The higher aspect of nursing

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Foreword

The writer feels that she owes to those who may read the following pages, a brief statement of the experiences which have impelled her publicly to venture her views on the subject of nursing. She believes (with becoming modesty, she hopes) that she has a definite message for those who are now actively interested in, and for all those who in future may devote their lives to, the profession to which her own life has been devoted. She even presumes to hope that her efforts may prove helpful to some of her fellow nurses — if not to all — who shall follow her, free from prejudice and with the honest desire to improve.

She wishes, in any event, to give to those who are interested in this noble, unselfish and diflScult work such benefits as she has derived from her personal experiences, analyses, reasonings, deductions and conclusions, in the hope that these may be of some real service to them in their own work.

During her life as a practising nurse she has studied long and earnestly the rnany and various problems of a nurse's life and work, always with the purpose and hope of finding for these problems practical solutions which might be passed on to her fellow nurses and serve them in the diflScult and arduous path they have elected to travel.

She has the temerity to believe that she has found solutions of at least some of the problems she has encountered in her life as an active nurse. Her earnest desire now is to pass her knowledge on to her fellow workers,

8 FOREWORD with a personal appeal to each and everyone to experiment with the "remedies," and determine for herself the correctness of the solutions.

The author completed a three years' course of practical training in one of the Eastern hospitals which accepted patients from all classes of society. After this she did private nursing for one year in the poorer districts of a large city. During this time she came in contact with the less intelligent classes of people, and thus had an opportunity to study nurses from their point of view. After a year of this work she entered one of the high-class hospitals of the same city, in the capacity of head, surgical nurse, coming in very close contact with many of the well-known physicians and surgeons, and particularly with many nurses of widely varying types of womanhood. For six months she was in position to study the motives, ideals, inner workings and experiences of these nurses.

Subsequently, at the New York Neurological Institute, nine months of daily personal contact with almost every type of womanhood — from those of the highest intelligence and ideals to the lowest — afforded another opportunity to study the members of the profession in their active and practical work. For, New York City seems to be a congregating place for nurses from all over the world, because of its working advantages and its many attractions.

All nurses intermingle in the hospitals. Those whose motives are the noblest and most unselfish live and work side by side with those who are actuated by motives and impulses the meanest, most sordid and selfish.

Follow^ing the nine months of post-graduate work in the heart of New York City, she began private nursing

FOREWORD 9 in that city, and lived in a large home which was occupied always by an average of thirty nurses. These nurses, when not busy on cases, or awaiting calls, would meet in the different rooms of the home for friendly visits and chats, or in the large reception hall where together they enjoyed music, singing, or other entertainment. This gave the very best opportunity for studying these women in their freedom, unhampered by any forced conventions, or false dignity.

Two months she lived daily among these women, studying their lives, their motives, their inspirations, and their purposes. Subsequently she was employed in a private sanitarium, in one of the fashionable suburbs of New York City, where she remained for five months in charge of a nervous patient. Here she was thrown into an association with a considerable number of English nurses, together with many others from different points in this country.

Later she was Superintendent of Nurses in a private sanitarium. This institution was under the personal supervision of a General Superintendent who accepted only such nurses and helpers as were willing to conform their lives, as nearly as may be possible, to a definite code of moral principles and ideals. Thus, as Superintendent of Nurses, she was brought in contact with a class of women who were held to a definite standard of life; and it afforded her many opportunities, much pleasure and valuable experience in the study of human nature.

She believes she has been associated with most of the varying types of womanhood; and in her association with all classes of patients, physicians and nurses she has been able to identify and classify at least some of the problems

10 FOREWORD and difficulties of a nurse's life. She hopes these experiences and associations will be accepted by her readers as a substantial basis for the deductions and conclusions contained in this volume.

From personal observations and interviews with disinterested patients, physicians, and people entirely outside the medical profession, the writer has found that the general reputation of nurses, as a class, is very far below the ideal. Scarcely any other profession has so invited and called down upon itself, both justly and unjustly, the criticism of the outside world. This has been a source of profound regret and sorrow; for, many beautiful and noble souls, with the loftiest ideals, who are striving to give the best of their lives to the Cause of Humanity, must unjustly suffer along with those of the profession who justly deserve, and are responsible for the establishment of, such a reputation.

The moral laxity and almost uncontrollable desire for relaxation following a strenuous case, tend to immorality on the part of the individual nurse, as well as to the degradation of the reputation of her profession. Usually among the so-called "upper class" of society no nurse is considered a "lady." This is because in some cases she is "earning a salary," and in others because she is not "high-born."

But being a "real lady" includes and involves vastly more than these requisites; and in the following pages an earnest effort is made to point out and define a "real lady." It is hoped thus to stimulate each reader with the desire to merit fully that designation and know in her inmost soul that she deserves it. If each nurse who reads these lines will, to the best of her knowledge and

FOREWORD 11 abilities, strive to become a true lady, in a very short time the general reputation of the profession will be what we truly desire it to be — one of the highest and most exalted in the world.

The author, as a result of the years of her experience, has arrived at the conviction that no woman has a moral right to enter the nursing profession with purely selfish motives. There is a higher aspect of the profession which seems to have eluded many of those who enter upon it.

It is to this higher aspect of the subject, and to this more exalted view, that the attention and interest of the reader are invited in the following work.

These are the credentials of

The Author.

Ajyril, 1919.

CHAPTER I Preliminary Explanation

Let it be understood at the outset that this is not a work of criticism. There is no intention of condemning the regular, conventional training required of a nurse prior to the time she receives her diploma entitling her to practice as a professional. The necessity for such training is fully understood and heartily approved.

It is assumed that the reader is either a graduate nurse who has had this regular, conventional training, or is now in process of acquiring that education. It is also assumed that in this training the reader has been, or is being, educated to a definite knowledge of the nurse's responsibilities and work in caring for the sick.

Assuming these to be true, the purpose is to point out a higher aspect of nursing which is not sufficiently taught in the regular training schools. The desire, if possible, is to open the way for the introduction of that higher education which has to do with the building of individual character. It is hoped to stimulate in every nurse an earnest desire and the personal effort to make her life and character an exemplification of true womanhood. For, this is the only basis of real success in her own profession, as well as in all others.

The following chapters of this work will deal with the Temptations of Nurses. It is believed, however, that

2 17 preparatory to this, it is well to give a short explanation of the reasons for making this the subject of the present volume. What follows is an attempt to do this as clearly and concisely as possible:

1. From personal experience it has been noted that, in the majority of cases, women enter upon their training as nurses innocently and comparatively ignorant of human nature in its many different phases. The average novitiate enters upon her studies with a very limited idea of the many and various temptations and difficulties she will have to meet and face alone, as an individual, in her chosen profession. Not realizing these temptations, she enters upon her training almost wholly unprepared for side-stepping the many pitfalls she inevitably will find in her pathway.

During her course in training school she is continually facing these difficulties and temptations; but, at the same time, she is not acquiring the knowledge necessary to meet and overcome them. No knowledge is given her, from those in charge of her training, which will equip her successfully to meet and overcome these temptations. After the completion of her school training she enters upon her regular, professional work no more prepared to recognize and overcome the temptations which lie in her pathway than when she first entered upon her schooling.

In many instances she is far less equipped to do so. For, because of certain degrading influences and tendencies unavoidably surrounding her in the training school, such high ideals of individual character and of the nursing profession as she may have possessed before entering have been, to some extent, vitiated or de-

PRELIMINARY EXPLANATION 19

stroyed. She enters the outside, professional work with a somewhat perverted ideal of nursing and a more or less demoralized standard of life. Therefore, she is unable always to recognize temptations, as such; and, when she does, often lacks the moral stamina to overcome them.

2. The many temptations of a nurse's life, as such, present themselves in various and most subtle ways. They disguise themselves so cunningly, so cleverly and so adroitly that, without a previous knowledge of these different phases, one would be inclined to overlook them as temptations. And no temptation can be overcome until it is first recognized as such.

It is a means of education to every individual to have difficulties pointed out by definition, illustration and elucidation in advance, until they become so impressed upon the individual's consciousness that they are forever before the mind.

In this work it is hoped so to define, identify and classify the various forms of temptation that each and every individual who studies them will be able to recognize, identify, understand and appreciate them in whatever form they may appear. The purpose then is to outline the remedy for each of these difficulties in a manner that will enable each individual nurse to apply it to her own life and experiences.

3. One of the most lamentable phases of the subject is in the fact that many temptations occur so frequently in the lives of nurses (especially those who have been in the profession for any length of time) that one has yielded before she is fully aware of the fact; and, after the first or second yielding, that particular form of self-indulgence becomes a matter-of-course to her. Later, inevitably and perhaps unconsciously, it becomes a fixed habit of life. It is accepted as one of the privileges or prerogatives of the nurse's profession and is taken for granted.

Through continued observance of the different forms of self-indulgence practised among her associate nurses, it soon comes to pass that such temptations are overlooked, and their evil effects are ignored. This is human nature the world over.

Naturally, the Uves, moral characters and ideals of these older members of the profession have their potent influence on the younger members. Not having been taught differently, these younger members soon come to accept the moral laxities and lower ideals of their seniors and superiors as legitimate. This also is human nature.

The object of the following chapters on ^^ Temptations^^ is to define, identify, classify and illustrate as many of the most common temptations of the nurse's life as possible; and to do this in such manner that each and every nurse will be able to recognize the various temptations, whenever and wherever she meets them, and thus be prepared to overcome them.

The purpose is to place within the reach of the younger members oi this noble profession, in advance, a knowledge that will be of service to them during their schooling, as well as during their professional fives.

And lastly, it is hoped to inspire those whose moral sensibilities have been blunted, by experience in the midst of temptations, with a higher ideal of their responsibilities, and a more exalted standard of life.

Chapter II

From personal experience and observation it is believed that Motive is the primary consideration of every prospective nurse. An effort has been made to determine the essential, beginning point of temptation, in the lives of those who elect to enter the training school. This has demonstrated the fact that a motive always precedes an action, whether that motive be defined definitely in the actor's mind, or not. Therefore, before a woman enters a school of nursing she has a motive for so doing, whether she has consciously stated that motive in her own mind, or not.

This motive may be noble and unselfish, or it may be of the meanest and most selfish character. However, it is a motive. Through study of the members of the profession, it has been observed that, in a large measure, the motives impelling nurses have been very largely of the purely selfish kind. These are many and varied.

In the following pages an effort will be made to present, illustrate and classify these various motives, in such manner that the reader may know and recognize them, and appreciate their unworthiness. It is hoped, then, that they may realize and appreciate the importance of right motives in the nursing profession.

The following are the motives most frequently observed :

1. Need of a home.

2. An occupation.

3. To forget sorrow and trouble.

4. Shelter for hiding.

5. Practical training and knowledge.

6. The study of human nature.

7. Adventure.

8. Money.

9. Romance. 10. Matrimony.

■ 11. Unselfish service to humanity.

The Hmitations of this volume will not permit a detailed consideration of all these various motives. Reference will be made, therefore, to those which appear to be of most vital importance.

Women frequently enter the training schools of nursing for the simple and sole purpose of finding a home, or a shelter from the outside business world. Frequently, too, we find those entered there by relatives who, in their goodness, as they believe, have found them a home — without having consulted the desire, choice, or abilities of the individual concerned.

These women enter, or are entered, with absolutely no motive in their own souls other than to have a place to eat, sleep and five. They do not consider the sorrows, trials, heartaches and disappointments they inevitably must encounter. Neither do they have any true desire to be of service to the sick and the weary. These altruistic ideas are foreign to them. They enter the work without enthusiasm or interest, begin the grind of making beds, bathing patients, rolling bandages, etc., and continue this grind, each day becoming more weary of the drudge. Consequently, before the term of their conventional schooling is completed the hard work and continual suffering they have faced have, as a rule, embittered them, disappointed them, and lowered any ideals they may have had of the nursing profession. However, the fear of being cast into the world without a home, or a place to live, hangs over them as a shadow. They decide to live out the drudgery until they receive their diploma entitling them to do "professional nursing." This will enable them, in turn, to earn money and provide for themselves a home. They proceed in the work of nursing with this alone as an impetus. The drudgery continues (for drudgery it is without the higher ideal constantly in mind) until they become irritable, embittered, pessimistic and selfish, and a disgrace to the profession.

The work of a nurse is so difficult, so nerve-racking, so discouraging at times, and calls for such a vast amount of unselfish effort, that only those are able to do it successfully who are actuated by unselfish motives, high ideals, a constructive attitude of soul, and the moral stamina necessary to maintain their ideals "in the midst of a hostile environment."

The second destructive motive is a mercenary one. The money temptation is one which enters into almost every profession of life. The nursing profession is no exception. It has many applicants who have the idea that it will enable them to make a large amount of money easily with the minimum of work. There comes a time, in the lives of a certain class of women, when they are compelled to face the problem of deciding upon an occupation through which they can earn a living. The question is: What profession can they enter which will afford the largest amount of wages for the smallest amount of personal effort and actual work ?

They have heard of the salaries demanded by graduate nurses for private-duty work; and, to them, the salaries are enormous for the amount of work required. They get the idea that the nursing profession is a great "paying business'* — a sort of gold mine, as it were — and thereupon they elect this as their life work. Consequently, they enter the school of training with this object in view — to obtain the highest salary of a professional nurse.

The probationery period is interesting and educating. The work is enjoyable and not difficult; therefore, the applicant who enters with the mercenary motive usually does her work well, appears interested, and is accepted as one of the regular class of nurses. After a year or two the conventional work inevitably palls, becomes monotonous, wearisome and uninteresting. She continues, however, always bearing in mind the time when she will receive her diploma and be entitled to the standard "large salary" of the private-duty nurse. This incentive leads her on to complete her course, however monotonous it has grown, and however lacking she has become in the real spirit of the work.

The work of private nursing is entered upon very enthusiastically because of the money which is to be received at the termination of each case. Great plans are made for the disposal of the "small fortune." And thus, at the outset of her journey, she is more or less unselfish and interested in her work as a private nurse. Her first wages delight her soul, and she believes she has chosen her life's work wisely.

Her first year as a professional nurse passes. Upon looking back over it she finds that the "small fortune" she had anticipated is chiefly conspicuous by its absence. In her planning she has failed to realize the expenses of a nurse, or the unoccupied weeks, perhaps months, between cases during which time her expenses continue. This she had overlooked. Now, however, in reviewing her accounts for the year she discovers, with deep disappointment, that the expenses have about balanced the income. Added to this disappointment is a realization of the uninteresting and monotonous life she has led while working with the idea of money alone in mind, and while waiting at home, day after day, for a case call. It seems hardly worth while to her — from a purely money standpoint.

However, after carefully studying the problem, she decides that possibly, after all, one year is not a fair trial. She intends to test out the following year by continuing to do the same character of work and by exercising greater economy. The year's work is begun in this attitude, with the hope of making more money.

Each case becomes more wearisome, uninteresting and repulsive to her, even though it does bring a large salary. Upon completing a case she finds herself irresistibly drawn to various kinds of entertainment to break the monotony of her life. She spends a considerable amount of extra money in accomplishing this end; but she appeases her conscience by promising herself to be more saving — after the next case. Following each case, however, she finds herself demanding more of the expensive forms of entertainment, and she grows less and less interested in her work.

This continues until at the end of the second year she is thoroughly disgusted with the drudgery of conventional nursing. This disgust is increased threefold when she finds that her bank account is no larger than it was at the beginning of the year. She is heart-sick and weary, discouraged and disgusted, disappointed with the nursing profession, and inclined to take up some other line of work. All worthy ideals of her profession, entertained by her prior to entering the school of training, are shattered.

She finds it difficult to leave this work after three years of schoohng, during which time she has earned virtually nothing. She feels that she cannot afford to give it up now, and therefore determines to go on as a sort of martyr.

It is in this attitude of soul that she enters upon her third year of nursing, with no desire nor motive but merely to make money enough to carry her through the year. Her influence on patients and associates has become more and more depressing and disheartening. She radiates disappointment, heartache and discouragement; therefore, she finds it more and more difficult to secure eases. She continues in the profession, however, a blot and a discord, a living justification of the public's condemnation.

And this result follows because she entered the profession with an unworthy motive, one which does credit neither to herself as a woman -nor to the dignity of the profession she has chosen.

The third motive is that of Marriage.

Marriage is one of the greatest events of a woman's life. It is an experience to which she has the right to look forward with happy anticipations. It is the dream of almost every true woman at some time in her life. It is one of her struggles for happiness. It is a legitimate, normal desire and a constructive one. For, any woman not having this desire at some period in her life, is abnormal. But however strong this desire and longing may be, it never must be allowed to fill the dominant place in a woman's life. She must not allow it to become the sole theme of her essential being and shape her course according to that dominant longing. Insofar as she allows this, the desire becomes destructive.

But how often we find this to be true ! How frequently we find women doing a certain kind of work with the only object in view of "getting a husband!" How common it is to find women allowing themselves to be dominated by this longing or desire, until it becomes, instead of a noble and constructive inspiration, a most destructive factor in their fives! It is, indeed, far too often that we find this true.

There is a considerable class of women whose sole object in life appears to be that of marriage. This class is again divided into two sub-classes, according to motive :

1. Those who have a true and earnest desire for the love relation.

2. Those who have a strong desire for someone to support them.

It is the second class to which this chapter specifically refers.

Either because of financial anxieties, or because of pure indolence, the women of this class decide they must have someone to support them. They come to the conclusion that marriage is the best and easiest solution of the problem. Then begins the search for a husband.

Knowing that nurses, in their work, are thrown into close relation with men of every type and station in Hfe, this appears to them a large field for their "researches." Accordingly, they decide to enter the field of nursing. If they know of the difficult and strenuous hfe of the practical nurse, they lead themselves to beHeve that "the end will justify the means." In other words, they are willing to work hard, even drudge, day after day if at the end they can capture a "husband." On the other hand, if they are ignorant of the difficulties of this work, they enter the profession enthusiastically, but with no motive in the world other than to gratify the longing of the soul for a husband.

By feigned or forced interest, and through purely mechanical work, they are accepted, perhaps on trial, into the regular class of nurses. After they have received the uniform and have become established in the work the real search begins. They put forth every effort to work among the male patients, and then to captivate and win them. This is their inspiration. The necessary work they find assigned them is done as rapidly and carelessly as possible, without interest or though tfulness, or any deep sense of responsibility. It is simply a means to an end. As they continue in the course, with their interest and energies directed in other channels, the work is virtually forgotten and inevitably shirked. It becomes tiresome and monotonous; but they continue in it, always hoping and waiting for the realization of their purpose and, in the meantime, doing as little work as possible.

Perhaps during their schooling they become "engaged." If not, it usually is no longer than a year following graduation before this important event occurs. By some hook or crook the end is accomplished. But God and the nurse alone know how. The work, in the meantime, has been done carelessly, has been shirked. All attention has been directed in another channel; and the reputation of the profession, as well as that of the nurse herself, has suffered accordingly.

Perhaps the accomphshment of the object of these women's lives brings happiness to them, but more frequently unhappiness is the result. Consequently, their nursing experience has been the cause; and, therefore, all manner of hard things are thought and said of the profession by these disappointed seekers. This adds nothing of good to the outside view of the profession, but only serves to justify the low respect in which it is held by many. Because of the women who enter the portals of this noble work with such motives, the other and more worthy members suffer alike the degraded reputation of those who justly deserve it.

At this point it seems proper to digress from the direct line of the theme, sufficiently to express a few thoughts on the subject of real Happiness as a result of True Marriage. The kindly forbearance and patience of the reader is asked during this short divergence, which may or may not be of interest to her.

Consciously or unconsciously, the objective point of every individual's Hfe is Happiness. From the beginning of his existence he is searching and striving for Happiness; for, ^'Happiness is the highest attainment of the soul,^^ and he intuitively recognizes this. His life is made up of struggles to reach this objective point.

Some may think they have found happiness in money, others in art, others in music. They may believe they have found happiness in some professional work. Yet, a time comes when there seems to be a void in their Hves, a longing for something they have not found. If these would but analyze this craving and understand its meaning they would find in themselves a longing for a greater happiness which never can be attained through money, social position, art, music, nor any professional work.

After years of experience and study in this line, students and searchers for Truth have come to the reaHzation that true happiness is the result of the perfect marriage relation alone. The true marriage relation has for its only basis perfect love: therefore, complete happiness can be only the result of the perfect love relation. It comes only through the perfect union of man and woman who are intelligently and harmoniously mated.

"Only, the man and woman who love really live. Only such as these are exercising the highest faculty of the soul. Only such as these experience that rare exhilaration of body, spirit and soul which constitutes the highest earthly happiness.^*

'^ Happiness is a matter of intelligent companionship, of sympathy and confidential cooperation, with another individual of our own plane of development."^

"The highest and most exalted phase or mode of consciousness is the desire of the soul for Individual Completion. Its satisfaction involves the highest activity of the soul, which is Love. Its complete satisfaction we call 'Happiness.^ "

"The attainment of rational Happiness rests primarily upon a possible, perfect marriage relation."^