NURSING PROBLEMS 
AND OBLIGATIONS 
BY 
SARA E. PARSONS, R.N. 
Superintendent of the Training School for Nurses 
Massachusetts General Hospital 
Boston 
WHITCOMB & BARROWS 
BOSTON, 1919 Copyright 1919 
By Whitcomb & Barrows 
Printed July, 1916 
Reprinted September, 1916 
Reprinted September, 1919 
Thomas Todd Co., Printers 
14 Beacon Street, Boston, Mass. THIS SERIES OE TALKS IS INSCRIBED TO THE MEMORY OF 
MY MOTHER, WHO GAVE ME FOR A MOTTO, 
"TO BE, NOT TO SEEM." 
For he does not wish to seem, but to be, the noblest, 
reaping a rich harvest from a deep furrow in his mind, 
from which sprout forth excellent counsels.-/Eschylus. FOREWORD FOR THIRD EDITION 
Since publishing this little book a world war has 
revolutionized society. It has exposed physical and 
moral weaknesses and has put the medical and nursing 
professions to the severest tests. 
No department was better prepared for this gigantic 
disaster than the Red Cross Nursing Bureau. The high 
standards set by the Red Cross have been criticized 
sometimes in the past, but the war demonstrated the 
value of Red Cross requirements. 
Out of the war has grown the Army School of Nurs- 
ing, also a strong feeling on the part of many, of whom 
the writer is one, that army nurses can never hope to do 
their best work until authority, reenforced by rank, is 
conferred upon them. The writer bases her belief on the 
experience of twenty months in an army hospital. Each 
year brings new problems and obligations, and a read- 
justment of the nursing service in the army is not the 
least important for consideration in the immediate 
future. 
There are instructors who may believe that some of 
the topics introduced for consideration at the close of 
each chapter lead the students too far into critical 
channels of thought. The writer has found, however, 
that the only way experience can help inexperience is to 
disclose the students' point of view and to discuss it 
frankly. During the process the instructor is often 
instructed as well as the student. 
Sara E. Parsons. 
August 23, 1919. 
V PREFACE 
After working together for the sick, both in peace 
and in war, through so many years, it goes without 
saying that Miss Parsons and I agree on the points of 
ethics with which she deals in this book; otherwise, 
one of us would have convinced the other. But as a fact, 
I think both of us have been convinced by the same 
masters, by daily trial and error, by daily experience. 
What she here records is well founded, because it is a 
transcript of what any honest, intelligent nurse finds 
written into her life by the successes and failures of her 
work. When she and others have followed the path 
described in this book, things have gone right; other- 
wise, wrong. 
Towards the end of the book Miss Parsons hazards 
some vigorous opinions as to the present limitations 
and future reforms of training schools for nurses. With 
these opinions, as well as with her ethics, I am in hearty 
agreement. It seems strange that people have not yet 
generally and generously realized the need of endow- 
ments for this branch of higher education as for every 
other. No one any longer supposes that a medical school 
can be both reputable and self-supporting. To maintain 
VII VIII 
PREFACE 
proper standards it must be and always is endowed. 
Tuition fees never support a good medical school, nor 
will the nurses' tuition fee (paid in labor) ever suffice 
to provide proper training for nurses in hospitals. We 
are still in the dark ages here; but a fair statement of 
the way out, such as Miss Parsons gives us, may make 
the beginning of much needed reform. Many others 
who care for the interests and standards of nurses will 
be grateful as I am for this book. 
Richard C. Cabot. CONTENTS 
Preface vii 
Introduction 1 
The Place of Ethics in Nurses' Training 
Common Faults 
Familiar Pitfalls 
Self-Control and Self-Discipline 
PART I 
ETHICS 
Chapter I. Ethics 9 
Ethics and Hospital Organization 
Chapter II. Ethics and the Probationary Period . 17 
Hospital Etiquette 
Health and Illness 
Social Relations with Men 
Manner 
Borrowing 
Chapter III. Ethics and the Student Nurse . . 26 
Judgment 
Honor 
Observation 
Thoughtfulness 
Imagination 
Reliability 
Moral Influence 
Forbearance 
Discretion 
The Dying Patient 
Chapter IV. Ethics and the Student Nurse-Continued 38 
Personality, Success, and Happiness 
Daintiness 
Voice 
Manner 
Charity and Sincerity 
Cheerfulness 
Courtesy and Kindness 
IX CONTENTS 
X 
Optimism 
Social Contact 
Moral Strength 
Loyalty 
Religion 
Chapter V. The Student Nurse and Co-workers . . 56 
Physicians 
Social Workers 
Non-professional Associates 
Clinical Secretaries 
Therapeutic Instructors 
PART II 
TALKS TO SENIOR NURSES 
Chapter VI. Qualifications fob Executive Work . 65 
Necessity of a Background 
Taking a New Position 
The Head Nurse 
Supervisors and Superintendents 
Chapter VII. Qualifications for Executive Work- 
Continued 78 
Dangers of Authority 
Privileges of Authority 
Discipline 
Records 
Chapter VIII. Specialized Nursing .... 92 
The Private Nurse and the Patient 
Moral Problems 
Miscellaneous Problems 
Nursing and Domestic Work 
The Nurse's Compensation 
Temptations 
Presents 
A Sliding Scale of Charges 
Organization 
Benefits by the Way 
The Public Health Nurse 
The Surgical Nurse 
Mental Nursing 
Rural Nursing CONTENTS 
XI 
Chapter IX. Miscellaneous Topics .... 108 
Moral Responsibility 
Economy 
Doubtful Policies 
Business Ethics 
Talking Shop 
Social Resources 
Living Expenses 
Professional Expenses 
Uniforms and Dress 
Efficiency 
Hints for Avoiding Trouble 
Married Graduates 
Old Age 
Chapter X. The Activities of the Graduate Nurse . 121 
The Alumnse Association 
The State Association 
National League of Nursing Education 
National Organization for Public Health Nursing 
American Nurses' Association 
The Red Cross 
The American Journal of Nursing 
The Nurses' Directory 
Chapter XI. Molding Public Opinion .... 131 
Hospital Superintendency 
Health Centers 
Hospital Requirements 
Hospital Abuses 
Tuition in Nursing Schools 
Publicity 
The Influence of the Private Nurse 
Advisory Committees 
Chapter XII. Looking Ahead 141 
Men Nurses 
Trained Attendants 
Advancement 
Approaching the Ideal 
The Goal This series of talks somewhat amplified is given 
annually to the student nurses of the Massachusetts 
General Hospital, and is now put into permanent form 
for the benefit of those nurses who have expressed a 
desire to have them. If, incidentally, the book proves 
of value to other nurses, the writer will be pleased. 
She is greatly indebted to Dr. R. C. Cabot and 
Virginia C. Hall for criticism and encouragement while 
arranging the material here presented. 
Sara E. Parsons. 
Massachusetts General Hospital 
Boston, Massachusetts 
June 12, 1916 PART I 
ETHICS INTRODUCTION 
The Place of 
Ethics in Nurses' 
Training 
A superintendent of nurses learns with 
experience that having made a good 
choice of probationers, she must begin 
at once to direct their attention to the ethical aspects 
of their work and to prepare them for the larger pro- 
fessional and social activities in which they should be 
interested after graduation. Consequently these talks 
for probationers and student nurses are given during 
the first three or four months, following a series of 
talks concerning the history of nursing and the lives 
of Florence Nightingale, Agnes Jones, Clara Barton, 
Linda Richards, and some of the distinguished modern 
nurses. 
Nothing is more inspiring and stimulating to nurses- 
in-the-making than the example of those who figured in 
the history of nursing from the time of Phoebe to the 
present day. Nothing can give them better appreciation 
of their present-day advantages. 
A glimpse of what the sisters and deaconesses endured 
in the pursuit of their calling in the days of the early 
church, and some knowledge of the evolution of the 
nursing profession, which has been due chiefly to the 
work and devotion of women like Florence Nightingale, 
Lucy Fisher, Linda Richards, and Isabel Hampton Robb, 
will fire prospective nurses with reverence and enthusi- 
asm for the occupation they have undertaken. 
Abundant and fascinating material for such talks 
may be found in "The History of Nursing," by Nutting 
and Dock; "The Life of Florence Nightingale," by 
1 2 
NURSING PROBLEMS AND OBLIGATIONS 
Sir Edward T. Cook; "The Reminiscences of America's 
First Trained Nurse," by Linda Richards; and "Under 
the Red Cross Flag," by Mabel Boardman. 
Sketches of the lives of some of our eminent pioneer 
nurses and of the work of some of our modern nurses, 
such as Sister Agnes, of Germany, and Lydia Holman, 
working among the mountain whites of North Carolina, 
will sustain the nurses' enthusiasm and give living 
embodiment to their ideals. 
To prepare and write articles requiring research will 
familiarize the nurse with the literature she should 
read and help her to fluency of expression. 
Historical and biographical data make a good founda- 
tion for the lectures on ethics which apply definitely 
to the work of the present-day nurse. During the senior 
year, when the nurses are considered in their prospective 
graduate activities, the ethical talks are supplemented 
by readings from the American Journal of Nursing 
(with which every nurse is supplied) and by class dis- 
cussions according to the "case method," which is so 
much used in law, medicine, and social work. 
This is a very practical and interesting way of teach- 
ing ethics. For this exercise it is necessary to get a few 
private nurses to write out a description of some of the 
situations in which they have found themselves that 
involved a professional, moral, or financial problem. 
The teacher assigns two or three of these cases to mem- 
bers of the class for discussion, putting the problems 
thus: " Suppose you were nursing a convalescent surgi- 
cal patient in a private home, and when your patient 
was nearly well another member of the family had to 
have an operation. You are asked if you are willing INTRODUCTION 
3 
to take care of the new patient. You are on twelve-hour 
duty. What will be your answer?" 
Or: "Supposing you are caring for an extremely 
wealthy patient, who offers you one of her discarded 
gowns. What will you do?" 
The nurses think about these cases, talk them over dur- 
ing the week, and tell the instructor at the next recitation 
how they would deal with the situation. She asks their 
reasons and helps them to arrive at sensible conclusions, 
after getting opinions from the class in general. 
An additional series of lessons in social service, with 
case discussions and visits to the homes of patients, will 
put the nurses in touch with other ethical aspects of 
their chosen work. They may thus get a glimpse of the 
great social problems that lie behind poverty, ignorance, 
and disease. The more nurses think, write, and discuss 
their impressions and convictions about the things they 
see, the more readily they will take a generous and 
noble view of their future work. 
The aim of the superintendent should be to have her 
nurses so alive to the vital things of life and to their 
debt to the workers who have preceded them, that for 
their own part in life's service they will seek the work 
in which they can do the most good, and the people with 
whom they can best solve some of life's problems. 
Common 
Faults 
There are certain character defects which 
disqualify a nurse for her work. The nurse 
comes into too close contact with people, and her 
professional relations with them are too intimate and 
responsible, to permit much experimentation by a train- 
ing school with nurses whose characters are not reliable. 4 
NURSING PROBLEMS AND OBLIGATIONS 
Student nurses, like other young women, are often 
inconsiderate, and show their lack of consideration by 
not picking up after themselves, by leaving unwashed 
bathtubs, by borrowing without permission, etc. 
Moreover, although they enter training schools volun- 
tarily after a period of probation, knowing the rules 
and what is expected from the nurses, a number are 
careless in the observance of some of the rules, such as 
those regarding the retiring hour, eating in the wards, 
etc. Approximate accuracy satisfies the standard of 
many, and it is surprising to one who has been brought 
up to regard truth as an exact statement of fact to find 
how many seem to be able, with a clear conscience, to 
evade precise accuracy in the record of temperatures, 
baths given, medicines administered, etc. 
There is too often a feeling that it is quite permissible 
to deceive and that the sin is in being caught. What 
constitutes real loyalty is not fully understood. Most 
pupils cannot justly estimate their obligations to the 
hospital, to the officers of the school, to the physicians, 
to their fellow-students, and to the patients in their 
relations one with another. After a nurse is detected 
in some flagrant offense, it is far too common to find 
that the nurses in general had previously been discuss- 
ing among themselves the conduct of the offender. It 
sometimes happens that nurses are graduated and have 
left the hospital before the officers of the school hear 
what has been the subject of common gossip for months. 
It is then too late to protect the reputation of the school. 
There are some pupils who will confidentially com- 
plain to an interne when they have been corrected or 
disciplined for any fault, even though they really know INTRODUCTION 
5 
such correction is merited. It is not that they dislike 
their head nurses or their superintendents, but the 
sympathy of the doctors is gratifying, and the nurses 
probably do not realize that their complaints are plant- 
ing in the minds of the doctors seeds of dislike for the 
training school officers. This leads to misunderstand- 
ing and distrust oftentimes that are quite unmerited 
and unreasonable. That the pupil does not intend to 
be disloyal is quite true, but all who have had experi- 
ence in hospitals know that if the internes come in close 
association with the pupils and head nurses, but see 
little of the other officials, there is usually a good deal 
of active antagonism on the part of the internes towards 
the administration. 
It is not that these young men prefer to be unjust 
and antagonistic, for often their intentions are quite the 
reverse. It is simply that they have no opportunity to 
get any point of view except that obtained by a super- 
ficial observation of the relations between pupils and 
training school officers, and by what they are told by 
the pupils. 
Of graduate nurses the most common criticisms are 
indiscretion of speech, extravagance in using materials, 
carelessness in handling the property of others, lack of 
judgment concerning social and business affairs, and 
indifference to what should be their larger professional 
interests. 
Familiar 
Pitfalls 
Many nurses in private practice find it hard 
to adjust themselves in the family, for they 
are not of the family and they do not belong to the 
domestic staff. A nurse needs badly to know where she 6 
NURSING PROBLEMS AND OBLIGATIONS 
belongs, because the family are usually sadly at sea. 
The nurse who expects to be invited to take her meals 
with the family is as unsophisticated as the one who 
consents to be classed with the servants. 
Many a nurse does not know whether or not to con- 
cern herself with the morals of a patient or a family 
whose standards do not conform to her own. 
The hardest situation of all arises when the nurse 
finds herself subject to the orders of a doctor whom she 
cannot respect, or when she knows the patient is actually 
the victim of a doctor's incompetence. If the nurse her- 
self is efficient and conscientious, this is indeed a most 
trying situation, requiring wisdom, tact, and courage. 
The nurse who finds herself in a family where she is 
the innocent victim of a jealous wife's suspicions, or the 
object of an unscrupulous husband's attentions, is also 
in a position that calls for wisdom and discretion that 
a young and inexperienced nurse may not possess. 
The private nurse has probably more difficult ethical 
problems to solve than the nurse in any other line of 
nursing work, but a nurse who is employed in institu- 
tions or in public health work is not without perplexi- 
ties. Finding herself in an institutional environment 
entirely different from the school in which she was 
trained, she is often shocked at existing conditions. 
She is fortunate if she can keep a level head and look 
well about her before she commits any indiscretion in 
word or act. She may make unwise confidences and 
an unfortunate selection of friends at the beginning. 
The tendency is to jump at conclusions, to judge and 
criticize hastily, and to attempt revolutionary changes INTRODUCTION 
7 
before the psychological moment has arrived when it is 
wise to do so. 
Self-Control 
and 
Self-Discipline 
The superintendent of nurses who could 
foresee all the difficulties that her pupils 
will encounter when they leave their 
school would be a wonderful person, and still more 
wonderful if she could tell her nurses just exactly how 
to meet them. No code of ethics has been devised that 
has kept any profession above reproach. 
The only safeguard against unwise decisions and 
conduct consists in the possession by an individual of 
certain fundamental principles directing his mode 
of life, and of well-established self-control and self- 
discipline. 
The training school government should be self-govern- 
ment so far as possible. The student who has observed 
rules merely because she feared the consequences of 
breaking them may not have caused trouble to her 
teachers, but she has not stored up the strength that is 
going to help her when she is out in the world, where 
she feels no pressure of rules or authority. It is best 
to speak of our faults plainly and to call them by their 
right names. Nurses are as often criticized for faults 
of omission as of commission. Self-indulgence at the 
expense of others, laziness, and selfishness are more 
often the flaws that bring us to grief than the oft-quoted 
excuses of thoughtlessness or ignorance. 
The reason that ministers, doctors, and nurses are so 
pitilessly criticized is because people feel that they have 
a right to expect much of these professions. Their rela- 
tions are confidential and bring them into the most vital 8 
NURSING PROBLEMS AND OBLIGATIONS 
experiences of the lives of those to whom they minister. 
And the nurse's contact is closer than the others. 
The doctor and minister make their visits and leave 
the house before patience is exhausted, while the nurse 
in private practice, who is the one most criticized (and 
often praised, it is only just to say), is with her patient 
and the family at least for twelve hours and often for 
twenty-four, day after day. She associates with the 
people for whom she works at such close range that no 
physical, intellectual, spiritual, or professional defect 
can escape notice. 
The circumstances are often such that fatigue, nervous 
and physical, exaggerates or exposes weaknesses that 
would under ordinary conditions lie dormant and un- 
recognized, even by the nurse herself. 
Only the character that is built on a foundation of 
generosity and sweetness (if linked to intelligence, 
common sense, and humor) is safe in any exigency that 
may arise. This character foundation is seldom in- 
herited, but must be built up by training and practice. 
So few can boast of such a rare combination of desir- 
able attributes that it behooves us to cultivate those 
that we have, and to eliminate so far as possible the 
undesirable qualities that we know we possess. 
We must study the rules of life that should govern 
all good, self-respecting women in their relations to 
others, and the qualifications that lead to success. CHAPTER I 
ETHICS 
"All things, therefore, whatsoever ye would that men should 
do unto you, even so, do ye also unto them." 
You will remember in your "History of Nursing" 
that Dr. John S. Billings, of New York, when consulted 
about a code of ethics for nurses, said, "Be good women, 
but don't have a code of ethics." Nurses have never 
formulated a written code of ethics, but an understand- 
ing of current ethical standards for nurses' conduct is 
essential. Dr. Richard C. Cabot's definition of ethics 
is, "Doing what you ought to do," and a very good defi- 
nition it is. It is not always easy, however, to know 
what one ought to do, especially while one is young in 
experience. 
Our duties to our patients, to the doctors, and to 
our own consciences often seemingly conflict. When 
we begin to consider differing points of view we become 
bewildered, and many a young nurse has exclaimed, 
"Oh, why wasn't I told what I ought to do in these 
situations! " 
It is impossible for any one to tell us just what we 
must do in any given situation, because so many circum- 
stances must be taken into consideration. The Golden 
Rule, more often than anything else, will help us in 
deciding. 
Just as the nurse must discover the underlying 
principles of all nursing procedures, so must she en- 
9 10 
NURSING PROBLEMS AND OBLIGATIONS 
deavor to learn and practice right methods of reasoning 
about conduct; and if she does so, she will never be quite 
helpless in any kind of emergency. 
"Obedience to law is liberty " A nurse must guard 
her own individuality and freedom of soul. Freedom 
is not license, neither is institutional restraint slavery. 
The pupil nurse who does her work to her best ability 
is giving a fair equivalent during most of her training 
for her education. 
She has definite rights as well as definite obligations. 
There is much that she should respect, but nothing that 
she need fear, so long as she is entirely honorable in 
her personal and professional relations. Her soul should 
be full of courage^and of aspiration. 
So long as she does her work faithfully and intelli- 
gently, she need not worry about results or about 
opportunities. There is still plenty of room at the top. 
Above all, she must remember that the work needs her 
own interpretation, initiative, originality; anything 
but slavish imitation. 
While in the process of training, the nurse must, of 
course, use the methods that have been accepted as best, 
but she must not for a minute suppose that what seems 
best today will necessarily be considered best tomorrow, 
and she must always hope to find some way to adjust 
and to readjust what she has been taught to the new 
conditions in which she will work. 
As a graduate she should meet the world with head 
up, a straight glance, and a determination to find her 
own work in it, that she alone can do. She must believe 
in the value of her work if she is to overcome obstacles 
and give to it any distinctive touch. ETHICS 
11 
If it were possible for every person con- 
cerned in the working force of a hospital 
to get an adequate idea of the organiza- 
tion of the institution, it would be easier for each to 
do his part than it is when, as is usually the case, so 
much has to be taken for granted. Often the obstacles 
to individual desires seem so unreasonable that much 
friction results. It is no exaggeration to say that even 
between the staff and the trustees' administrative rep- 
resentatives there almost always exists a relation of 
polite tolerance, rather than of full understanding and 
cooperation. This spirit breeds misunderstanding and 
criticism, which are passed on indefinitely to sub- 
departments. * 
The administration seem to the staff to be arbitrary 
and unreasonable. The staff seem to be selfish and 
extravagant in their requirements and practice. The 
house staff stands by the visiting staff. The heads of 
departments stand by the administration. When we 
get down to the nursing force, which is the largest of all 
the different factions in the hospital and the most im- 
portant (inasmuch as the nurses come into the closest 
contact with the patients and work intimately with 
both the administration and the staff), we find that it 
is difficult for the nurses to know where their allegiance 
lies. Conflicting demands are made upon them. 
I shall try to put as simply as possible the general 
scheme of organization of most hospitals. The trustees 
are ultimately responsible for all that occurs in the 
hospital and for the investment and expenditure of 
hospital funds. If a patient is dissatisfied, his friends 
make their complaints to the trustees and hold them 
Ethics and 
Hospital 
Organization 12 
NURSING PROBLEMS AND OBLIGATIONS 
accountable. If a nurse is rejected or disciplined by 
the training school, the trustees are the ultimate court 
of appeal. 
Since this is the case, logically the trustees must 
select a very able administrator to direct expenditures 
of hospital money and to organize the departmental 
activities. They must demand strict accountability and 
place great confidence in the person chosen. Some 
boards of trustees make the heads of the administrative, 
medi( al, nursing, and domestic departments directly 
responsible to them, rather than to the administrator 
of the hospital. But this division of responsibilities 
leads to so much friction that the consensus of opinion 
favors a central administration vested in the superin- 
tendent of the hospital. He (or she) then chooses all 
subordinates subject to the approval of the trustees. 
It follows that the loyal support which the trustees 
give to the superintendent must be given in turn to 
the heads of all sub-departments, and so on down the 
line. If, however, there is inefficiency or extravagance 
in the hospital, the trustees hold their superintendent 
responsible. 
The members of the staff, fully conscious of the value 
of their services, usually chafe at the restrictions that 
must be made for the sake of economy and order, and 
are apt t^ blame the superintendent of the hospital. 
The head of each department naturally craves all the 
advantages of equipment and service for his depart- 
ment, and as one surveys the field, the difficulties con- 
fronting the person or committee that must decide the 
relative merits of the various demands appear less 
simple than the casual critic realizes. When requests ETHICS 
13 
are refused, the administrator may seem arbitrary and 
unreasonable. But if the critic could see the whole 
picture, he would probably reserve his judgment. If 
each subordinate official could realize that the results 
of his errors in judgment or act are not borne by him- 
self, but by the hospital, in loss of reputation and 
sometimes in litigation, he would adjust himself with 
better grace to administrative restrictions. 
If every nurse realized, for example, that she does 
not suffer the consequences of hot-water-bag burns, but 
that it is the patient who bears the physical consequence 
and the hospital which is morally and legally responsi- 
ble, she would be less ready to rely upon her own 
judgment and more willing to conform strictly to hos- 
pital rules concerning the application of hot-water bags. 
It has been found that the more one knows of the 
reasons governing the technic of one's occupation, 
the more interest and accuracy will be put into the work. 
The more ways that are discovered whereby heads of 
departments can bring about mutual understanding 
concerning mutual interests, the better it will be for 
all departments. Understanding and cooperation are 
worth great pains to attain. 
If the humblest worker can be made to feel that he 
is working with rather than for others, and that his 
part of the work is important, he is more likely to render 
good service. The less rules are applied as rules, the 
better the results, for we all like a feeling of freedom 
in our work. But when we see a reason why we should 
conform to rule or precedent, our conformity becomes 
voluntary and not compulsory. 14 
NURSING PROBLEMS AND OBLIGATIONS 
A successful superintendent once said that the ideal 
administrator was a person who could direct the activi- 
ties of his subordinates so that they were not conscious 
of direction. If a head worker can inspire in a sub- 
ordinate his own vision of the end to be accomplished, 
he will do well to let that subordinate work out the 
result in his own way. Given such freedom, he will 
work with initiative and enthusiasm. Lacking these, 
he becomes a mechanical instrument instead of a think- 
ing organism. 
The solution of some of the difficulties in hospital 
administration is to give the different departments an 
insight into the problems of all the departments. 
Probably the time will come when every department 
will be represented on the executive committees of hos- 
pitals, and when men and women will more often share 
the responsibilities of trusteeship and administration. 
TOPICS FOR CONSIDERATION 
Write a list of desirable mental, physical, and moral 
qualities for the professional nurse. 
Indicate honestly, by usual gradings, your own stand- 
ing. 
What are the alleged faults of Schools for Nurses ? 
Where does the responsibility lie ? 
Why are nurses subjected to so much criticism? 
Why is self-government better for the individual than 
faculty government? 
Define loyalty. 
What is the usual organization of a hospital ? 
Why do so many parents object to their daughters 
studying nursing ? 15 
ETHICS 
What advantages has the profession of nursing over 
some other popular professions for women ? 16 
NURSING PROBLEMS AND OBLIGATIONS CHAPTER II 
ETHICS AND THE PROBATIONARY PERIOD 
During this period of test, you as a probationer 
must realize that you are entering a new world, where 
life and death may depend upon the intelligence, 
fidelity, and accuracy with which the work is done. 
Efficiency and accuracy demand the closest attention 
to business every minute when "on duty." It is to 
insure this attention that nurses and doctors are re- 
quired to conform to certain rigid rules of conduct. 
Hospital 
Etiquette 
This consists of the recognition of the pro- 
fessional relation existing between the sub- 
ordinate and a superior officer. When this relation 
exists in its perfection the subordinate will always be 
alert in rising to a superior, and will show by her 
expression and attitude that it is her pleasure to be of 
assistance to the other. 
This is made easy if the superior officer is courteous 
and dignified in behavior. But however that may be, 
a nurse should never permit herself to be remiss in her 
own professional attitude; and if she rightly appre- 
ciates the significance of hospital etiquette, she can 
adapt herself to its rather unusual situations with 
pleasant dignity and without servility. 
Every nurse permanently or temporarily in charge 
of a ward will then regard herself as a hostess to all 
others who visit the ward. To orderlies and domestics 
the nurse's attitude should always be considerate and 
17 18 
NURSING PROBLEMS AND OBLIGATIONS 
dignified. These assistants, if they perform their duties 
conscientiously, are worthy of every one's respect, and 
their work should not be made more difficult by in- 
considerate treatment. There are many small ways in 
which the nurse can show just consideration for her 
co-workers, and thus win their respect and interest. 
The nurse who "picks up after herself" in the kitchen, 
who puts the tins to soak after she has emptied them, 
and who speaks appreciatively when the maid has made 
a special effort to do her work well, is establishing a 
habit of kindness and tact that will serve her well in 
many difficult situations. 
On the other hand, the nurse who thoughtlessly calls 
an orderly away from one patient with whom he is 
working, and asks him to do for another something 
which the nurse might do herself, is creating antagonism 
and dislike on the part of the orderly towards herself. 
This does not make for harmony. 
Familiarity, coaxing, or flattery is never permissi- 
ble, and if indulged in shows lack of judgment or of 
breeding. 
Health 
and 
Illness 
Probationers must not feel discouraged be- 
cause they get tired at first. If they have not 
been accustomed to active work that calls all 
the faculties into play as nursing does, it will take time 
to accustom the brain and muscles to the unusual 
demands made upon them. One of the advantages of 
hospital nursing is the comprehensive exercise of body 
and mind with regular habits of sleep and meals. 
It is normal to get tired, and if one is rested after 
a night's sleep there is no cause for alarm. A nurse ETHICS AND THE PROBATIONARY PERIOD 
19 
should begin as a probationer to apply to herself the 
instruction received in hygiene. She should not spoil 
her appetite with candy between meals, or her night's 
rest with a late and hearty supper. Boxes from home 
are doubtful kindnesses. 
Above all things, a nurse should train herself to eat 
everything that is wholesome and to eat what is served, 
without complaint, unless the food provided is so poorly 
chosen, cooked, or served that a complaint at the train- 
ing school office is justified. It is to be remembered 
that it is impossible to cater to every individual taste. 
If boiled dinners were struck off the menu to please 
certain people, there are others who would feel it a 
deprivation. 
After graduation, nurses may find their work taking 
them into all sorts of homes and into any country. The 
useful and happy nurse is the adaptable one, who does 
not depend too much on material comforts. This remark 
is not intended as an excuse for hospitals that do not 
provide their nurses with a good and varied diet. But 
nurses should realize that it is vulgar to complain, as 
many people do complain habitually about food, and 
to have one's day spoiled if a meal has not been to one's 
particular taste. 
A nurse should be fastidiously clean and well 
groomed. Daily baths, with more frequent local baths 
and sufficient changes of clothing, are necessary. Teeth, 
hair, hands, and feet-all should be kept in good con- 
dition. Prophylactic treatment for the teeth is recom- 
mended. It is very important that any wound or 
'abrasion of the skin on the hands should be promptly 
cleansed and protected by a collodion dressing. 20 
NURSING PROBLEMS AND OBLIGATIONS 
The hands should always be washed and well dried 
before going to meals. The habit of rubbing the eyes 
with one's hands should be avoided, and for the sake 
of cleanliness the hair should be dressed in such fashion 
that it is not necessary to keep brushing it away from 
the eyes and face. An individual towel pinned under 
the apron should be used, and it should be remembered 
that individual use of hair brushes and combs is as 
necessary for sanitary reasons as that of individual 
tooth brushes. 
In a new environment one is apt to have gastric or 
intestinal disturbances or sore throats. These condi- 
tions must not be neglected, but should be reported to 
the proper authorities immediately. Although nurses 
and doctors have often to ignore their own physical 
discomforts in the performance of duty, and would be 
unfit for their high callings if their own comfort was 
their first consideration, it is poor judgment to omit the 
"ounce of prevention" when situated so that competent 
advice may be secured. Also it must be remembered 
that one's best work cannot be done when one is con- 
scious of one's own body all the time. There is danger, 
too, with heavy colds and sore throats, of spreading 
infection to one's associates. 
Social 
Relations 
with Men 
Whatever the rules of the school, nurses must 
expect to obey them while connected with it. 
If the rules prohibit the acceptance of social 
attentions from men met in the hospital, they have 
been found to be for the best good of the nurses and 
for the work of the hospital. If men could always be 
relied upon to treat other women as they would wish ETHICS AND THE PROBATIONARY PERIOD 
21 
their sisters treated, or if social relations between the 
young men and women in hospitals never interfered 
with the performance of duty, such rules would not be 
necessary. As it is, they are useful. 
A nurse should be above clandestine affairs of any 
kind, and she may well distrust a man who offers her 
attentions, knowing that she cannot safely or honor- 
ably accept them because of her school obligations. It 
would be absurd to suppose that a nurse can spend 
three years in a hospital working intimately with men, 
under conditions that bring out all the basic human 
qualities, admirable and otherwise, without making 
friendships. But these friendships, if real, will last, in 
spite of social restrictions, during the time of profes- 
sional relationship in the hospital. 
Cultivate a quiet way of moving and talking. 
A quiet nurse will never offend because of 
her quietness. A noisy person will often find herself 
criticized or actually disqualified for the care of certain 
types of patients. Hence if the fault is not corrected 
during training, it will make her unsuccessful in private 
practice or as an executive. A pupil should not feel hurt 
if corrected for mannerisms. On the contrary, she 
should seek such correction for her own sake. 
Because she comes in such close contact with people 
who are sick, and perhaps are abnormally sensitive to 
the peculiarities or defects of those who serve them, 
it is very desirable that a nurse should have a well-bred, 
dignified demeanor. Lounging, leaning on furniture, 
carrying the hands on the hips, staring, snuffing, and 
various other habits of which one may be unconscious, 22 
NURSING PROBLEMS AND OBLIGATIONS 
are awkward and are disagreeable to most people, sick 
or well. 
The essence of good manners is to try never to do 
anything that might offend a fastidious person. Besides 
that, it is desirable to conform to the accepted standards 
of social custom. Some practices, such as eating with 
a knife or leaving the spoon in the cup, are not serious 
offenses, but such deviations from custom make a person 
conspicuous, and that is to be avoided. It is unfortu- 
nately true that in the pressure of hospital life it is easy 
to acquire bad manners. Many doctors, and nurses as 
well, who have had most careful home training be- 
come careless about many things, trifling in themselves, 
but extremely annoying to patients. Walking into a 
patient's room unannounced and needlessly exposing 
patients are the commonest faults. A nurse should try 
particularly not to err in these ways, and to be so 
alert that she will prevent intrusion and unnecessary 
discomfort for her patients. 
It is often necessary for a nurse to interrupt a con- 
versation to give some message that cannot be delayed. 
Of course she should always excuse herself and not 
break in abruptly. Sometimes it is possible to write 
the message and hand it to the person to whom it is to 
be delivered, which is the least obtrusive form of 
interruption, 
Borrowing 
Never borrow as a habit and never with- 
out permission of the owner of the article 
borrowed. When one appropriates another's property 
without permission, borrowing is nearly as bad as steal- 
ing. The consequences are often as serious. ETHICS AND THE PROBATIONARY PERIOD 
23 
Do not be afraid, when in doubt or in difficulties, 
to refer to your head nurse, or to her substitute if the 
head nurse is not on duty. Other pupils may offer 
advice. Many errors would be avoided if probationers 
and young nurses never accepted instruction from any 
but charge nurses or supervisors. 
Remember that the most valuable lessons learned by 
the probationer are not found in the curriculum, but 
are the lessons of obedience and self-restraint learned 
by the observance of hospital rules. 
TOPICS FOR CONSIDERATION 
Are all nurses subordinate in position to all phy- 
sicians ? 
Is there any danger of confusing the social and pro- 
fessional relations between doctors and nurses ? 
Explain the difference between servility and courtesy. 
Why are familiarity and coaxing undesirable ways 
of attaining results ? 
Why is it vulgar to complain habitually about food ? 
What is meant by prophylactic ? 
Why is it undesirable to rub the eyes with the hands 
or to brush the hair away from the face when working 
over patients ? 
What is your impression of the rules governing the 
social relations between student nurses and the men 
whom they meet in the hospital ? 
What are some of the outstanding differences be- 
tween the behavior of those who are well-bred and 
ill-bred? 
What is the best method of conveying a message to a 
busy person? 24 
NURSING PROBLEMS AND OBLIGATIONS 
What are some of the most important lessons to be 
learned by a probationer? 
Case for discussion 
Patient, ready to be dismissed from hospital after 
operation, was found to have hot water burns on feet 
which had not been reported by interne or head nurse 
to superintendent of hospital or school. Patient was 
young married woman with baby, very much needed at 
home, but on account of burns would be unable to walk 
for weeks. When questioned neither doctor nor nurses 
knew who was responsible for hot water bag. Head 
nurse said she preferred not to know who had given hot 
water bag, because she would have had to report said 
nurse. The doctor concealed the accident for the same 
reason, hoping to cure the burns before the patient was 
otherwise well. 
What might have been the consequence to the hospi- 
tal? What was the injustice to the nurse who gave the 
hot water bag? 
What action should be taken in such a case ? ETHICS AND THE PROBATIONARY PERIOD 
25 CHAPTER HI 
ETHICS AND THE STUDENT NURSE 
Nurses cannot avoid exercising a moral influence. They 
exercise it by their characters. ... It is what a nurse is in 
herself and what comes out of herself, out of what she is (al- 
most without knowing it herself), that exercises a moral or 
religious influence over her patients.-From ''The Life of 
Florence Nightingale," by Sir E. T. Cook. 
The duties of the student nurse are to put in practice 
what she has been taught as a probationer, and to 
adapt herself to conditions that she has had a chance 
to study and that she has accepted. 
We do not contend that conditions are even near- 
perfect in our hospitals and training schools. But we 
do affirm that we are working towards an ideal, and 
you must realize from the history of nursing that im- 
provement depends chiefly upon the intelligence and 
devotion of nurses themselves and that progress takes 
time. It is necessary that you should visualize the 
patient, persistent workers, whose efforts have brought 
about the better educational opportunities that you now 
enjoy and the comfortable living conditions that make 
your lot a pleasant one. Do you not see yourself join- 
ing a band of people who are going to take up the work 
for still better education for nurses and better service 
for humanity? 
Remember that you too are going to make history. 
The next three years give you the opportunity to pre- 
pare yourself adequately for your future work. Just 
how much you will get out of this opportunity depends 
26 ETHICS AND THE STUDENT NURSE 
27 
chiefly on what you are prepared to put into it. There 
will be many difficulties, because while work can go on 
without interruption in the classroom in a routine 
manner, in the ward equipment sometimes gives out 
and there are all sorts of unexpected complications. 
The pupil nurse finds herself confronted with several 
things to be done at once. A new patient waits to be 
received, there is a patient to be sent to the operating 
room, medicines are to be given, a medical visit must 
be attended, and so it goes. 
It is this sort of thing that develops your 
ability to judge relative values and your 
power to dovetail your work. These powers will give 
you self-possession. To know what to do first and how 
to accomplish the various tasks is an art. (If you find 
that you cannot do all that is expected of you, or that 
you have forgotten a temperature or a medicine, you 
must have moral courage enough to be honest about it.) 
In this early stage of the nurse's career, she should 
not be too sure of her own judgment concerning many 
things. She sees hospital life from one point of view 
only, and with very limited experience. Many of a 
nurse's worst grievances are those that she adopts in 
behalf of some friend. She hears the friend's side of the 
story and concludes that an injustice has been done. 
She hears rumors and thinks they are true. She thinks 
she detects bad management on the part of the training 
school office, and thinks she could have planned better. 
But she should remember that there are dozens of con- 
siderations affecting every situation. All these should 
enter into our judgment, since only when we are in a 
Judgment 28 
NURSING PROBLEMS AND OBLIGATIONS 
position to comprehend the whole field can we realize 
the difficulties in arriving at wise and just conclusions. 
The young nurse may be sure that the head nurses 
and officers chosen are the best available, and in their 
more responsible positions are trying to do the right 
thing. 
The unscrupulous nurse is the one who will 
do surface work, who records fictitious temper- 
atures and baths, expecting to escape detection, because 
the officers dislike to ask patients whether the nurse 
has really done these things, thereby seeming to dis- 
credit the nurse. Such a nurse is, however, soon recog- 
nized by other pupil nurses, but owing to a widespread 
dislike of tale-bearing the knowledge is not usually 
reported. Patients unfortunately have a fear of report- 
ing nurses, expecting that if they do the nurses "will 
take it out of them" I 
This is the time when you must cherish your ideals 
of honor and of service, for the first year will be par- 
ticularly hard in a busy hospital. Nevertheless your 
effort to do all the mechanical part of the work expedi- 
tiously, and as you have been taught to do it, will soon 
show results. There will, however, be ever new phases 
of nursing responsibilities, and until you have had 
three or four months of service in a medical and in a 
surgical ward, with night duties in each, you will feel 
very much a novice. After the first year you will feel 
more competent and will adapt yourself more easily 
to the different departments until you come to the 
operating room. There you will again feel like a 
probationer. 
Honor ETHICS AND THE STUDENT NURSE 
29 
The pupil nurse, in order to be successful, must con- 
centrate her mind absolutely on her patients. Hence 
you must endeavor to master as soon as possible the 
technic of the duties assigned to you. Then you can 
take an intelligent but not intrusive interest in all the 
other patients and in the ward activities not especially 
your duty. 
You may be found alone on the ward and be 
confronted with an official visit. If you can answer 
questions intelligently, nothing will more clearly indi- 
cate your interest in the work or place you in the minds 
of your superior officers as a nurse who is going to be 
equal to larger responsibilities. 
As you become familiar with the ward, 
you will naturally observe the work of the 
head nurse and of the other assistants. You will see 
that some do their work methodically, accurately, 
and intelligently; that others run to and fro without 
accomplishing much, and that they are forgetful and 
sometimes, unfortunately, indifferent and unreliable. 
The observer can profit by her observations. From 
every one she may learn something good, and by their 
faults she may learn what not to do or to be. She must 
study the needs of her patients, anticipate their wants, 
and show a helpful rather than a critical spirit towards 
her fellow-workers. She should read up her cases and 
study the effects of the medicines and other treatments 
given. Thus as she goes on she will be learning about 
what she is doing, why she is doing it, what results are 
to be looked for, and she should always note deviations 
from the normal. 
Observation 30 
NURSING PROBLEMS AND OBLIGATIONS 
Thoughtfulness 
There is great danger of doing our work 
mechanically. For illustration, one may 
see in any hospital at times some kind, well-educated, 
and intelligent nurse serve a tray to a one-armed or 
helpless patient without cutting up his food so that he 
can eat it. She will hurry away and never realize what 
she neglected to do until she returns for the tray. This 
is not because she is naturally unintelligent or unkind, 
but because she has concentrated on getting the meal 
served as soon as possible and she is mentally oblivious 
for the moment to the personal side of the work. It is 
observed in many instances that we have eyes to see 
with and ears to hear with, but if the apperceptive part 
of the brain is not recording impressions, the proper 
motor reaction does not take place. 
Our hospital system is doubtless much to blame for 
many of the defects of our nurses. Often our equipment 
is inadequate, the working arrangements are incon- 
venient, the demands upon the nurses unreasonable. 
But in spite of all such handicaps, good nurses have 
been evolved out of these conditions. Perhaps they have 
been better in some ways because of the obstacles they 
had to overcome. 
Imagination 
If we can think of each patient as if he 
were in some way of special personal 
interest to us, imagine him, for instance, even the rela- 
tive or employee of some dear friend, we shall see him 
with a more illuminating comprehension. If he does 
not speak English, we shall see that some one visits 
him who can interpret for him. We shall see that his 
personal belongings are safely cared for. We shall ETHICS AND THE STUDENT NURSE 
31 
realize that for him his spectacles, his false teeth, etc., 
have more than their intrinsic value, and by good care 
and kind words we shall make him as comfortable and 
happy as possible. 
The diagnostic use of scientific experiments 
and the educational use of modern research 
in our hospitals make it highly necessary that nurses 
appreciate scientific accuracy. The time, for instance, 
that is wasted in the laboratory on account of errors 
in the procuring of specimens is appalling. The nurse 
should realize this, and if she is found to be deliberately 
unreliable, she proves herself unfitted for the profession. 
Reliability 
Nurses are so taken for granted in our hos- 
pital wards that their moral influence is 
scarcely appreciated. If the attitude of the nurses 
towards the patients is humane (not sentimental), 
even the hurried and sometimes abrupt chief will react 
to it. The patient should be prepared for the necessity 
of the routine physical examinations by a simple, kindly 
explanation from the nurse or doctor. 
Moral 
Influence 
A nurse should not wear her feelings too 
near the surface. She comes too close to 
people just as they are to expect always to receive 
personal courtesy or consideration. The preoccupied 
chief will neglect to say "Good morning I" The anxious, 
overstrained surgeon, be he ever so much a gentleman, 
may use abrupt, rough, and sometimes unjust language 
under temporary vexational stress. As a result of much 
disappointing experience, the executive may be over- 
Forbearance 32 
NURSING PROBLEMS AND OBLIGATIONS 
suspicious or autocratic; but " for the sake of the work " 
the true nurse will bear all, as did Florence Nightingale 
under much more trying circumstances. 
Here and there we shall work with big souls who may 
also be big in a professional way; to help such will be 
a privilege worth all the necessary hardships. 
Discretion 
Nurses and doctors are sometimes thought- 
less in conversation; they discuss a pa- 
tient's condition before him, thinking he does not 
understand or care, and sometimes believing him too 
ill to notice what is said. This is a great mistake. A 
patient may seem unconscious and yet take in quite 
clearly the discussion about him. Nothing should be 
said in his presence that may trouble or perplex him. 
If a mistake has been made in treating a patient, 
the patient is not the person who should know it if it 
can be kept from him, because the anxiety and lack 
of confidence that he would naturally feel might be 
injurious to him and retard his recovery. Later it is 
right that he should know about it; but at the time 
of the blunder only one's superior officers and those 
who can remedy the error should be told. If a nurse 
makes a mistake, serious or otherwise, the least she can 
do to remedy her carelessness is to report at once to 
the head nurse or to the doctor. If her record has been 
good it will mitigate the personal consequences of her 
act, and her truthfulness and moral courage will offset 
in some degree her error. 
The affairs of the hospital or of patients in the hos- 
pital should not be carried outside the institution 
except when publicity has been allowed by the hospital ETHICS AND THE STUDENT NURSE 
33 
authorities. When persons are in the hospital who are 
very important in the community or who are closely 
identified with the public, it is then customary to issue 
bulletins of their condition through the press. 
Many people, however, are very sensitive about their 
illnesses and have a right to expect privacy. When 
nurses are in private practice, it is unpardonable for 
them to discuss their patients or the family affairs with 
any one else. What they learn and know should be re- 
garded as inviolable confidence. If this lesson is not 
thoroughly learned by the student nurse, it is doubtful 
whether, as a graduate, she will ever be trustworthy 
in this respect. 
If a patient in his weakness, or in delirium, or under 
the influence of an anesthetic discloses some of his past 
misdeeds, real or perhaps imaginary, the nurse may be 
obliged to listen, but she must try to forget the con- 
fidence afterwards. Such confidences must never be 
betrayed, and the nurse must try to act as if she had 
never remembered them. Patients after recovery often 
find it difficult to discriminate between dreams and 
reality, and the nurse need not commit herself beyond 
assuring patients that things said in delirium have 
been disregarded. 
It sometimes befalls that a critically ill patient, 
fearing or anticipating death, turns to the nurse for 
information or consolation. He sometimes begs the 
nurse to tell him whether he is going to die. If the 
doctor is not at hand to be referred to, and if the nurse 
knows that the patient is not expected to live, yet fears 
to destroy his last chance by telling him the truth, it 
is a difficult situation. There are times when the nurse 34 
NURSING PROBLEMS AND OBLIGATIONS 
cannot refer to the doctor or to the family, but must 
take the responsibility of answering the patient's de- 
mands. Nobody can safely say that there is no hope, 
because there have been so many instances of almost 
miraculous recovery when all experts had agreed that 
death must speedily ensue. Therefore the nurse might 
say: "We hope you will recover. Others as sick as you 
have recovered, but every one of us ought to be ready 
to die if the call comes; and if there is the least thing 
that can be done to give you ease of mind, do not 
neglect it." 
If the patient seems anxious, the nurse may ask him 
if he would like to talk with some friend, a clergyman, 
or a priest. If the patient asks the nurse to pray with 
or for him, she should be ready sympathetically to do 
her best. She can at least pray for wisdom to deal 
rightly with the sick one depending upon her. If she 
carries with her a prayer book, she can surely find 
something comforting and appropriate. 
The 
Dying 
Patient 
The most awe-inspiring duty a nurse has to 
perform is the service she renders to a dying 
patient. A new life seems a natural phenom- 
enon ; we know something of the existence the new soul 
enters; but when we have done all we can for an indi- 
vidual who has run his life-race and reached the point 
where no mortal help can avail to hold the spirit back, 
we must as tenderly and reverently perform the last 
duties as we would wish them done for one of our own 
who might die among strangers. 
No matter how many other pressing duties you may 
have, do not let yourself seem hard or indifferent, and ETHICS AND THE STUDENT NURSE 
35 
up to the very last moisten the dry lips and do every- 
thing possible that may render death easier. It is a 
great comfort to the patient's friends who are not 
present to know that some one was there at the last. 
TOPICS FOR CONSIDERATION 
Read "Reminiscences of Linda Richards." 
On what does progress in knowledge chiefly depend ? 
What important qualities are developed by the con- 
flicting demands of ward work ? 
What is one of the most important faculties of an 
assistant nurse ? 
Give instances when assisting with a surgical dress- 
ing. 
If you could, would you eliminate all the handicaps 
of your work ? If not, why not ? 
Give instances in which inaccuracy on the part of a 
nurse will spoil scientific diagnosis. 
What would you think of an interne who would play 
a joke on another interne by putting sugar in specimens 
of urine to be examined? 
Name the qualities and accomplishments that have 
made Linda Richards a famous nurse. 
Case for discussion 
If a student nurse went out in the evening without 
permission to stay late (having already used the cus- 
tomary permit) and met an out-of-town friend accident- 
ally who invited her to the theatre, under what circum- 
stances would she be justified in assuming that she 
might accept the invitation and that her explanation 
would be acceptable ? 36 
NURSING PROBLEMS AND OBLIGATIONS 
Give instances when either an explanation or an 
apology is due to the superintendent of nurses. ETHICS AND THE STUDENT NURSE 
37 CHAPTER IV 
ETHICS AND THE STUDENT NURSE 
Continued 
There is always a best way of doing everything, if it be 
to boil an egg. Manners are the happy way of doing things.- 
Emerson. 
Skill and education avail little if one's 
personality is not pleasing. It is scarcely 
worth while for a woman to begin training 
if her personality is positively unpleasant. Every pupil 
does well to study herself with a view to improvement 
in every possible way during the three years in which 
she is an undergraduate. 
Why do we say of certain people that their person- 
ality is attractive? Is it because they are beautiful to 
look at? No, most assuredly not. At the moment, I 
think of a nurse who was most popular with her patients, 
the doctors, and all her associates. To strangers she 
was plain and unquestionably she was awkward, yet 
she had magnetism and charm. As nearly as I can 
analyze her attraction, it lay in her goodness, her lack 
of self-consciousness, in her humor and originality. 
She was always desperately in earnest to do well what- 
ever she had to do, and she was untiring in her efforts. 
She was sympathetic and intelligent with her patients, 
attentive and honest in her relations with the doctors. 
She was unselfishly interested in the nurses profession- 
ally and socially, always ready to do her share on any 
Personality, 
Success, and 
Happiness 
38 ETHICS AND THE STUDENT NURSE 
39 
occasion. She had faults which she struggled with 
and in the main conquered. 
Study the people you know and decide what charac- 
teristics interest or antagonize you. Think how much 
depends upon manner, voice, appearance! 
Few of us can be beautiful, but we may all 
be well groomed. This in itself will be a 
charm and offset some defects. 
Observance of the rules of hygiene will insure a good 
digestion, a healthy circulation, and an appearance 
of well-being that rests a patient. 
We must remember that patients, unless desperately 
ill, are often hypersensitive. They may and often do 
have an acute sense of smell and hearing. 
Daintiness 
A pleasant voice well modulated is a great 
attraction, and a harsh, loud voice is often the 
undoing of a nurse. The quality of the voice can be 
cultivated and the pitch is under the control of the will. 
Voice 
A dignified but pleasantly cheerful manner 
imparts confidence to the patient. The nurse 
must shun, while on duty, any suspicion of frivolity. 
Her duties are too serious, and the very necessity for 
her presence in the ward or in the household means 
anxiety and sorrow. Of course it is hard for a young, 
high-spirited woman to remember always to be on her 
guard while going through corridors or when conversing 
with friends or relatives of her patient, to check loud 
laughter, jests, etc. But the necessity of dignity and 
reserve for "on duty" deportment is one of the most 
Manner 40 
NURSING PROBLEMS AND OBLIGATIONS 
important lessons to learn while in training. In a 
hospital nurses cannot be too careful, particularly at 
night, about talking and laughing with each other or 
with the doctors while on duty. 
If we could always remember the point of view of the 
patient and the patient's family, self-control would be 
easier. 
Some nurses err when trying to be sympathetic and 
reassuring to patient or friends by being unduly 
familiar. One may pet a child, although even children 
should not be imposed upon, and should never be 
fondled or kissed against their will. They should never 
be kissed on the mouth. To caress or use terms of 
endearment to adults is out of place and liable to cause 
offense. Physical contact should always be avoided 
except when the actual performance of duties requires 
it. With some patients it is difficult at times to observe 
a proper reserve on account of their demands; a wise 
nurse will be very cautious about yielding to familiari- 
ties. Some people when ill are susceptible through 
weakness, and would regret their own lack of reserve 
on recovery to health. 
A wholesome appearance, a pleasantly modulated 
voice, taste in dress, discreet conduct added to an un- 
selfish interest in others, with a sincere effort to be more 
useful in the world, will lead to success and make a 
personality that is agreeable. 
Charity 
and 
Sincerity 
An important element m happiness is a 
generous disposition that thinks no evil, 
that is ready to make due allowance for the 
faults and weaknesses of others. A person who is intent ETHICS AND THE STUDENT NURSE 
41 
on making her own conduct square up to an ideal will 
have little time to dwell upon the faults of others. One 
who is ready to put a charitable construction on the 
conduct of others is less likely to do an injustice and 
is certainly much less likely to stir up trouble. It is 
possible to be shrewd without being suspicious, but 
it is an art and an art to be long cultivated. Belief in 
the essential, underlying good of humanity is necessary 
even for shrewdness, and still more if one is to be truly 
optimistic and cheerful. 
It is needless to say that a helpful person 
is always appreciated. One reason why 
certain nurses are so often successful is because of their 
cheerful, comfortable temperament. They are reassur- 
ing by their mere presence. Once in a ward of surgical 
male patients some one asked, " Supposing there was a 
bottle of beer in the center of the floor, who do you 
suppose would get to it first?" An Irishman with a 
double amputation of his legs spoke up and said, 
"I would." The men asked him derisively how he would 
do it, and he said merrily, "Sure, I'd roll to it." He 
was an inspiration to the whole ward. A buoyant 
spirit makes some nurses invaluable in the sick 
room. They do not know the word "fail" or the word 
"despondency." 
Can these qualities be acquired or must they be 
inherent? Indeed, it would be a sorry world if we could 
not adapt our dispositions as well as our clothing to 
the demands of expediency and comfort. Even the 
people who enjoy being miserable can say to themselves, 
if they realize that they make other people miserable 
Cheerfulness 42 
NURSING PROBLEMS AND OBLIGATIONS 
by their grouches, "I would rather sulk or scold, but it 
will not do anything but harm; so I will forget my 
mood, take an interest in some one else, and make myself 
agreeable." Of course they can do it. It is a matter 
of self-control and habit to a great extent. 
Courtesy 
and 
Kindness 
Granting that we have religious feeling, 
how may we best show it? Good manners, 
which means regard for others, and kind- 
ness, which also means unselfish service, will character- 
ize our conduct. 
We respect ourselves, so we will not be servile; but 
we will try to accord to all our associates the consider- 
ation that belongs to them. To our patients we will 
give sympathetic and intelligent care which looks 
deeper into the needs of each than the obvious physical 
disability that brings him to the hospital. We will 
study him as an individual and not merely as a "case." 
Through imagination we will try to put ourselves in 
his place. What has been his racial inheritance, his 
environment, his education, his interests, his religious 
training? 
If you were he, how would you react to your present 
surroundings? Can he understand our language and 
our customs ? Is he superstitious, terrified, and lonely ? 
If so, will you not reassure him? Just by your expres- 
sion you may assure him that he is among friends. 
If you cannot speak his language, you will attempt to 
get an interpreter to explain what the examinations 
mean, what the doctors are trying to do to help him, 
and to ask him if there is anything he wishes. You will 
stand between your patients and all unnecessary dis- ETHICS AND THE STUDENT NURSE 
43 
comforts. You will assume that they are all modest 
and sensitive, and give them such privacy and consider- 
ation as is within your power. In other words, you will 
be their friend. Your reward will be an hundredfold. 
You will not be indifferent to racial and religious 
practices. You will show no partiality beyond dis- 
criminating between the relative needs of your patients. 
When you have neglected anything you will express 
regret, which must be sincerely felt to be effective. 
You will discover that in the lowliest people there exist 
some of the finest attributes of character-unselfish- 
ness, honesty, deep affections, and real gratitude. Look 
for good in every man and you will find it; indeed, you 
will inspire it. 
You will anticipate your patient's wants so far as 
time permits, and the time you have depends much 
upon how you plan your work. Young nurses need to 
remember that sick patients are not able to ask for 
things, and it is for the nurses to take the initiative, 
to give the drink of water, turn the pillow, shift the 
sheet, draw the shade, change the position, moisten 
the dry mouth, support the weak knees, or to do any 
of the countless kindnesses that constitute real nursing, 
without waiting for the patient to call. 
Optimism 
Optimism is a virtue that any individual 
may cultivate to his advantage, but a nurse 
must have it. Patients and their friends do not wish 
to see in the sick room a countenance that is depressing. 
For one who does not naturally look on the bright side 
the habit must be cultivated, and it can be cultivated 
if a person is wise enough to realize what an asset 44 
NURSING PROBLEMS AND OBLIGATIONS 
optimism is. There are cheerful things that one can 
think and say always if one wills to do so. Discretion 
must be used, of course. No one likes a person about 
who is perpetually smiling or who is treating every- 
thing as a huge joke. What I am urging is a rational 
optimism. Perhaps I can illustrate by a personal 
experience. 
Soon after assuming a responsible position, I found 
myself beset by criticisms of the pupils, which came 
from the supervisors and the instructors. Unfortu- 
nately for those who are training nurses, a critical 
attitude is unavoidable. The pupils come to learn and 
all their faults must be pointed out, efforts must be 
made to remedy them, and the superintendent must 
be kept informed of these same faults. 
Our office had been under a heavy cloud for nearly 
a week; no great or serious thing had happened, but 
medicine bottles were not returned promptly to the 
apothecary, toast was burned, swathes were not always 
tightly and neatly pinned, sometimes pediculosis was 
not promptly reported. The most insistent complaint 
was that nurses were dilatory in getting to class and 
lecture. 
On Sunday I went out feeling discouraged. It seemed 
to me everything was "going to the dogs." Nurses 
were no longer alert and industrious as they used to 
be! I happened along just as the bells were ringing 
for vesper service at one of our Boston churches, and 
I dropped in to be soothed by the music. That day, if 
the preacher had prepared his sermon for me, it could 
not have been more helpful. I have forgotten the text, 
but after years the sermon remains an inspiration. ETHICS AND THE STUDENT NURSE 
45 
The minister preached about people who permitted 
the defects of their friends or of the community in which 
they lived so to fill their vision that the virtues and 
beautiful aspects of character or of environment were 
totally obscured. 1 went out of church that day with 
a determination never to let myself forget the truths 
I had been listening to. I readjusted my own point of 
view. I could see how unjust it was to expect perfection 
in the first place. If three or four nurses were dilatory, 
why let annoyance with them kill one's joy in the forty- 
four or more who were prompt and attentive? Why 
expect a task without its problems to solve and diffi- 
culties to overcome? Just the effect of that half hour 
illustrates the influence of one mind over another. 
How dull a bright day becomes when some one enters 
your room or office with drooping mouth, gloomy eyes, 
and a tale of hopeless woe! But there is no situation 
so bad but there is a way out. Sometimes a structure 
is so poor that it ought to be torn down, and if it is not 
torn down it will fall down; but if it is needed, it can 
be replaced and reconstructed worthily. 
WThen one becomes so discouraged and depressed that 
he cannot resist the depression, the fault is within 
that individual and not without. He becomes a psycho- 
path and requires treatment as such. So long as we are 
normal, we can and should, for the sake of our work 
and of our associates, look squarely but hopefully on 
all aspects of our work. This philosophy is needed 
by all. The probationer should begin with it and should 
cultivate it all through the evolution of her career, 46 
NURSING PROBLEMS AND OBLIGATIONS 
Social 
Contact 
Ours is a hard task, to conserve our strength 
and individuality without losing the inspira- 
tion and devotion to our vocation that ennoble it. 
Sometimes it is easier to give up everything but one's 
work, to live a hard if short life, than to establish a 
proper balance. There are people who believe a nurse 
should live and dress in a more austere way than other 
young women, and they criticize her as frivolous if she 
is seen in evening dress, or indulging in the ordinary 
diversions enjoyed by the average young woman. 
The nurse, however, can have more influence if she 
takes a reasonable amount of time to meet other people 
in social ways quite removed from nursing interests. 
She is likely to have a saner judgment if she rounds 
out her life with wholesome recreation and a certain 
amount of companionship with people who are inter- 
ested primarily in other things than health and disease. 
Moral 
Strength 
Some people, fortunately for themselves and 
for others, are born with moral strength, 
with well-balanced characters, with good judgment, 
even temper, and discretion. Such people happily have 
little difficulty in walking the "straight and narrow 
path"-their prayer must be for understanding and 
sufficient tolerance for their weaker brethren. If they 
do not become arrogant and self-satisfied, they are 
indeed rare and lovely beings. Most of us are beset with 
wayward tendencies, and it behooves us to "weigh our 
balance with an even hand" and to become acquainted 
with ourselves as soon as possible. 
"A chain is as strong as its weakest link," and one 
unrecognized or serious fault may cause our downfall. ETHICS AND THE STUDENT NURSE 
47 
If rewards are ever to be bestowed, they ought to be 
given to the person who resists and conquers his weak- 
nesses. Puritan theology, I think, is responsible for 
focusing our attention on certain obvious and vulgar 
sins or indiscretions of social origin, without due em- 
phasis on the effects of other sins, such as suspicion 
and bad temper, traits of character which may ruin 
one's usefulness just as truly as the more vulgar faults. 
We should seriously ask ourselves, Are we charitable? 
Are we really truthful and sincere? Can we control 
our temper? What are our besetting faults? 
One may take pleasure and recreation if one is not 
neglecting any duty for the sake of one's pleasure. 
Few things are wrong in themselves; it is the circum- 
stance, the environment or effect or reaction, that may 
make the thing wrong; not wrong for everybody, but 
perhaps wrong for you or me. 
Sometimes strength lies in running from temptation; 
when we cannot escape it, we can well pray for wisdom 
and strength to resist it. Strength grows by resistance 
and weakness increases with indulgence; large tempta- 
tions do not dominate one's life, but small ones are 
always with us. Are you deliberately regardless of 
other people's rights and comforts? Would you borrow 
another person's notebook without permission ? If you 
would and do, you are permitting a fault to flourish 
in your character that is as much a flaw as a worm- 
infested branch is to an otherwise perfect tree. Such 
a fault can be easily corrected. A determination to be 
considerate of others and to be honest with one's self 
is all that is necessary, 48 
NURSING PROBLEMS AND OBLIGATIONS 
Are you indifferent to the rules that govern your 
position ? If so, have you thought that you are setting 
a bad example and are not a good citizen in your com- 
munity, any more than a law-breaking person is a good 
citizen in the state? Would you record a temperature 
which you had not taken ? Would you say you had given 
a medicine or any other treatment that you had not 
given, supposing you felt the patient was really no worse 
for your fault? There may be times when it will be a 
temptation to do so, rather than to accept a reprimand. 
But I want to urge upon your understanding that it is 
better to receive the severest reprimand than to soil 
your honor and to lessen your own self-respect. 
It would be a wonderful blessing to your 
school if you could all determine upon a wise 
loyalty to the highest interests of the hospital. It would 
mean putting your own personal feelings aside if you 
ever found apparent injustice had wounded them. It 
is always easier for most people to seek a confidant 
when anything has gone wrong, but it is wiser to keep 
one's own counsel. Above our own interests we should 
put those of the hospital. And what are the hospital's 
interests? A hospital stands for a great charity. The 
trustees have assumed the responsibility of expending 
in the most efficient manner large sums of money given 
for the benefit of unfortunates. They are men of recog- 
nized ability and integrity. They select the adminis- 
trator of the institution, and he in turn selects those 
who are to carry out the purpose of the hospital. Inci- 
dental to the care of the sick are the education of doctors 
and nurses and the study of disease. Everything that 
Loyalty ETHICS AND THE STUDENT NURSE 
49 
produces friction and distrust between departments 
or between persons or between patients and those who 
care for them lessens efficiency and weakens the con- 
fidence of the philanthropic public upon whom the 
hospital depends for financial support. If that support 
should be withheld, think of the thousands of sufferers 
who would be deprived of the benefactions of the 
hospital. 
First of all let us remember that it is easy to criticize, 
and also that there may be a point of view that we have 
not seen. If we think we have noticed mistakes in those 
above us in official positions, let us be as charitable to 
them as we would wish others to be towards us and 
our shortcomings. At least, let us aim never to be de- 
structive until we have something constructive to 
suggest. Let us always give people the benefit of the 
doubt and put the best construction possible on a situ- 
ation that seems to have more than one interpretation. 
Suppose a doctor should be very cross and unreason- 
able sometimes; instead of thinking he is naturally 
disagreeable and rude, let us assume that he is over- 
strained by hard work, anxiety, broken rest, and irreg- 
ular meals, as probably he is. Instead of meriting our 
dislike, he deserves our sympathy. 
Suppose you think a supervisor is unreasonable and 
unjust; would it be better to credit her with sincerity 
in her criticisms and to try and profit by them, or to 
tell the other nurses and the internes that you think 
she is "horrid," and thereby make them antagonistic 
to her? If you do the latter your annoyance may soon 
fade away, and on better acquaintance or after more 
experience you may change your mind completely con- 50 
NURSING PROBLEMS AND OBLIGATIONS 
cerning the supervisor. But you may have planted in 
the minds of others who lack your opportunity for closer 
acquaintance seeds of prejudice that will grow with 
time and bear bitter fruit. Let us try to be reasonable 
and to be peacemakers, instead of instigators of trouble. 
When misunderstanding occurs, there is probably 
fault on both sides. But it arises chiefly from lack of 
close acquaintance and from a lack of knowledge of the 
necessity for business principles and for certain rules 
and regulations without which an institution would 
soon become disorganized. If they desired to do so, the 
pupils who work so constantly with the doctors could 
do much towards creating a good understanding be- 
tween the medical and administrative departments. 
It takes wiser and older heads than most of us have 
when we are pupils to see and improve our opportuni- 
ties. I can only ask you when the time of temptation 
comes in your own experience to try to be loyal to the 
medical staff and to your training school officers as well. 
Faults they have; but after all, they more than others 
are trying to guard your interests. Remember that it is 
as unethical for you to listen to criticism by doctors 
of other nurses as it would be for one of the doctors to 
criticize to you other doctors on the staff. These are 
situations in which nothing is gained and much is lost 
by criticism. 
We feel that we should be loyal to our school and to 
our classmates; indeed our school and its reputation 
depend upon this loyalty. But what is involved in this 
obligation? Does it mean loyalty to the school, right 
or wrong? Does it mean allegiance to each other re- 
gardless of moral consideration? ETHICS AND THE STUDENT NURSE 
51 
If you were to see another nurse neglecting or 
abusing a patient, or if you knew another nurse was 
guilty of some serious misdemeanor, would you think 
you ought to shield her, or would you report her at the 
office? Ninety-nine out of a hundred would say nothing 
where it would do any good. Why ? Would it be because 
they feel it dishonorable to "tell tales" or to spoil 
another's career, or because they think it is none of 
their business? Or would it really be because they 
lacked the moral courage to do an intensely disagree- 
able duty? What will a diploma profit a dishonorable 
nurse? Why should she be protected? In my opinion 
our duty to our patients, to the reputation of our hos- 
pital, and to our profession looms far ahead of any 
possible personal consideration. 
If an honest nurse sees what she knows as dishonest 
work, it is her duty to have a talk with the offender, 
whoever she may be, unless there is a student committee 
to whom such matters can be submitted; and to tell 
her that if she does not discontinue her discreditable 
conduct, it will be reported to the proper authorities. 
No one enjoys being called a sneak or underhanded, 
and it is much easier, if less noble, to do nothing. It 
takes real courage to do the right thing at the risk of 
unpopularity and possible enmity. A few high-minded, 
courageous nurses, however, could inspire an atmos- 
phere in which dishonesty and cowardice would eventu- 
ally die. 
To my mind, loyalty means using every effort to make 
our own school the best or one of the best in the coun- 
try, and that can be only if our nurses are of a high 
character and of superior intelligence. 52 
NURSING PROBLEMS AND OBLIGATIONS 
Religion 
In hospital work there is a tendency to forget 
that we are not entirely physical beings. 
We get so little time to think of our spiritual needs we 
are scarcely conscious that we have them. It is a sorry 
person, however, that descends to a merely physical 
plane, and our work will suffer if it is not illumined 
by a consciousness of the fact that our patients demand 
not only physical but spiritual and mental care. This 
does not mean preaching or proselytizing, but it means 
that spiritual healing must manifest itself by a per- 
vading atmosphere of goodness, faith, courage, and 
sympathy. How one shall keep her own spirit un- 
dimmed, each must decide for herself; but one must 
not outrage her conscience or neglect what she believes 
to be her duties as regards her religious observances. 
Every one may easily find a church home; every one 
may read her Bible and pray; each must seek for her 
inspiration from the source that yields it. Some find 
it in church, some in people, some in nature, and some 
in books. 
None of us can know all the truth; we cannot all of 
us reach the same plane of spirituality; but we may 
all follow a vision of what seems to us to be God or 
Goodness. The most inspiring and enduring example 
I ever knew was a woman who never preached, but who 
lived her religion. She was a friend of the poor and 
suffering; she bore her sorrows and her physical dis- 
abilities with cheerful resignation. She had patience 
and understanding for those who were less spiritual 
than herself; she shared all her pleasures with others, 
and bore her troubles alone. Dying, she became im- 
mortal in the hearts of all who knew her. ETHICS AND THE STUDENT NURSE 
53 
As we differ in our temperaments, our education 
and inheritance, so must we differ in the externals of 
our religious practice; but surely the working out of our 
religion should result in the same essential attributes 
of love towards humanity and faith in God's good 
purposes. 
TOPICS FOR CONSIDERATION 
Give examples of "physical contact" that are often 
seen but are in bad taste. 
What are the advantages and disadvantages of night 
duty? 
How may one cultivate cheerfulness ? 
Enumerate some of the small attentions that con- 
tribute to a patient's comfort. 
Study your own character for its weaknesses and take 
them into account when planning your manner of living. 
Name the faults of character that are most objec- 
tionable to you. 
Name some habits that may be wrong for some per- 
sons and not for others. 
Name some things that lessen confidence in an insti- 
tution and cause friction between workers. 
Would you rather think a person better or worse 
than he is ? Why ? 
In what ways may student nurses help to create good 
feeling between the administrative, nursing, and medical 
departments ? 
Write a short paper on what you regard as the beau- 
tiful things in the world that offset the ugly things. 54 
NURSING PROBLEMS AND OBLIGATIONS 
Cases for discussion 
Case I. A student nurse living in a suburb of the 
town where she was studying nursing was found to be 
staying out all night without permission, but came on 
duty promptly in the morning. 
What should be done with the nurse in a case like 
that? 
Case II. If a student nurse knows that another nurse 
is unkind to her patients or that she is neglecting them, 
what is her duty toward the patients, the school, and the 
nurse ? 
Case III. A regular night nurse once found another 
nurse (who was specialling an extremely suicidal 
patient), asleep on duty. The special had arranged her- 
self comfortably for a nap. The regular night nurse 
knew that this was not the first offense, and that the 
special was running about daytimes instead of sleeping. 
Under such circumstances what should she have done? 
Case IV. A head nurse off duty was injured by an 
automobile accident, which she said happened when 
she was riding with friends whom she frequently visited. 
Several months later it was learned that she and a pupil 
nurse had taken a patient's car, invited an interne to 
go with them, and had met their accident while riding 
together. 
What discipline should have been administered to the 
graduate and pupil nurses ? ETHICS AND THE STUDENT NURSE 
55 CHAPTER V 
THE STUDENT NURSE AND CO-WORKERS 
The best workers are those who by temperament and by per- 
sonal experience of suffering and loss have come to possess an 
all-around point of view, not merely sympathetic, but deep-see- 
ing-a capacity to arouse as well as to soothe.-Dr. R. C. Cabot. 
One of the chief values of training in a large hospital 
is the opportunity of working with so many who come 
from various parts of the country. It is an education 
in itself to know intimately numbers of persons outside 
one's own particular circle. That the students have 
different religions, have been educated in various schools 
and colleges, have had such varying social experiences, 
makes for a fine democracy if they meet with the de- 
termination to learn from each other and to establish 
harmonious relationships while working for a common 
cause towards the same goal. 
When a school contains self-supporting students who 
are working contentedly with those who are liberally 
supplied with money, and neither class is self-conscious, 
it is a sign that we have got down to reality, where it 
is character and mutual interests that count. It is good 
training for a young woman to have to live on a limited 
income, and if she be brave enough to rise above envy 
or covetousness she will be a stronger and happier 
woman as a result of her self-denial. On the other hand, 
if a girl who might live in luxury and spend her time in 
pursuit of pleasure voluntarily elects to assume hard, 
exacting duties and a simple manner of life for the sake 
56 THE STUDENT NURSE AND CO-WORKERS 
57 
of a good preparation for usefulness, she has qualities 
that mark her as a woman who will leave the world 
better than she found it. 
It pays to look for the peculiar and individual good 
in every one of our fellow-pupils, to keep one's faith in 
the essential soundness of human nature, with all its 
varieties and all its "queerness." We usually find what 
we look for, and our hospital friendships, which are 
based on real knowledge of our friends' characters, 
are among the choicest blessings of hospital life. 
In contrast to the time, not many years ago, when 
the nurse and the doctor were the only conspicuous 
figures in connection with the patient in the hospital, 
we now have the dietitian and the social worker also. 
Each must know something of the other's profession in 
order to minister adequately to the patient's necessities. 
Clinical secretaries and therapeutic instructors are still 
newer creations of our modern system. 
Physicians 
The nurse s attitude towards the doctor 
should be that of helpfulness. It is her duty 
to carry out his prescriptions and directions as faith- 
fully as she knows how. She will seek to understand 
his orders so that she may be intelligent in her observa- 
tions. She will try to be his eyes and his judgment 
when he is not there, so that all that should be reported 
to him concerning the patient may not be neglected, 
and that he may leave the patient in her care with an 
easy mind. She will anticipate his wishes and prefer- 
ences so far as possible. She will also do all in her 
power to establish confidence in him on the part of the 
patient. As a young and inexperienced nurse, she will 58 
NURSING PROBLEMS AND OBLIGATIONS 
not presume to criticize his treatment, even in her own 
mind. She will never criticize it to the patient. 
When she becomes sufficiently experienced to detect 
a mistake, she will, of course, call his attention to it 
by asking if her understanding of the order is correct. 
All are liable to make errors, and where lives may be at 
stake each must act as a check on the other, regardless 
of an old supposition that doctors could not err and 
that a nurse had only to obey orders regardless of con- 
sequences. The nurse is the doctor's assistant, but her 
work is no less responsible than his. His success and 
the patient's recovery often depend upon her intelligent 
interpretation of his orders. She must not allow her 
work to be underestimated. 
The pupil nurse's relation to the doctor in a hospital, 
where both have competent and almost constant super- 
vision, is much simpler than that of the graduate nurse 
on a private case working with a private practitioner. 
The nurse in the hospital always has some one to go to 
with her problems, if her duties to the doctors, the 
hospital, or to the patient seem to conflict. Outside 
there is usually no one. Under these conditions it is 
important that the nurse should keep an open mind and 
remember that different doctors use different methods, 
yet often have equally good results. She must also 
remember that nature, with little or no assistance, may 
restore very sick persons to health. The doctor's work 
and the nurse's work is chiefly to assist nature. 
Social 
Workers 
This new-old work, now called social service, 
that is springing up all over the country, 
humanizing medical work and counteracting the frigid- THE STUDENT NURSE AND CO-WORKERS 
59 
ity of science in its application to the human body, is 
permeating the hospitals, and its spirit is being gradu- 
ally absorbed into the nursing structure. Soon it is 
surely going to be generally recognized as a part of the 
training school curriculum. Social workers are eagerly 
seeking the medical knowledge that will make their 
social work more truly effective, and are making a large 
contribution to the general welfare of humanity. We 
must meet them openmindedly to get and to give all 
that will make the work in which both nurses and social 
workers are interested more effective. 
Non-professional 
Associates 
It is almost superfluous to say that a 
nurse should treat her non-professional 
associates with consideration; if she is able to make 
their work more interesting and their lives happier by 
courteous cooperation, the opportunity should not be 
neglected. A nurse must learn to bear herself so that 
an attitude of friendliness to those with whom she 
works may never be mistaken for personal favoritism. 
Hospital etiquette, with its distinctions between officers 
and subordinates, may be made bearable by courtesy. 
It is the rude chief to whom we grudge recognition of 
his official position. It is the rude and inconsiderate 
nurse who fails to obtain cooperation from the various 
hospital workers. 
Clinical 
Secretaries 
Untrained young women of intelligence 
can relieve the doctors and nurses of much 
clerical and routine work. Managing a clinic so that 
the patients are seen in proper order by the doctors, 
making arrangements for further treatments, etc., are 60 
NURSING PROBLEMS AND OBLIGATIONS 
time-consuming duties that have prevented doctors and 
nurses from devoting themselves to more technical 
tasks. There are altruistic young women who are 
willing to volunteer their services as non-resident secre- 
taries. They make a valuable contribution both socially 
and economically to the hospitals which they serve. 
Therapeutic 
Instructors 
These are also untrained women who learn 
to interpret the doctors' orders to the 
patients about to leave the hospital and see that the 
orders are carried out. If the instructions have to do 
with special or weighed diets, the instructor must be 
a specially trained person. 
The patient's welfare is now looked after in some 
institutions by a group comprising the doctor, who 
diagnoses the patient's physical condition and pre- 
scribes his treatment; the social worker, who investi- 
gates and readjusts, if possible, the social conditions; 
the nurse, who carries out the treatment prescribed 
by the doctor and who may assist both the doctor and 
the social worker in their investigations; and the thera- 
peutic instructor, who may be a lay person or a nurse, 
according to the necessities of the case. 
A recognition of the value of each person's contribu- 
tion to the patient's welfare will eliminate the jealousy 
and friction which occur when the nurses are not broad- 
minded and progressive. 
TOPICS FOR CONSIDERATION 
Why is it desirable to know people from all walks in 
life? 
What do you understand by democracy ? THE STUDENT NURSE AND CO-WORKERS 
61 
Dr. Charles Fleischer, of Boston, says:- 
"Democracy means an equal opportunity for all, ac- 
cording to ability, regardless of race, sex, color, or re- 
ligion." 
Could you agree to that ? If not, why not ? 
What is the difference between a profession and a 
trade? 
What do you think is meant by the statement: " Medi- 
cine is the noblest of professions and the meanest of 
trades"? 62 
NURSING PROBLEMS AND OBLIGATIONS PART II 
TALKS TO SENIOR NURSES 
Don't think that I fail to understand and value that fine 
ethical side of the nurse's career; but in my knowledge that 
fine side of the life is developed out of experience, sorrow, 
struggle, and time. With women as well as with men the 
"noble career" is a thing of painful and laborious growth.- 
"A Doctor's Table Talk," by James G. Mumford. 
There is no higher mission in life than nursing God's poor. 
In so doing a woman may not reach the ideals of her soul; she 
may fall far short Of the ideals of her head; but she will go far 
to satisfy those longings of the heart from which no woman 
can escape.-William Osler. 
63 CHAPTER VI 
QUALIFICATIONS FOR EXECUTIVE WORK 
Never seek for the soft spots or the easy places in hospital 
work; if you get them, you will surely lose golden experiences 
that will be regretted by and by, when the opportunity is gone 
beyond recall.-"Nursing Ethics," by' Isabel Hampton Robb. 
It is time to consider seriously what you intend to 
do after graduation. Every nurse will naturally plan 
to join the nurses' alumnae and state associations. 
You will, it is hoped, always subscribe for and read 
the American Journal of Nursing, which is owned and 
edited by the American Nurses' Association. 
It seems as if every American-born nurse, at least, 
should aspire to enroll in the Red Cross. It is not 
enough to be willing to volunteer one's services at the 
last minute in time of disaster. Knowing the value of 
preparedness, each nurse after graduation should, if old 
enough, put in her application to the local chapter, 
and should be ready in so far as these preliminary 
requirements go to do her part when need arises, if the 
occasion finds her free. 
If you are going to do private nursing, there are 
various ways in which you may go about it. You may 
depend upon the doctors whom you know for cases; 
you may depend upon some popular commercial direc- 
tory to furnish you with calls (by commercial is meant 
a directory run as a means of livelihood to the man- 
ager) ; or if the nurses have established a central direc- 
65 66 
NURSING PROBLEMS AND OBLIGATIONS 
tory which is run for nurses by nurses for their profes- 
sional interests as well as for the convenience of doctors 
and the public, you should register there. 
It may cost you more to support your own directory 
(for the nurses' directory is yours), but you will have 
the satisfaction of doing the professional thing. Until 
nurses manage their own affairs, they cannot hope to 
develop much business ability or to win respect as an 
independent professional body. If we are content to let 
others make rules for us and conduct our affairs, we are 
no better than a parasitic body. We gain independence 
only through experience, and experience costs in time, 
strength, and money. 
Now that nearly every state has examinations for 
registration of nurses, every graduate who wishes to be 
eligible for any of the previously mentioned organiza- 
tions will take the state board examinations as soon 
as possible. She will feel interested in the status of 
nurses in her community; if the law is poor, she will 
prepare to do her part towards getting it properly 
amended. Any nurse familiar with her American Jour- 
nal of Nursing will use its Directory when seeking 
information concerning any nursing organization. 
Necessity 
of a 
Background 
Any artist will tell you that the back- 
ground of his work must be just right or 
his picture will be a failure. It is a thing 
to be considered. The background is not the principal 
part of the picture, but it can spoil it. Its purpose is 
to bring into effective relief the rest of the work; in itself 
the background may be inconspicuous and give no hint 
of the time and thought expended upon it. QUALIFICATIONS FOR EXECUTIVE WORK 
67 
It seems to me that nurses often thwart their object 
of professional attainment by going at their work in a 
haphazard sort of way. Instead of looking ahead and 
considering what each ultimately wishes to accomplish, 
she is too apt to accept what offers immediately after 
graduation, without considering whether that will be 
the best thing in relation to what she hopes eventually 
to do. 
My advice to all seniors is to consider carefully the 
field of possibilities open to them, to estimate their 
own talents and aspirations, and to choose as single- 
mindedly as if there were no question but that their 
lives were to be given to professional activities. The 
possibility of matrimony has wrecked many a career 
by hovering about the young woman, distracting her 
interest and proving in the end to be an illusion. Good 
professional knowledge is not wasted if marriage enters 
a woman's life, and if she does not marry such knowl- 
edge is distinctly an asset. 
If a young graduate wishes to be an executive, it is 
very important for her to have several months' experi- 
ence as head nurse of a ward or as an assistant super- 
intendent in a small hospital soon after graduation. 
This is to establish confidence in herself; otherwise, if 
she does private nursing for any length of time, she 
is often too timid to undertake a position that involves 
responsibility for other people's work. A superintend- 
ent, moreover, seeking a head nurse or assistant always 
prefers some one who has already had some experience 
of that kind. The new graduate, knowing the doctors 
and the customs of the hospital, is more likely to suc- 
ceed as a head nurse than one who has been out of 68 
NURSING PROBLEMS AND OBLIGATIONS 
the school for some time, unless she has already made 
for herself an executive reputation before leaving the 
hospital. 
Her experience before entering the training school 
will make some difference as to the time a nurse must 
spend before advancing to an important position. While 
creating a background, it is desirable to work in more 
than one hospital. It is a remarkable person who can 
do her best work by staying continuously in one place. 
The tendency under such circumstances is to contract 
rather than to expand. It is a good thing to have 
had varied experience for purposes of comparison. For 
those who cannot create or who have not a prophet's 
vision (and the majority are of that class), it is a great 
gift to be able to discern the good points in other 
people's work and to know how to adapt or to graft 
on new methods to familiar systems. We should all 
be eager to exchange ideas. The nurse who wishes to 
"corner" a good method for her own hospital or school 
solely ceases to be truly professional. 
In maturing one's self for one's best work, a nurse 
should remember that from graduation she should keep 
abreast of the professional literature and participate 
in her professional organizations. If one does not keep 
up with history in the making, it is difficult to catch up 
later. The old graduate who does not know one nurs- 
ing organization from another; who could not tell you 
who Isabel Hampton Robb was; who has not helped 
in securing registration; who has no interest in the 
improvement of nursing education, is not the kind of 
executive that is sought for in important positions. QUALIFICATIONS FOR EXECUTIVE WORK 
69 
The nurse who never writes a paper or expresses 
an opinion at the alumnae meetings is not developing 
herself wisely. The best way to prepare for public 
speaking or writing is to get so full of some nursing 
interest that one has to speak for it, and to feel one's 
duty so strongly towards helping the nursing journals 
and nurses' conventions that one must write, no matter 
how hard it seems. Social preparation is often neg- 
lected by the nurse who aspires to hold some day an 
important position. The executive who has the broadest 
usefulness is the one who not only is an expert in her 
own line, but the one who has points of contact with 
the men and women she has to deal with. To hear good 
music, to see good pictures, to travel, to meet other 
people of different professional interests, is to prepare 
one's self for more effective service. The business man 
or woman also can give us ideas, and we need their point 
of view in order to solve many of our own problems. 
Taking 
a New 
Position 
Going to a new position, the wise nurse will 
try to familiarize herself as soon as possible 
with the ways of the place. She will seek to 
learn from those who are there as much as they will 
impart. She will appreciate all that is admirable, and 
will be very slow to criticize or to make changes until 
she has become acquainted with her co-workers and has 
won their confidence. She must not deceive herself by 
supposing that her own methods are necessarily better 
than others. Any receptive person will learn something 
new from every one she works with. 
Caution in making intimate friends or confidants is 
desirable. There is almost always a certain amount 70 
NURSING PROBLEMS AND OBLIGATIONS 
of jealousy and misunderstanding on the part of some 
of the people whom one finds in any established insti- 
tution. If this comes to the surface, usually it is best 
to have a frank talk with the person or persons and to 
endeavor to win their cooperation, if possible. Justice, 
patience, and ability will win in the long run. Even 
if one gets into a seemingly impossible situation, the 
work should be given a fair trial before abandoning it. 
If one can see possibilities for good in the position, 
it is worth a long and hard struggle to overcome the 
obstacles. Sometimes it is a question of educating 
the public, or the trustees, or some reactionary member 
on a board. 
If the nurse understands her problem, however; if 
she knows what ought to be done, and how and why 
it should be done, she can usually persuade the higher 
authorities after a time to let her have her way. Some 
one must be willing to redeem the waste places; and 
a good piece of pioneer work, or a good job of recon- 
struction done, is worth all it costs. When in doubt one 
should not act impulsively, but should take time to 
consult some wise professional friend who is discreet 
and conservative. This precaution will save many a 
mistake. 
Women are apt to expect things to go too smoothly, 
and they are inclined to become easily discouraged 
when they are criticized or opposed. We should try 
hard to build up a wise philosophy and we should talk 
to ourselves sensibly once in a while. Criticism is good 
for all of us; it is wounded vanity that hurts us when 
criticized, but it stimulates us nevertheless. In fact, 
we should do our work for love of the work, and try to QUALIFICATIONS FOR EXECUTIVE WORK 
71 
meet criticism with an open mind; and as for obstacles, 
what work would be interesting without them? 
It is a mistake to stay too long in one place. The 
nurse who leaves her school and puts her education to 
the test among strangers will come back to it, if she ever 
does return to her own hospital, much more valuable. 
The 
Head 
Nurse 
If every ward or separate department could be 
perfectly organized, what a joy institutional 
management would be! More than any other 
one person, the head nurse of a ward has an opportunity 
for influential work. It rests with her whether the 
patients are well cared for and happy (given the ma- 
terials to work with). She can see personally that they 
are met pleasantly when they enter the ward, that 
they are cared for properly by the doctors and nurses, 
and that the ward has a homelike atmosphere which 
will make the patient feel that he is glad to be there, 
if he must be in a hospital at all. 
She can be invaluable to the doctors, bearing in mind 
the things they might forget or overlook, seeing that 
orders are carried out accurately and intelligently, and 
that everything of importance is reported to them. 
When misunderstandings arise between them and the 
administration officers, she is in a position to explain 
to the physicians the reason and necessity for conform- 
ing to hospital rules, and can tell the administrators 
the difficulties that sometimes prevent observance of 
rules. Even a senior nurse has been in the hospital 
longer and has had more experience with the adminis- 
tration of hospital affairs than any interne has had. 
As for the nurses, the head nurse has an opportunity 72 
NURSING PROBLEMS AND OBLIGATIONS 
to embody their ideals of what one in such a position 
should be. She will see, in the first place, that a new 
nurse coming to her ward meets her patients properly; 
that their condition and needs are carefully explained; 
that she is instructed as to the rules of the ward, shown 
where supplies are kept, introduced to the doctors, and 
taught how to do the work that is new to her. An ideal 
head nurse will not scold or criticize her nurses before 
the doctors or patients. She will give the nurse a chance 
to present her side of a story. She will commend what 
is good and criticize frankly all that is wrong in the 
pupil's work. She will hold her nurses to the highest 
standard of excellence that she knows, and will make 
an honest report concerning them to her superior officers 
when such report is due. 
The head nurse will realize that a good hospital is 
a clean, orderly, and well-kept hospital. She will re- 
quire her nurses to use supplies economically, to "pick 
up after themselves," and to keep the wards, furniture, 
and utensils clean. Any nurse who has not learned to 
love orderliness and good housekeeping still lacks much 
of having perfected her education. 
The head nurse who is trying her executive abilities 
for the first time is laying the foundation for her future 
career; everything depends upon how that foundation 
is laid. Her daily and hourly opportunity to work for 
and with all these people who depend upon her accord- 
ing to their various needs may be made a wonderful 
experience by a person who rightly apprehends it. 
Whoever forgets her first head nurse! As I remember 
mine, her image is still as vivid as it was twenty-five 
years ago. Kindly, dignified, courteous, thorough, skill- QUALIFICATIONS FOR EXECUTIVE WORK 
73 
ful, discriminatingly critical, patient in reason, forceful, 
and a splendid teacher; I still feel deeply grateful for 
having had her guidance and supervision during my 
first three months of training. 
The besetting faults of head nurses are the opposite 
of all the virtues I mentioned as characterizing my first 
one. There are those who waste time at their desks 
and with the doctors, to the detriment of patients and 
student nurses. 
The head nurse can and should be entirely loyal to 
all her responsibilities; and the wise head nurse can 
so coordinate them that instead of being conflicting 
elements they will resolve into a harmonious whole. 
Supervisors 
and 
Superintendents 
Usually it is the capable head nurse 
who has been able to direct and teach 
others, who has manifested loyalty to 
the institution and interest in the development of her 
work, and who has the personal and professional 
qualifications that indicate her fitness for larger re- 
sponsibilities who is chosen for the advanced executive 
positions. 
A nurse should desire to give to her work her very 
best ability, and should prepare herself as thoroughly 
as possible. If she is going into training school work 
as superintendent or instructor, she should collect 
the announcements of several of the best schools in the 
country and of those that are similar to the one she is 
to work in. She should, if possible, visit several hos- 
pitals, talk with the superintendents of the training 
schools, see the records, and discuss the problems that 
arise in different schools. 74 
NURSING PROBLEMS AND OBLIGATIONS 
She should join both the National League of Nursing 
Education and her State League, and should have a 
copy of the suggested curriculum issued by the National 
League. Familiarity with the Department of Nursing 
and Health at Teachers College, Columbia University, 
New York City, will be very helpful as a source of 
up-to-date information concerning nursing and health 
matters. She should be familiar with the history of 
nursing and with the lives and names of the more 
prominent men and women who have figured in it. 
Otherwise she cannot bring to her pupils the inspiration 
and knowledge that she owes them. 
An interest in the alumnae activities and ability to 
represent her school outside the hospital are essen- 
tials. A superintendent must be in a position to know 
what her school needs in order to do its twofold work 
of caring for hospital patients and of furnishing theo- 
retical instruction and varied practical experience to 
student nurses. She should be a leader in her own 
sphere, and should take the same share in community 
life that any public-spirited professional woman would 
take. To be too busy to belong to the Women's Club 
or to keep in touch with affairs of vital interest to the 
community is to fall short of her obligations. If the 
superintendent is to be a success, she must select good 
assistants, giving them the responsibility of administer- 
ing the details of her work. 
She must also have rest and recreation enough to 
keep herself in an equable state of mind, so that she 
can administer justice without rancor and can keep 
a serene and buoyant spirit in the midst of all her 
problems and perplexities. QUALIFICATIONS FOR EXECUTIVE WORK 
75 
Her correspondence must be attended to with prompt- 
ness and courtesy. A helpful attitude towards those 
who seek advice and assistance is necessary. Time taken 
to see personally applicants and their friends, as well as 
graduates, will be well spent. Flexibility is a condition 
tn be cultivated; and above everything a faith in the 
essential goodness of all human beings. If a sense of 
humor were a gift to be acquired, it should be placed 
as an essential attribute; but alas! it is a gift of the 
gods, blessing those who possess it, but almost as in- 
accessible to those who are denied it as are the stars 
above us. Still it can be cultivated to some extent, 
provided we really wish to cultivate it. 
When a superintendent can see no further develop- 
ment in the school she is conducting, she should leave 
it-at least long enough to renew her own forces- 
because the limitation lies purely with her rather than 
with the school. The school that does not progress goes 
back. 
Superintendents, like all other graduate nurses, need 
to attend the nursing conventions for the stimulus they 
will get from meeting other women who are working 
at the same problems; it is only a survey of the whole 
field that will show them the relative importance of 
their own sphere of activity and its possibilities. 
TOPICS FOR CONSIDERATION 
Describe in writing the most perfect nurse you have 
ever known, and specify her superior qualifications. 
Who is the editor of the American Journal of Nurs- 
ing? 76 
NURSING PROBLEMS AND OBLIGATIONS 
Why is it assumed that you will join your alumnae 
and other nursing organizations? 
How did the world war demonstrate the wisdom of 
the Red Cross Nurse Reserve? 
Why was Ambrine treatment rejected in this country 
for a long time ? 
Who was Isabel Hampton Robb ? 
Why does general culture help a nurse in her career ? 
What is the relative importance of good housekeep- 
ing and good nursing in a hospital ? 
How may a head nurse teach ? 
What is the relative value of instruction from the 
head nurse and from the class room ? 
Who wrote the "History of Nursing" ? 
How was the Department of Nursing and Health at 
Teachers' College, New York, founded, and by whom en- 
dowed ? 
What do you count as the most important functions 
of a supervisor ? 
Cases for discussion 
Case I. Miss F. went to an institution where she was 
associated with several physicians, one of whom was a 
woman. She very soon became flirtatiously intimate 
with one of the physicians and confidential with a nurse 
supervisor. She criticized and made fun of several mem- 
bers of the staff. For a time she was popular socially, 
but suddenly she found herself completely ostracized 
by the whole staff and learned that her confidences had 
been betrayed by the supervisor, and that the man she 
had been flirting with was engaged to the woman doctor. 
What should the nurse have done before and after her 
exposure ? QUALIFICATIONS FOR EXECUTIVE WORK 
77 
Case II. Miss S. went to a hospital to establish a 
school for nurses. She found a dreadful scandal which 
had extended over some years, associating the married 
chief of staff and one of the nurses. 
In her case, what would you have done? 
Case III. A woman applied to enter a well-known 
nursing school; said she had been in it six months 
several years previously; had left on account of health 
and had done private nursing ever since; had worked 
for the best doctors and had received the usual pay given 
to graduates. She was tired of private work and wished 
an institution position, which she couldn't get without 
a diploma. She could obtain recommendations from 
reputable physicians. 
The school records showed that she had been sus- 
pended from the school and had never returned. 
Should she have been readmitted ? What conclusions 
do you draw from this incident ? CHAPTER VII 
QUALIFICATIONS FOR EXECUTIVE WORK 
Continued 
I learn the lesson of life from a little kitten of mine, one of 
two. The old cat comes in and says, very cross: "I didn't ask 
you in here. I like to have my Missis to myself! " And he runs 
at them. The bigger and handsomer kitten runs away, but the 
littler one stands her ground, and when the old enemy comes 
near enough kisses his nose and makes the peace. That is the 
lesson of life-to kiss one's enemy's nose, always standing 
one's ground.-From "The Life of Florence Nightingale," by 
Sir E. T. Cook. 
Dangers 
of 
Authority 
Nurses in executive positions must beware 
of the dangers of authority. Removed a 
degree from the humanizing contact with 
patients, charged with the responsibility of developing 
"perfect nurses" from human material, conscientiously 
observing every minutest fault, they are indeed wonder- 
ful who do not become unduly autocratic, emphasizing 
too much the defects and too little the virtues of their 
students, placing too much importance on the perfec- 
tion of obvious work, like the housekeeping, and appar- 
ently ignoring the kindly, sympathetic interest of the 
nurses in their patients. If they do not become too 
much involved in the details of their work to see it in 
its larger aspects, they are fortunate. The pressure 
under which superintendents and head nurses have been 
wont to work, and the unreasonable demands that have 
often been made upon them, have in many instances 
almost ruined fine characters and have spoiled good 
78 QUALIFICATIONS FOR EXECUTIVE WORK 
79 
executives. It is absolutely necessary to keep in good 
physical and mental condition in order to perform one's 
duties with justice and foresight. 
The tendency is to rank highest the nurse who accom- 
plishes the ward work most expeditiously; but it is a 
mistake not to reckon with the individual possibilities 
of nurses. Some who are very awkward about manual 
work have mental qualifications that will fit them 
admirably as instructors; and they may excel in many 
important lines of nursing work, although not in the 
least adapted to bedside nursing. There are others who 
never learn to plan their work well when they are re- 
sponsible for several patients, but who do beautifully 
with one. Some of the pupils who are the despair 
of critical head nurses on account of their lack of 
order and ability to do finished work are very suc- 
cessful in private nursing because they are so adaptable 
temperamentally. 
What the pupil does when in the hospital has a great 
influence on the reputation of the institution; but the 
superintendent must never forget that taking good care 
of the patients and making them happy is, in itself, 
not sufficient. The pupil must be so trained and in- 
structed that when she leaves the school she will feel 
satisfied with her preparation for graduate work, even 
after she has measured her acquirements with those of 
graduates from other schools. She must be made to feel 
that her three years have been well spent. 
The fetish of military discipline has exacted many 
a pound of flesh to the detriment of the disciplinarian 
and of the disciplined. Too much hard work and too 
much authority have often been associated with ad- 80 
NURSING PROBLEMS AND OBLIGATIONS 
ministrative positions and have denuded them of their 
legitimate attractions. 
Privileges 
of 
Authority 
Yet these positions have great compensa- 
tions. Every new class is a fresh interest. 
Watching the development of the student 
nurse to graduation and helping her to start her career 
is an experience that makes life worth living. 
The wise superintendent will stand ready to advise 
and assist graduates in finding congenial occupation 
according to their best abilities, and if a failure is made 
in one position, to help the young graduate to restore 
herself in another. 
A great effort should be made to keep in touch with 
the graduates of the school, both for the good of the 
graduate and even more for the benefit of the school. 
It is doubtful whether our schools of nursing have ever 
quite appreciated the advantages to them of a devoted, 
loyal body of graduates. What the graduate is and 
does makes the reputation of the school. The graduates 
should always find a true friend in the superintendent 
of nurses. It is desirable to have some definite time 
when graduates may find her in, and the hospital may 
wisely extend its hospitality to the alumnae for a reunion 
within its walls every two or three years. In this way 
the nurses may see the changes that have taken place, 
may attend clinics and lectures that have been prepared 
expressly for them, and if room can be made in the 
dormitories so that they may stay over night, they will 
really feel that they are home again. 
From the very first the pupil nurses should be en- 
couraged to take a personal interest in their school. QUALIFICATIONS FOR EXECUTIVE WORK 
81 
If each class leaves behind some present of beauty and 
permanence in the hospital or nurses' home, the members 
will enjoy seeing it when they return. Such generous 
and friendly tokens build up associations and create 
an atmosphere that brings cheer and comfort to the 
student nurses. 
There is a tendency on the part of most people to 
tax unnecessarily the moral strength of nurses, and 
they are often forced into needlessly hard situations 
both by superintendents and by doctors. We have 
found that the nurse must be taught to protect her- 
self, if she is to be protected, and that the superintend- 
ent of nurses is the one who should prepare her pupils 
for what lies before them. Wherever duty really calls 
a nurse, it is safe to assume that strength will be given 
her to meet her responsibilities safely. But it should 
be remembered that nurses are human beings, and 
that although they usually have high ideals and much 
knowledge of life they are not unsexed. 
They are, if normal, just as susceptible to luxury, 
to attention, and to affection as are other young women. 
When far away from home and friends, when weary and 
overstrained, perhaps they are more susceptible than 
others. Consequently they should be taught to avoid 
situations where they may be tempted to indiscretions 
beyond their power to resist. 
It is doubtful if many young women under twenty- 
five ought to do private nursing, with all the uncertain- 
ties of the situations in which they may be placed. A 
well-conducted institution, where they will have some 
oversight and a chance for a fairly normal existence, 
with its quota of rest and wholesome recreation, or 82 
NURSING PROBLEMS AND OBLIGATIONS 
almost any other line of nursing work, so long as their 
living conditions are right, will be better for the very 
young graduate. 
The necessity for discipline is gradually 
disappearing from the schools where the 
pupils are carefully chosen. The well-bred, self-respect- 
ing young woman will wish to conform to reasonable 
rules except when under the stress of unusual tempta- 
tion. The kind of young woman who needs much dis- 
cipline ought not to be in the nursing profession, yet 
many such candidates are recommended to take up 
training by anxious parents or interested family doctors, 
because it is believed that the hospital discipline will 
be beneficial. 
There is the automatic discipline of the necessary 
routine of hospital life, which is undoubtedly in itself 
of great benefit. Regularity of habit, obedience, pre- 
cision, accuracy and concentration must be practiced 
by a nurse. 
Discipline should be of permanent value, and not the 
kind that produces simply superficial conformity to 
rule; to exercise it wisely is the despair of most super- 
intendents who cherish high ideals of responsibility to 
their students and to their profession. In the first place, 
we should ask ourselves what we mean by discipline; 
what we wish to accomplish by it. Do we, when annoyed 
or offended, wish to punish and hurt for the sake of 
hurting and to relieve our own feelings, or is our object 
to bring the offender to a realizing sense of the flaws in 
her conduct and to create in her a feeling of remorse 
and a real desire to do what is right? If the latter 
Discipline QUALIFICATIONS FOR EXECUTIVE WORK 
83 
is the purpose, she must not be humiliated and an- 
tagonized by a harsh correction before other people. 
She should be talked to frankly and severely, if the 
offense warrants it, but usually when alone with the 
superintendent. 
There are exceptions, however, when a fault must be 
quietly spoken of before the patient, rather than later, 
because we must show the patient that certain things 
are not countenanced by the officers. But the correction 
should never be made with temper, or the effect will be 
counteracted by loss of respect for the one in authority. 
It is best not to wait too long after a mistake has 
happened or a misdemeanor has been observed before 
speaking about it. Accusations should always be veri- 
fied and the nurse be given an opportunity to make an 
explanation of a seemingly culpable circumstance before 
she is reprimanded. It is most important for the super- 
intendent to establish a reputation for justice; she will 
never do so if she listens to one side only or trusts 
entirely to her own observations. Due allowance should 
be made for individual peculiarities and temperament. 
It is absurd to expect the same reaction to hospital 
life from a petted only child and from a girl who may 
be one of a large family where she has taken responsi- 
bility and is already seasoned to hard work and self- 
sacrifice, although some of the former class do adapt 
themselves readily to responsibility, rules, and regula- 
tions. We cannot hope to get a school made up of 
perfect beings; certain faults, one might say, are inevi- 
table, or at least they are to be expected. We must 
expect to struggle with nurses to correct their de- 
ficiencies as we were struggled with ourselves. 84 
NURSING PROBLEMS AND OBLIGATIONS 
Nurses as a class will bear comparison with any other 
class of people, and until they are found unfit for the 
profession they have chosen, it is the duty of those who 
supervise and instruct them to work patiently and 
hopefully to help them correct their faults and also 
with an eye of appreciation for their excellencies. If 
possible, the student must be made to discipline herself, 
to recognize the fault in herself; and that inspiration 
should be given which will cause her to do right because 
she wishes to do right. If she conforms to hospital re- 
quirements only through fear of expulsion, she will 
probably relapse into objectionable ways as soon as 
she receives her diploma. 
When a nurse has made a favorable start in a training 
school and her work is found to deteriorate instead of 
improving, or if her deportment is less satisfactory, 
it is well before reprimanding her to find out whether 
she is in usual health or whether she is working under 
some strain that the superintendent may not know 
about. It is often found that flagging interest, enthusi- 
asm, and loss of efficiency are due to fatigue, or to 
loss of sleep, itself the result of some private anxiety. 
A short vacation or an encouraging, sympathetic word 
may do much more than criticism. 
Hospital life is so different from home life that it 
takes time to conform to all its varied demands. There 
is no other work where so much is expected of the 
worker. She is subject to criticism as to her appear- 
ance, her voice, her manner, and, in fact, there is noth- 
ing about her that some one does not criticize. The 
very restraint and tension under which she works so 
much of the time tend to produce a reaction to license QUALIFICATIONS FOR EXECUTIVE WORK 
85 
in deportment when she gets out of the wards. It is 
all to the credit of nurses that as a class there is so little 
to criticize. Unnecessary rules and restrictions should 
be abolished. Life as we find it in the working world is 
hard enough. Conforming voluntarily to the life of the 
institution and school, accepting the responsibilities 
of the work consciously and conscientiously, will entail 
practically all the discipline that should be necessary 
for the development of character. 
There are many ways of trying to produce right living, 
which means a kind of living that looks after the best 
interests of all. Many things, perhaps, that society does 
not permit us to do might be right enough in them- 
selves, but are inexpedient because they would be dis- 
turbing to the community. For instance, supposing one 
of you may be able to do with four hours' sleep in the 
twenty-four; perhaps you would like to get up at four 
o'clock in the morning and practice on the piano or 
some other instrument. There would be no crime in 
doing that, but it would be inconsiderate towards all 
those who are getting their best sleep at that hour, 
and it would likewise be inexpedient for any one to 
try it I 
Fortunately that inclination is so uncommon we do 
not have to guard against it, but we do have to protect 
ourselves from those who would like to take baths after 
ten o'clock, and otherwise disturb the peace between ten 
and twelve. We could lock the bathroom doors and 
put out all the lights at ten. In fact, that has been done 
in many places; but is that method as desirable as it is 
to inculcate in each member of the institution family a 
desire to be a good member, who prefers not to be 86 
NURSING PROBLEMS AND OBLIGATIONS 
a nuisance in the family and who will therefore volun- 
tarily refrain from practices that are disturbing? 
Prison bars are unpleasant reminders of our unlawful 
citizens, and they are so provocative to insane people 
that civilization has done away with them in the best 
hospitals for the insane. Although there are still people 
who would rather be compelled by rules and punish- 
ment and bars to be good, the best goodness is of the 
voluntary kind demanded by one's own conscience. 
The best discipline is self-inflicted discipline. The best 
community is the one governed by the fewest laws. 
A nurse should not be disgraced by expulsion unless 
she is found in some flagrant fault. 
There are gross moral offenses that merit expulsion 
about which there can be no question. Insubordination 
must meet the same fate, for an order once given must 
be obeyed unless there is good reason for reconsider- 
ing it. Cumulative inefficiency, a repetition of errors, 
and persistently frivolous conduct are sufficient excuse 
for requesting the withdrawal of a nurse from a school. 
Suitable punishments for minor offenses are hard to 
find without descending to childish or vindictive 
methods, which do more harm than good. With nurses, 
as with children, idle threats are worse than nothing, 
and a monotony of scolding will finally be taken as a 
matter of course. 
It is safe to exclude any punishment that is obvious 
to the patients, for whom everything should be made to 
go smoothly, such as taking away the uniform or cap. 
Loss of privileges within reason or the imposition of 
fines may serve, and if the fines are used for the benefit 
of the school the effect is entirely salutary. A report QUALIFICATIONS FOR EXECUTIVE WORK 
87 
to the parents or guardian is sometimes more effective 
than anything else. 
Some will say, "Is this all that can be done when a 
nurse has made a mistake or has been neglectful, rude, 
or insubordinate?" A good nurse will feel badly enough 
if she has made a mistake not to need extra punishment. 
If she is allowed to go on with her work, she should 
show that she appreciates the seriousness of errors; 
and if it is her first mistake, though a very serious one, 
and if her record is otherwise good, she should not be 
suspended. The mistake should be recorded, and if other 
errors follow it may be necessary to ask her to with- 
draw from the school on the ground of general ineffi- 
ciency and lack of ability to improve. 
Any discipline that leaves a feeling of injustice and 
resentment to smolder in a pupil's mind makes of that 
pupil many times an indifferent alumna. If criticism 
is just and is administered with candor and dignity, 
pupils may be relied upon to appreciate it in the future, 
if not immediately. There is no good reason why 
student nurses should not be made to feel that their 
teachers are also their friends. It is a good thing to 
rank a nurse on her habits of punctuality, neatness, 
and observance of rules, especially if the nurses are 
working for scholarships. It pays sometimes to make 
an effort to show the pupil your own point of view. The 
easy-going head nurse or superintendent is not the one 
who is remembered with affection or respect. A high 
standard, maintained with justice and tempered with 
mercy, will produce the most satisfactory results. 
The greatest mistake that was made under the old 
system of military discipline was to administer as severe 88 
NURSING PROBLEMS AND OBLIGATIONS 
a reprimand for some comparatively trivial fault as 
for one that was vitally serious. Every nurse recog- 
nizes that the minor mistakes of internes or of the staff 
do not bring public rebuke, nor is the offender often 
made to sacrifice his career, as used to be the fate of 
nurses when mistakes were reported. 
Training schools should be self-governed schools. 
Unfortunately it taxes students with responsibility 
when off duty, and hence it would be easier to throw 
the responsibility of government upon the officers of the 
school. But the compensation for the difficulties of 
student-government is in moral growth and in a point 
of view that faculty-governed students lack. The feel- 
ing of self-government should blend itself with loyalty 
to the hospital and should extend into the wards. Such 
a sense of pride in the integrity of the student body 
should exist that a dishonest nurse should find it impos- 
sible to remain in the training school. 
Records 
After a nurse has graduated, it should be 
possible to find her complete record as to 
practical and theoretical work, deportment, personality, 
etc. The record of theoretical work should give the 
subject and hours devoted to it, also the method em- 
ployed, whether recitation, lecture, or laboratory. 
There is a difference in opinion as to whether her 
faults or misdemeanors should be recorded, some believ- 
ing that an injustice might be done the nurse later on 
and no allowance made for development and change. 
I feel that it is a great mistake not to record reasons 
when nurses have been suspended or discharged from 
the school or when they have been allowed to withdraw. QUALIFICATIONS FOR EXECUTIVE WORK 
89 
Any one referring to the records later can use her dis- 
cretion as to the value of such facts as may be disclosed. 
To record favorable data is also equally helpful and 
important. 
Nothing is of greater importance to every phase of 
nursing work than concise, accurate, and complete 
records. Even the nurse in private practice who keeps 
records of her cases for personal use will find them 
invaluable if she is ever called to the same patient twice. 
A successful nurse who was called for the second time, 
after ten or twelve years, surprised and pleased her 
patient very much by remembering her personal tastes 
and prejudices, which the nurse was able to recall by 
referring to her carefully preserved notebook. 
For institution work the card system can be adapted 
to all uses. The data concerning nurses and all em- 
ployees should be accessible, and should contain all 
important information concerning each person and his 
work. It should be possible at any hour to get infor- 
mation concerning the pupil nurse. Statistics and 
written observations concerning one's special work in 
whatever field may become valuable as they accumulate. 
Some important truth may be disclosed by a record of 
intelligent observations. Statistics may be made vividly 
interesting and are the searchlights that we turn on 
our obscure problems. Nothing is so convincing. Many 
a case has been won by the presentation of statistical 
facts which prove the argument. 
TOPICS FOR CONSIDERATION 
There are hospitals where women nurses are required 
to take entire care of male patients, including prepara- 90 
NURSING PROBLEMS AND OBLIGATIONS 
tions for G. U. operations and catheterizations. There 
are physicians who say a nurse should care for such 
cases habitually. 
What is your opinion, and why ? 
What faults have you observed among nurses that 
cause discomfort to the student body? 
What would you suggest as a remedy ? 
What are the principal faults you have observed 
among your superior officers ? 
What treatment do you think a student nurse de- 
serves who deliberately disregards the rules that make 
for comfort in the nurses' home? 
What do you consider the weaknesses of student 
government ? 
What are the usual complaints from the nurses con- 
cerning the following hospital departments: Staff? 
Administration? Kitchen? Laundry? Pharmacy? 
What complaints may these departments justly make 
concerning the nursing staff? 
Could you suggest satisfactory adjustments between 
the nursing staff and other departments? 
What are justifiable grounds for suspension or dis- 
missal of a nurse ? 
Why is it better to ask for a student's resignation 
when possible than to dismiss her ? 
Name justifiable disciplinary methods. 
What should be the effect sought when administering 
discipline? 
Cases for discussion 
Case I. Graduate nurse in a middle-aged professor's 
family. Wife a chronic invalid. Family admits nurse QUALIFICATIONS FOR EXECUTIVE WORK 
91 
to intimacies of home life. Professor asks nurse one 
evening before family if she will give him massage for 
lumbago. When in his room he made improper advances 
and proposals. Later begged her pardon and promised 
there should be no recurrence of scene if she would 
continue to stay in the family. 
What should she have done ? 
Case II. A nurse was called from the directory late 
one night to a prominent hotel. Patient was a man 
guest. Nurse found him partially dressed and smoking. 
He said he didn't need much care-had engaged the 
room next to his for nurse so she need not be up all 
night. Nurse went to her room, which he had engaged, 
locked herself in, and stayed there until morning. 
Do you approve of what she did ? If not, why not ? CHAPTER VIII 
SPECIALIZED NURSING 
There is benevolent and noble work that has been done by 
men and women. There is hard work that has been done 
by men and women. Of all these, my friends, nursing is the 
noblest. Of all these, nursing is the hardest.-Baron Ozawa. 
The Private 
Nurse and 
the Patient 
Ordinarily the nurse is caring for a patient 
under a doctor's supervision, which is 
more or less constant, according to the 
condition of the patient and the doctor's confidence 
in the nurse. Sometimes her responsibilities are tre- 
mendously important, involving crises where life and 
death are at stake. It is almost superfluous to say that 
the nurse should enter into her part of the work with 
all her sympathy and intelligence. Her first care should 
be the comfort and well-being of the patient; her second 
should be an earnest effort to supplement the doctor's 
skill with all the knowledge she can bring to bear on 
the case. She must remember that doctors differ as 
widely as possible in their methods of treating the same 
disease, and instead of doubting the efficacy of a method 
deviating from those she has observed, she should 
neglect nothing that can help make the physician's 
work a success, and should watch with interest the 
result of his efforts for the patient. Personal feelings 
should be left at home; the nurse exists for her 
patient while on duty, and her care of herself should 
be that which will enable her to do her work to the best 
advantage. 
92 SPECIALIZED NURSING 
93 
It is well for the nurse to remember that the mental 
condition of the patient is a most important factor. 
Hence she should work as if recovery were the only 
possibility for him; she should try quietly but definitely 
to create an atmosphere of hopefulness; and whatever 
problems present themselves in connection with her 
cases, she should always take into consideration the 
effect of her decisions upon the patient. Whatever 
solution would be detrimental would probably be contra- 
indicated. 
The patient's faith in the doctor is another important 
factor in recovery, and the nurse must try to foster that 
faith as long as she stays on the case. There are rare 
instances when the nurse knows that this faith is not 
justified; but when she can no longer cooperate sin- 
cerely with the doctor and believe that her work is for 
the patient's advantage, she should withdraw. 
There are those who say that so far as the nurse is 
concerned the doctor is always infallible; that whatever 
may be the result of his orders, even if he makes an 
obvious mistake, the nurse is not responsible for the 
result so long as she carries out his orders literally. 
Such teaching is, of course, an insult to intelligence. 
If trained nursing means anything, it means educated 
observation and carefully considered opinions. A ma- 
chine does not need brains; it is created by brains and 
is useful when skillfully manipulated. But a nurse 
should aim to be something better than a machine, and 
when she gives her loyalty it should be given with the 
consent of her intelligence. 
A wise nurse will not judge a physician hastily and 
will always remember that, whatever her training as a 94 
NURSING PROBLEMS AND OBLIGATIONS 
nurse has been, she has not been trained as a physician. 
Occasions in which a nurse might be justified in refus- 
ing to work with a doctor would very rarely have to do 
with diagnoses and seldom with medical treatment; 
they are the unfortunate instances in which a man has 
degraded his high calling and is dragging it in the mire, 
either through ignorance, greed, or moral obliquity. 
Fortunately there are seldom times when a nurse 
cannot seek advice from some one who she knows is 
experienced and trustworthy before she makes a decision 
that might not only have serious consequences for the 
patient, the doctor, and herself, but that might also 
be both unwise and unjust. 
In her relation with a patient, a nurse may easily 
err in taking the view that devotion means always 
doing everything possible for him regardless of other 
considerations. Such a nurse working without discre- 
tion may easily do more harm than good. Convalescence 
is the time when the inexperienced nurse is most likely 
to err. This is a period in which some patients easily 
become demoralized. The nurse should remember that 
the patient must be brought along to the place where 
he may safely wait upon himself and assume his habitual 
activities. The patient must not be allowed to become 
dependent upon his nurse, so that when the nurse leaves 
there is going to be a reaction and a painful period of 
readjustment. This situation is most likely to occur 
with a woman patient. 
The relation between nurse and patient should always 
be kept a wholesome one, whether it exists in a hospital 
or in a family. When sentimentality enters into the 
relationship, efficiency is banished, and the consequences SPECIALIZED NURSING 
95 
may be serious for both patient and nurse. In families 
nurses must be particularly careful that all their rela- 
tions with the men in the family are simply profes- 
sional. It is a common subject of jest that nurses often 
marry their patients, and when it does occur there may 
be serious cause for criticism. 
When people are ill and dependent, a nurse should 
understand better than any one else how feelings of 
interest and affection may develop in the unusually 
intimate relations that the situation imposes. If the 
nurse finds herself reciprocating, she as the well person 
must remember that the feeling may be transient on 
both sides, and she should control the situation by abso- 
lutely preventing any personal element entering their 
professional relations. In a hospital there is little 
danger of this kind, but it may more easily be a com- 
plication in private work. 
Moral 
Problems 
When a nurse finds herself in a family whose 
morals may be questionable, she should re- 
member the text, " Judge not, that ye be not judged." 
She has gone into the family with a certain duty to 
perform; it is a temporary relationship; and so long 
as the nurse herself is not inveigled into wrongdoing, 
it is scarcely possible to conceive of a situation where 
she would be justified in giving up her case. To illus- 
trate, a nurse was sent to a family to care for the wife, 
who was critically ill. She heard outside that the 
couple were not legally married and she left the case, 
although she had not seen or heard anything in the 
house to corroborate the rumor. This, I think, was a 
mistake. 96 
NURSING PROBLEMS AND OBLIGATIONS 
Nurses are criticized sometimes because 
in private practice they refuse to do many 
things that the family expects of them. On the other 
hand, they are sometimes criticized by other nurses for 
doing many things that are not strictly nursing duties. 
The conscientious young nurse may well be puzzled to 
know what to do or what not to do. In the first place, 
she must realize what her position is in a family. It 
is similar to that of a governess. If she be socially and 
intellectually the equal of the family, she is not there 
as a guest and should not expect to be treated like one. 
She is there to nurse some sick person back to health, 
to be a help and comfort in the family. Just how best 
to accomplish that end circumstances must determine. 
If the patient is too ill to be left, some one must wait 
on the nurse. If not, she should expect to wait on 
herself, unless she is told that the family prefer to have 
the servants fetch and carry for her. She should try 
never to be an added burden, and she should never con- 
sider any service menial that conduces to the patient's 
peace of mind and that tends to his recovery. 
The nurse should not object to eating at a second 
table or to having a tray. If asked to eat with the 
family, circumstances should deterinine the wisdom 
of doing so. It may be easier and pleasanter when the 
family are by themselves and the patient can be left 
alone. If there is company, it is often best that the 
nurse should voluntarily ask to be excused, as her 
presence may be distinctly incongruous. The nurse 
should never feel hurt or offended if not asked to the 
family table, for since the meal time is a time of social 
reunion and relaxation for the family, it is not strange 
Miscellaneous 
Problems SPECIALIZED NURSING 
97 
if they are more at ease and happier without a stranger 
to consider. 
As for rules of conduct, it seems impossible to make 
them. Conditions differ so in every case that the nurse 
has to rely on her common sense, tact, social experience, 
and judgment. The hardest place for the nurse is un- 
doubtedly the home of the very wealthy, where class 
distinctions depend upon wealth or on whether or not 
one works for a living. The technical part is not diffi- 
cult, because the nurse has everything she requires to 
work with; but if she is unsophisticated, she will 
probably have a hard time in maintaining her self- 
respect and running a safe course with the servants. 
Unless her patient's demands keep her busy all the 
time, she will need to have her own resources, for the 
idle nurse sitting about is the one who gets into diffi- 
culties of various kinds. 
Nursing 
and Domestic 
Work 
Whether the nurse should assist in the 
domestic work of the home or not also 
depends entirely on circumstances. It is 
inconceivable that a real woman could see important 
things neglected that she could do, simply because they 
were not her particular work. Anything that needs to 
be done, that she can do, she should be glad to do. But 
that domestic work, outside of the sick room, should 
be regularly a part of her duties is as unreasonable as 
if the patient should expect the doctor to put coal in 
the furnace if it needed attention during his visit. NURSING PROBLEMS AND OBLIGATIONS 
98 
The 
Nurse's 
Compensation 
A common and gross fallacy is the idea 
that private nurses are very well paid. 
Considering their preparation, their re- 
sponsibilities, the amount of time they give to their 
patients, the irregularity of their work, and what other 
workers ask for their services, they are not well paid. 
The seamstress gets nearly as much for eight hours' 
work of an inexpert kind; the plumber and painter 
get more for an eight-hour day; and they all work on 
materials that cannot be compared in value to the object 
of the nurse's care. 
All nurses realize that it is almost impossible for a 
person of moderate means to pay for their services for 
any length of time, and it is a poor type of woman who 
will not try very hard to make the burden as light as 
possible in these families. In an ordinary case the com- 
mercial side of the relation should be forgotten until 
it is time to present the bill, and then a fair charge 
should be made, taking into consideration the patient's 
financial condition, the character of the service ren- 
dered, the personal necessities of the nurse, and the 
customary rates. In some localities it is the custom of 
nurses to charge a certain rate per week for services, 
or so much per day for any time less than a week, with 
an extra charge for car fares and laundry. These extras 
are a source of considerable dissatisfaction on the part 
of the patients, because of the various and uncertain 
charges made by different nurses. Unfortunately the 
complaints do not go to the nurse, but are taken to 
the doctor and by him back to the schools or nurses' 
registries. SPECIALIZED NURSING 
99 
If all these minor matters could be adjusted so as to 
make the nurse less an object of gossip and criticism, 
she would gain much in dignity. A nurse knows what 
her incidental expenses usually are; she should know 
what she can afford to work for; and it would be better 
if she asked an amount that covers what she believes 
to be fair compensation for her services and kept her 
incidental expenditures to herself. Any nurse who 
works chiefly for the mercenary advantages to be gained 
will lose out eventually in soul-growth and all those 
things that are really worth while. 
Temptations 
There are many besetting temptations for 
the private nurse. If she is successful, 
she is apt to spend most of her time in the homes of 
the very rich. Surrounded habitually by luxury, it is 
strange if she does not eventsa'lhf'ber^djpe dependent 
upon it. Unless she reali^e;§ ''danger and takes 
especial pains to keep herself in simple, wholesome ways 
of living when she is off duty, she may find herself later 
a bitter, dissatisfied, extravagant woman. 
Presents 
Through a mistaken sense of kindness, pa- 
tients often embarrass nurses by offering 
them presents of wearing apparel as well as of money. 
The inexperienced nurse may not know how to refuse 
them without hurting the patient's feelings. Money, 
if given as pay for services well rendered, does not 
demoralize any worker, but is an incentive to better 
work. But if given simply as a present, when no return 
can be made by the nurse, it is in doubtful taste. 100 
NURSING PROBLEMS AND OBLIGATIONS 
Of course no hard and fast rule can be made to meet 
all occasions of this kind, but the nurse must realize 
that the jealousy of servants and various dissatisfac- 
tions might easily result in a household from the custom 
of receiving gifts when bestowed as "tips." In good 
training schools a wise rule forbids nurses and em- 
ployees to receive presents from patients. Back of it 
are excellent reasons which do not need to be stated 
here. Grateful patients can find graceful ways of show- 
ing their appreciation of the nurse by remembering 
her at Christmas time, if their regard endures until 
then; and a remembrance coming in that way would 
undoubtedly give pleasure to any recipient, without 
making her uncomfortable in accepting it. 
When hospital patients or their friends insist on 
leaving money for the nurses, the hospital authorities 
let them give df tp ,thp- school in a way that will be of 
general benefit.^ »Wh| should not private nurses, who 
do not wish to repulse the generous intentions of their 
patients, guide them into the very worthy and legitimate 
channel of offering something to the hospital or school 
from which the nurse graduated? A free bed in her 
name, a gift to the Nurses' Loan or Endowment Funds, 
would be a beautiful token of the patient's apprecia- 
tion, while his respect and regard for the nurse would 
be increased if she refused these gifts for herself. 
A Sliding 
Scale of 
Charges 
It surely seems reasonable to believe that a 
nurse who has been in private practice for 
some time, who is in constant demand, who 
works for the most successful doctors, must be worth 
more to her patients than the less experienced or less SPECIALIZED NURSING 
101 
well-endowed nurse. If so, why should not such nurses 
increase their rates according to the demand for their 
services? One of the most discouraging facts in con- 
nection with private nursing is, that as one grows older 
and has less vitality for constant work there is nothing 
to look forward to. Experience does not give the nurse 
any pecuniary advantage, as it does in other occupa- 
tions; and the life is apt, if followed many years, to 
unfit her for other kinds of nursing work. 
Organization 
The status of private nurses as a class 
is not what it could be if nurses who are 
doing private work would get together, work for the 
elimination of unethical practices among nurses, and 
manifest their disapprobation of those who deliberately 
degrade their profession. The substance of their experi- 
ence and the solution of their problems should be avail- 
able for younger and less experienced nurses. As it is, 
in the mind of the public, the private nurse stands on 
her individual merit. Many are respected and loved; 
all are valued for their technical knowledge; but as a 
class, though they are considered necessary, they are 
often dreaded and not always respected. 
Nurses are not alone to blame for this condition. 
Society at large is partly to blame, because it has not 
studied the nursing situation, or concerned itself with 
the schools of nursing, or demanded high standards of 
education, refinement, and instruction. The condition 
under which nurses work and live in many hospitals 
is demoralizing. In fact, if we bring our patients and 
their friends into some of the so-called schools, and show 
them under what conditions the nurses work and live 102 
NURSING PROBLEMS AND OBLIGATIONS 
and how little time and opportunity are given for their 
social and ethical development, none will wonder that 
there are so many nurses in the field who fall far short 
of the ideal represented by Florence Nightingale. 
If unreasonable perfection is expected of the nurse, 
we can remember what Dr. James G. Mumford said in 
"A Doctor's Table Talk": "I often think that on account 
of the almost incredible intimacy which must exist 
between nurse and patient, the position of a nurse in 
private practice is one of the most difficult positions 
conceivable. Two young sisters, or husband and wife, 
are more intimate, but with these exceptions compar- 
isons cease." 
And if the situation is hard for the nurse, even though 
she is trained for it, how much harder is it for the 
patient and the patient's family, upon whom the rela- 
tion is thrust by misfortune I 
To adjust the difficulties that now exist, we require 
the combined wisdom and help of doctors, patients, and 
nurses. All need education, for when things go wrong 
the fault cannot be attributed solely to one cause or to 
one source. 
Benefits 
by the 
Way 
In the field of private nursing there are 
opportunities for all the talents and all 
the virtues ever possessed by any nurse. A 
woman who has the spirit of helpfulness in her heart 
and can see all the opportunities in the homes where 
she goes is a source of strength and comfort. She is 
sure in the course of time to make rare friendships, 
and if she appreciates choice things in the way of art 
and beauty that wealth can buy, she may get a liberal 
education by studying her surroundings. SPECIALIZED NURSING 
103 
She should try to understand the point of view of 
her private patients in connection with their heredity, 
environment, and education, just as she did that of her 
ward patients in the hospital. She will get more real 
satisfaction from her work if she looks at them all, 
regardless of environment, as people-people in trouble, 
whom she wishes to help. 
The 
Public Health 
Nurse 
If the nurse, during her training, has not 
been educated for this branch of work, 
she should take a post-graduate course 
of at least four months. She needs to know more of 
community needs, of municipal and household sanita- 
tion, of sociology and the sources of relief, and of public 
health agencies than the ordinary training gives, if she 
is to be entirely successful in this work. Such a nurse 
must love people, must have optimism, sympathy, tact, 
and great persistence. She should not only read the 
American Journal of Nursing and belong to the state 
association for the sake of keeping in touch with nurs- 
ing affairs in general, but she should subscribe for 
the Public Health Nurse Quarterly and belong to the 
national and local public health associations. She 
should attend the conventions, should visit other health 
organizations, and should be well informed in her own 
line of work. 
The 
Surgical 
Nurse 
She who would specialize m this branch 
should seek to make herself an expert. To 
be thoroughly competent, with the ability 
to improve her department, she must make opportuni- 
ties for visiting other operating rooms than those in 104 
NURSING PROBLEMS AND OBLIGATIONS 
which she has had her training. She should know what 
other experts are doing and should read the literature 
that pertains to operating room work. She should be 
on the watch constantly for opportunities to improve 
her technic. 
When a surgical nurse is going to take a new position, 
she is wise if she takes pains to find out what surgeons 
she is to work with and what their preferences are in 
regard to preparations, needles, and sutures. The nurse 
who anticipates these things has a great advantage 
over the one who waits to be told about them, or who 
assumes that she will introduce the customs in which 
she has been trained. It may be that she will be asked 
to do so, and she may or may not find that by compar- 
ison her methods are superior; but she should be very 
sure of her judgment before she offers criticism or 
suggestions. 
Mental 
Nursing 
There are neglected fields of nursing which 
you should carefully consider. The most im- 
portant of these is in the hospitals for the insane. 
It is probable that there is less interest in and more 
need of good mental nursing than of any other branch. 
The highest order of intelligence and the most resource- 
ful mind will find scope in this field. It requires physi- 
cal courage and mental dexterity to cope with the varied 
needs of the psychopath. 
One only needs to imagine one's mother or father a 
patient mentally deranged, separated from home and 
family, locked in with strangers, responsibility gone, 
to realize what a blessing and relief it would be to feel 
that the nurses were intelligent enough to recognize SPECIALIZED NURSING 
105 
the patient's vagaries as abnormal. One can be sure 
that such nurses treat the patient with kindness, 
patience, and sympathy; that they will be capable of 
rendering companionable service and will know how 
to try to divert his perverted mind from morbid ideas. 
Yet nurses shrink from this branch of the work and are 
taught very little about it while in general training. 
Rural 
Nursing 
Cities teem with trained nurses following 
the hackneyed routine of private nursing 
among the rich, or the more picturesque work of nurs- 
ing in the slums, while the country, with its varied and 
interesting needs, is sadly neglected. In the remoter 
rural communities there are localities without doctors 
or nurses where the people desperately need instruction, 
nursing, and friendship. If nurses would plan to spend 
some portion of their working lives doing their share 
of the unpopular work in the world, their altruism 
would repay itself in the broader experience and out- 
look thus gained, and they would render a finer and 
more complete service to humanity. 
TOPICS FOR CONSIDERATION 
In what ways is a convalescent patient easily spoiled 
for normal activities ? 
Under what circumstances might it be appropriate 
for a nurse to accept presents from her patient, even 
clothing? 
Why is it objectionable for a private nurse to make 
extra charges for laundry ? 
What are the objections, if any, to a sliding scale of 
charges ? 106 
NURSING PROBLEMS AND OBLIGATIONS 
How does mental nursing compare with general 
nursing? 
Who are the nurses who have done the most pro- 
gressive work in hospitals for the insane ? 
Who are the nurses best known for public health and 
settlement work? 
What can you tell about social service in the scheme 
for health work ? 
Cases for discussion 
Case I. A convalescent, parsimonious old lady wishes 
to see nurse always busy. Asks her to make a dressing 
gown for her. 
What would you do in such a case, and why? 
Case II. Obstetrical case in country. Patient shows 
every symptom of septicaemia and is constantly growing 
worse. Nurse believes an expert should be called in 
consultation; thinks patient requires curettage, but phy- 
sician makes no move for consultation or operation. 
What would you do in such a case ? 
Case III. Nurse has patient with morphine habit. 
Nurse can see no physical necessity for indulgence. 
Patient becoming more and more degraded. Physician 
continues to prescribe drug. 
What should nurse do? 
Case IV. A nurse in a private family was given a 
handsome evening dress by her patient, which she put on 
for patient's amusement. Later it was reported that the 
nurse dressed up in patient's clothes while patient was 
sick in bed. 
What is your criticism of this case? SPECIALIZED NURSING 
107 
Case V. Nurse caring for surgical case in private 
home. While patient is convalescing another member 
of the family is operated on and same nurse is asked to 
care for him. 
Should the nurse do so, and if she does, what should 
she charge for her services ? CHAPTER IX 
MISCELLANEOUS TOPICS 
In this world the one thing supremely worth having is the 
opportunity, coupled with the capacity, to do well and worthily 
a piece of work, the doing of which is of vital consequence to 
the welfare of mankind.- Theodore Roosevelt. 
Moral 
Responsibility 
Interpreted m its broadest terms, the 
responsibility of a nurse, whether in a 
family or in an institution, is to perform her work 
with a punctilious regard for the interests of the people 
for whom she is working. If actuated by the highest 
motives, she will subordinate all other interests for the 
time being. She will be even more careful of the prop- 
erty of others than if it were her own. 
Economy 
Few of us discriminate between generosity 
and waste, or between economy and stingi- 
ness. For example, a certain hospital superintendent 
took charge of an institution which he found had been 
wastefully administered. He instituted a regime in 
every department for the elimination of waste. To do 
that required inspection and close supervision, which 
were resented by employees, even by those with enough 
intelligence to have known better. Misrepresentations 
were spread abroad to the effect that he was depriving 
patients and employees of necessary comforts, etc. 
What he really did was to minimize waste of all kinds 
of supplies by a wise system of checking-up that saved 
the hospital thousands of dollars, which he put to use 
108 MISCELLANEOUS TOPICS 
109 
for the patients and employees in providing a more 
liberal and attractive diet, more equipment, etc. In fact, 
he expended the funds at his disposal in such a way that 
they contributed in the most efficient manner to the 
well-being of the people who were cared for in his insti- 
tution. Willful waste should be regarded as wrong as 
stealing. 
Doubtful 
Policies 
A nurse may find herself in an institution 
where she cannot respect her superior offi- 
cers or approve of the policy of the institution; if 
so, she can hardly stay in such a place permanently 
without conforming to the objectionable ways or seem- 
ing to condone the malpractice of other officials. It 
would be practically impossible to be loyal, and when 
loyalty is not possible the nurse should leave the insti- 
tution. Even in such a case, it is not for her to judge 
other people's motives. But she must in all situations 
try to keep a clean-cut ideal of honor for herself. 
Business 
Ethics 
Very many of us have lacked business train- 
ing that would make us easier to deal with. 
All superintendents of nurses will tell you that a large 
majority of graduates are remiss about sending their 
changes of address to the training school office; yet 
they wonder why they do not receive reports and invi- 
tations to hospital functions. Graduates often rely on 
a casual verbal announcement of their change of address 
to some nurse who lives in the hospital, expecting the 
information to be transmitted to the office. The busi- 
ness manager of the alumnse journal will tell you the 110 
NURSING PROBLEMS AND OBLIGATIONS 
same story, as will the secretaries of the alumnae and 
of other nurses' organizations. 
To remedy this, each graduate nurse should have 
always on hand plenty of personal cards and envelopes, 
a list of the societies to which she belongs, and the 
periodicals to which she subscribes. Whenever she 
changes her address for any length of time, she should 
systematically write her new address (and the former 
address) on her cards and send them to the secretaries 
of the organizations of which she is a member. Full 
names and the year of graduation should be given. 
Not all the fault, however, lies with subscribers to 
magazines and with members of our organizations. 
The secretaries are usually women untrained in secre- 
tarial duties, and they may not have good filing systems 
and may neglect to record new addresses. They should 
have a good card system and inform themselves of the 
most efficient way in which to perform their duties. 
Women in business are given to petty economies in 
the use of telegrams and cabs. There are occasions 
when obviously conservation of time and of nervous 
energy are more valuable than the cost of a telegram 
or of a cab, especially when distances are great. Many 
times a superintendent wishes to fill a position, and it 
is most important for her to know as soon as possible 
whether a candidate intends to accept or reject an offer. 
The day or two required for a letter to reach its desti- 
nation may make an immense difference in the super- 
intendent's plans. Definite, courteous, and prompt 
communications are excellent recommendations for the 
candidate. It is equally important for the candidate to 
know promptly whether or not she is to be accepted. MISCELLANEOUS TOPICS 
111 
Reliability in the matter of keeping engagements 
of all kinds is essential. The unbusinesslike nurse is 
equally annoying as an executive or in private duty. 
Our business engagements should always he hept. 
Talking 
Shop 
If a nurse, when meeting friends, finds her- 
self invariably talking shop, gossiping about 
doctors, nurses, and patients, she must realize that she 
is on the road to unhappiness and cynicism. She should 
at once take account of her conversational topics, and 
if necessary restock her supply with the subjects of 
good books, lectures, music, pictures, and drama. A 
doctor who had met a nurse at a social function was 
much surprised afterwards to learn that she was a 
nurse, since she had made no reference to "cases" or 
to professional gossip. On the contrary, she had con- 
versed on many impersonal topics of general interest 
during the evening. This is as it should be. The nurse 
needs for her own refreshment hobbies, or a variety of 
intellectual interests that will take her quite away from 
the sick room in mind as well as in body. 
Social 
Resources 
The nurse who has mental and social re- 
sources will find them useful when isolated 
with a patient, and invaluable in her work. The more 
points of contact the nurse has with her patient, the 
more successful she will be in diverting him from morbid 
introspection, and the less easily will she fall into the 
pitfall of gossip. A knowledge of games and of occu- 
pations has helped many a nurse to lead her patient 
happily back to health and to interest in living. 
Susan E. Tracy's "Studies in Invalid Occupation" 112 
NURSING PROBLEMS AND OBLIGATIONS 
should be in the library of every nurse, for there she 
will find suggestions for every type of patient. 
The young nurse who is still deficient in social ex- 
perience can make up for it to a certain extent by a 
receptive attitude of mind which enables her to listen 
interestedly to what her patient may say; and well- 
chosen reading and amusements will supply her with 
sufficient conversational material to tide her over the 
convalescent period. 
It will require a high sense of honor and much dis- 
cretion to carry a nurse through several weeks in a sick 
room without lapsing into professional gossip. It will 
be easier to be discreet if she remembers that although 
her patient may listen eagerly to what she says con- 
cerning some former patient or some hospital experience, 
the patient will inevitably distrust such a nurse thence- 
forth as a person who may betray her own confidences. 
Living 
Expenses 
The nurse is rare who can resist the reaction 
that is almost inevitable when she receives 
her first salary, after three years of careful economy. 
The wise nurse, however, will make a budget and care- 
fully apportion her salary, so that it will cover comfort- 
able and decent living accommodations, other necessary 
personal expenses, professional expenditures, and some- 
thing in the bank for unpleasant necessities, like den- 
tistry, illness, idleness, old age, as well as for the more 
agreeable possibilities, such as philanthropy, vacation 
trips, and ordinary recreation. 
Working women are always warned by the best busi- 
ness men to put their money in a savings bank and 
to leave it there as the safest place. Most nurses take MISCELLANEOUS TOPICS 
113 
out a life insurance policy on the endowment plan 
and put some money in the bank to be used only for 
emergencies. 
Professional 
Expenses 
Every nurse should put aside money to 
pay her club dues, her magazine subscrip- 
tions, etc., as regularly as she puts aside her money 
for room rent or for insurance premiums. Twenty-five 
or thirty dollars a year should not be considered exces- 
sive for this purpose. A nurse pays less for her pro- 
fessional outfit than almost any one else, and these 
expenses should be looked upon as necessary, even if it 
means fewer theater tickets. 
Uniforms 
and 
Dress 
A suitable uniform, worn while on duty, is 
usually restful to the patient and identifies 
the nurse in the hospital or the home. The 
uniform should be fresh, attractive, and comfortable; 
there should be rubber heels to the shoes always, for 
the sake of quiet; starchless skirts and aprons to avoid 
rustling; soft collars and cuffs, for the comfort of both 
the nurse and patient. 
Outside the sick room, except when on duty, the uni- 
form is out of place, and the nurse who unnecessarily 
goes about the street or in any public place with her 
uniform on has lapsed from good standards. The uni- 
form should never be worn as an advertisement, even 
in a good cause, since this detracts from its dignity. 
A nurse should adopt a simple style of hair dressing, 
because it is more harmonious with a uniform and more 
appropriate. A nurse who appears in curl papers or 
is addicted to curling irons when on duty shows bad 114 
NURSING PROBLEMS AND OBLIGATIONS 
taste and bad judgment. A brooch is the only article 
of jewelry permissible with a uniform, except a school 
pin. The watch should be carried as unobtrusively as 
possible. Dangling chains are in the way and ornaments 
are entirely out of place in a sick room as far as the 
nurse is concerned. There are many nurses who believe 
that a moderate amount of jewelry is permissible with 
a uniform when worn by an executive who is not deal- 
ing directly with patients. This is, of course, a matter of 
taste and custom. Certainly when one is lifting, bath- 
ing, and taking actual care of patients, there can be no 
question of what is appropriate. Scents should never 
be used when on duty, because even if delicate they 
may be objectionable to the patient. Appropriateness 
is the keynote, and a nurse who has not developed 
a sense of fitness and taste before or during her three 
years of training will probably outrage propriety after 
she is graduated by appearing on duty in embroidered 
collars, high heels, rings, chains, and bracelets. Possibly 
she will wear silk stockings when nursing a patient in 
a home where a mortgage has been put on the house 
to defray the expenses of illness. Such instances have 
been known. 
When off duty, the nurse will naturally dress accord- 
ing to her taste and her circumstances; and if she is 
fond of "fluffy" clothes and jewelry, and is young and 
gay, there is more reason why she should indulge her- 
self, provided she can afford to do so, than if she were 
always in society. Critics should not forget that a 
nurse's "on duty" hours are long and taxing. She 
occasionally needs complete change in order to keep 
her equilibrium. MISCELLANEOUS TOPICS 
115 
A tradition still exists to the effect that a 
nurse's working life is only ten years. One 
has only to look about and see the middle-aged nurses 
who are doing active work, in order to realize that such 
a tradition is false. There are, however, undoubtedly 
nurses who break down from overwork. They are the 
private nurses who have hard, taxing cases, and who 
do not rest sufficiently between them. If a nurse goes 
from one hard case to another, having broken sleep, 
irregular and often cold meals, with little or no recre- 
ation, she is bound to break down after a few years. 
But if she takes a good rest every year, and uses dis- 
cretion in her plan of work, she can continue to work 
as long as women in other professions. 
If she is to be successful after the first few years, 
she should occasionally take a post-graduate course 
or an institution position for a few months. She must 
also read her nursing and medical journals and attend 
the nurses' conventions whenever possible. 
The institution nurse who takes the superintendency 
of a small hospital, and carries responsibility both day 
and night, as many have done in the past and as some 
are still doing, is almost sure to become a nervous wreck 
after a few years. How trustees can permit a woman 
to carry such a burden as some of them are carrying is 
inexplicable; many a superintendent is her own house- 
keeper, instructor, bookkeeper, and general manager, 
and is called at night for accidents and maternity 
cases, and also when patients become critically ill. 
It is folly for any woman to suppose she can work 
in that way and do her best work, to say nothing of 
keeping her head clear, her disposition serene, and her 
Efficiency 116 
NURSING PROBLEMS AND OBLIGATIONS 
health good. She may for a while make a good financial 
record, but she is establishing a bad precedent that is 
going to make the position very hard for her successor 
after she has broken down. There is never a hospital 
so small that it should not have a graduate head nurse 
on duty at night. The superintendent should have at 
least two graduate assistants on day duty, who could 
help her with the housekeeping, with ward supervision, 
and with the instruction of the nurses. 
Women would do well to observe how men conduct 
their business. As a rule, they take time for rest and 
recreation; if they do not, they also become dyspeptic 
or nervous wrecks. 
Hints for 
Avoiding 
Trouble 
Serious complaints or reports to or in an 
institution should always be made in writing 
and be signed by the person making the 
report. Hysterical exaggeration will in this way be 
reduced to facts. In estimating the ability or desira- 
bility of a student, do not rely upon superficial obser- 
vation, or upon the opinion of one person. Do not believe 
all the stories that are told you. 
Do not send disagreeable messages by a third person; 
talk things out face to face. 
Practice courtesy. 
Do not expect to be always understood or approved. 
If you are sincere, you will in time be appreciated. 
Married 
Graduates 
As a great many nurses are sure to leave 
the professional practice of their art sooner 
or later, they need to be acquainted with ways in which 
as private citizens they may use their knowledge for MISCELLANEOUS TOPICS 
117 
the benefit of the community. The married graduate 
sometimes misrepresents her school unintentionally 
because she has neglected to keep informed as to its 
progress. If nurses keep in touch with their schools 
and with the progress of nursing activities, they can 
be most valuable on hospital boards, on training school 
committees, and in district nursing associations. Hav- 
ing had inside knowledge of hospitals (yet always re- 
membering that hospitals differ), they can interpret 
the hospital to the community, and as private citizens 
they are in the way of intelligently interpreting the 
needs of the community to the hospital. The value of 
an institution to a community depends upon the adjust- 
ment of one to the other. 
The married alumna, or one who has retired to private 
life, can do many things for the alumnae and state asso- 
ciations that the other members have not time to do. 
She can also hold official positions, act on committees, 
and do much to promote the social side of their organ- 
izations. It should be as much a matter of pride and 
of pleasure to do these services and to be identified with 
one's school and nursing interests as it is for the college 
alumna to maintain her collegiate interests. 
When graduates settle in states remote from their 
training school they may often find others of their school 
with whom they could form branch organizations, 
or with whom they could at least meet socially once or 
twice a year. 
Old 
Age 
The nurse need not fear old age if she keeps 
plastic in her ideas and up-to-date in her methods. 
A woman who does this will always be sought, and 118 
NURSING PROBLEMS AND OBLIGATIONS 
will never have to seek positions. Many a nurse sixty 
or more years old is doing important, interesting work, 
and finding life more vitally worth while as she gains 
experience, friends, and a larger perspective. Julia 
Ward Howe said at ninety, "The deeper I drink of the 
cup of life, the sweeter it grows-the sugar all at 
the bottom." 
TOPICS FOR CONSIDERATION 
Record in writing the most beautiful act you have 
observed during your hospital experience; the saddest; 
the most amusing and the hatefulest. 
In what way may a young graduate with limited 
social experience make herself companionable to a culti- 
vated patient ? 
How may a nurse retain her usefulness as she grows 
older? MISCELLANEOUS TOPICS 
119 120 
NURSING PROBLEMS AND OBLIGATIONS CHAPTER X 
THE ACTIVITIES OF THE GRADUATE NURSE 
"Educated means trained, and the better trained the work- 
ers, the better should be the product. Our aim is to produce 
not only a worker, but a well-developed man or woman." 
The nurse who has been permitted to go through her 
training with no introduction to her professional organ- 
izations and literature until her senior year, is not 
likely to respond with ardor at that late hour to the 
invitation to join these organizations. The probation- 
ary period, as has been said before, is not too soon to 
emphasize the necessity of organized efforts in bringing 
about educational advancement. The pupil should be 
inspired to look ahead to participation in graduate 
activities. She should be made to see how such forces 
as alumnae associations, state societies, the American 
Nurses' Association, the National Organization of 
Public Health Nurses, the National League of Nursing 
Education, the American Journal of Nursing and other 
forms of nursing literature, are the outgrowth of the 
ambition of our pioneers to make our schools better, 
in order that the service rendered to the community 
may be worthy of and adequate to the opportunities 
offered us. 
Perhaps there is one lesson more important than any 
other to learn regarding participation in societies; it 
is the necessity of an attitude of mind that is willing 
to let the majority rule. 
121 122 
NURSING PROBLEMS AND OBLIGATIONS 
The fault with organizations in general is, that they 
are controlled too exclusively by small groups of people. 
There must be leaders, of course, but wise leaders will 
try to cultivate or to develop initiative in others. When 
strong wills clash or opinions decidedly differ about 
important policies, there should be free and full discus- 
sion, after which the majority vote must decide on the 
final action for the society. 
The spirit shown by the defeated contestants will 
indicate how valuable they are to the association. Those 
who are true to their profession will continue to work 
loyally and pleasantly in the organization. Our nurs- 
ing organizations have thus far been remarkably har- 
monious; as they grow larger and more influential, 
it behooves us to foster their democracy and good 
spirit. 
The 
Alumnae 
Association 
The value of the alumnae organization to 
the training school and of the school to the 
alumnae should be emphasized all through 
the course, in order that student nurses shall anticipate 
membership in the alumnae society. The nurse should 
ask herself how she can be of use to the association, 
and how she can use it for her own professional develop- 
ment. The association may be whatever its members 
wish it to be, and the more members there are who take 
an active part in it, the more interesting will be the 
meetings. 
Each member should be willing to do her share of 
work. She should go to the meetings with the intention 
of making each one a success; and that will be accom- 
plished by bearing her part in discussions, in enter- THE ACTIVITIES OF THE GRADUATE NURSE 
123 
taining, and by assisting in other alumnae work. The 
alumnae may become a kind of home circle, where one 
gets acquainted with old and new graduates, and where 
one may come for advice or help if either is needed. A 
great effort should be made to enroll all the graduates, 
wherever they may be, and some way must be found to 
keep their interest alive. An alumnae journal is the best 
means of accomplishing this; if well edited, it can be 
made an educational and social factor. 
The alumnae should naturally take an interest in the 
undergraduate life of the school, and should be ready 
with criticism and help, and should urge the school 
on to greater perfection. 
Through the alumnae organization a sick relief fund 
may be established and supported, and scholarships may 
be given either to pupils or to graduates. Those who 
do the work of the society will gain valuable business 
experience and ability to express themselves in writing 
or public speech; it will be an excellent training for 
work in the larger associations in which all nurses 
should be interested. This is equally true of both small 
and large alumnse societies. 
The 
State 
Association 
The next organization to which each nurse 
owes a duty is the state association. This 
is the medium through which the gradu- 
ates from different schools become acquainted, and in 
various states they have procured registration laws 
which are stimulating our nursing schools to higher 
educational standards. These legislative activities have 
considerably enlarged our horizon. We have been com- 
pelled to study the situation in which we are placed. 124 
NURSING PROBLEMS AND OBLIGATIONS 
We know now who are our friends and who are our 
opponents in their approbation of, or opposition to, 
our progress. 
In the work of the state and national associations, 
the nurse learns that no school can afford to stand alone 
on its pedestal of excellence. Unless all our nursing 
schools, or at least a majority of them, are good, nurses 
will not be prepared to do the work that we are now 
being asked to do. In order to give the experience 
needed by a well-trained general nurse, the large, the 
small, the general, and the special hospital have had to 
open their wards to affiliations with each other. 
National League 
of Nursing 
Education 
There are special organizations that 
exist to promote specialized branches 
of work. The nurse educators have a 
National League, which grew out of a narrower asso- 
ciation that was organized in 1893, and was called 
the American Society of Superintendents of Training 
Schools for Nurses. In it will be found the acknowl- 
edged leaders of the nursing profession. Its activities 
are so vital and its work so potent that the young 
graduate who is doing any kind of educational work 
whatever cannot afford to miss the inspiration of the 
League's conventions. 
Although each member who attends the conventions, 
which are held in different cities from coast to coast, 
goes at her own expense, the meetings are always well 
attended. In these meetings are sown the seeds that 
bear fruit in state laws, university affiliations, and 
better educational opportunities for nurses all over 
the country. The improved professional training now THE ACTIVITIES OF THE GRADUATE NURSE 
125 
given is due to the efforts of the women who have been 
and are now members of the League. 
The young nurse can begin where the older one leaves 
off, and can bring to our problems fresher points of view. 
Many of them have enjoyed educational advantages 
that the older women lacked. Twenty years ago there 
were few college women in our ranks. We now have 
many. 
The youngest and largest of our special 
organizations, this is the one that binds 
together those who are doing all sorts 
of public health work. These workers have their own 
Journal, and are doing a great deal to prevent illness 
by teaching other nurses how to do preventive work 
and sending them suitably equipped all over the United 
States to work in the country, in city slums, in schools, 
in factories, in milk stations, etc. 
National Organ- 
ization for Public 
Health Nursing 
American 
Nurses' 
Association 
The nurses in all these organizations are 
united in one big national association 
that enrolls many thousands. This asso- 
ciation is composed of nurses who have cared enough 
for their work to spend at least two years (most of them 
three years) in hospital training; who are registered 
nurses if they live in states that have registration; 
who belong to either or both the alumnae and state 
associations; and many of them are also members of 
the National Red Cross. There are of course thousands 
of nurses, real and make-believe, who do not belong to 
these associations, but there are none who do not benefit 
by the work done by these organized women. 126 
NURSING PROBLEMS AND OBLIGATIONS 
The 
Red 
Cross 
The young graduate allying herself with the 
organizations in which she may be most useful, 
and from which she will get the help she needs 
in her chosen line of work, will also wish to join the 
Red Cross. There is danger of neglecting this society 
on account of the uncertainty of a call to service; but 
for several good reasons the wise nurse will attend to 
the necessary formalities as soon as she has qualified. 
If there was war or other calamity, the Red Cross 
authorities would call out the nurses who were already 
enrolled. The nurses who had neglected to place them- 
selves on the list might miss an unusual opportunity 
for experience and service. The first test of the nursing 
section of the Red Cross is its preparedness for imme- 
diate service. Information concerning enrollment can 
be procured from the Bureau of Nursing Service of the 
American Red Cross, Washington, District of Columbia. 
The American 
Journal of 
Nursing 
Since October, 1900, the nurses have 
published their own Journal, the organ 
of all these societies. It was established, 
financed, and edited by nurses. At first the private prop- 
erty of a few who were willing to assume a financial risk 
for the sake of their professional interests, it is now the 
property of the American Nurses' Association. In it may 
be found the important facts of nursing history; and 
every graduate nurse should consider the Journal one 
of the professional publications that she must have, 
and that her duty is not done unless she tries to con- 
tribute something to make it interesting. In it she will 
find a directory of the various nursing organizations 
and the addresses of the secretaries. THE ACTIVITIES OF THE GRADUATE NURSE 
127 
There are commercial publications that are attrac- 
tively presented which appeal to the nurse who has not 
yet learned to discriminate between true and false teach- 
ing. The publications and associations that seek to 
control nursing affairs for commercial purposes only 
are not merely to be avoided, but are to be exposed. 
There are correspondence schools, directories, and 
some hospitals that exploit the young women who wish 
to train as nurses, and humbug the public that employs 
them. So long as these exist, so long must nurses take 
an active part in urging legislation that will make it 
illegal for institutions or associations to graduate as 
nurses women who have not had proper training, and 
for women to practice as nurses unless they can meet 
the state's requirements. 
The 
Nurses' 
Directory 
A central directory for nurses, under the 
auspices of the state or city nurses' associa- 
tion, should exist in every city, in order that 
nurses who are seeking institution work or private 
duty nursing may have a reliable place to register. The 
directory should of course maintain the highest possible 
standard, and should take only those nurses who have 
passed the state board examinations, if there is regis- 
tration in the state, and properly qualified attendants 
who are willing to work as such. It should seek to do 
justice to its patrons and to the nurse. The directory 
has to stand on its merits only, as no doctor owes 
allegiance to it unless it renders him satisfactory 
service. 
Many a doctor has wasted precious hours in calling 
up various small directories, when if all the eligible 128 
NURSING PROBLEMS AND OBLIGATIONS 
nurses agreed to register in one place one call would 
be sufficient if there were a nurse to be procured. 
The business experience gained by the nurses in con- 
ducting their directory is not the least of its advantages. 
Many desirable features may develop in connection with 
directories, such as libraries, clubrooms, educational 
and social activities in which all registered nurses could 
participate. 
In cities where a central directory exists, the nurses 
are independent if they wish to change lodging places, 
and they can also control the rules and regulations 
governing the directory, making them consistent with 
a dignified profession. 
Superintendents of schools should tell their nurses 
why it is their professional duty and privilege to support 
a nurses' central directory. Directories in connection 
with different hospitals still exist, but they are of 
limited service, since their enrollment is too small 
to render large community service. 
One of the greatest objections to a hospital directory 
is the fact that it tends to cultivate an exclusive policy 
among the graduates of that hospital, rather than a 
democratic attitude towards all registered nurses. 
TOPICS FOR CONSIDERATION 
Have you ever heard about government by organized 
minorities ? 
What is your opinion about it ? 
Write a short paper on each of the three national 
nursing organizations. 
Write a paper on the Red Cross nursing service during 
the world war. THE ACTIVITIES OF THE GRADUATE NURSE 
129 
Discuss the advantages of and objections to a central 
directory for nurses. 
What other kinds of directories are there? 
Do you think the American Journal of Nursing meets 
the needs of the profession ? 
What is the latest important nursing organization ? 130 
NURSING PROBLEMS AND OBLIGATIONS CHAPTER XI 
MOLDING PUBLIC OPINION 
I know perfectly well that my pen cannot now be called a 
force, but if I can only use the power of a dove's wing in the 
right direction I am happy to be able to do so.-From a letter 
written by Mrs. James T. Fields a few weeks before her death 
to Miss Parsons. 
As the majority of hospitals, with the exception of 
private hospitals under the management of physicians, 
are superintended by nurses, these nurse superintend- 
ents have a great responsibility and opportunity. 
Hospital 
Superin- 
tendency 
A nurse before assuming such a position 
should picture to herself an ideal hospital 
and then work for its realization. In the 
interests of economy, it is better that two or three 
suburban towns should cooperate in establishing a 
hospital in some central place, easily accessible by street 
and motor cars. The fifteen-bed hospital needs as much 
scientific equipment to do its work well as the seventy- 
five-bed hospital, and the expense of running the smaller 
institution will be greater in comparison than for the 
larger plant. 
Health 
Centers 
The modern hospital should be a real health 
center, with accommodations for all classes 
of patients and with all the necessary departments, 
suitably equipped. There should be laboratories, X-ray 
machines, a dispensary, a department of social service, 
131 132 
NURSING PROBLEMS AND OBLIGATIONS 
conveniences for private, semi-private, and free patients; 
also suitably equipped classrooms and sufficient living 
accommodations for the necessary staff of officers, 
nurses, and employees. The hospital should not only be 
a refuge for the sick, but an educational center where 
physicians, nurses, and social workers may gain experi- 
ence. It should extend its educational advantages into 
the homes of the community that support it. 
Experience has proved that it is poor economy for 
a community to supply hospital care to people who 
are going back, as soon as they are cured, into 
exactly the environment that was responsible for their 
illness. If the hospital cannot follow up its patients 
to see that they take the home treatment that has been 
prescribed, or in other ways live so as to retain the 
benefits gained in the hospital, the patients are almost 
sure to return repeatedly for treatment. 
The doctors and nurses associated with a hospital 
can do much to educate the community in right living 
by giving health talks to schools and clubs. Prenatal 
and postnatal instruction has done wonders in reducing 
infant mortality wherever such instruction has been 
given. 
Hospital 
Requirements 
Before building, the hospital expenses 
should be estimated and account should 
be taken of the fact that the hospital cannot be run 
without nurses and domestics. These essential workers 
must be suitably provided for. It is often forgotten 
that the probationers in the preliminary class must 
also have accommodations; usually they are the last 
to be considered. The two factors that warrant the MOLDING PUBLIC OPINION 
133 
establishment of a hospital are an existing need in 
the community and the ability to support it. The factors 
that warrant the establishment of a training school in 
a hospital are a sufficient amount of material for experi- 
ence in the various kinds of cases with which a trained 
nurse should be familiar, either in the hospital or by 
affiliation with other institutions; classrooms, teaching 
equipment, and instructors properly qualified for their 
duties; living accommodations that will accord with 
the lectures in sanitation, hygiene, and refinement; and 
finally, funds to maintain the school. The superintend- 
ent is the one person who has the facts sufficient to 
prove to the board of trustees the reasonableness of these 
demands. 
If the hospital cannot provide these necessities for 
its school, it should pay for graduate nurses in sufficient 
numbers to care for the patients, or at least to do im- 
portant nursing. Attendants or domestics should be 
trained to do the routine part of the ward service. 
Hospital 
Abuses 
There are certain abuses that still exist in 
our hospitals which we must correct as soon 
as possible. Much depends upon educating the senti- 
ment of the community. It is inconsistent to do social 
service work for our convalescent patients when at the 
same time we fail to provide in our hospitals the normal 
kind of home life, so far as an institution can give it, 
for the nurses and employees. When they are forced 
by lack of suitable accommodations to meet their friends 
outside the hospital, we may be driving them to dangers 
which later may cause them to become themselves 
hospital patients. 134 
NURSING PROBLEMS AND OBLIGATIONS 
Hospitals that have arrived at an eight-hour system 
for their nurses are in advance of the large majority 
that still have a sixty-hour week. But when one con- 
siders that it is eight hours a day, seven days in a week, 
that meals and four or five hours of class work a week 
are exclusive of these fifty-six hours on duty, and that 
preparation for class and recreation must still further 
encroach on the time for rest, we feel that we are not 
yet very close to the ideal. 
We do not wonder that mothers do not rejoice when 
their daughters choose nursing as a profession. Yet we 
love the work so much we are willing to submit to these 
hard conditions while necessary, realizing that we are 
all the time improving them. We must not cease our 
exertions towards the ideal. 
There are other conditions that we must contest until 
they are vanquished. The practice of twenty-four-hour 
duty in hospitals is entirely unnecessary and ought to 
be relegated to the past. When a patient in a hospital 
is ill enough to need continual nursing care, he should 
have two special nurses. Twelve hours' continuous duty 
is long enough for any person, except in cases of emer- 
gency. Allowing nurses to sleep on cots in small hos- 
pital bedrooms is unhygienic as well as a bad precedent. 
Private nursing in the home by pupil nurses, without 
proper observation or regard for their educational, 
interests, along with the excessive use of pupil nurses 
as specials in hospitals, is a practice to be controlled 
to the limit of what is just to the nurse. 
It is difficult for the hospital to harmonize its duties 
to the patient and to the nurse in training, but it is no 
more right to sacrifice the nurse than it is to neglect MOLDING PUBLIC OPINION 
135 
the patient. Both are dependent upon the integrity 
of the hospital administration. There are hospitals that 
fail to provide trained orderlies or men nurses to per- 
form for men patients certain important duties that 
should never be done by women nurses unless in times 
of emergency, when it is impossible to get a man nurse 
and the patient is suffering for want of attention. The 
importance of correcting this neglect is particularly 
urgent now that our nurses are coming to the hospitals 
at an earlier age than formerly. That certain duties 
should be performed for male patients by male attend- 
ants is as much for the satisfaction of the patient as to 
protect the sensibilities of the nurse. 
Nurses ought to be taught how to do all the duties 
that may be necessary in times of emergency, but the 
hospital routine should be such that they may leave 
the school with as much modesty and natural delicacy 
as they brought to it when they came as probationers. 
Tuition in 
Nursing 
Schools 
The economic relations now existing between 
pupil nurses and the hospital are misleading 
and unsatisfactory. The efficient nurse who 
has good health pays liberally for her education. The 
slower pupil, or one who has much illness and is cared 
for by the hospital, would if accounts were squared 
find herself considerably indebted to the hospital. 
If in the course of our nursing evolution our hospitals 
would relieve nurses of the unnecessary ward routine 
of making empty beds, dusting, carbolizing mattresses, 
etc. (after this work has ceased to have educational 
value), and in other ways provide enough help so that 
the pupils could pursue their duties only where there 136 
NURSING PROBLEMS AND OBLIGATIONS 
was something to learn, hospitals would be justified in 
asking tuition for the educational advantages given 
to the pupils. Their services would be an equivalent 
for maintenance, but the class and lecture work should 
be paid for. 
The pupil who could pay her tuition in money should 
do so each semester, in advance, as is the custom in 
college. Students who could not afford to do so might 
be assisted by a loan fund, and after graduation they 
could as executives or specials pay off their debt 
in a few weeks. This could be easily done within six 
weeks as a special nurse, or in three months as a head 
nurse, unless the tuition was excessive. This would put 
our training schools on a more dignified basis, and the 
financial return to the hospital could be used to defray 
the expenses created by the increase of domestic labor. 
More and better domestics would be needed, but the 
hospital could be run with fewer nurses, decreasing 
the expense of teaching large classes of probationers, 
usually a third of whom never qualify. The wards 
would benefit by the change, as the nurses would be free 
to devote themselves to nursing and the domestic help 
would not have their time interrupted by classes. 
Under our present system, most hospitals are so 
dependent upon their pupils for the care of the sick 
that some who ought to be eliminated are retained, 
rather than that the hospital should suffer a deficiency 
in numbers. Ethically this ought not to be allowed. 
A superintendent should feel that once having decided 
that a nurse is unsuited to the work, she can require 
the nurse's withdrawal and if necessary employ a 
graduate nurse in her place. MOLDING PUBLIC OPINION 
137 
Publicity 
No institution can afford to ignore the uses 
of legitimate publicity. Newspaper report- 
ers may be of the greatest value, or they may do tre- 
mendous mischief; it depends usually on the way they 
are treated by the hospital officials. The public has a 
right to a certain amount of accurate information con- 
cerning the activities of any public or semi-public 
institution. When well-known people are sick in the 
hospital, it is better to give correct information about 
the patient than to have fictitious stories circulated. 
Nothing should appear that can be construed as an 
advertisement of any physician, as that is contrary to 
medical ethics. 
It is advisable to invite a reporter to hospital func- 
tions, such as anniversary celebrations, nurses' gradu- 
ations, etc. If reporters are cordially and courteously 
treated, they will repay by giving the public informa- 
tion that is reliable and helpful to the institution. An 
institution that is dependent upon charitable contri- 
butions and popular donations should be ready to 
make public its statistics, to give to the public every 
opportunity to know what kind of work it is doing. 
An institution that aims to be to the community a 
health center, and that looks for support from the 
public, needs a cordial relationship between itself and 
its patrons; and a special newspaper correspondent 
might well be a recognized factor in establishing that 
relationship. 
The hospital should have "at homes" when guests 
are made welcome. It should also be prepared to send 
to a reasonable extent its officers into the community to 
teach and to study community needs. 138 
NURSING PROBLEMS AND OBLIGATIONS 
Nurses doing private duty, as well as 
institution nurses, have an unusual 
opportunity to interest the many influ- 
ential people with whom they become intimately ac- 
quainted, in nursing education and in the far-reaching 
results of well-administered hospitals and schools for 
nurses. Nurses can often secure financial help for any 
work or society in which they are interested, and they 
have already been able to do a great deal in procuring 
legislation favorable to state examination and registra- 
tion of nurses. It is hoped that private nurses will be 
the means of interesting their patients and friends in the 
endowment of training schools for nurses, as it can be 
easily demonstrated by a thoughtful nurse that such 
an investment of money would result in better candi- 
dates for the schools, better prepared graduates, and 
better community health. 
The Influence 
of the 
Private Nurse 
The value to an institution of a well-chosen 
group of people representing the trustees, 
the medical staff, the alumnse, the public (and includ- 
ing at least one educator), cannot be overestimated. 
The members of the committee must be intelligent, 
broad-minded, and well-balanced. If they will attend 
the hospital conventions, read The Modern Hospital, 
and throw the weight of their influence on the side of 
efficient, progressive administration, they can be most 
useful to the superintendent and the trustees. 
Advisory 
Committees 
TOPICS FOR CONSIDERATION 
Outline your ideal organization for a modern hospital. 
Describe an ideal hospital superintendent. MOLDING PUBLIC OPINION 
139 
In what ways may private nurses act as educators? 
What is the value of publicity ? 
Name twenty-four leaders in the nursing profession 
and tell what work each is doing. 
Name first text-book for nurses. 
Name two nurses who have become popular authors. 140 
NURSING PROBLEMS AND OBLIGATIONS CHAPTER XII 
LOOKING AHEAD 
The man who is worthy of being a leader of men will never 
complain of the stupidity of his helpers, of the ingratitude of 
mankind, or of the inappreciation of the public. These things 
are all a part of the great game of life, and to meet them and 
not to go down before them in discouragement and defeat is 
the final proof of power.-Elbert Hubbard. 
The next great development will probably be the 
endowment of nursing schools, the advancement of 
nurses to more technical duties, and an abandonment 
of the superfluous manual part of our present work. 
As nursing schools become real schools, it is probable 
that a tuition system will in time become common, and 
the numbers of so-called trained nurses will decrease 
in proportion to the number of hospitals. No doubt the 
trained attendant will to a great extent take her place 
in private practice and in hospitals. 
There are types of nurses, however, that we have 
never seriously considered. Are we going to leave them 
out forever? What part are men nurses to play in the 
future ? What will be our attitude towards attendants ? 
Have we reached the place in our evolution as nurses 
where we can afford to be democratic and generous? 
If not, why not? 
Unfortunately as schools are now organized in con- 
nection with hospitals that depend upon the pupils 
for the care of patients, a superintendent must shape 
her policy so as to attract candidates. Although she 
may wish to follow some liberal conviction, she must 
141 NURSING PROBLEMS AND OBLIGATIONS 
142 
consider the school in all its relations. It is not as if 
she had a private school of her own with which and 
in which she could try social experiments at her own 
risk. If it is one's desire to build up a popular school 
with high standards, the applicants must be chosen 
carefully, with regard for the social customs and preju- 
dices of the class of people from whom the probationers 
are to be selected. 
Economic independence of training schools and 
public sentiment favoring a true democracy would be 
essential if we desire to establish a more liberal policy 
in relation to all applicants. Nurses can scarcely do 
better than to aim toward a system that recognizes a 
standard based on equality of opportunity for all people 
who meet the essential requirements of character, edu- 
cation, and refinement, regardless of color, nationality, 
or religion. 
Men 
Nurses 
Considering how essential men nurses are, the 
medical world has been singularly apathetic 
in making any effort to improve their status. It may be 
conceded that most of them at present go into the work 
simply to get a job, and that the best men now doing 
the work are usually making it a stepping-stone to 
something else. In spite of these facts, men nurses are 
a necessity for certain kinds of cases where physical 
strength is needed as well as skill. There are certain 
conditions and circumstances where men patients prefer 
and ought to have men nurses instead of women. Alco- 
holics and certain types of genito-urinary and mental 
cases need intelligent, well-trained men nurses. We 
need them in our institutions, and yet, what are we LOOKING AHEAD 
143 
doing to make such work attractive and desirable, 
or what can we do to make it so ? 
The answer is simple, for I believe that the same 
means that have made training schools attractive to 
women will also prove effective in attracting more of 
the right type of men. Furnish comfortable living con- 
ditions, give men students good instruction and a chance 
to do real nursing, treat them with courtesy and respect, 
and the results will justify the effort. Several doctors 
who worked their way to a medical degree by their 
nursing skill have said the experience gained was 
invaluable. 
The fact that educated, refined men will seldom use 
the profession except as a stepping-stone to another 
profession is no more reason for neglecting to avail our- 
selves of their services when we can get them than it 
would be to say that because many women nurses marry 
and never practice as nurses we should cease to train 
them. 
Women nurses having been longer in the field should 
be the first to recognize the value to the work of well- 
trained men nurses, and they should do their part 
towards giving men an opportunity for obtaining such 
training. 
Trained 
Attendants 
Nurses have been almost as much prejudiced 
against trained attendants as physicians 
have been towards trained nurses. The reason we have 
given for our prejudices is that partially trained 
women will practice as trained nurses. So physicians 
have feared that nurses would assume medical duties. 
In the early days of trained nursing, it is probable 144 
NURSING PROBLEMS AND OBLIGATIONS 
that the skill with which nurses learned to do the 
manual part of their work is what made them popular. 
Certainly it could not have been the theoretical or 
scientific instruction received! Women with limited 
education were able in those early days to become satis- 
factory bedside nurses. The need of educated, cultivated 
women was felt chiefly when filling executive positions 
or when patients needed companionship. 
In these days of scientific treatment and of advance- 
ment in medicine, an educated as well as an intelligent 
nurse is usually necessary, and even for ordinary hos- 
pital nursing in the institutions used for teaching 
purposes. There is, however, much of the work that can 
be passed on to attendants, and there are many cases 
for which they could care acceptably and safely. In 
many hospitals and in many private cases the trained 
attendant who could make good beds, give baths, take 
temperatures, serve trays, give enemata and douches, 
and medicines that had been prepared would be a bless- 
ing and would meet all needs. Many times when the 
trained nurse is caring for hard cases, she could take 
time for sleep and exercise if she had a good attendant 
to relieve her. 
The nurse should be as ready to relinquish or to teach 
any part of her work to another who is able to be taught 
as is the liberal-minded physician when he passes on 
some of his responsibilities to the nurse. We should 
be glad to teach home nursing and to let others share 
as far as possible our useful knowledge. Nurses are 
right in demanding educational standards and recog- 
nition for nursing education; but the field is large 
enough for the doctor, the trained nurse, and the trained LOOKING AHEAD 
145 
attendant, if all are known for what they are and do 
not pose as something else. Compulsory registration 
for graduates will protect the public. 
Since the establishment of the first school 
for trained nurses at St. Thomas Hos- 
pital in London, we have advanced a little way towards 
better nursing conditions. We have registries and 
clubhouses; we have compiled text-books; we have 
edited journals; we have procured examination and 
registration in many states, and in some states the 
law is compulsory. But we have only begun our work. 
The first nurse in America to receive a diploma is still 
living, as are several of our pioneers. They have put 
their training to the test; they know approximately 
what the newer generation requires in order to do better 
work. They have worked for our advantage, and it is 
our privilege to set the standard higher for the benefit 
of those who will follow us. 
From a limited field of opportunity, comprising insti- 
tution work and private duty, we have seen the nurse 
called into at least twenty distinctly different lines of 
work, all of them important and interesting. 
Schools and colleges, as well as nursing schools, are 
seeking properly qualified nurse-instructors for both 
practical nursing and theory. The instructors may be 
residents or non-residents. 
The call for nurses to take up office work as dental 
hygienists and as X-ray technicians, at salaries ranging 
from $600 to $1,200 per year, with maintenance, are 
among the latest opportunities. 
Advancement 146 
NURSING PROBLEMS AND OBLIGATIONS 
In surveying the field, one sees that the 
tendency to tie up our schools with uni- 
versities is emphasizing the scientific and 
theoretical part of the education of nurses. That they 
are being taken away from the practical side of the work 
is not true as some people say, because in our leading 
schools the practical methods have never been taught 
or practiced so thoroughly as they are today, and never 
have the schools planned so laboriously to provide 
practical experience. This has been brought about in 
all its fundamental branches by the influence of state 
examination and registration. 
With a generous endowment for the training school, 
so that the economic necessities of the hospital need 
not conflict with the educational needs of the school, 
we may hope to develop an ideal system of theory and 
practice. 
Approach- 
ing the 
Ideal 
The 
Goal 
Where our special training will lead us next 
remains to be seen, but it behooves us to prepare 
ourselves as thoroughly as possible, so that we may be 
equal to our opportunities. 
Those who are educating the nurse of the future must 
realize that in every sense of the word the best-equipped 
women are needed, and that they must be actuated 
by the professional motive which is defined thus by 
Florence Nightingale: 
"The professional motive is the desire and perpetual 
effort to do the thing as well as it can be done, which 
exists just as much in the nurse as in the astronomer 
in search of a new star, or in the artist completing a 
picture." LOOKING AHEAD 
147 
No place is closed to the nurse. She goes to the palace 
and the hovel, into schools and factories; she works 
with men, women, and children; she works with Chris- 
tian and pagan; she is necessary in times of peace and 
in times of war. Her contact with people is compara- 
tively permanent, while that of the physician or the 
social worker is transient. If the nurse has the gospel 
of health to carry to the people, her opportunities are 
limitless. We have only to go on keeping our ideal 
before us, working for the good of all with our best 
skill. By so doing we shall make history worthy of the 
past and full of promise for the future. 
No one is wise enough to predict what the next step 
will be, but of this we may be sure: it is towards a con- 
dition of general health and sanity that we trust will 
bring the world to a state of civilization worthy of 
comparison with that of the Hindus, four centuries 
before Christ. 
"Theft was unknown, the people temperate; false- 
hood held to be an iniquitous thing; the people enjoyed 
to a great extent immunity from disease; maturity was 
early and life prolonged. There was no compulsory or 
unpaid labor; cultivators lived on their land and paid 
a share of their produce to the king; food was abun- 
dant; roads were good, with sheltering avenues; . . . 
inns and other establishments for strangers were every- 
where, including hospitals and dispensaries. At inter- 
vals there were rich towns and cities, the houses large 
and beautiful, the streets well watered, the gardens full 
of flowers and fruit trees; . . . the people prosperous 
and happy; none were poor or fed on unclean things." 1 
lu Medicine in Ancient India," by Surgeon General C. A. Gordon, 
M.D. London, 1887. 148 
NURSING PROBLEMS AND OBLIGATIONS 
TOPICS FOR CONSIDERATION 
What are the progressive movements concerning 
nurses and nursing education ? 
Name the latest professional opportunities for gradu- 
ate nurses. 
Write a short history of the Army School of Nursing. 
Write a short paper on the Schools for Colored Nurses. 
On Schools for Men Nurses. 
What do you know of the status of the army nurse ? 
Name other nursing publications than those we have 
already discussed. 
Name the influences that are opposed to progressive 
nursing education and legislation. 
What is the status of nursing schools in hospitals for 
the insane? 
Tabulate the different branches of nursing work, with 
subheads. 
Write a short paper on personal qualifications of 
nurse for each type of work. 
Specify desirable professional qualifications and 
preparation for executive positions in each line of work. 
Write a paper on one or more of the following sub- 
jects : - 
The development of private nursing to its highest 
plane. 
The besetting temptations of each type of nursing 
work. 
The budget system for personal expenses. 
Uniform, dress, and social resources. 
Business ethics and economy. 
Preliminary steps before taking a new position. LOOKING AHEAD 
149