nightingale nearly fifty 
years ago deplored the fact that nurses were more anxious 
for positions than they were to find out what the posi- 
tions were desiring in them, and how near or how far 
they came from meeting the just expectations of those 
who employed them. To fill well some of the positions 
mentioned in this chapter requires that a nurse must be 
ready every year or two to take up some new kind of 
study. Visiting nurses need to be familiar with the 
methods of organized charity, “ with new housing regula- 
tions which are made, to learn new facts about immigra- 
tion, the best way of dealing with young girls whose 
surroundings make morality difficult, and to keep up with 
social as well as with medical progress.” The nurse who 
neglects or refuses to study, soon falls behind, and finds 
it harder and harder to secure a satisfactory location. 
As long as she is in the work, a nurse should expect to 252 
ETHICS FOR NURSES 
be a student. She should invest in books and magazines 
as a mechanic does in tools, that she may keep abreast 
with the march of modern progress. 
Suggested Subject for Written Work.—Prepare a short 
paper containing suggestions which might be helpful to a 
young nurse who was about to apply for an institutional 
position, things to do, things to avoid. 
FOR DISCUSSION OR REVIEW 
1. What is meant by the term “vocation?” In what 
sense does it differ from “occupation?” 
2. Mention the three great divisions of the nursing 
field. 
3. Outline briefly the difference in the qualities required 
for effective service in each of these fields. 
4. State some important things which a nurse should 
consider before making a choice of any branch of nursing. 
5. In applying for a position as chief surgical nurse in a 
distant city, what information may a nurse wisely and 
rightly ask for in regard to the place she is considering? 
6. Make a list of the questions which a nurse may 
properly ask about a head nurse’s position which she 
intends to apply for, also for a position as superintendent 
of a training school. 
7. What is the value of experience in an executive 
position to a nurse? Would a nurse be wise at first to 
work for a comparatively small salary in order to secure 
experience? How should she rate the value of her 
services? 
8. Mention the chief points on which a hospital board 
of managers is likely to wish to be informed regarding 
applicants for the following positions: 
Superintendent of a hospital. THE WIDE FIELD 
253 
Principal of a training school. 
Instructor of nurses. 
Chief surgical nurse. 
9. What suggestions would you give a nurse who 
wished to prepare herself for infant welfare work? What 
qualities should she possess? 
10. Mention three books which you would advise a 
nurse who wanted a position as a school nurse to buy and 
study. 
11. Give a list of books which might be helpful to a 
nurse who desired to secure employment as a social 
service worker in connection with a hospital. 
12. Mention some qualities which a nurse in an execu- 
tive position in a tuberculosis hospital should possess. 
13. Write a short paper giving your idea of places in 
which pioneer work is needed in the United States? 
In Canada? Tell why you feel such work is needed 
and the kind of nurses needed to do it. 
14. Give some reasons why nurses should not settle 
down close to the hospital in which they were trained. 
State some of the problems created by doing so. 
15. Give some suggestions as to how the pioneer 
spirit may be developed in the nurse of today. 
16. How many years after a nurse graduates should 
she need to send back to her training school for recom- 
mendations? To what extent should she depend on 
them to help her find her place in the wide field? CHAPTER XXII 
A Nurse and Her Money 
A speaker in a public address to men, emphasized 
the point that the best index to a man’s character was 
the use he made of the margin of his time—that part 
of it which was not devoted to work or sleep, or the actual 
necessities of life; another important indication of char- 
acter mentioned was the way an individual spent the 
money he earned. 
Would the application of these two tests, “How do 
you spend the margin of your time?” “What do you do 
with your money?” give any idea of character in the 
nurses you know? 
The charge that nurses are unbusinesslike in their 
habits, inclined to extravagance, apt to live up to the 
extent of their incomes, is frequently made and with 
some degree of truth. Whether they are more improvi- 
dent than other classes of workers, is an unsettled 
question. 
The National Young Women’s Christian Association 
recently appointed a committee on “thrift and efficiency.” 
In a leaflet issued by that committee occur the follow- 
ing questions which nurses in common with other 
workers may wisely ask themselves: 
FIVE PERTINENT QUESTIONS FOR A WOMAN 
EARNING A SALARY 
1. How much have I earned all told in my life? 
2. How much could I have saved if I had wanted to? 
3. How much do I possess free and clear now? 
254 A NURSE AND HER MONEY 
255 
4. How much of the difference between earnings and 
present possessions has been frittered away? 
5. What am I going to do from this time on to secure 
my living expenses in sickness and in old age? 
In considering one’s duty, or in the study of ethics, it 
is certain that the right or the wise use of money should 
not be overlooked. It is also certain that it is easier 
to earn money than to spend it wisely, that the wise 
investment of the reward of one’s own labor is one of 
the big problems of life. Whether one is considering 
the spending of one dollar or one thousand, the matter 
is an investment. To a great many young nurses $35 
a week seems a large sum, and in the first flush of the 
elation over their wage-earning ability, they proceed 
to invest in various items of longed-for finery, and 
presently when work is slack they find themselves with 
no bank account, a very slim pocketbook, and expenses 
going steadily on. 
Mention some reasons why a nurse should keep ac- 
curate account of income and expenditure from year 
to year. 
Make a list of a model wardrobe for a private or in- 
stitutional nurse, stating the approximate amount of 
each article, and the total cost. 
If a private nurse’s income amounts to $1500 a year, 
what part of this amount should be devoted to each of 
following classes of expenses: Housing accommodation, 
food, clothing, recreation, books and magazines, health 
expenses, church? 
How much should a private nurse, who has no one 
dependent on her, save from this sum each year, con- 
sidering that she has no unusual expenses? 
Investing One’s Savings.—Not every one who knows 
how to save knows how to invest the savings wisely, 256 
ETHICS FOR NURSES 
when a certain amount has accumulated. A writer in 
a magazine* discussing the subject of unwise invest- 
ments in which the investor emerges minus his hard- 
earned savings, asks the question, “Who are these 
dupes?” and answers it as follows: 
“The list of names and addresses seized at the fraud 
offices when an arrest is made shows that they are chiefly 
school-teachers, widows, clergymen and clerks. The 
number of women all over the country swindled by 
mining-stock and patent-right schemers is something 
appalling. There are no actual statistics on the subject, 
but the number of gulls and dupes runs up into the 
millions. In the past five years nearly a hundred million 
dollars has been sent to New York by these persons, and 
the money is still coming in at the rate of about fifty 
thousand dollars a day. 
“It is strange that women with their oft-credited 
‘intuitive minds/ the possession of that wonderful 
‘sixth sense/ are so easily swindled by glittering cir- 
culars and prospectuses.” 
We would like to believe that nurses are not among 
the dupes, that they are not easily dazzled by so-called 
gilt-edge investments, that they are wiser than those 
who embark in the numerous get-rich-quick schemes. 
But, unfortunately, we have reason to believe they are 
not all as wise in the investment of their hard-earned 
money as they should be. Not long since we learned 
of over a dozen nurses who had been “bitten” in their 
attempt to get rich by buying stock in a mine of some 
kind, supposed to be in Arizona. One nurse had sunk 
the entire savings of years—over two thousand dollars— 
in the scheme, and had persuaded others to follow her 
example. Before long the bubble broke and she was 
* The Technical World. A NURSE AND HER MONEY 
257 
moved to retaliate by instituting a law suit against the 
stock broker who made the investment for her. 
An important ethical question is whether a nurse 
should ever take the responsibility of inducing other 
nurses or friends to invest in schemes in which there is 
a strong element of risk. 
When the business is legitimate and at one’s door, and 
apparently a perfectly safe investment, are there reasons 
why nurses or other wage-earners should hesitate to 
invest in stock concerns over the management of which 
they have no control? If so, what are such reasons? 
Should a nurse need to use the money which she has 
invested in a stock concern, how shall she proceed to get 
it and what difficulties is she likely to encounter? 
Ten Rules Concerning Investment.—A magazine* 
intended especially for the feminine half of the country, 
gives the following rules regarding investments. Study 
them carefully. What would you add to them if you 
were giving a nurse advice regarding how to invest her 
savings. 
1. Six per cent, is a liberal return for the use of money. 
2. The higher the interest return, the less safe the 
investment. 
3. Before buying a security find out what you could sell 
it for if you owned it. 
4. Stock extravagantly advertised should never be 
bought. 
5. The personal magnetism of a stock salesman does 
not add one cent to the value of the stock. 
6. Investment, like medicine, is a science practised by 
experts. 
7. Get expert advice concerning investment. You can 
afford to pay for it, if necessary. 
* Woman’s Home Companion. 258 
ETHICS FOR NURSES 
8. The successful banker is the best adviser—when he 
will advise. 
9. Get information about securities from as many 
sources as possible before buying. 
10. Don’t invest hurriedly. 
Three Bits of Advice.—A very successful business man 
gives three rules for investors which long experience has 
taught him should be observed. He says: 
“ Most failures in life grow out of the unwillingness of 
a person to profit by the experience of others. My own 
mistakes would nearly all have been avoided by observing 
a few simple principles, which I shall endeavor to embody 
under three short rules. 
“Rule I.—Never loan a needy friend any more money 
than you can afford to lose. 
“Your friend probably intends in good faith to pay 
back the money, but the chances are that his schemes 
will miscarry and he will not be able to repay you. 
“Rule II.—Never invest in a business with which you 
are not familiar without first having a careful investiga- 
tion made by disinterested experts of established skill and 
responsibility. 
“This precaution would save investors from at least 
nine-tenths of the bad investments that are made. 
“Rule III.—Never take stock or invest in any new enter- 
prise unless you are willing to devote to it your own time 
and energy.” 
Charities and Free Service.—In every life well lived 
there will be found running through it, as a golden thread, 
the expression of the individual’s ideals of service in 
some way. Whether black or white, learned or illiterate, 
the obligation of service is on us, and the nurse, in com- 
mon with others, feels or should feel this obligation. 
To be sure, all nursing is service, but the individual who A NURSE AND HER MONEY 
259 
refuses to render any service for which he is not to receive 
payment in the coin of the realm misses much of the 
joy of living and giving. It should be made a matter of 
principle every year for a nurse to render a certain 
amount of service for which she never expects to be paid 
—and we like to believe that most nurses are carrying 
out the spirit of this principle and rendering free service 
in a thousand quiet ways and places. 
The vexed questions as to whether a nurse should be 
bound by contract not to work for less than the regulation 
rate, what treatment should be accorded a nurse who 
works for less than regular rates, whether a fixed rate or a 
sliding scale should be adopted—these questions are not 
to be answered in this volume. Whether the nurse should, 
when remaining on a long case where the family is un- 
doubtedly having a hard time to meet expenses, lower 
her rates or give a week’s service or two weeks free, is a 
technical question which cannot be settled by any fixed 
rule, to which objections cannot be made. But the 
principle that every nurse in common with every other 
right-minded individual owes every year some measure 
of free service to humanity cannot be easily reasoned 
away. 
Nursing in Homes of Moderate Means.—It should, 
however, be remembered that to the great two-thirds 
of humanity as we know it in town, city, and country 
the idea of accepting free service from a nurse is 
objectionable. The normal life is a life which is lived 
with the idea of paying, as far as one can, for the com- 
modities and service of others which are received. De- 
pendence on charity is not a wholesome condition, and 
the spirit of independence and self-respect which is found 
in the normal life should be cherished by every possible 
means. Distress may come, periods of adversity may 260 
ETHICS FOR NURSES 
come, when long illness and slack work or unemployment 
may make the paying of bills a great difficulty or an im- 
possibility, but this does not necessarily mean that a 
nurse called to nurse in such families should ask them to 
accept charity. It does mean that she should consider 
their circumstances and feelings and needs. 
A great deal of serious study has been given to the 
study of how to provide better nursing service for this 
great two-thirds—the middle-class families living on a 
moderate income—and the failure of the graduate nurse 
to understand the spirit of this class of people, to appreci- 
ate that their needs can never be met by charity—against 
which their souls rebel—is responsible in large measure 
for many perplexing and troublesome conditions relating 
to nursing, which today are giving serious concern to 
those who are sincerely interested in nurses, and also in 
seeing human needs in sickness met in the best possible 
way. 
A graduate nurse marries a man who is earning a salary 
of $150 a month which must provide rent, food, heat, 
clothing, care in sickness, etc., for himself, wife and child. 
What sort of care in sickness is such a woman entitled 
to in her home, and how should it be provided for her? 
The home care in sickness of the great majority of the 
sick—all classes of sickness—is a question which nurses 
should carefully study with an open, unprejudiced mind. 
It is a common mistake to imagine that most of the sick 
are or can be cared for in hospitals. It is only lately that 
we have begun to appreciate that, busy and active as are 
the hospitals, the proportion of people who are ill and 
cared for in hospitals is small as compared with the whole. 
In one of the largest cities of the country an investigation 
made a few years ago showed that even in contagious 
diseases more than 79 per cent, of the acute contagious A NURSE AND HER MONEY 
261 
disease patients were cared for at home. The proportion 
of patients suffering from non-contagious diseases cared 
for at home is much higher. Investigations carried on in 
various cities place the proportion of patients who receive 
hospital care at about 10 per cent. Taking towns and rural 
districts into such calculations would reduce materially 
such a percentage. It is an economic mistake to tax the 
public to erect hospitals for patients who can be ade- 
quately cared for at home. The home field offers to the 
nurse of today her largest opportunity, if only she culti- 
vates a right attitude of mind toward the real needs and 
shows herself ready to improve her opportunity. 
As an illustration of how far we are from providing 
proper care in sickness even in populous centers where it 
would seem that medical and nursing care should be 
easily available, the following figures obtained in an ex- 
haustive survey of a section of a county near New York 
City are given: 
“Of the one hundred and thirteen women who went 
through childbirth in their homes, only one had the con- 
tinuous care of a graduate nurse, and only eighteen had 
any service whatever from visiting nurses. Thirty-five 
per cent, of the children born came into the world under 
unfit conditions and surroundings.”* 
What responsibility has the graduate nurse for the 
existence of such conditions? WTat should her attitude 
of mind be in regard to such conditions, and in what ways 
can she improve them? 
What is, or should be, her relation to other workers 
now in this field? 
While it is undoubtedly true that the great two-thirds 
do not want charity, it is also true that the poor we have 
always with us, and that occasionally we are called on for 
* Report made by State Charities Aid Association of New York. 262 
ETHICS FOR NURSES 
either financial help or free service, or both. The nurse 
should carefully consider her personal obligations in this 
matter, and how to wisely distribute such help as she is 
able to give. Nurses, in common with many other peo- 
ple, are far too prone to appoint a committee to attend to 
this matter for them and then to consider their duty 
done. 
In your opinion can nursing needs in homes of all 
classes be met by graduate service alone? What sug- 
gestions would you make as to the proper way to care for 
a mother about to give birth to her fifth baby in a small 
city where the income is $120 a month, the family being 
several hundreds of miles from any relative. 
The New Psychology.—The nurse who watches the 
clock, and who insists on leaving her patient, however ill 
he may be, when the clock strikes the hour, has been the 
cause of much discussion during the last decade. One 
hears occasionally of nurses who have left their posts 
before an operation was completed or who failed in their 
duty to a woman in childbirth, because the baby’s arrival 
was delayed beyond their regular hours of duty. With- 
out doubt a few nurses have brought discredit on the 
profession by their selfish insistence on what they re- 
garded as their rights. The young nurse of today is 
certain to be more or less influenced by the example and 
practice of older nurses in her attitude toward such 
questions. What should her general course of action be? 
Suggested Subject for Written Work.—How may a nurse 
whose work is chiefly in private hours so adjust her hours 
of service so as to secure needed rest, and yet render the 
most efficient service to a patient suffering from pneu- 
monia. A NURSE AND HER MONEY 
263 
FOR DISCUSSION OR REVIEW 
1. To what extent, if any, is an individual’s choice of 
recreation an index of character? Give illustrations and 
reasons for your answer. 
2. Mention some forms of investment which seem wise 
for nurses, giving reasons, also the precautions which 
should be observed regarding them. 
3. What are the advantages of life insurance as a form 
of investment for nurses? What precautions should a 
nurse use before taking out a life insurance policy? 
4. State some different methods of providing for life 
insurance with some advantages and disadvantages of 
each method. Give some estimate as to annual pay- 
ments required in each form. 
5. What are the advantages or disadvantages of nurses 
investing in a business the location of which they have 
never seen, and which is hundreds of miles from where 
the investor lives? 
6. What are the arguments for or against the fixed rate 
or the sliding scale for a private nurse? 
7. Give some reasons why a nurse should hesitate to 
offer a self-respecting middle-class family charity? 
8. What should be her attitude of mind and what is her 
responsibility toward this class of people? 
9. In a case of minor illness or a chronic ailment, if a 
practical nurse or untrained worker or attendant assumes 
the responsibility for the housework and the care of the 
patient, and the graduate nurse will assume no responsi- 
bility beyond the care of the invalid who is only very 
moderately sick, which worker is the more desirable in 
that family? Which is worth most to the family? 
Give reasons for your answer. 264 
ETHICS FOR NURSES 
10. Can you see any reasons why a physician should 
choose an untrained woman for such a case? 
11. Should a nurse expect to be paid for the time she 
has spent in training, or for the service she actually 
renders in a home? 
12. Mention some reasons why the home field offers to 
the nurse of today a large opportunity for service. 
13. Suggest some methods by which improvement in 
present-day conditions might be accomplished. 
14. What has the attitude of mind of the individual 
nurse to do with this great problem? 
15. What do you understand by the term “trades- 
unionism”? Have nurses given any reason why the term 
may be used in regard to their practices? CHAPTER XXIII 
Ethical Problems in Private Nursing 
It is probable that in no branch of nursing do more per- 
plexing ethical problems arise than in private nursing. 
In a hospital, and in visiting nursing, there are general 
rules of guidance that help a nurse to steer clear of many 
pitfalls, and there is usually some experienced worker to 
appeal to for advice. In a hospital, also, the nurse is 
surrounded with all sorts of conveniences for her work. 
In private nursing the conditions vary with each 
individual case, and the nurse must frequently decide 
questions of large importance without a chance to talk 
the matter over with anybody. 
In the hospital it is essential that a nurse be systematic 
in her work, that she make a careful division of her time 
between several patients, that she carefully observe 
orders and regulations and develop a certain amount of 
speed in getting through with duties according to a 
prescribed method. 
In the field of private nursing a nurse must be able to 
get along with few orders, must regulate her own habits 
and methods according to the situation in which she 
finds herself, must know how to get along with the patient 
and his friends without antagonizing them, and must 
show a willingness to do whatever she finds necessary that 
will add to the comfort or recovery of the patient. 
It is well for a nurse to remember that the financial 
success of a private nurse depends greatly on whether or 
not she so conducts herself in the homes of her patients 
that they will recommend her to her friends. No nurses 
are so dependent on this matter of recommendations as 
265 266 
ETHICS FOR NURSES 
private nurses. A satisfied patient and family is a 
nurse’s best advertisement. Her technical skill counts 
for much less in the estimation of many families than the 
thousand and one little things which she may do every 
day that will keep things running smoothly, and the 
patient as happy and contented as can be under the cir- 
cumstances. A patient is not usually either greatly 
interested in or deeply appreciative of a nurse’s knowledge 
of embryology or bacteriology, but he is intensely inter- 
ested in how his egg is cooked, how his beefsteak is served, 
whether his tea or coffee is to his liking, whether his 
tray comes with salt, pepper, butter or some other item 
missing, thus causing him exasperating delays. He may 
ply a nurse with questions about the hospital, the doctors, 
or about former patients, and then after she has satisfied 
him that she has no objection to freely discussing these 
subjects, he will tell his friends that she is a great gossip, 
and that a nurse who will talk to him about other 
patients and their affairs will carry tales about his affairs 
to others and they had better not employ her. 
The variety of ethical problems that arise in private 
homes is exhaustless, but most of them will fit into one 
of the following classes: 
Problems for which the nurse herself is responsible. 
Problems directly connected with the patient. 
Problems relating to the family and domestic situation. 
Problems relating chiefly to the doctor. 
The remainder may be classed under the head of 
"miscellaneous.” 
Responses to Calls.—The most frequent complaints 
about private nurses are heard in regard to the questions 
of responses to calls, to her unwillingness to wait on her- 
self or to do anything not directly connected with the 
care of the patient, and to her extravagance. These are 
types of problems for which the nurse herself is respon- PROBLEMS IN PRIVATE NURSING 
267 
sible. A ery frequently she takes her cue in these matters 
from some other nurse whose example should be avoided 
rather than followed, instead of seriously asking herself 
“ What is my duty in this case? If the Golden Rule were 
followed, what course would it lead me to pursue?” 
A doctor who has had a wide experience with private 
nurses states emphatically his opinion of the nurse’s 
professional obligations in regard to responses to calls in 
this manner: “A nurse who has reported that she is on 
call or who is not actually on duty is as much bound, 
ethically and professionally, to respond to a doctor’s 
call for a nurse as is a doctor to respond to a call for 
his professional service.” 
If this doctor’s view of the nurse’s professional obliga- 
tions were subscribed to and practised by nurses in 
general, what desirable or undesirable results would be 
likely to follow? 
To what extent and at what time in her career is it 
desirable for a nurse to specialize? 
What limitations should she make regarding what cases 
she will or will not take and what times she will and will 
not work? 
Having made limitations and announced them, is a 
nurse under obligation to observe them? 
When a nurse announces herself as “on call” for “ general 
nursing” what does she mean? Does she mean that she 
is ready to respond to any call that comes? If not, what 
does she mean by “general nursing?” 
What does it mean to be “on call,” and what limita- 
tions does a nurse place on her own plans and movements 
when she has announced that she is “on call?” 
Should a nurse on private duty be either absolutely 
“on call” or absolutely not “on call?” 
Would the adherence to a rule requiring a nurse to be 
either absolutely “on call” or absolutely not “on call” 268 
ETHICS FOR NURSES 
settle some of the perplexing questions in nursing that 
arise? We think it would. To be “ on call ” only for an 
easy or so-called “good case” or for a favorite doctor is 
perhaps the chief thing which physicians condemn, and 
rightly condemn, in nurses. A rule to do general nursing 
and to be “on call” or not “on call” absolutely, and a 
determination to give prompt response to any call at any 
time or place when one is “on call,” is one of the best 
rules that a young nurse can make, due regard being 
made to the matter of just remuneration. 
A rule to be “on call” or not “on call” absolutely 
gives a nurse large command over her time, and makes it 
possible for her to secure the rest periods that she needs. 
The charge of “picking cases,” which is so detrimental 
to the whole nursing body, would never have been made 
had trained nurses adhered to the principle of absolutely 
being “on call” and ready to respond, or absolutely not 
“on call.” This evil can be remedied only as the indi- 
vidual nurse resolves to remedy it in herself, and to use 
her influence to help other nurses to realize their profes- 
sional obligations in this matter. 
The absolutely unethical conditions which prevail in 
many places may be illustrated by the following: A 
doctor requires a nurse for a boy fourteen years old. 
The boy lives with his parents in a comfortable home five 
miles beyond the city limits, easily reached by trolley 
car. The first nurse called “didn’t care to go out of the 
city.” The second called had made an engagement to 
go to the theatre. Would tomorrow do? The third 
nurse “didn’t care to nurse children.” The fourth had 
just had a short case and didn’t wish to take another. 
The fifth would go, but her clean linen had not come from 
the laundry and she hadn’t a thing to wear. The sixth 
had a headache, but if she felt better might go tomorrow. 
It is nothing unusual to call fifteen nurses for some PROBLEMS IN PRIVATE NURSING 
269 
serious ease of this kind before getting one who is ready 
to respond, while all have reported themselves as “on 
call.” It is hardly to be wondered at that doctors tire 
of this attitude and refuse to call such nurses for any 
case. Nor is it to be wondered at that such nurses are 
idle a good part of the time, and thoroughly discontented 
with conditions. 
Practically the same conditions are met with by the 
registrars who manage registries for nurses. Nurses 
report that they are “on call,” yet when a call comes 
they have a dozen questions to ask about it, then finally 
decide they do not care to take it. 
Specializing is entirely proper and the only ethical 
way of limiting responses to calls. If a nurse wishes to 
register for “surgical cases only” or for other cases only, 
that is her privilege. There is nothing unprofessional 
about it, but when she begins to ennumerate the kinds of 
cases she will not go to, she leaves the impression that she 
regards no obligations to the profession or to the sick, 
that she is unwilling to sacrifice her personal convenience 
under any circumstances, that she is going to do just as 
little as she can possibly manage, and that she is in- 
fluenced wholly by selfish or personal motives. Con- 
sistent adherence to the professional limitations which 
she has made in regard to her calls is the chief ethical 
requirement in such cases. 
The dilatory nurse is always a trial to doctors, to those 
who are in charge of her calls and to those who employ 
her. She is never quite ready to at once respond to a 
call, or she has developed a habit of “dilly-dallying” 
over her preparations, or she deliberately refuses to go 
at once to a case by the shortest route and in the shortest 
possible time. In any case the results are exasperating 
and often serious. A doctor is called to a case of uterine 
hemorrhage. He uses emergency measures, telephones 270 
ETHICS FOR NURSES 
for a nurse who says she will be there at the earliest 
possible moment. He expects her in less than an hour. 
He is afraid to leave the patient till she comes. One 
hour, two and sometimes three hours pass before the 
nurse appears with an assortment of excuses and ex- 
planations ready to present. The doctor’s duties and 
appointments are interfered with, and those of many 
other people who had appointments with him. What 
should be a doctor’s attitude toward this type of nurse? 
The most reprehensible fact about the dilatory nurse 
is that she often deliberately delays going to a case 
after she has agreed to go. A nurse stated her policies 
to the author in this manner: “I am never in any hurry 
about getting to a new case. I find that people respect 
you more if you don’t act as if you were too glad to get 
the call, or as if you were sitting waiting for it.” The 
condition or needs of the patient seemed to be an entirely 
secondary consideration with this nurse. It was herself, 
and how she was to be received, that was uppermost in 
her thought and plans. What important ethical qualities 
for a nurse were lacking in the case just cited? 
Economy and Nursing.—The charge of extravagance 
is so frequently heard about nurses that measures to 
guard against it should be seriously considered by every 
nurse. It is one of the chief reasons wrhy many families 
who could afford to pay a graduate nurse prefer an un- 
trained or practical nurse, because the latter is usually 
more careful regarding general expenses. 
True economy is not stinginess. “It is a far-seeing, 
clear-sighted grasp of all the possibilities of a situation, 
and a habit of mind which secures the maximum advan- 
tage from every fraction of outlay, whether in energy or 
cash, which are frequently interchangeable terms. True 
economy conduces to comfort, while false economy is the 
essence of discomfort.” PROBLEMS IN PRIVATE NURSING 
271 
Quite often the really good work that a nurse does on a 
case is forgotten because it was expected and taken for 
granted, while some bit of carelessness or extravagance 
is remembered and talked about because it was un- 
worthy of a trained woman. A nurse wrapped a baby 
in an expensive blanket, sat too near a grate fire with it, 
and burned a fairly large hole in the blanket. So long 
as that patched blanket remains, the story of that nurse’s 
carelessness will be told. 
Quite often a nurse fails to provide herself with a good 
practical working outfit which every nurse should have, 
and calls on every family to which she goes to purchase 
things which she expects to need frequently and should 
carry with her. 
Too lavish use of linen is a common complaint, and in 
many cases the laundry bills seem to be out of all pro- 
portion to real needs. One difficulty with the whole 
matter of economy is that, while in training, nurses are 
constantly using expensive articles for which they do not 
pay, and they leave the training school ignorant of what 
waste means, or of how the cost of common articles 
mounts up when combined with the other added expenses 
of sickness. Many nurses are experts at improvising. 
Bed-rests, cradles, supports, heating appliances, croup 
kettles and tents, foot baths, drinking cups, urinals, 
measuring glasses, etc., are all produced without cost. 
Every nurse should take pride in being able to improvise 
such things. She may not need to do it in all cases, 
but she should know how to meet needs as they arise. 
The marring of costly furniture—dresser tops or tables— 
by setting hot water pitchers on them or by spilling water 
or chemicals on them, and not quickly wiping it off, or 
by wet-dusting, is another danger point which nurses do 
well to guard against. 
A nurse writer in one of the nursing magazines cites 272 
ETHICS FOR NURSES 
this incident which illustrates admirably the impression 
made in some homes by nurses who offend by their 
carelessness. 
“A friend recently told me with horror in her eyes 
that she had just had a trained nurse who had actually 
spilled olive oil on her bath-room rug and the spots 
would not come out. ‘Why/ said she, ‘I, who have 
never been in a hospital, used it myself for weeks without 
spilling a drop!’ Alas for that nurse! Of what use has 
her training been to her if she occasionally spills olive 
oil? As long as the bath-room rug exists in that home 
the name of nurse will not mean the sweet-faced, min- 
istering angel, the tower of strength, the kindly presence. 
No, it suggests but one thing—unremovable, unfadable, 
unpardonable spots!” 
Very often at first sight it looks as though there is no 
way to avoid considerable expense if the sick one is to 
be made comfortable, yet it can often be done. A nurse 
called to nurse a young man in the country, ill with 
typhoid fever, was distressed to find the sick-room and 
house swarming with flies. There were no screens on 
the house and she explained the danger from the flies, 
and the necessity of screens. It was harvest time and 
nobody on the farm had time to make screens. The 
people were deeply in debt and said they simply could 
not afford the cost of screening the house. Several yards 
of mosquito netting had been bought, part of which had 
been used to throw over the patient. The nurse pon- 
dered over the matter, and next morning undertook the 
screening herself. She tacked pieces of the netting over 
the lower half of the windows in the sick-room, and with 
the remainder she made a curtain for the door of the 
room, tacking it at the top and on one side. She then 
instituted a “swat-the-fly” campaign in the room, and in 
a few hours had the room clear of flies without a cent of PROBLEMS IN PRIVATE NURSING 
273 
extra expense. Thousands of nurses have shown similar 
and very commendable ingenuity in keeping expense 
down, yet doing the needed things. 
Quite frequently a nurse on going to a home will find 
that the family themselves have exhibited little sense in 
regard to sickness, and that their devotion is expressed 
in very unwise ways. A young woman will often supply 
an expensive layette for the coming baby, and fail to 
supply herself with sufficient nightdresses; or some mem- 
ber of the family will invest in an expensive coat or ring 
for the child when there is real need of sheets for the 
mother’s bed. These are trying occasions to meet, but 
at least the nurse should be able while there to give such 
a family better notions of true economy. 
In many families a spirit of recklessness regarding ex- 
penditures develops owing to misguided devotion. Use- 
less and unnecessary expense is incurred, the effect of 
which will be felt long after the illness has passed. Too 
often the whole blame for this reckless extravagance is 
laid on the nurse, and the family, handicapped by pressing 
bills, resolves never to have a trained nurse in the house 
again. By tactful management, the nurse can often 
persuade a family that some proposed expense is needless. 
A short time ago the writer was told of a nurse who 
donned a clean white dress every day, sent the dresses to 
the laundry, and added her laundry bill in every case to 
her regular charges. Such nurses do more to prejudice 
the public against trained nurses than a score of sensible 
conscientious nurses can undo. What do they expect to 
gain by such conduct? Is there any way to check the 
growth of such practices? 
Suggested Subject for Written Work.—A private nurse 
made the statement that a graduate nurse is no more 
under obligation to accept a call to a case unless it hap- 
pens to suit her than is a carpenter to accept an oppor- 274 
ETHICS FOR NURSES 
tunity which is offered him to build a house unless the 
conditions were satisfactory to him. Contrast this men- 
tal attitude of the nurse with Florence Nightingale’s ideals 
of service. Tell why you do or do not agree with this 
nurse’s position in the question under consideration. 
What is the meaning of the phrase “professional obli- 
gations?” Is this nurse practising a profession or a 
trade? 
FOR DISCUSSION OR REVIEW 
Estimate the cost to a family, living on an income of 
$125 a month, of an illness from typhoid fever lasting 
six weeks. The woman assists and relieves the nurse; 
the man is the patient. A maid is secured at $5 a week. 
Include in your estimate doctor’s calls, drugs of all kinds, 
extra laundry, extra food supplies for the sick, for the maid 
and the nurse, loss of wages, trained nurse’s salary, 
board of nurse and servant, and such incidental expenses 
as you think are necessary in a middle-class home. 
A nurse carried a fruit knife, which a patient had pre- 
sented to her, with her when she went to nurse in a pri- 
vate home. Accidentally she threw the fruit knife with 
some orange peelings into the grate, and before she dis- 
covered it the knife was ruined. The patient knew 
nothing of the occurrence till a bill for $2.50 was pre- 
sented to him by the nurse for the knife which through her 
own carelessness she had destroyed. In what moral 
qualities was this nurse lacking? 
Under what circumstances is a nurse who has applied 
to doctors and through a registry for general nursing 
justified in refusing to nurse patients ill with acute con- 
tagious diseases? 
Is a nurse justified in accepting engagements for ob- 
stetrical cases with the provision that she has no other 
case when the call comes? PROBLEMS IN PRIVATE NURSING 
275 
A nurse makes an engagement for an obstetrical case 
for probably a certain week. The obstetrical case calls 
her three weeks before the expected time. She is em- 
ployed on a pneumonia case. Should she leave to keep 
her engagement with the obstetrical patient? 
A nurse in a western state was called to a case of 
typhoid fever on a farm in an isolated section. The 
family was hardworking, ignorant, and lacking in the 
first principles of cleanliness. The bed was wooden and 
infested with bed-bugs which bothered both nurse and 
patient, who slept on another wooden bed in the same 
room. The nurse told the family she would have to 
have a new bed for herself and one for the patient that 
was free from bugs. They paid no attention to her re- 
quest, so she wrote to a firm in the city ordering an iron 
bed and mattress for the patient, a cot and mattress for 
herself, rubber sheeting, several basins, ice-caps, etc., 
having the bill sent to the family. When she presented 
her bill the family paid part of it, but deducted the amount 
of the bill for the articles which she had ordered without 
their knowledge or consent. She sued for the remainder 
of her bill. The newspaper notoriety in the case affected 
her and other nurses in the region adversely. Was her 
course of action in regard to the case commendable or 
otherwise? What different methods should she have 
pursued? 
If called to nurse an obstetrical patient in a home with 
an income of $150 a month, what articles would you ask 
the prospective mother to provide for the sickness? 
Itemize the cost of the different articles and estimate the 
total cost of the sickness. 
Outline what you would consider a nurse’s duties in 
such a home where there is a child two and a half years 
of age. CHAPTER XXIV 
Ethical Problems in Private Nursing 
(Continued) 
Nurses probably more than any other class of workers 
see the inside of people’s lives and the seamy as well as 
the happy side of domestic situations. The nurse’s 
greatest difficulty arises as a rule in determining the 
exact extent of her duty in the home she has entered. 
Shall she set for herself a certain routine of duties which 
she deems to be all that the patient or family have a 
right to demand, or shall she give consideration to the 
problems of each individual household and try to do her 
best for each situation? 
The question of dignity frequently arises in the mind of 
a nurse. She is perhaps afraid if she does this, that, or 
the other thing, she will be less respected, or she has 
been told that she will be imposed on, and consequently 
serves notice on the family in a dozen indirect ways that 
“they need not think they can impose on me.” Her 
perplexity increases perhaps as she relates her experience 
in one home to some older nurse friend and the friend 
perhaps criticizes her for doing some small thing, which 
took but little time or effort, but relieved the patient’s 
mind, a thing which was simply an ordinary kindness. 
The inexperienced nurse who really wants to follow the 
Golden Rule and who really wants to fulfil her pledge 
which stated “That into whatsoever house you shall 
enter, it shall be for the good of the sick to the utmost of 
your power,” who interprets this pledge literally, really 
276 PROBLEMS IN PRIVATE NURSING 
277 
means to keep it, is often seriously disturbed because of 
the criticisms of older nurses, and wonders whether she 
has done something “unprofessional.” 
A young graduate on her first obstetrical case was 
asked by the young mother if she would wash out the 
baby’s fine woolen shirts in the bathroom, and stretch 
them carefully while drying. The mother did not want 
to send them to the laundry. The maid-of-all-work was 
a foreigner, who did not understand English very well, 
and the mother was afraid to trust her with the little 
shirts, which she expected to take care of herself when she 
was out of bed. The young nurse was not sure whether 
this duty came in her province or not, but she finally 
decided to do it, and then try to find out what the custom 
of other nurses was in regard to such matters. The 
incident assumed an importance in her mind out of all 
proportion to the matter involved, which was a simple 
act of kindness. Two nurses whom she consulted said 
she should not have done it, that she was “lowering the 
standards of the profession,” a third one thought she did 
right, said she would have done the same thing. To 
settle the disputed question, the young nurse finally 
wrote to the office of a nursing magazine for an opinion 
as to whether she did right or wrong to wash out those 
little shirts. The whole question was so unimportant 
as to seem unworthy of any earnest sincere group of 
women, who desired to be treated as professional people. 
The nurse who really desires to keep her promise to 
labor “for the good of the sick to the utmost of her 
power” will wisely settle such questions, by adopting a 
resolution the spirit of which is “ I will do such necessary 
duties as present themselves, whole-heartedly and gladly. 
I will not neglect the opportunity to perform acts of 
everyday kindness that come to me.” Considering 278 
ETHICS FOR NURSES 
incidental duties which are not strictly nursing, as “acts 
of kindness, thrown in for good measure” will help a 
nurse in the long run, more than she can possibly realize. 
It is still true that “ with what measure ye mete, it shall 
be measured to you again.” 
Another rule of thought which expresses the spirit 
which a nurse should carry into her work is this: “ There 
is nothing which needs to be done for the comfort of any 
patient which it is beneath my dignity to do.” 
When Florence Nightingale began her work, it was 
necessary to educate the public to a higher conception of 
nursing than the world had ever known. It was neces- 
sary to draw a more or less distinct line between the duties 
of a nurse and the duties of a domestic servant. Then, 
female labor was cheaply and easily secured. Most 
middle-class families who did not employ servants 
had some “unattached” relative who could help in times 
of sickness in the home. But a half century has wrought 
marked social changes. Opportunities for women to 
become wage-earners have greatly multiplied, and house- 
hold helpers in the home are less readily secured. 
Labor-saving ideas have been applied to the home. 
Flat-dwellings and apartment houses have simplified 
household duties, so that domestic servants are not 
needed or employed in the great majority of homes. 
The social status of the nurse has been established. All 
these changes should have wrought corresponding changes 
in the nurse’s outlook on her duties, but there are 
thousands of nurses who refuse to move or change with 
the times, who have very false notions of dignity, and 
very exaggerated ideas of the deference which should be 
shown to their position. The list of things which they 
will not do in homes often far exceeds the list of duties 
which they will do. One physician in speaking of a PROBLEMS IN PRIVATE NURSING 
279 
certain nurse stated that “she was too classical to see 
anything to do;” so the family dispensed quickly with 
her services. It is such nurses who complain that the 
field of nursing is overcrowded. Without doubt, parts 
of the field are overcrowded by this type of nurse, but 
for the nurse with a vision, the nurse who is willing, kind, 
industrious, and tactful, as well as skilled in technic, the 
field is ever broadening. 
Too much dignity leads to poor nursing very often, 
which the following incident will illustrate: 
A young graduate was engaged to nurse an obstetrical 
patient on the fifth floor of an apartment hotel. The 
nurse was to have her meals in the common dining room 
in the basement of the hotel, and the patient’s meals 
were to be served from the hotel kitchen. The arrange- 
ment seemed admirable. The working out was abomi- 
nable. The nurse assumed no responsibility about 
the patient’s tray, and at nearly every meal something 
was missing that caused exasperating delays. The nurse 
rang for the elevator man to carry messages to the kitchen, 
waited for him to come, told him perhaps that tea had 
been sent when it should have been coffee, or that the salt 
or butter was missing. The elevator man carried the 
message to the kitchen workers. They were busy about 
other things, and did not always respond at once. Mean- 
time the food on the patient’s tray was cooling and the 
result was that the meals were most unsatisfactory affairs, 
when a little less dignity, and a little more effort on the 
part of the nurse, would have resulted in satisfactory 
meals and a contented instead of disgruntled patient. 
The same nurse monopolized the bath room each 
morning for nearly an hour, taking a morning bath, and 
dressing her hair elaborately and leisurely, while the 
husband fumed about it to his wife, because he couldn’t 280 
ETHICS FOR NURSES 
get into the bath room to shave before going to his work. 
After the second morning that this happened, he was 
going to dismiss the nurse, and only the pleadings of his 
wife to avoid “a fuss” prevented his doing so. 
The same nurse was most unaccommodating so far as 
the maids were concerned. She was always busy bathing 
the baby or attending to the patient when the maid came 
to clean the room, and the result was that the husband 
complained at the office that their rooms were neglected. 
The family, after she was gone, announced to their doctor 
and friends that never again would they employ a nurse 
trained in Blank training school. 
Comment on this nurse’s management of the situation 
and show where her real failures were. What desirable 
qualities did she lack? Outline what you would con- 
sider a good method of managing such a situation. 
The arrangements about meals are the cause of many 
disagreements that arise between nurse and family, 
which difficulties, practically always, react to the disad- 
vantage of the nurse. A nurse is entirely justified in 
refusing to go to the kitchen for meals with the servants, 
but is she always justified in demanding that she be 
treated as a guest in the home? Many nurses seem to 
feel that the family that is employing them owes them 
exactly the same attention and deference that would be 
shown to a guest. A nurse in advising a young private 
nurse as to what to do and what to refuse to do in a home 
remarked to her, that she always took an “evening 
gown” with her to every case, and always “dressed for 
dinner.” Naturally such a nurse is discontented when 
a family occasionally desires to have a dinner without 
her, while she is in the home. This false idea of a nurse’s 
real position and mission in a home is the cause of the 
loss of many hundreds of dollars a year to nurses. Two PROBLEMS IN PRIVATE NURSING 
281 
illustrations are typical of the way in which such diffi- 
culties react adversely on the nurse herself. 
A nurse was called to nurse a patient in a wealthy 
home. The illness was of a chronic nature, with occa- 
sional periods in which the patient suffered considerably, 
and needed some special care for weeks at a time. As 
the illness progressed, the services of a nurse were needed 
practically all the time, though the duties were very light. 
The young people of the family wished to entertain 
friends at meals frequently, and asked the mother to 
arrange for the nurse to take her meals before or after the 
regular meals in the dining room. [The nurse rebelled 
against this arrangement. The family waited till the 
end of her week, dispensed with her services, and called 
an untrained or practical nurse to the case. The nurse 
lost a case that would have lasted for months, where the 
family were able and willing to keep her, and a case in 
which her work was about as light as it could possibly be. 
What did she gain? Was her position in the matter 
right or wrong? 
In another case, the patient, an elderly gentleman, had 
had a slight stroke of paralysis. The family were 
wealthy, and quite nervous about further attacks, and 
employed two nurses, so that the patient would always 
have some one within call, night and day. He was re- 
covering, and able to sit up in a chair most of the day, 
when the family had several visitors arrive at their sum- 
mer home, where the patient was. The family felt they 
would prefer not to have the nurses at the table, and 
offered to serve their meals on trays on a small table in 
a room adjoining the patient’s room, or else have the 
nurses come to a second table in the family dining room. 
The nurses objected to either arrangement. They felt 
they should come to the family table with the guests. 282 
ETHICS FOR NURSES 
The result was that the family telephoned to a near-by 
city for a male nurse who would do all that needed to be 
done for the patient night or day, and take his meals at a 
second table, and the two nurses were told that their 
services would be no longer required. 
What general principles should guide a nurse in settling 
the question of arrangements for meals? What are her 
rights in this matter? 
Domestic problems usually increase for the nurse, very 
decidedly when the woman who is head of the home be- 
comes the patient. When the woman is in general 
charge, affairs are apt to move along more evenly. A 
difficulty that sometimes arises is due to jealousy when 
the husband is the patient. Quite frequently there is 
absolutely no reason for such jealousy. At other times 
the nurse’s methods and manner are such as to arouse 
prejudice against her. She perhaps objects to the wife 
being in the room at certain times, or her manner and 
tones are a shade too familiar. A nurse was employed 
to nurse a young husband who had typhoid fever. The 
young couple were very devoted to each other, and at 
intervals during the day the wife would sit by the bedside 
holding the patient’s hand, petting him in various ways 
and calling him by endearing terms. The nurse foolishly 
allowed herself to fall into the habit of using some of the 
same endearing terms as the wife did. She called the 
man by his Christian name before she had been in the 
house a half day. When she came to take temperature 
and pulse after the wife had been holding his hand, she 
would remark “Now it is my turn to hold your hand.” 
The sick man himself was disgusted with her familiar 
way of talking, his wife became jealous, and at the end 
of the first week the nurse was sent away and another 
nurse called. PROBLEMS IN PRIVATE NURSING 
283 
Tone and Manner.—It is hard to make some nurses 
realize that their relation to men patients has no counter- 
part in ordinary life. There must be new rules of con- 
duct, and no nurse can too soon learn the importance that 
tone and manner assume in such relations. Thoughtless 
acts which may have a perfectly innocent intention back 
of them are apt to be misconstrued. Is it ever proper 
for a nurse to call an adult male patient in his home by his 
Christian name? What rules should a nurse observe in 
this respect? 
Difficulties with servants can usually be avoided if a 
nurse is careful to make requests and avoid commands, 
and if she takes pains to speak the kind words which 
do so much to keep the domestic machinery running 
smoothly. If the nurse is careful not to impose on the 
servant, or make unnecessary demands on her, is kind, 
obliging, and tactful, friction will rarely occur. 
Temperamental difficulties in families frequently occur 
which tax the nurse’s ingenuity to the utmost. For 
example: The patient is a young man and an only child. 
His mother is a widow. His disease is empyema and the 
nurse is on the case for more than two months. His mother 
is nervous and apprehensive about the patient and wants 
to be with him as much as possible. Her presence is dis- 
tinctly depressing to the patient and tends to make him 
nervous and to worry over his condition. He admits this 
to the nurse, but insists that his mother must not know 
that her presence affects him as it does. How can the 
nurse manage this situation so that the young man has 
the best possible chance for a comfortable and speedy re- 
covery, and the mother is not offended or made suspicious 
that the nurse is trying to keep her out of the sick-room ? 
Ethical difficulties in which doctors are concerned are 
of frequent occurrence, and a nurse’s chance for future 284 
ETHICS FOR NURSES 
work can often be affected disastrously, if a doctor has 
reason to suspect her disloyalty or if she appears to be 
overstepping what he considers to be her professional 
province. It is a rather one-sided loyalty frequently 
that the physician demands. He often sees no reason 
why he should be loyal to the nurse, while he is quick to 
condemn her for apparent disloyalty to him. 
Not infrequently, a nurse is torn between her desire 
to be loyal to the patient’s interests, and not disloyal to 
the doctor, who has it in his power to turn calls in her 
direction and to influence other doctors to do the same, 
or the reverse. Doctors are loath to admit that loyalty 
to the patient’s welfare is ever incompatible with the 
loyalty which a nurse has been taught she must render 
to a physician. The following quotation from an 
eminent New York physician probably states what most 
physicians believe: “Loyalty to the physician and faith- 
fulness to the patient do not form a twofold proposition, 
but a single one, for supposing that the nurse detected 
the physician in an erroneous course of treatment, she 
should so notify him at once.” Unfortunately, theory 
and practice are not always in accord, and the difficulty 
is by no means so easily disposed of as the distinguished 
physician imagines. It is, however, well that nurses 
should understand how physicians look at the matter, 
and proceed cautiously in doubtful situations. 
Does loyalty to the physician and faithfulness to the 
patient always mean one and the same thing? 
A nurse is called to care for a patient who appears to be 
suffering from some abdominal trouble. The patient is of 
a nervous type and has been operated on for abdominal 
trouble less than two years previously. The doctor 
suggests another operation. The patient protests against 
it and the doctor demands that a consultant be called. PROBLEMS IN PRIVATE NURSING 
285 
He is given permission to choose his own consultant and 
they exactly agree as to diagnosis and treatment. The 
husband of the patient is far from satisfied that an opera- 
tion is needed. The nurse is not supposed to diagnose, 
but she can hardly help forming an opinion as to whether 
the operation is as urgently needed as the doctor suggests. 
The patient and husband both look to her for some 
suggestion. What should she do? 
A nurse is called to nurse a case of septicemia following 
abortion. The patient, a young married woman, is 
very ill, and confesses to the nurse that she wished she 
had never had the abortion performed. It is evident 
that the doctor in charge of the case is the one who 
secured the abortion, though the patient does not plainly 
say so. The doctor appears to be attentive to the case, 
but thoroughly incompetent. The nurse feels that under 
different management the patient might have a chance to 
recover. What is her duty in the matter? 
A patient had been ill for several months, and had 
suffered many things of many physicians. The diagnosis 
differed with each physician. Finally she died. The 
husband had paid large bills for physician’s services and 
was determined to have a post-mortem examination 
made, to find out the real cause of death. He privately 
told the nurse that he had no faith in the physician in 
charge of the case at death, and tolerated him only 
because his wife liked him. The husband has a suspicion 
that the physician who did the post-mortem examination 
might refuse to reveal the true findings and might make 
the post-mortem findings agree with his diagnosis made 
during the illness. The husband asks the nurse to be 
present at the post-mortem and report the truth to him. 
What should she do? 
A nurse in charge of a patient with a chronic illness is 286 
ETHICS FOR NURSES 
instructed to keep the physician informed as to the 
patient’s condition. The patient grows dissatisfied with 
the physician; the nurse feeling that the change from day 
to day is very slight, does not communicate with the 
physician nor report the patient’s growing dissatisfac- 
tion with the treatment. Another physician is called. 
Wherein was the nurse at fault? 
A nurse is engaged to travel with a patient. The 
doctor tells the nurse that the patient requires no treat- 
ment but just ordinary care. At the last moment before 
starting the nurse learns that the doctor has deceived 
her, that the patient has been having and is expected to 
have long and somewhat difficult treatments every day 
which are hard to manage in hotels and while traveling. 
What should she do? 
A family engages a nurse for an obstetrical case, telling 
her the name of the physician who will be in charge of the 
case. Before the birth the family change physicians 
owing to some business reasons, and the physician who 
will have charge of the case is one whom the nurse dis- 
trusts professionally, and dislikes personally. Should 
she go on with the case? If not, what reason should she 
give the family for refusing? 
A nurse is called to a hotel to care for an elderly gentle- 
man who has been taken ill while traveling. He is 
1500 miles from his family. He does not improve. The 
doctor makes light of his illness, tells the patient he is 
going to get well, and when asked by the patient if there 
is any danger, that if there is he would like to make his 
will, is told there is absolutely no danger. The family 
expect the nurse to keep them informed of the patient’s 
condition. The doctor, apparently for no reason, insists 
that she shall tell the family that the patient is im- 
proving daily. The nurse knows he is failing steadily. PROBLEMS IN PRIVATE NURSING 
287 
She fears death cannot be very far off. What is her 
duty in the case? 
A patient is told by a friend that some one has been 
helped of a disease similar to his, by a certain medicine. 
He asks the doctor if he can be given that medicine. 
The doctor agrees, because the patient seems to greatly 
desire it. He prepares a placebo and tells the nurse she 
is to tell the patient that this is the medicine he asked 
for. The nurse objects. The doctor tells her that it is a 
case where a lie is justifiable and she must tell the 
patient that this is the medicine his friend recommended 
What should the nurse do? 
A nurse who had been accustomed to accompanying 
doctors when they visited patients in their rooms in a 
hospital, felt she must carry the same rule of procedure 
into private homes. A lady patient complained that the 
nurse watched her like a cat and never let her have a 
word in private with any one, until she finally had to ask 
her to leave the room when she wished to have a private 
conversation with the doctor who was an old family 
friend. Should a nurse always remain in a room in a 
private home while a doctor is making his visit? What 
general rules of procedure should she observe in such 
cases, with the doctor, with the family? 
A nurse is employed on a case when a doctor, who fre- 
quently calls for her services, asks her to take a case for 
him; he tells her they will wait a few days for her if neces- 
sary. The family in which she is nursing think she can 
be spared at the end of the week, and she arranges on that 
basis. Meantime the patient develops a rather serious 
complication, needs her, and the doctor in charge is un- 
willing to let her go to the other case as agreed. Should 
the nurse stay? 
A patient under treatment of one doctor calls another 288 
ETHICS FOR NURSES 
physician without suggesting to the first doctor his desire 
to change. The patient claims that he has as much 
right to go to whom he chooses and when he chooses for 
medical treatment, as he has to go to a different grocer. 
He had told the first doctor that when he wanted him 
to call again he would let him know, and he considers 
that is sufficient. What is the nurse’s duty in the 
case? 
How would you improvise substitutes for the following 
hospital appliances: bed-rest; bed-pan; douche-pan; rub- 
ber air cushion; rubber sheeting; ice-cap; hot-water 
bottle for application of heat to abdomen; croup kettle; 
measuring glass for urine; fountain syringe; dressing 
basin; screen. Estimate the cost of these hospital ap- 
pliances, if bought through a neighborhood drug store, 
or retail establishment in your own vicinity. 
A nurse is called to nurse a child critically ill with 
pneumonia. The family wish her to apply onion poul- 
tices to the feet, and to rub a certain ointment on the 
chest. The treatments will probably not do any harm. 
What should the nurse do about it? 
Is it possible for a nurse to literally obey the rule, never 
to diagnose and never to prescribe? If a child is taken 
suddenly ill in the night with a suspicious-sounding 
cough, and labored breathing, what might she suspect, 
and what should she do? What working rules may a 
nurse adopt to guide her in such situations? 
A nurse who had been caring for a seriously ill patient 
in his home was dismissed, and another nurse substituted. 
The first nurse took away with her the clinical records 
which she had kept and refused to return them, until 
threatened with a law suit. She claimed that the records 
belonged to her. The doctor claimed that they belonged 
to the patient—that the keeping of clinical records was a PROBLEMS IN PRIVATE NURSING 
289 
part of the professional service, which the nurse had been 
paid to render. Rather than allow the question of 
ownership to go to the courts, the nurse gave up the rec- 
ords. Which party was right in this matter? CHAPTER XXV 
Miscellaneous Problems in Ethics 
Among the ethical problems which arise before gradua- 
tion, disciplinary problems loom up large. However 
carefully nurses are taught, and however fine and noble 
are the human examples placed before nurses, it is im- 
possible, sometimes, to have important rules observed 
unless penalties are attached. Various forms of self- 
government in schools of nursing have been tried and the 
plan has much to commend it. One principal in a 
Canadian school has instituted a Council of Honor, or 
Court of Honor, on which representatives of the different 
classes in training have a place. A variety of ethical 
problems are referred to the pupils for consideration and 
a feeling of responsibility for maintaining the honor of 
the school is developed by the consideration of real 
problems in ethics on which their judgment is asked. 
1. A principal who had great difficulty in regard to 
punctuality at breakfast, finding that admonitions had 
little effect, instituted a roll call, and a rule that failure 
to report in the dining room promptly at the appointed 
hour, twice, would deprive the nurse of her afternoon off 
duty for the week following the second time the nurse was 
late, or tried to go on duty without breakfast. 
Was this method of discipline wise or unwise? Can 
you suggest other methods of discipline more suitable for 
dealing with this condition? 
2. A doctor became very angry with a senior pupil 
nurse, because she answered a patient’s questions as to 
290 PROBLEMS IN ETHICS 
291 
what had been done in a certain abdominal operation. 
He demanded that the pupil nurse be dismissed from the 
school within twenty-four hours or he would set in motion 
machinery to have the superintendent, who was also the 
principal of the school, removed. The superintendent’s 
position in the hospital (a fifty-bed institution) was ex- 
ceedingly difficult, owing to one-man control on the 
board, and to the fact that the one man in actual control 
invited petty gossip and complaints about the institution 
to come to his office, and every doctor knew this. The 
nurse in question was within four months of graduation. 
The superintendent decided to suspend the nurse till the 
storm which she had caused had subsided, let her return 
to finish her term, and to place her on night duty, in the 
children’s ward, and in other places where she would not 
encounter the doctor who demanded her dismissal. Dis- 
cuss this method of dealing with this situation, and of 
dealing with similar situations, in which nurses create 
trouble with the tongue. Suggest ways of impressing 
nurses with the necessity of diligent control of the little 
unruly member. 
3. A young principal of a training school, in her first 
position, believed that a training school should be 
“ruled by love” and was opposed to written or printed 
rules, regulations or by-laws of any kind for the guidance 
of head nurses and pupil nurses. Is there anything 
incompatible between “ruling by love” and having 
definite rules of guidance? Mention some difficulties 
which pupils might experience who were in their proba- 
tion period in a large school with no rules or regulations 
about anything, outside the orders which related to 
patients? 
4. A pupil nurse who was assisting in an out-patient 
department of a large hospital, by neglecting to carefully 292 
ETHICS FOR NURSES 
read the label on a bottle, accidentally caused a patient 
to be burned with carbolic acid. The disciplinary 
method used in her case was as follows: The nurse was 
suspended for two weeks from duty, was obliged to 
remain in the city and go every day to apply a dressing 
to the wound which she had caused. Discuss this 
method of discipline with regard to its probable effect on 
the nurse, the school, the patient, and the hospital. 
5. The question of rank or seniority in a certain small 
school had for many years been decided by the day or 
hour at which pupils arrived. A serious situation de- 
veloped because for some misdemeanor a nurse, who had 
been the senior in rank in her class, was deprived of her 
rank and placed at the foot, and a nurse whom she dis- 
liked was promoted to first place. These two nurses 
who were fiercely jealous of each other, were in charge 
of a seriously ill patient. They refused to cooperate on 
the case or even to speak to each other. The patient 
died. The principal impressed with the seriousness of 
the situation which developed, decided in future to 
determine seniority or rank in a class by the record 
made in theoretical and practical work during probation, 
and to let the record the nurse made each year in ob- 
servance of rules, care of room, general deportment, and 
theoretical and practical work, fix her rank in the class 
and school. Which method of determining rank seems 
best, and why? 
6. A pupil nurse in her senior year in a hospital was 
placed on operating-room duty. She hated operating- 
room work, she said, and could see no reason why she 
should ever have to do it. In what way would her atti- 
tude toward the operating-room work be likely to affect 
the quality of her work? What should the principal do 
in such a case? It is necessary or desirable for every PROBLEMS IN ETHICS 
293 
nurse to spend a fixed term of training in the operating 
room? Give reasons for or against. 
7. A nurse who had just completed a post-graduate 
course was employed to take the place of a supervisor 
of nurses who was given a two months’ vacation. The 
school was connected with a special hospital of over 100 
beds, and having affiliation for medical nursing ex- 
perience with a large hospital. The nurse, who was 
supplying for the supervisor, had a prejudice against all 
training schools connected with special hospitals, and 
told the pupil nurses how strongly she felt on the subject. 
She established confidential relations with several of the 
pupils, and in confidence told them they were wasting 
their time in such a school and she would advise them to 
leave and seek admission into a certain hospital where 
she claimed to have influence with the superintendent. 
She even went so far, while she was employed by the 
special hospital, as to write out recommendations for 
the three nurses in whom she was particularly interested, 
for them to send with their applications, promising to 
write recommendations for other pupil nurses if these 
three applications wTere accepted. Comment on this 
incident stating why you approve or disapprove of this 
head nurse’s conduct. 
8. Should a pupil nurse who is habitually untidy about 
her room and lax in regard to neatness in her general 
work be allowed to graduate? How can such habits 
be corrected? How can a principal be sure that, even if 
temporary improvement is made, such a nurse will not 
bring discredit on the school by her untidiness in private 
homes? 
9. A graduate nurse is engaged by a doctor for special 
duty with an obstetrical patient in a hospital. She 
seems devoted to the mother and baby and the general 294 
ETHICS FOR NURSES 
nursing care is good, but in the two weeks she was on 
duty in the hospital, the room was never tidy. The 
baby’s things were scattered on radiators, chairs, window 
sills, dresser and every other available spot on which 
things could conveniently be dropped. Before leaving, 
this nurse asks the principal to give her other calls for 
special duty? What should the principal do? How 
will the example of this graduate affect the pupils in 
training? 
10. A nurse who has an unusual memory is able to 
pass written examinations taking a full 100 per cent, in 
many, and a high grade in all. Her practical work is 
very inferior. She seems to lack judgment and tact 
and is not always truthful. What should the principal 
do in regard to this case? What points should be 
considered? Which is more important, the theoretical 
knowledge a nurse possesses, or the way she does her 
work? Give reasons for your answer. 
11. A principal of a large training school, writing on 
ideals for nurses, expresses herself as follows: “It does 
not seem to me that the probationer who tucks her 
napkin in her collar will make the kind of nurse we want 
to send out into the world, nor does it seem to me that 
it is my function to instruct her in the matter.” Is the 
fact that a probationer “tucks her napkin in her collar” 
a sufficient reason for rejecting her, if she is acceptable 
otherwise? If she is accepted as a nurse, whose business 
is it to call attention to such breaches of etiquette? 
12. A nurse through carelessness caused a patient to 
be burned with a hot-water bottle. In order to impress 
her with the seriousness of her failure the principal took 
away her cap for a month. She rebelled against this 
treatment and left the school. A little later she meekly 
applied to be reinstated. What should the principal do? PROBLEMS IN ETHICS 
295 
ETHICS AND VISITING NURSING 
13. A visiting nurse making a call at a home is asked 
by the keeper of a rooming house next door to see a young 
man who has a room there and who is ill. The landlady 
of the rooming house has called a neighborhood doctor to 
see the lad. This doctor diagnoses the case at once as 
appendicitis, and states that an operation within twenty- 
four hours is imperative. The young man is told that 
the operation will cost $200 and his hospital bill about 
$50. The young man has not the money and is a com- 
parative stranger in the city. He explains his circum- 
stances and symptoms fully to the visiting nurse. She 
doubts the necessity for an immediate operation and sug- 
gests that another doctor be called before an operation 
is decided on. The second doctor diagnoses the disease 
as quinsy, treats it accordingly, and the patient recovers 
without the $250 operation. Did the nurse do right? 
Is this a case where the nurse’s loyalty to the doctor and 
loyalty to the patient’s interests conflict? 
14. A doctor calls a certain office asking for a visiting 
nurse to be sent to a patient suffering from gastric ulcer. 
He wishes the visiting nurse to administer a nutrient 
enema at stated intervals, to be preceded by a soap and 
water injection. After a few visits the nurse sends the 
following written report to the doctor: 
“Dear Dr. X:—I have attended this afternoon Miss 
Y. She appears more bloodless than ever; her respiration 
resembles that of bad dropsy. The nutrient enema given 
this morning was rejected after three hours without ap- 
pearance of slightest change, color, etc. Rectal tube 
used ten inches. No resistance to injection. I think there 
is a block of fseces in intestine high. Before it is too late 
will you let me make a suggestion? That she have on 296 
ETIIICS FOR NURSES 
abdomen for three hours, occasionally, hot linseed with a 
little turpentine, and after two days take one ounce castor 
oil every third day, for twelve doses. She has painful 
spasm and hemorrhoids after soap injection. Is not her 
anaemia the outcome of constipation, doctor? She says 
for three years she has not used cathartic medicine. 
Please bear with me if I tell you that in the past I have by 
cathartics perforated an ulcer rather than allow death by 
stoppage, since healing can be found for moving ulcers. 
I think Miss Y. desires to see you in the morning. Will 
you tell her your wishes regarding poultice? I hope to 
visit in the afternoon.” 
Signed, Mary—Visiting Nurse. 
Comment on this report, stating your reason for dis- 
approving of it in any particular. What desirable quali- 
ties did the writer of this note appear to show or lack? 
Should the nurse herself or the training school be held 
responsible for such faults as you detect in this nurse, 
judging from the above report? 
15. A visiting nurse is assigned to visit patients who 
are insured by a certain insurance company. She re- 
sponds to a call sent by the insurance office. The doctor 
is with the patient when she arrives. He tells her she is 
not needed. She states that she is required to visit all 
patients, on instruction from the insurance company. 
The doctor says he cares nothing about insurance com- 
panies or their rules, and states that he will not have 
a trained nurse interfering with any of his cases. The 
nurse tries to reason with him; he gets angry and states 
that if she insists on interfering with his patients he will 
resign from the case. The patient seems to be very ill. 
What should the nurse do? 
16. A visiting nurse is called to an old lady patient by PROBLEMS IN ETHICS 
297 
a neighbor. She finds that the old man and woman live 
alone; both are ill in bed with influenza, the old lady- 
having some kidney complication besides. Both are over 
eighty years of age and are living on a little pension which 
barely suffices for their daily needs. The nurse takes 
the temperatures of both patients, gives the old lady a 
bath, and does not return. The old couple are entirely 
dependent in their illness on such attention as a kind 
neighbor with a baby and family of small children can 
give them. Did the nurse do her full duty in this case? 
If not, outline what you think her method of procedure 
should have been, if she wished to do her best for the 
welfare of the old couple. 
17. Does this clause in a nurse’s pledge apply to visit- 
ing nurses: “ That whatsoever you shall see or hear of the 
lives of men and women, whether they be your patients 
or members of their households, you will keep unviolably 
secret, whether you are in other households or among 
your own friends?” Is it possible for visiting nurses to 
keep this pledge? To what extent is it permissible for 
visiting nurses to discuss the domestic affairs of their 
patients? What restrictions should be observed in dis- 
cussing cases with members of the board of managers, 
some of whom may be women or men who are not averse 
to gossip? Have the poor the same rights to have the 
privacy of their homes respected as the middle class or 
rich? Give reasons for your answer. 
18. A visiting nurse is engaged by a family to assist 
at a birth and to visit the patient afterward. The 
doctor’s manner when she arrives shows very plainly that 
he does not wish the nurse to assist him in any way. 
She offers to prepare a disinfectant solution for his hands, 
asks whether he wishes anything sterilized, etc. He 
gruffly declines all such suggestions and does not even 298 
ETHICS FOR NURSES 
wash his hands before making an examination to de- 
termine progress of labor. What should the nurse do in 
such a case during the labor? If a septic condition fol- 
lows the birth in such a case, and the nurse knows the 
doctor is careless or incompetent, what are her duties in 
the matter? 
19. A visiting nurse is employed by a committee of 
ladies for service in a town of 3500. Two graduate 
nurses whose homes are in or near the town are practis- 
ing there and are busy, a considerable part of their work 
being maternity nursing. The committee of ladies have 
raised by means of various social affairs about $600 
before the visiting nurse arrives. They are to pay her 
$100 a month, but she is supposed to earn most of it. 
The committee announces through the press that they 
are providing a nurse for the poor. They announce to 
the visiting nurse that they expect her to secure as much 
work as she possibly can from people who are able to 
pay, and that the continuance of her service there 
depends on how much she herself can earn toward her 
own salary. Through their clubs and churches and 
friends the committee advertises the benefits of their 
visiting nurse, and prospective mothers are urged to 
secure her for service at birth and for as many hours 
daily therafter as they need. The visiting work, through 
the advertising given and the activity of the committee, 
enjoys a “boom;” the work of the two private nurses 
dwindles. They go to the visiting nurse and complain 
that she is cutting rates, spending whole days at cases, 
and taking away their work. She explains that she has 
to do this work in order to keep her position, and that the 
committee fixes the rates. What should the visiting 
nurse do and what should the private nurses do under 
such circumstances? PROBLEMS IN ETHICS 
299 
ETHICS AND PRIVATE NURSING 
20. A nurse is called to nurse an only child, a boy of 
eighteen, who has typhoid fever. An uncle of the boy is 
the doctor. The boy hates his uncle, who seems rather 
tactless and incompetent, but the boy’s parents insist on 
having his uncle treat him, and seem to trust him 
implicitly. The boy has a highly nervous temperament. 
He confides to the nurse his hatred of his uncle and his 
distrust of his professional ability. The case is very long 
and tedious. The temperature refuses to remain normal, 
and the doctor insists that nothing but fluids shall be 
given till the temperature is normal ten days. The 
doctor will not listen to any suggestion from the nurse. 
The boy chafes against being starved, grows more 
and more depressed and melancholy, and frequently 
declares his intention of committing suicide. The nurse, 
believing that more liberal feeding would help to relax 
the tension and relieve the intense mental depression, 
resolves to make false entries of temperature on the chart, 
to lead the doctor to believe the temperature was normal 
when it was not, in the hope that he would allow the boy 
to have more food. The nurse’s plans succeed. The boy 
improves quickly and markedly. The doctor and every- 
one is pleased, but the nurse suffers horribly from remorse 
because of her deception in the case. What should the 
nurse have done under such circumstances? 
21. A private duty nurse thinks she should be called 
to any case needing a special nurse in the hospital from 
which she graduated if her name appears at the top of 
the list on call in the school registry. The principal of 
the school refuses to take nurses in rotation from the 
registry, and reserves the right to choose nurses according 
to her ideas as to temperamental or other fitness for such 300 
ETHICS FOR NURSES 
cases. The private nurse secures several signatures from 
graduates of the same school to a protest against what 
is termed “unfair discrimination” in calling nurses for 
special duty, and sends the protest to the principal and 
to the training-school committee. The committee re- 
fuses to take action in the matter. The principal still 
asserts her right to choice of nurses and states that any 
nurse who has conducted herself while on special duty so 
as to give satisfaction, who has shown her loyalty to the 
hospital and set an example to pupil nurses as to what a 
graduate nurse’s conduct should be, need not fear but that 
she will get her fair share of calls for special nursing. 
Which party is right in this situation? 
22. A nurse is asked to accompany a nervous patient 
on a visit to her sister in a neighboring city. The 
patient likes to dine at hotels and restaurants, expects 
the nurse to accompany her, but does not offer to pay 
for the expense, and evidently expects the nurse to pay 
for her own dinners. What should the nurse do? 
23. A nurse is called to care for two elderly ladies who 
are ill with bronchitis. The maid, the only other 
member of the household, develops grippe and goes to 
her sister’s. Outline the nurse’s duties under such 
circumstances. 
24. A graduate learns that a member of her alumna 
association is in the habit of charging $5.00 for ordinary 
care to a body after death, in addition to the regular 
rate by the day or week. The nurse who makes the 
extra charge maintains that she is entitled to a special 
fee for services rendered to the body after death. The 
other nurse disagrees. What is her duty in regard to 
the discovery that the demanding of a special fee for 
services after death is being practised by a graduate of 
her own school? PROBLEMS IN ETHICS 
301 
25. A nurse is called to a case of ptomaine poisoning 
in a young man in the country some eight miles from the 
city where the nurse is located. The nurse goes in the 
morning. The patient dies about four in the afternoon. 
The nurse returns to the city that evening and charges 
the family $8.00 for the eight hours in which she was 
there and $5.00 for going to the country. Comment on 
this nurse’s action and attitude toward human needs, 
and tell how such incidents are liable to affect the gen- 
eral reputation of trained nurses and the demand for 
their services? 
26. A doctor asks a nurse who has just returned from 
a case of scarlet fever to assist him at an operation the 
following morning. He insists that there is no dan- 
ger. The nurse fears she might carry infection. What 
should she do when the doctor says he will assume all 
responsibility? 
27. A nurse is caring for her sister, a maternity pa- 
tient, on a Dakota farm. A young man is very ill on 
a ranch about five miles distant. The nearest doctor is 
twelve miles away. The young man is unable to void 
urine, and the request is made for the nurse to catheterize 
him. What should the nurse do? What general rules 
should a nurse observe in regard to the catheterization 
of male patients? 
28. A nurse is called to care for an alcoholic male 
patient in a hotel in a small town. The patient is vomit- 
ing incessantly, and the heart is in exceedingly bad con- 
dition. Should a nurse respond to such calls? If so, 
what general rules of conduct should she be careful to 
observe while in the hotel? Mention some general 
rules which nurses should commonly observe when 
nursing in hotels, whether the patient be male or female. 
29. A nurse is asked to dress in uniform and assist in 302 
ETHICS FOR NURSES 
collecting money for the support of nurses in a tag-day 
affair on a public street. Several young women who 
are not nurses are also to dress in nurse uniforms and 
have charge of collection boxes in public places. What 
attitude should a nurse take toward such a proposition? 
30. Mention some good reasons why nurses should 
restrict the wearing of their uniform to the sick-room 
and its immediate vicinity. Is it desirable for nurses in 
uniform to visit drug stores and ice-cream parlors in the 
vicinity of the hospital and remain there with other 
patrons while they partake of ice cream and other re- 
freshments? Give reasons for or against wearing the 
uniform in such places. 
31. A nurse on an obstetrical case in a wealthy private 
home finds that the husband is very indifferent to wife 
and baby. The wife worries a good deal over his neglect. 
He is very profuse in his attentions to the nurse, insists 
on her always dining with him and prolongs the meal 
hours as long as possible. The nurse knows how the wife 
feels about matters and is perplexed to know how to 
manage the situation. What suggestions can you offer 
her? 
32. A graduate nurse has been for several weeks in a 
suburban town nursing two children. When the children 
are convalescent the mother decides to go to the neigh- 
boring city to spend the day with a friend and attend a 
meeting or social affair in the evening. She leaves the 
nurse in entire charge of the home. As soon as the 
mother has gone, the nurse telephones to the city and 
invites two friends to spend the day with her. She bribes 
the little girl not to tell her mother. Comment on this 
nurse’s actions in this case. Would they tend to increase 
the confidence and respect accorded to trained nurses in 
that town? PROBLEMS IN ETHICS 
303 
33. A young graduate, on special duty in a hospital 
in a small city, is invited by the husband of her patient 
to go for an automobile ride, and to bring with her a 
certain pupil nurse who had relieved the special nurse 
and of whom the patient was fond. The ride is arranged. 
The patient’s husband has a married man, a friend of his, 
in the car when they start for the drive. A long drive is 
taken in the country, and on their return the car is halted 
at a roadside hotel and the party of four go inside for re- 
freshments. The hour is late. Several other “joy-riders” 
are in the place drinking, and drinks are ordered for the 
nurses by the men. They have never been in such a place 
before, and as they do not know exactly what to do or how 
to get away they accept the drinks. A friend of the presi- 
dent of the hospital board happens into the road house, 
recognizes the nurses drinking with the two married men, 
and reports the matter to the president of the board. 
The president blames the principal of the school for 
laxity of discipline in allowing her nurses to go about 
late at night with married men of loose character. The 
principal is so heartbroken over the scandal that she 
resigns her position. Who was to blame throughout this 
incident? Should the nurses have gone for the ride? 
Having done so, how could they have prevented the un- 
pleasant consequences? What restrictions should be ob- 
served in accepting invitations of this sort? 
34. A lady happened into a hospital which kept a 
registry for its graduates, asking for a nurse immediately 
for a seriously ill patient. There were no nurses available 
at this registry. The lady used the hospital telephone 
to call another registry which promised to send a nurse 
at once. The nurse failed to appear in two and a half 
hours, and an exasperated member of the family secured 304 
ETHICS FOR NURSES 
a nurse from still another registry. The nurse secured 
had been on the case about an hour when the nurse who 
had first promised to come came driving up in a taxicab, 
at noon, and was told that she was not needed. She was 
very indignant and sent the bill for the taxicab, which 
amounted to $1.95, to the family. They refused to pay it. 
She then wrote a most indignant letter to the superin- 
tendent of the hospital from which the first telephone 
call had been sent, demanding that the hospital pay the 
bill for the taxicab. 
Write comments on this situation telling who was at 
fault, whether the nurse should have called the taxicab 
in daylight without asking the family about it, and who 
should have paid the bill in this case. 
35. A nurse is called to a case of typhoid fever, when 
the patient becomes delirious and a second nurse is 
needed. When convalescence begins, the family wish to 
retain the second nurse called because the patient pre- 
fers her. What should the first nurse and the second 
nurse do under such circumstances? 
36. In a certain case, similar to the above, the family 
settled the above question by retaining the first nurse, 
though they much preferred the second. The day after 
the second nurse left the case, the nurse who remained 
in charge of the case received a call to another typhoid 
fever case which was just developing and would probably 
last six weeks, while the case she was with would be con- 
cluded in a week. She suddenly tells the family that 
she must leave at once and does so, leaving behind her a 
bundle of soiled clothing which she tells the family they 
are responsible for having laundered and for sending to 
her. Comment on the nurse’s actions in this case, show- 
ing where her ethical lack was and how such conduct 
affects the reputation of other graduates. PROBLEMS IN ETHICS 
305 
37. A patient, an elderly man, dies. The body is to 
be shipped out of the city for burial. The only daughter 
of the deceased is to accompany the body, leaving the 
widow, an elderly woman, alone. The daughter asks the 
nurse to stay with her mother till she returns from 
the funeral. There is nothing for the nurse to do but 
ordinary household duties and to serve as companion 
for the old lady. Should the nurse stay? 
38. A nurse is called to a case on which there is 
another nurse who is careless and does very poor work, 
is exceedingly disagreeable, and will accept no suggestion 
as to change in methods. The family are not exactly 
satisfied with the first nurse, but say nothing to her 
about her work and evidently intend to tolerate her where 
they cannot admire, respect, or love her. The whole 
situation is exceedingly distasteful to the second nurse 
in her dealings with the first nurse. The patient is very 
seriously ill. What should the second nurse do? 
39. A well-to-do family (not rich) living in an apart- 
ment house had occasion to call a nurse for the mother 
of the lady of the house, an old lady in the eighties, who 
was slowly dying of some form of cancer—no external 
wounds. The man of the house was obliged to take busi- 
ness trips out of the city which often kept him away for 
weeks. He thought a trained nurse would be a pleasant 
companion for his wife. The nursing duties were light, 
but he did not care to have his wife left alone. No maid 
was kept. The nurse came, a stern, unbending creature 
who literally took possession of the sick-room and, from 
the moment she entered, gave the lady of the house 
to understand that she would tolerate no trespassing on 
her domain. Neither did she intend to offer to do 
anything outside the actual care of the patient. There 
was no rise of temperature in the patient, yet she religi- 306 
ETHICS FOR NURSES 
ously took the temperature three times a day, kept 
detailed charts and, so far as technical work was con- 
cerned, she apparently left nothing undone and did 
much that was unnecessary. 
The situation was painfully tense. The old lady 
grieved at the thought that her daughter, who knew how 
she liked things done, could do nothing for her, that she 
was not allowed to have her with her as she had been 
accustomed to. The daughter prepared more elaborate 
meals for herself and the nurse than she would have done 
when she was alone, washed the dishes and waited on the 
nurse instead of on her mother. The nurse rocked 
hours each day in a rocking chair, reading or doing 
embroidery, but not once did she suggest to the lady of 
the house that she stay an hour or two with the patient 
while she washed dishes or prepared a meal. 
At the end of two weeks the husband returned, and 
finding that his wife was working harder than before 
the nurse came and the mother missed her daughter so 
sorely, dispensed with the nurse’s services. A few days 
later they secured an untrained woman who fitted into 
the household as if she belonged there, assisted the 
daughter with the nursing and with any other duty that 
had to be done, and remained with the family till the 
patient died. 
What were the chief reasons for the failure of the 
trained nurse in this case? 
40. A nurse is called to an obstetrical patient on the 
second day after the birth of the child. The baby’s eyes 
are infected. The patient, privately to the nurse, blames 
the doctor, whom she declares was in a great hurry and 
did not take proper care of her and the child at delivery. 
The doctor privately tells the nurse that the husband 
is to blame, that he had previously had gonorrhea and PROBLEMS IN ETHICS 
307 
thought himself cured. What should the nurse do 
when questioned by the patient as to how the infection 
occurred, and when the patient is telling all her friends 
that the doctor’s neglect is the cause of the trouble? 
41. A nurse has made an engagement to nurse a 
maternity patient due, probably, the first week in 
October, the engagement to last two weeks. The last 
week in September the nurse received a call to nurse a 
case of typhoid fever that will probably last from four to 
six weeks. The doctor who is to have charge of the 
obstetrical case is a stranger to her. The doctor who 
calls her for the fever case is one who frequently employs 
her. Is she justified in giving up the shorter case and 
taking the longer? What are the gains and losses to be 
weighed in coming to a decision? 
42. A nurse is called to care for a little girl five years 
old in her home. The child has not been trained to obey. 
She objects to taking food. The doctor is most anxious 
to have the child gain in weight, and leaves a tonic to 
increase appetite. The child kicks and rebels against 
every dose of medicine. The mother does not interfere 
either to hinder or help. How should the nurse manage 
to get the medicine taken? What can she do to overcome 
the difficulties in regard to getting the child to take more 
food? 
43. A nurse is employed for two months in a home 
in which a child has scarlet fever. The patient is 
practically convalescent after three weeks, but because 
there are five other children in the home the family feel 
they must somehow contrive to keep the nurse till the 
doctor pronounces all danger to the other children past. 
The man earns $200 a month and pays the nurse half 
of it, besides her board and laundry. No maid is kept. 
What are the nurse’s duties under such circumstances? 308 
ETHICS FOR NURSES 
44. What can a nurse do to make a protracted con- 
valescence less tedious for a boy of five; a boy of ten, and 
a boy of fifteen years of age; also for girls of the same 
age? 
45. To what extent is it wise for a nurse to discuss 
politics or religion with her patients? 
46. A nurse is called to a patient who is suffering from 
a nervous collapse, following weeks of social dissipation 
in which dances, drinking, midnight suppers and late 
hours had been indulged in. The patient finally was 
unable to continue the strain longer and went to bed, 
ill and full of remorse over her dissipation. She feels 
that she can never be forgiven for some things which she 
did, and the question of forgiveness preys on her mind. 
She wants to talk with a minister. The family tell tne 
nurse that she must guard against the patient “getting 
excited over religion” and that the subject of religion 
must not be mentioned. The doctor does not seem to 
understand how the patient’s mental condition is 
hindering her recovery. The family so firmly believe 
that a minister would do the patient harm that they 
would not consider having one called. How should the 
nurse manage such a situation? 
47. A doctor (married) who frequently employs a 
nurse for private duty is inclined to be familiar in his 
manner. He visits the patient, presumably, but spends 
twice as much time with the nurse as with the patient. 
The nurse is afraid the patients will think she is to 
blame for the doctor spending most of the time spent in 
the call with her. She does not wish to offend the doctor 
because he sends her many calls, but she is determined 
that her name shall not be connected with this doctor’s 
as a topic for neighborhood gossip. How shall she 
manage this problem? 309 
PROBLEMS IN ETHICS 
48. A nurse is nursing an old lady in a home and is 
asked to prescribe for a child who is taken ill in the night, 
presumably with diarrhea. The family owe the doctor 
and do not wish to add to his bill till they can pay part 
of it. What should the nurse do? 
49. A graduate nurse, on special duty in a hospital 
with a very seriously ill patient, is relieved several hours 
every day by a pupil nurse. The pupil nurse discovers 
that the graduate is falsifying her records, is recording 
duties done before they are done, nutrient enemata given 
that have not been given, etc., and that her method is to 
write up the records once or twice a day just previous 
to the time the doctor makes his visits. The pupil nurse 
reports this condition to the head nurse in charge of the 
department. What is the duty of the head nurse and of 
the institution in regard to this matter? 
50. A graduate nurse in a smaller city has a friend 
who is a druggist. He suggests to her that she might 
throw favors in his direction, that there are ways of in- 
creasing drug orders, and that she might use her influence 
with other nurses to patronize him. The nurse knows 
that he frequently substitutes inferior drugs for those 
ordered. He frequently sends her bottles of perfume, 
cold cream, etc. Should the nurse accept such articles? 
What should her attitude be regarding the friend’s 
suggestions? CHAPTER XXVI 
Cooperation for Wider Service 
During her final year of training a nurse will probably 
hear more or less about the duties which she owes to her 
alumna association and to other associations of nurses. 
It is hard to define such duties or to generalize about 
them, because the situations of nurses differ so greatly 
and nurses so often have to choose between apparently 
conflicting claims of duty on their time. The joining 
of an alumna association should be regarded in the light 
of a privilege. An active alumna association has much 
to offer the young graduate. Among its advantages 
may be mentioned the following: 
It fosters the spirit of comradeship and good-will. 
It promotes the work-together spirit, the spirit of 
cooperation for the good of all graduates of the school. 
It furnishes a means by which a nurse may keep in 
touch with the developments and progress of her own 
school. 
It should tend to foster a spirit of loyalty to the school 
and devotion to its best interests. 
It gives a sense of strength and courage to a nurse who 
might otherwise feel herself to be an isolated unit, whose 
failures or successes as a nurse were of no special interest 
to anyone. 
It furnishes an opportunity through which a nurse may 
assist her comrades as she could not assist as an isolated 
individual. 
It frequently affords opportunities for a nurse to par- 
ticipate in programs and listen to lectures on newer 
310 COOPERATION FOR SERVICE 
311 
methods or movements, thus stimulating in a nurse the 
desire to keep abreast with the times and to continue 
her studies. 
It offers the natural opportunity for social activities, 
which most nurses need. 
It enables a nurse to make her influence count where 
movements for social betterment are concerned. 
Other advantages might be cited, but these indicate 
the possibilities of a well-managed alumna association. 
That all these advantages are not found in every alumna 
association is true. The association is just what the 
graduates make it. Not infrequently the older members 
are inclined to form in groups by themselves, and the 
same may be true of younger members. Where such 
conditions develop, the good influences which the associa- 
tion might exert are greatly lessened and its usefulness 
crippled. 
In many smaller cities the county association of nurses 
serves many of the purposes of an alumna association, 
and affords a natural means of communication with 
nurses of various schools. 
The objects of an association are always important. 
Many of these objects are planned chiefly with the idea of 
mutual benefit and improvement in mind. This idea 
to a certain extent should be present, but when an asso- 
ciation exists solely for the benefit of itself and its mem- 
bers, its field of usefulness is limited and its influence 
comparatively slight. Too radical effort on the part of 
one set of nurses to improve another set may easily 
defeat its object, and material benefits are often hard to 
show. Where, however, an association demonstrates 
that it is working not solely for the benefit of its mem- 
bers, but for the utmost service it can render to humanity, 312 
ETHICS FOR NURSES 
it furnishes a stronger appeal to individual members than 
any mutual benefit plan can supply. 
“To promote, by cooperation, the effectiveness of the 
nursing profession and through it the good of the com- 
munity” is the object of an association of English nurses 
that has rendered conspicuous service in a variety of 
ways. This tersely stated object is well worthy of con- 
sideration. It embodies much. 
One or two illustrations out of hundreds that might be 
mentioned are cited to show how far-reaching are the 
benefits that a local association of nurses may render. 
In a certain small city of about 40,000 a local association, 
because of the vision of one of its members, became con- 
vinced that a dispensary was needed to which poorer 
patients could come for free examination and treatment. 
Their first appeal was to the doctors of the community. 
The appeal was backed up by numerous descriptions of 
patients, of whom the nurses knew, who should be helped 
by dispensary treatment. The doctors agreed to coop- 
erate and to contribute their services. Next they ap- 
pealed to the hospital for a room and for other assistance. 
The hospital could not immediately offer accommoda- 
tions for the dispensary, but promised to when the opening 
of its new nurse’s home would make it possible. It of- 
fered to assist by sending one or two senior nurses during 
dispensary hours, and in other ways as might be neces- 
sary. Nothing daunted, the nurses set about to find a 
room which could be rented. The room was found in 
the basement of a store. They raised, by subscription 
among themselves, the doctors and interested citizens, 
a couple of hundred dollars for a modest equipment. 
Finally they hunted up many of the patients and brought 
them personally to the dispensary. The hospital has 
since taken over the dispensary, and its value to the com- COOPERATION FOR SERVICE 
313 
munity has been unquestioned. One of its indirect 
results was to increase profoundly the respect and ad- 
miration for trained nurses in that community. The 
object of working for the good of the community does 
much to maintain that wholesome interest that is essen- 
tial for the highest success. 
In another smaller city, the county association of 
nurses subscribed and collected funds to put a visiting 
nurse at work for the summer months. The need was so 
thoroughly demonstrated that an organization of citizens 
was easily effected to continue the work. 
Ye Have Need of Patience.—It is a common failing of 
nurses as of many other workers, that they clamor for 
immediate benefits or results from some organization 
with which they have allied themselves. If these 
benefits are not speedily forthcoming they lose interest. 
Many of the results which accrue from such organizations 
are indirect, and a nurse very often benefits in proportion 
to the amount of herself that she puts into it. The 
enriching of one’s own life, the finding of a channel 
through which our best desires may find expression, is a 
benefit to every nurse who honestly wants to make the 
world a better place to live in. 
“Learn to labor and to wait” is an admonition fre- 
quently needed in this age when the tendency in many 
places is to expect to reap a harvest before a seed has had 
time to germinate and really take root. 
The spirit of intolerance with those whose opinions 
differ from ours is frequently seen in nurses’ associations, 
and it is a spirit which every nurse who really desires the 
best things for an association should try to suppress. 
There are truths in the following quotation from a popu- 
lar weekly paper which are worthy of earnest considera- 
tion, lest we become “self-opinionated,” censorious, and 314 
ETHICS FOR NURSES 
uncharitable in our judgments of the motives of other 
workers who have every right to an opinion of their 
own. 
“We are sometimes tempted into thinking that this 
would be a very much better and happier world if other 
folks would only agree with us and see things as we do. 
But really the chances are that this tremendously radical 
change in affairs would be no improvement. This 
conflict of judgment and clash of opinions is not the bad 
thing that we sometimes take it to be. It is a way—yes, 
even a divine way, of progress. The radical who stirs 
up our inert conservatism may not be altogether agree- 
able to us, but we may need him just the same, and the 
man who opposes some of our pet plans and policies 
may be our good, though much disguised, friend. To 
agree to differ is sometimes much better than to agree. 
Conflicts of judgment will never cease, but contempt of 
other folks’ judgment ought to. ‘You are entitled to a 
point of view/ said a lecturer, ‘but not to announce it 
as the center of the universe.’ ” 
The peril of narrowness has been mentioned before. 
It is one which threatens every nurse and is one which 
membership in a nurses’ association should help to combat. 
It should help to give her a view of national movements, 
and an opportunity to cooperate in many of the broader 
programs and efforts for human betterment. There 
is, however, a real danger of a nurse joining so many 
nursing associations that she does not count for much in 
any of them. Her energies are so dissipated, spread 
out so thinly, that she fails to accomplish anything of 
real value in any of them. There is also the danger of 
becoming so engrossed in nursing affairs that one has 
neither time nor energy left to give to any other good 
movements. Nurses who commit the blunder of ming- COOPERATION FOR SERVICE 
315 
ling with nurses and of thinking of nursing exclusively 
or to the neglect of other friends or causes, cannot fail to 
grow narrow in their views, and this is reflected in their 
conversation. They “talk shop” constantly because 
they know of little else besides nursing to talk about. 
If for no other reason than for her salvation from petty 
prejudices, selfishness and narrowness, every nurse 
needs to connect herself with some cause, some interest 
that is not connected with nursing. To the man or 
woman who has allowed himself (or herself) to become 
engrossed with one interest, or has allowed one cause to 
loom up and fill the whole horizon, there is a constant 
temptation to go to harmful extremes, and to regard 
those who have more varied interests in life, and a 
different viewpoint, as enemies to the cause they have at 
heart. 
A variety of interests in life helps one greatly to form 
a just estimate of relations and proportions and values, 
and very often shows that the thing we have been urged 
to throw our whole energies into has not in itself the 
possibilities of enough returns in good to ourselves, our 
associates or the commonwealth, to justify spending 
much time or effort on it. 
Beyond all this there is found in the person who has 
read widely and is well informed on a variety of lines of 
activity, the person who is “broad” in his viewpoint of 
life as a whole, a geniality, generosity, a freedom from 
petty prejudice and suspicion, that gives to him a genu- 
ine charm of character, much to be coveted. In this 
breadth of interest there is also a veritable bulwark 
against loving one’s own way too well, and the tempta- 
tion to go to extremes on any question. 
There are, perhaps, no reminders which nurses as a 
body need more frequently than that they should try to 316 
ETHICS FOR NURSES 
see both sides of a question before coming to conclusions; 
that they should avoid rushing to extremes; that they 
should study to keep always an open mind, and avoid 
letting petty prejudices possess them. 
If one is to successfully accomplish this, one must have 
one or more interests outside of the nursing world and 
cultivate acquaintance with “many men of many 
minds.” 
No nurse is doing justice to herself who does not ally 
herself with some other great movement, social or reli- 
gious, to help her to keep a proper balance in her life, to 
help her to see nursing in its true proportions and in its 
true relation to other great uplift movements. 
Conferences and meetings with social service and 
charity workers are always broadening and educative. 
There are many points at which the work of the nurse 
and other social service workers touch, and it is important 
that a nurse be able to appreciate the work and the 
viewpoint of social workers who are making large con- 
tributions to state and community betterment. 
Women’s clubs in many cities are doing a work that 
is far-reaching and valuable. They are influencing 
public sentiment and legislation in a variety of ways. 
An active club devoted to earnest work is a good thing 
for any nurse to belong to, who has time to give to it. 
The women in such clubs represent to a large degree 
the great field which private nurses serve, and it is well 
worth while to get their viewpoint regarding nursing 
problems. Incidentally the nurse who is a member of 
such a club has frequent opportunities to give the “lay 
members” her viewpoint and to secure their cooperation 
in improving conditions, where nurses alone would be 
powerless to effect such improvement. COOPERATION FOR SERVICE 
317 
Working with Men.—Whatever other organizations a 
nurse belongs to, she should endeavor to become a mem- 
ber of at least one organization in which men and 
women are working together toward a common end. 
The masculine viewpoint on many problems is well 
worth having; in many circumstances it is essential to a 
well-balanced judgment. Better social and community- 
conditions are only secured as men and women work 
together. The millennium will not be ushered in by 
women alone, or by men alone, but by men and women 
working together and working with God. 
Suggested Subject for Written Work.—At a public 
meeting held to discuss the passage of a law restricting 
the use of habit-forming drugs, the promoters of the bill 
presented a strong letter from a graduate nurse. The 
letter especially called attention to the use of habit- 
forming drugs among nurses and hospital internes. It 
stated that not only were nurses addicted to habit- 
forming drugs themselves, but that they often procured 
them for patients who craved them. Also that they gave 
drugs to patients under their care and without authority, 
in order to obtain restful nights, and that in many cases 
the patient’s recovery was seriously retarded thereby. 
What should be the attitude of the alumna association 
toward a nurse who is a member of the association and 
who makes public statements of this kind? Has an 
alumna association any responsibility in regard to in- 
vestigating or disproving such statements? 
QUESTIONS FOR DISCUSSION OR REVIEW 
1. How much should a member of an alumna association 
be expected to do in the association beyond paying her 
dues and attending such meetings as she conveniently 
can? 318 
ETHICS FOR NURSES 
2. Mention some obstacles commonly encountered in 
carrying on alumna association work? 
3. If a few older members of a county association domi- 
nate everything, and use up the time for discussion at 
every meeting, what is the duty of younger graduates in 
regard to such an association? 
4. If the members of one alumna association assume airs 
of superiority over graduates of other schools, in a 
county organization, and constantly insinuate that the 
training given in other schools in the same county is 
inferior, what is the duty of a graduate of one of the 
so-called inferior schools to the association, three out of 
five officers being of the “snobbish” or “superior” 
school? 
5. What is the cause of “cliques” or factions in nurse’s 
organizations? In what ways are they a detriment and 
how can they be prevented or eliminated? 
6. How would you answer this request? “ I would like 
to have some suggestion as to how to keep up interest 
in an alumna association and its meetings.” 
“Our association has been organized almost two years, 
we have twenty-four members; sometimes we have a 
quorum, sometimes we do not; and seldom more than 
enough to hold a meeting. I have recently been elected 
president and am anxious to build it up.” 
7. If a nurse who is a stranger in a city attends a few 
meetings of a county association and finds the time 
occupied with trivial details and the meetings most 
uninteresting, her opinion neither asked for nor ap- 
parently desired on any question, what is her duty in 
regard to such an association? Is she justified in con- 
sidering attendance at such meetings a waste of time 
which she otherwise might profitably employ, and in COOPERATION FOR SERVICE 
319 
ceasing to attend? Should she be censured for not 
attending under such circumstances? 
8. A nurse of rather indolent habits was accustomed to 
refuse to do various duties, such as keeping the patient’s 
room neat, carrying the tray from kitchen to the invalid’s 
room and back, filling the hot-water bottles for patients, 
etc., and always gave as her reason “the registry doesn’t 
allow us to do such things.” Finally she refused on one 
occasion to get up at night to give a drink to a child 
patient who was inconsiderate enough to become thirsty 
at night, and the child’s aunt got up and got the drink. 
The aunt reported the matter to the registry, mentioning 
the various things which the nurse had said the registry 
didn’t allow nurses to do. The registrar stated that no 
such rules existed in regard to the duties mentioned. 
The registry was controlled by the graduates of the 
school. What attitude should an alumna association 
assume under such circumstances? 
9. It becomes known to members of an alumna associa- 
tion that one of their members is addicted to the use of 
morphine. She is practically under the influence of the 
drug all the time, yet is doing private nursing. Has the 
alumna association any responsibility in regard to this 
matter. What is their duty in regard to the nurse 
herself, to the public, and to the association? How 
should such a matter be handled? 
10. Of what ethical failure is a nurse guilty who in a let- 
ter to a newspaper makes serious charges in regard to an 
organization, institution, or individual and refuses to 
sign her name to the letter? Should any individual 
make serious statements for public reading or discussion 
who is not willing to back up such statements with his 
name? TLord. fill our minis to tt)2. brim with truth uni love, 
TFrom our blurts root out all vanity, prl&c, prejudice, ani 
bitterness. Ifteep us from feeling that other people ought 
to be Just like us, 3Uake us large-mlniei. like thyself, 
taking pleasure In the beautiful varieties of life, ani appre- 
ciative of ilverse human values. Remove from us all bigotry, 
unchurlty. hurshness. ani the unconscious hspocrlsy of 
self-will ani secret lauiatlon. 3\elax the false strain 
that converts our tongues Into threshing-flails, ani keeps 
our souls seething ani boiling with blame ani faultflniing. 
5tlake us glai that <5oi reigns, even when we io not. 
Mlake us a little shy of our own wlsiom ani always hospi- 
table to other people’s suggestions. Show us the hiiien sore 
of sin ieep In our own hearts, ani cure that first of all. 
—From a Veteran Pastor’s Prayers. 
A RESOLUTION 
I will start anew this morning with a higher, fairer creed; 
I will cease to stand complaining of my ruthless neighbor’s greed; 
I will cease to sit repining while my duty’s call is clear; 
I will waste no moment whining, and my heart shall know no fear. 
I will look sometimes about me for the things that merit praise; 
I will search for hidden beauties that elude the grumbler’s gaze; 
I will try to find contentment in the paths that I must tread; 
I will cease to have resentment when another moves ahead. 
I will not be swayed by envy when my rival’s strength is shown; 
I will not deny his merit, but I’ll strive to prove my own; 
I will try to see the beauty spread before me, rain or shine; 
I will cease to preach your duty and be more concerned with mine 
Author Unknown. INDEX 
Ability, 23, 65, 108, 197, 198 
executive, 121, 196, 197, 213 
teaching, 222 
Abuse, 85 
Accidents, 79, 156, 247 
Accuracy, 119 
Adaptability, 180, 233 
Addams, Jane, 228 
Advice, 258 
Ambition, 32, 213, 218 
Anesthetists, 241 
Anger, 33 
Antitoxin, 183 
Appliances, 88 
Asset, 201, 227 
Association, 247, 300, 310, 313 
Atmosphere, 24, 26, 34, 148 
Attire, 117 
Authority, 18, 20, 66, 68, 101 
Backbone, 197 
Bed, 54, 103, 275 
free, 86, 102, 103 
linen, 88 
Bed-bugs, 275 
Bed-rests, 271 
Blanket, 88, 271 
Blues, 170 
Books, 51, 137, 188 
Breakage, 80, 90 
Calls, 266 
Carelessness, 20, 123, 158 
Carriage, 44 
Character, 25, 31, 32, 44, 83, 113, 
126, 141, 158, 175, 189, 214, 
254 
Charity, 193, 251, 258, 316 
Church, 51 
City, 85, 234 
hospital, 91, 92 
Clubs, 298, 316 
College, 137, 141 
Comfort, 100, 113 
Conduct, 17, 48, 57, 100, 126, 
273 
professional, 182, 201, 220, 
224 
Confidence, 25, 58, 197, 208, 302 
Conscience, 17, 35, 52, 118 
Contract, 24, 251 
Conversation, 155, 168, 173 
Conviction, 198 
Cost, 86, 90, 136, 139, 140, 250, 
271, 275 
Courage, 108, 118,149,198, 242. 
250, 315 
Courtesy, 20 
Criticism, 199 
Customs, 18, 49 
Damage, 85, 157, 161 
Danger, 142 
Department, 20, 22, 223, 291 
Development, 29, 30, 115, 250 
Diagnosis, 116, 285 
Diet, 201 
Dignity, 276, 279 
Diploma, 189, 237 
Discipline, 68, 175, 178, 195, 292 
Dispensary, 242, 312 
Disposition, 43, 50, 126, 129, 181 
Doctor, 59, 61, 153, 215, 235, 
267, 284, 286 
323 324 
INDEX 
Habit, 34, 49, 86, 123, 129, 149, 
189, 190 
Hair, 45, 46, 245 
Hands, 34, 44, 53 
Health, 17, 54,122,201, 205,207 
Holiday, 205 
Honesty, 74, 82, 118, 175 
Honor, 32, 74, 75, 76, 78, 118 
Hotel, 279, 286, 301 
Hubbard, Elbert, 217 
Ideal, 18, 26, 48, 74, 129, 141, 
227, 274, 294 
Imagination, 104, 108 
Impressions, 234 
Inclination, 32 
Industry, 232 
Infection, 52, 163, 201, 301, 307 
Influence, 26, 30, 44, 141, 147, 
168, 171 
Injury, 156, 164 
Instinct, 132, 222, 242 
Institution, 18, 23, 54, 229 
Integrity, 76 
Intelligence, 17 
Interests, 171, 315 
Investments, 255, 257 
Judgment, 19, 63, 65, 85, 88, 
114, 126, 154, 188, 294 
Justice, 65, 76, 154, 157, 316 
Keenness, 100, 131 
Kindness, 101, 123, 151, 191 
Laundry, 88, 177, 271, 277 
Laws, 17, 18, 157 
Lie, 58, 176, 184, 185 
Loyalty, 24, 71, 117, 144, 152, 
189, 208, 216, 284, 295, 300, 
310 
Drugs, 120, 160, 161, 317 
Duty, 18, 48, 54, 65, 113, 177, 
194, 276 
Economy, 84, 270 
Educator, 214 
Efficiency, 84,162, 214, 218, 221, 
223 
Enthusiasm, 206, 207, 218, 246 
Ethics, 49, 52, 168, 212, 255 
Etiquette, 148, 190 
Example, 214, 221 
Excuses, 29 
Executive, 197, 199 
Expression, 40, 258 
Extravagance, 84, 86, 266, 270 
Fairness, 215 
Faith, 146, 171, 203 
Faithfulness, 126, 142, 180, 284 
Fatigue, 161, 205 
Faults, 30 
Favoritism, 215 
Feet, 53 
Foundation, 17 
Friends, 33,59, 62,106,114,146, 
179, 208, 
Friendship, 207, 209 
Gentleness, 43, 44 
Gifts, 20, 79 
Golden Rule, 164, 267, 276 
Good breeding, 31 
Gossip, 117, 129, 190, 291, 308 
Governors, 19 
Grace Hospital, 95-99 
Graduates, 218, 233, 239, 277, 
300 
Graduation, 227 
Grievance, 181, 182 INDEX 
325 
Magazines, 171, 172, 277 
Management, 164, 180 
Managers, 19 
Manners, 68, 123, 188, 190, 235, 
282 
Medicine, 120, 161 
Misuse, 88, 90 
Money, 19, 78, 81, 84, 86, 136, 
142, 254 
Moral courage, 197 
Morals, 184 
Motives, 18, 66 
Movements, 43, 172, 245, 311 
Narrowness, 142, 167, 208, 314 
Neatness, 194, 235, 293 
Neglect, 115 
Nightingale, Florence, 78, 131, 
156, 159, 177, 221, 228, 231, 
251 
Noise, 109, 121 
Nurse, graduate, 212, 214, 233, 
260, 293 
head, 120, 193, 212, 217, 242 
night, 113, 115, 117-120 
private, 236, 239, 265, 267 
pupil, 212, 291, 293 
types of, 36 
special, 115, 194, 220 
visiting, 200, 248, 251, 295, 
313 
Oath, Hippocratic, 226 
Obedience, 65, 66 
Observation, 115, 131, 188, 212 
Offense, 68, 82 
Operation, 160, 163 
Opinions, 116, 184 
Opportunity, 65, 152, 177, 227, 
236, 242, 261 
Optimism, 28, 204 
Orders, 105, 156, 160 
Outlook, 171, 182 
Overstrain, 202 
Patience, 126, 188, 223 
Patient, 19, 22, 33, 49, 82, 102, 
115, 223 
Personality, 30, 31, 45 
Phthisis, 58 
Physician, 25, 55, 153, 212, 278 
Pioneer, 249 
Placebo, 185, 287 
Poise, 40 
Position, 121, 236, 240, 249 
Precautions, 52, 162, 258 
Principles, 18, 40, 75, 80, 82, 164 
Probation, 151 
Probationer, 22, 46, 67, 70, 149, 
160, 241 
Problems, 128, 235, 290 
Profession, 49, 191, 227, 247,312 
Progress, 230 
Progressiveness, 218 
Property, 81, 85 
Psychology, 29, 169, 262 
Purpose, 19, 141, 229 
Qualities, 30, 49, 72, 83 
teaching, 222 
Quality, 43, 45, 67, 134 
Questions, 100, 223 
Recommendation, 77, 265 
Records, 80, 126, 176, 213, 288, 
309 
Recreation, 206, 207 
Registrar, 269 
Registry, 233, 299, 303 
Regulations, 70, 72, 265 326 
INDEX 
Relation, 127, 167, 193 
confidential, 132, 293 
professional, 132, 134 
Relatives, 108, 179 
Reliability, 126, 175, 188 
Religion, 51, 134, 143, 308 
Remuneration, 198 
Reports, 60 
Reproof, 67, 216 
Reputation, 25, 66, 87, 130, 153 
Responsibility, 23, 29, 72, 87, 
113, 148, 179, 198, 206, 236, 
257, 261 
Reverence, 65, 179, 193 
Riis, Jacob, 229 
Risk, 158, 164 
Rules, 69, 72, 75, 122, 152, 177, 
180, 291 
Sacrifice, 33, 215, 228 
Self, 26 
Self-analysis, 29 
Self-control, 33, 40, 188 
Selfishness, 219 
Self-reliance, 197 
Servants, 63, 280, 283 
Service, 22, 27, 85,128, 172, 179, 
227, 251, 258, 289 
mechanical, 146 
Sickness, 52, 260 
Slang, 190, 205 
Sleep, 122, 203, 206 
Society, 18 
Solitude, 38, 129 
Solution, 160 
Speech, 60 
Spirit, 26, 34, 48, 128, 142, 313 
Standards, 149, 215 
Strangers, 191 
Success, 131, 177, 229, 237 
Suggestion, 185 
Suicide, 299 
Superintendent, 20, 213, 252 
Supervisor, 114, 121, 137, 293 
Supplies, 90 
Swelled head, 199 
Sympathy, 44, 50, 66, 101, 105, 
154, 179 
System, 120, 130, 165 
Tact, 100, 108, 294 
Teacher, 214, 222, 241 
Temper, 32 
Temperament, 193, 196, 212, 
240, 299 
Temptation, 34, 51, 117, 143, 
227 
Therapeutics, mental, 185 
Thorndike, 29 
Thrift, 90 
Tone, 43, 147, 149, 221, 283 
Tongue, 60, 62, 291 
Towels, 84 
Trades unionism, 264 
Training-school, 17, 21, 24, 54, 
101, 137, 141, 238 
Trustees, 19 
Truth, 57, 59, 182, 183 
Types of nurse students, 36 
Uniform, 45, 188, 301, 302 
Vacation, 207 
Value, 43, 136, 146, 207 
Veracity, 183 
Viewpoint, 101, 219, 232, 233, 
316 
Vision, 229 
Visitors, 107, 281 
Vocation, 141, 239 
Voice, 42, 43 INDEX 
327 
Wardrobe, 255 
Waste, 84, 90, 118 
Weakness, 158 
Welfare, 18, 25, 57, 154, 157, 
178, 233, 243, 284 
Well-bred, 31 
Will, 32, 142, 205 
Workman, 228 
World, 17, 237, 238, 239, 250 
Worry, 102, 203