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Nursing training in New Zealand over the last 125 years

Dorothy - 22/07/05

Part 2

A changing scene 1896-1945

Useful and interesting information on nursing training is recorded in Looking back: a history of the Christchurch School of Nursing 1891-1987 by Helen Campbell, published in 1997.

Helen Campbell describes the first years of training at the Christchurch Hospital. The trainees were admitted in groups and during their training they were given lectures by the resident House Surgeon and the matron. The honorary medical staff were examiners and issued certificates of proficiency to the successful nurses after two years.

New Nurses' Home
The new nurses’ home was opened in 1895 and provided accommodation described as suitable for refined and educated young women. All the nurses lived in the Nurses’ Home. All the women had single rooms and there was plenty of hot water for baths. The doors of the Home were locked at 10 pm.

New uniforms
The staff welcomed a change in uniforms when the original serge uniforms were replaced by washable cotton dresses – a great improvement being easy to care for and much more hygienic. There was great emphasis on the importance of having a spotless appearance.

The sisters worked a nine hour day and had half a day off on Sundays and another half day off during the week. The probationers worked a nominal eight hours – nominal because all work had to be finished before they went off duty.

The meals were wholesome but plain, and occasional treats of extra food were real highlights.

Nurses Registration Act
In 1901 came the first Registration Act for nurses drafted mainly by Mrs Grace Neill, Deputy Inspector of Hospitals. Three years’ training and a pass in a state examination was necessary for the status of registered nurse. This was the first Registration Act in the world purely for nurses.

Nurses overseas and in war service
Around this time it became more common for trained nurses to travel overseas. Four Canterbury nurses were officially appointed to serve in the Boer War, and forty in World War I. Nine were on the hospital ship TSS Marquette when it was torpedoed and sunk and three lost their lives.

In 1907 salaries were set at sixty to seventy pounds a year for sisters, forty pounds for staff nurses and twenty five pounds for trainees.

New Routines
By 1910 the lecture programme was well organised. The nursing staff had lectures in the morning and afternoon and had to attend even in their time off. They also had to be in full uniform to attend the doctor’s lecture from 5-6 pm. Nurses had a change of duty once a week and a day off at the weekend once a fortnight. From 1927 they had a day off each week.

Trainee nurses’ first tasks for the day were cleaning, sweeping, mopping and polishing. Liquid polish was splashed on the floor and this was rubbed in with mops. This had to be finished before the doctors’ rounds.

Jan Williams, the head dietitian in 1939, noted the changes in food service which came in the next half century, with tray service, conveyor belts, central dishwashing and dietary assistants in the wards.

The use of commercial cleaners relieved the nurses of such duties.

Etiquette
There were strict rules regarding etiquette. Juniors had to stand up when seniors entered the room and had to stop talking. They were to address a senior only on professional matters. They must stand with their hands behind their back when spoken to or asking a question. They must let seniors go through a door first and not pass a senior in the corridor. At one stage they had even to ask a senior nurse for permission to go to the lavatory.

Staff shortages
There were difficulties keeping the hospitals staffed during World War 1 from 1914 to 1918, and then the influenza epidemic made exceptional demands on the hospital services.

Prelim School
In 1923 the Preliminary School, known as Prelim School, was established. Under this system nurses spent the first three weeks, and later the first three months, in Prelim School learning the basics before working in the wards. At Christchurch Hospital their uniforms were pink, and they were therefore known as the Pinks. Other nurses wore grey.

Methods of treatment
This was the pre-antibiotic era in the community and the hospital.

In treating respiratory tract infections camphor was used, hung in a flannel bag around the patient’s neck.

For colds eucalyptus was given to the patients on lump sugar. Friars Balsam was used for inhalations. Salt or aspirin solutions were used for gargles.

Heat was applied through poultices or commercial preparations such as antiphlogistine or medicated cotton wools such as Thermogene and Warn’s Wonder Wool.

Croup was treated in a makeshift steam tent.

For ear infections glycerine and phenol ear drops or a nasal spray was the treatment.

Sulphonamide drugs introduced in 1936 helped pneumonia patients and shortened their convalescence.

Streptococcal infections such as tonsillitis, cellulites and erysipelas were treated at Christchurch hospital, but scarlet fever and diphtheria were treated at Burwood Hospital which was then known as the fever hospital. Rheumatic fever sometimes set in after streptococcal infections. The symptoms were pyrexia (fever), painful joints, and at worst endocarditis (inflammation of the heart tissue) which could lead to chronic valvular disease. These patients needed twice daily sponging by two nurses. Patients wore flannel night shirts, had warm blankets, and were given methyl salicylate to reduce joint pains.

Memories of two registered nurses who began training in the mid 1930s
Florence Wilson (nee Kemp) trained in the Dunedin Hospital and Eileen Hudson (nee Flanagan) trained in Auckland. Both recalled their three months in Prelim School where they received lectures from the tutor sister.

Once out of Prelim school they started working six days a week from 6 am to 3 pm with a lunch hour, or 3 pm to 11 pm with a break for an evening meal, or at night from 11pm to 7 am with a meal served in the small hours. Sometimes they worked a divided shift being in the wards at peak times and having time off in between. Every three months they changed to a different ward.

When they first went into the wards they did the jobs of housemaids, cleaning and polishing. Then they progressed to bed-panning and bed bathing the long term bed patients. Those who could not move had to be turned every four hours to prevent bed sores. If they developed bed sores nurses washed their backs regularly with soap and water, applied methylated spirits or cream and put on fresh dressings. Nurses had their own patients and got to know the long term patients well in the three months they spent in the ward.

Once nurses became seniors they dressed wounds, removed sutures and sometimes took blood for tests.

Patients for surgery or illness stayed in hospital much longer before the use of modern drugs and they were much more dependent on the nurses than today’s patients who are got out of bed and into the shower soon after surgery. The patients’ longer stay and their dependence meant that there was good rapport built up between them and their nurses.

With no penicillin pneumonia patients needed a lot of nursing. After four or five days came the dreaded crisis that we only read about in modern times. If recovery was on the way the patient’s temperature fell at that time. In the early 1940s penicillin proved effective in treating streptococci and the endocarditis which had resulted from the earlier cases of rheumatic fever.

After a cataract operation the patients had to lie still for days with their heads between sandbags.

Cellulitis cases had to be given four hourly soaks and hot wet bandages every four hours.

Patients with heart trouble were given digitalis tablets and kept on bed rest until their condition improved.

As well as working in the wards Florence and Eileen had regular lectures and looking back they remember how they sat lots of tests and exams, and the Junior State exam which they had to sit after a year in training hung over them like an ogre during the first year.

They always had to do as they were told without questioning any instruction. There was strict observance of seniority and nurses in each rank had to obey the instructions of those above them.

Strict uniform had to be worn at all times and in the hospitals where they trained that meant wearing a white smock, white veil, white stockings and white shoes. For serious breaches of discipline nurses were sent to the matron.

Every morning the matron inspected the wards for tidiness and the afternoon sister did the same. The staff nurse did the flowers and took them out of the ward at night and ensured that the ward was tidy.

Only the sister and the house surgeon talked to the patients about their condition and only those two talked to the patients’ relatives.

In the 1930s the formal regimes of earlier years continued and the doctors were all men at Christchurch Hospital except for Dr Caroline Stenhouse, the eye specialist. No Christian names were used. The house surgeons were given the title of Doctor … but the specialists were known as Mister … and addressed as Sir.

The nurses lived in at the Nurses’ Home and had to be back in the Home by 10 pm unless they had a late night pass. Only one pass for late leave or sleeping out of the Home was allowed each week. Without a pass they could never see the end of a film so they would go to a 5 pm session missing their evening meal and buying fish and chips to eat instead. Sometimes they climbed in late through a window which was known to be easy to open.

Eileen and Florence felt that the nurses were like a family, living in the same building, swotting together and generally supporting each other. If one of the class wanted to leave the group would do everything possible to persuade them to stay.

General training followed by maternity nursing
They spent four years training at the hospital, passing State Finals after three years and then spending a year as a staff nurse. After that they spent six months on maternity training in a different hospital. Some training was given at small town hospitals with the final period being done in a large hospital.

Association of Registered Nurses
They have clear memories of the first moves to establish a union for nurses initiated by the late Sonya Davies, always a champion for workers' rights. The registered nurses protested that they were professionals and professionals did not have unions. The solution was the foundation of the Association of Registered Nurses.

World War 2
The war years brought their own difficulties. All the buildings had to have blackout curtains or screens to abide by the blackout regulations. Nurses had to be supplied with a black arm band to be worn at all times as without it nurses would not be allowed on the streets in an emergency. Preparations had to be made for the care of patients in the event of an air raid. Air raid practices were ordered to prepare for such an event.

Food rationing of sugar, butter, tea and meat made the task of the dietitians very difficult and rice which was needed for Chinese patients was very hard to get.

Equipment had to be handled with great care as replacements were almost impossible to obtain. As staff volunteered for war service outside New Zealand other people were manpowered into jobs. Some who disliked the work and resented being posted to the hospital would not work as expected in the hope of getting sacked.

Nurses had new challenges in caring for American marines who were brought in suffering from malaria.

In the post-war years many changes were to come – in the training of nurses, in treatments, in administration and in the rigid attitudes of earlier years

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