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The Nightingale School for Nurses


VERY year on the 12th of May, her

birthday, before the beautiful statue of Miss Florence Nightingale in Waterloo Place, London, are laid many wreaths and flowers, the centerpiece being that sent by the "past and present probationers of the Nightingale Training School," and one and all bearing messages of affection and gratitude from those who hold her name in reverence. This year in particular, when we are keeping the centenary of the Great Pioneer of Nursing, it is a cause for thankfulness to realize that the spirit of energy and resourcefulness which was so remarkable in her, lives not only in memory but in concrete form-in the education and training of nurses all over the world. Her dearest wish in the latter part of her life was the development of the nursing profession, and it was with this aim that she founded, with the funds subscribed in gratitude to her after the Crimean War, the first great Nursing School, the Nightingale School of St. Thomas's Hospital.

She began her active campaign in 1860 by inserting an advertisement in the public press for 15 young women to undergo a course of training in a hospital specially organized for the purpose, which should also be a home fit to form their moral life and discipline. We know that this discipline was strict-no nurse was allowed to go out unaccompanied-no intercourse with men was permitted-the Chaplain addressed the nurses twice a week on their spiritual welfare. The matron, Mrs. Wardroper, dismissed one young woman because while she did not accuse her of "flirting," she did not like "the use she made of her eyes." But if the rules were strict, the arrangements made for the comfort of the pupils were adequate. Even in those days each had a bedroom to herself, there was a

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comfortable sitting room and two rooms. were provided for the home sister. Miss Nightingale herself sent books, flowers, prints and maps for the enjoyment of the Board, lodging and uniform were provided by the fund and £10 was allowed annually to the nurse as pocket money. Instruction was given by the sister, lectures by the resident medical officer, and as rewards for good conduct and efficiency the Council offered sums of money at the end of the training.

The school of the present day is of necessity worked on a far more complicated basis, but in all essentials it is true to its ideals and its Foundress. It is needless to say that a very high standard is maintained and only girls of good education and birth are ad

mitted to the preliminary training school for the nine weeks' tuition, which includes elementary anatomy, physiology and hygiene, theoretical and practical nursing and sick room cookery. At the end of this period an examination must be passed before the candidates are enrolled as members of the Nightingale School. There are two classes of probationers special and ordinary. "Specials" sign on for three years and pay a premium of £30; receive a salary of £25 in the second year and £30 in the third. They may leave the hospital when they gain their certificate at the end of their third year. Ordinary probationers who pay no premium serve the hospital for an additional twelve months and receive a salary of £20 the first year, £25 the second, £30 the third and £40 the fourth. With permission they may enter for a course of midwifery or massage at special fees and gain the advantage of an extra year of tuition before starting out on their own responsibility.

First year probationers are under the instruction of the sister tutor and attend 32 tutorial classes on the theory and practice of nursing. No examination is held, but weekly corrections and reports of the written and practical work are made. The sec ond year is devoted to two courses of anatomy and physiology and one course of chem istry, and the nurse sits for a separate examination in each of these subjects. In her third year she studies senior surgical and medical nursing and gynæcology.

The "Nightingale Medals," designed by Countess Feodora Gleichen, which are a great incentive and stimulus to study, are awarded to the three candidates heading the list, the Gold Medallist obtaining at least 60 per cent in each examination and 75 per cent of the total, the Silver Medallist 50 per cent on each and 65 per cent of the total, and Bronze Medallists 40 per cent in each and 55 per cent of the total. But no medal is awarded to any nurse who has not obtained 280 of the 400 marks for efficiency and good conduct. It will be seen

that in this way the authorities of the Nightingale School guard against the danger of theoretical excellence alone winning the day, for the 400 marks stand for capability in the ward and seemly behavior. If the practical work is below the standard and the ward reports unsatisfactory, however brilliant the theoretical work, the nurse cannot become a medallist. These medals are naturally much coveted and are presented at a public function held yearly at the Hospital.

In addition to medals three scholarships are awarded by which Nightingale nurses may qualify themselves for the higher posts in Hospital Administration and the public health service and thus help to carry light and learning into every sphere of ministration to the sick. The scholarships provide for a year's further training at King's College for Women, in social and household science. They carry with them the payment of all fees and a grant of £30 to each scholar. So far St. Thomas's is the only English hospital offering such advantages to its nurses.

The present matron of the Hospital is Miss Alicia Lloyd Still, C.B.E., R.R.C., herself a Nightingale nurse. She was also for some time sister in charge of St. Thomas's Home for Private Patients attached to the institution, and matron of the Brompton hospital for consumption and of the Middlesex Hospital. She takes a keen interest not only in the welfare of her own staff, but in nursing affairs at large. She was a promoter of the Hospital Matrons' Association, is a member of the Council of the College of Nursing and of the first General Nursing Council appointed by the Ministry of Health under the Nurses' Registration Act of 1919.

The comfort and happiness of the probationers are considered in every way, true to the ideals of Miss Nightingale. The Home has its own home sister and each nurse her own bedroom. A sitting room is provided and also a writing and study room.

No smoking is allowed. There are various clubs-one for tennis, for hockey and for badminton-which ensure healthful exercise, and a musical society has been formed which gives frequent concerts. As regards off duty time, staff nurses have one day off monthly, with the preceding evening from 6 p. m.—a much valued privilege-two afternoons, two mornings and two evenings a week, one hour daily for dressing and lunch and late leave weekly. On Sundays nurses are allowed six or seven hours off. The night staff have two nights after two months on duty and one night and day after the remaining month. No nurse works more than 56 hours weekly (on a monthly average). All receive generous holidaysone week in the Spring and three in the Summer.

Such is the outline of the educational system of Miss Nightingale's school. It is only an outline-for all of us who have trained in a school worthy of the name

know that the soul and spirit of our Alma Mater is elusive and known only to those who love her. But the nurses who have sought education within the walls of St. Thomas's Hospital have carried the wisdom. and lore they acquired all over the world. In England some 50 of the greater hospitals and infirmaries have within the last 20 years owned the Nightingale nurses as their matrons; to the United States came the pioneer, Miss Linda Richards, who had undergone post graduate training at St. Thomas's; Miss Alice Fisher, who regenerated Blockley Hospital, Philadelphia; Miss Parsons of the Johns Hopkins Hospital, Baltimore, and Miss Mitchell of St. Mark's Hospital, Salt Lake City. America no less than Europe owes much to Miss Nightingale; indeed, it is significant that in the States in 1910 was celebrated the 50th anniversary of the opening of the Nightingale School, while in Great Britain it passed unnoticed.

To Vaccinate 400,000 Persons at Dvinsk

The American Red Cross field unit was recently sent south to Dvinsk from the headquarters at Riga, has completed arrangements for the wholesale vaccination of the population in that region. Smallpox has broken out in the province of Latvgallia, and unless checked, seriously threatens the Baltic States and Poland.

The vaccine is being shipped to Dvinsk from the Red Cross headquarters in Paris, and is being distributed under the direction of Capt. J. F. Brown. A recent report from Dvinsk says in part: "The situation

is extremely serious. Steps are being taken to prevent the spread of typhus and influenza. Dysentery is also on the increase. We are distributing a trainload of hospital supplies to the towns and villages, which are almost invariably lacking in these materials. The hospital work is being supplemented by such distribution of food and clothing as our available supplies permit. Two refugee kitchens have been opened in Dvinsk to take care of a temporary emergency until the local authorities are able to deal with the situation."


Standing Orders For Operative Cases of the Woman's Hospital, New York City*

One of the most difficult problems of the nursing departments of a hospital with a large attending staff is the proper carrying out of the numerous and varied preoperative and post-operative standing orders. The members of the attending staff, including the assistants, all have their own ideas and methods which they wish used on their respective patients. These standing orders, which are kept on file in the wards, usually are compiled without any thought as to whether they conflict with the meal hours or other essential scheduled routine ward work. Their multiplicity and variety are so confusing as greatly to increase the chance of error, and with the constant rotation of pupil nurses can never be satisfactorily enforced. The ideal plan is to have but one set of standardized orders, which are as simple as is consistent with common sense, and which are adjusted to the time schedule of the ward routine. They should be published in such form as to be readily available to nurses, internes, or students. One set of standing orders means a saving of time and energy for the nurses and internes, and reduces the chance of error to a minimum, with resulting benefit to the patient and economy to the hospital. They also greatly facilitate the training and teaching of those who may work in the hospital. We have compiled and put in practice in the gynecologic wards of the Woman's Hospital such a set of standardized orders, and after a thorough trial they have proved most satisfactory. Simplicity and clearness. were the objects aimed at in their compilation, and the judgment of the head nurses in charge of the wards was the guide as to

Abstracted from a paper read at the Annual Convention of the American Medical Association by George Gray, Jr., M. D.. Chief Surgeon Woman's Hospital, New York City.

their practicability, in the endeavor to make them as "fool proof" as possible.

The following orders will apply to all patients except emergency cases, complete lacerations of sphincter ani, vesico-vaginal fistuale and rectal cases, for which special orders will be given by the attending surgeon or house staff.

Pre-Operative Care

Patients will receive a full tub bath on admission, except emergency or very sick


A specimen of urine must be obtained from each patient as soon as possible after admission and sent to the laboratory not later than 4 p.m. If it is not possible to obtain a specimen before this time, the night nurse will send the morning urine to the laboratory the following day.

Castor oil (1 oz.) will be given 48 hours before operation if the case is in the hospital.

Cases admitted, or ordered to be prepared less than 48 hours before operation, do not get cathartics.

Light meals are to be given on the day preceding operation.

Preparation for operation is to be made on the afternoon of the day preceding the operation, not later than 6 p. m.

All cases will receive both the abdominal and the vaginal preparation.

All cases are to remain in bed after preparation for operation.

Preparation on the Day Preceding

1. Shave. The entire abdomen and the external genitals are to be shaved, commencing at the ensiform and continuing over the pubes and vulva to the coccyx.

2. Tub bath, temperature 100° F. 3. One soapsuds enema given with a high rectal tube.


4. Wash the abdomen and genitals with gauze and tr. green soap and warm water, commencing at the insiform and continuing down over the vulva.

5. Wash the abdomen first with ether and then alcohol, using sterile gauze.

6. Cover the abdomen with sterile gauze.

7. Give a three (3) quart vaginal douche of 15,000 potassium permanganate solution, temperature of 110° F.

(NOTE-The douche may be omitted on order for cases in which there is to be no pelvic surgery.)

8. Cover the vulva with a sterile pad and fasten it to a T binder.

Preparation on the Day of Operation

Not less than two hours and not more than four hours before sending the patient to the operating room, paint the abdomen with 31⁄2 per cent tr. iodine and cover with fresh sterile gauze; give the patient a three (3) quart vaginal douche of 1:5,000 potassium permanganate solution, temperature 110° F., and cover vulva with sterile pad fastened to T binder.

Cases to be operated on in the afternoon are to receive on the morning of the same day:

One soapsuds enema given with a high rectal tube at least six (6) hours before the operation.

On the day of operation cases do not receive nourishment or liquids within 3 hours of going to the operating room. Tea, coffee, or broth may be given before this period.

Morphine gr. 1-6th Atropine grs. 1-150ths are to be given per hypo. half an hour before the patient goes to the operating room.

(NOTE-This order may be omitted for cause by direction of the attending surgeon.)

Post-Operative Care

Days are to be counted at the completion

Temperature, pulse and respiration are to be taken every four (4) hours until the temperature remains normal for 48 hours, after which they are to be taken B. I. D.

Temperatures are to be taken by rectum. for the first three (3) days and indicated on the chart by an X; after this time temperatures are to be taken by mouth and recorded in the usual way. Rectal and "drip" cases to have mouth temperature only.

A specimen of urine must be sent to the laboratory the morning following the operation.

Pain-Hypodermic of Morphine gr. 1-4th P. R. N. for pain, and repeat Q. S. P. R. N. for 48 hours.

Catheterization-Do not catheterize when curetting cervix operations only have been done, unless compulsory.

Catheterize every 8 hours or sooner for cause, until the patient can void. In extensive cystocele operations (also Mayo and Watkins interposition operations) catheterize every 6 hours for 3 days, or sooner for cause.

Dip the point of the catheter in 25 per cent Argyrol in all cases before introducing it into the urethra.

After catheterization or micturition the external genitals are to be freely flushed with a warm solution of potassium permanganate solution 1:5,000 by pitcher douche.

Thirst-Nothing is to be given by mouth for 24 hours after operation but sips of hot water; then cool faucet water in small amounts if desired. is to be allowed.)

(No ice or ice-water After 24 hours, if not nauseated, the patient may have lemon albumin water.

Diet-After 36 hours the patient may have weak tea or coffee with sugar (no milk), lemon albumin water, broth or fermilac in small quantities, repeating every 3 hours if desired.

After the bowels move, liquid diet, milk,

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