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A “Burnham scale” for hospital nurses
64 and characteristics of the population in different parts of the country. Some of the outstanding differences from the medical services of this country were the absence of any national scheme of insured medical treatment, and consequently of " panel " practice, the almost complete absence of midwives, and the greater degree of specialisation in the medical profession. He described the agencies for maternal and child welfare as (a) Government controlled (Federal, State, City, or County government); and (b) privately controlled--/.e., mainly philanthropic foundations and trusts, or voluntary societies dealing with a particular branch of child welfare. Co-ordinated Government schemes came to the fore after the last war under the pressure of public opinion resulting from the reports of the federally appointed Children's Committee-which led to the formation of the Federal Children's B u r e a u - and the federally appointed Committee on the Cost of Medical Care, which showed that adequate curative and preventive medical care was then beyond the reach of a large proportion of the middle and lower classes. Federal Government aid was directed primarily to educational and fact-finding activities. It had no executive function and did not directly subsidise treatment or relief. Grants were made by the Federal Government to a State under conditions and subject to agreed expenditure by the State also, which might in turn distribute financial aid and allocate responsibility to constituent counties. Dr. Becker paid special tribute to the public health nurse as a most important factor in State-aided educational work: she usually holds a University degree in addition to her nursing degree. T h e privately controlled agencies dealing with health and welfare numbered thousands. Many were in touch with Government departments and might be used by the latter for specific purposes. Dr. Becker described in some detail the work of the Kellog Foundation. T h e great resources of the Foundation were at first used in an attempt to improve the health of the children of the State of Michigan by the creation or the financing of clinics, hospitals, and similar curative agencies, but the absence of any appreciable effect on succeeding generations ted to a shifting of the emphasis to education--and especially the education of doctors and of public opinion through the schools, the clergy, and the newspapers. Dr. Becker spoke with conviction of the good results achieved by intensive educational work among general practitioners, for whom the Kellog Foundation arranged meetings and postgraduate courses in paediatrics and obstetrics, and supplied the services of consultant paed~atricians whose work was deliberately educational as well as clinical.
A " Burnham Scale " for Hospital Nurses The report of the Committee presided over by Lord Rushcliffe will be a historical document in British nursing because for the first time it fixes national salary scales covering every grade of nursing staff and every type of hospital (with the exception of mental hospitals where nationally negotiated salary scales already apply). Nearly two years ago the Minister of Health announced the intention of the Government to secure national scales for nurses on similar lines to the Burnham .scale for teachers, and as an earnest of that resolve he increased the rates for members of the Civil Nursing Reserve employed in hospitals. This led both municipal and voluntary hospitals to increase their scales, adding about one million a year to the total nursing cost. When the Rushcliffe scales now proposed come fully into operation--for many nurses they will take effect on April 1st next--they will mean a further increase of between one and a half and two million pounds a year, and the Government is prepared to meet half the increased expenditure. The grades of nursing staff are so many, and the scales in existence among hospital authorities are so various, that it is difficult to put shortly to what extent the average nurse--if there be such a person--will benefit. But if we take the general trained staff nurse in a general hospital, the Rushcliffe scale will be £100 rising by annual increments of £5 to ~140, to which must be added emoluments, in the shape of board, residence, and laundry, to the annual value of £90. Two
PUBLIC HEALTH, March, 1943 years ago the British Hospitals Association recommended voluntary hospitals to adopt a m i n i m u m of £90 for a nurse of this grade, and £95, rising to £110, is paid by some municipal hospitals. The ward sister in a general hospital will receive under Rushcliffe £130, rising by £10 to £180, and after ten years' service she will have one year's additional service increment of £20. T o this must be added emoluments equal to £100 a year. I n general, again, this will mean a considerable increase on the salaries now paid to ward sisters. As for the matron in a general training hospital of 400 to 500 beds, she will receive £400, rising by £30 to £580, and the total value of her emoluments can be estimated at a further £200. T h e present salary of such a matron may be £250 or rather more, rising to £400. The staff nurse in an infectious diseases hospital, if on the " general " part of the State register, will receive £100, rising by £5 to £140, with emoluments of £90, and the salary of the superintendent or head nurse in a public assistance institution of 400 or more sick beds will have £240, rising by £15 to:£360, and emoluments valued at £140. It is not proposed to set up any cost of living bonus, but the scales may be reconsidered at the request of either the employers' or the nurses' national panel. Another recommendation is that all nurses below the rank of assistant matron or tutor shall receive an additional payment of £5 a year if they possess a university diploma in nursing. I n addition the report makes recommendations on other matters perhaps as important as salary in the nursing service. It recommends that there should be a 96-hour fortnight day or night, that" continuous periods of night duty should not be longer than six months for sisters and staff nurses and three months for students, and that the charging of fees to student nurses on their entry for training in a hospital--which is a practice adopted by some authorities---should be discontinued. There are several matters on which the Committee has still to report. These include the salaries and emoluments of male hospital nurses, of health visitors and school nurses employed by local authorities, of district nurses, and of nurses in day and residential nurseries. Another technical problem on which conclusions have not yet been reached is superannuation provision, and on this an expert sub-committee is now sitting. These new benefits will attract recruits of the right type into the profession, and they will not make it less of a vocation. Another thing which a national scale will do will be to eliminate the undesirable competition for nursing staff between different hospital authorities. Congratulations are due to Lord Rushcliffe and his Committee, which included representatives of the Association of Municipal Corporations, the County Councils Association, the Urban and Rural District Councils Associations, and the National Association of Local Government Officers, as well as the British Hospitals Association, the Trade Union Congress, and nursing bodies. Cities a n d Shires of To-morrow The structure of local government in this country is a patchy and complicated affair, not nearly as efficient nor as economical as it might be if it were simplified. That it has functioned so well on the whole is a tribute to our public spirit rather than to our faculty for logic. Few people understand all its woIkings except those actually engaged in it, and even those engaged in it are not always knowledgeable. I n the large revision which must be looked for after the war one body well qualified to offer expert guidance is the National Association of Local Government Officers, which has brought out an interim report on the subject.* With most of " Nalgo's " arraignment of the defects of the present system we are in agreement, although we rather challenge the statement that public apathy about local government is largely owing to the narrow and rigid areas of local authorities. Have they never witnessed a ward election in some little old town, with the candidates sporting party colours, or the making of a mayor, when the smaller the borough the greater the solemnity ? Will a citizen of Oakham who has taken no interest in his town suddenly develop an * "Nalgo," 27, Abingdon Street, S,W.1. 6d.
A " Burnham Scale " for Hospital Nurses The report of the Committee presided over by Lord Rushcliffe will be a historical document in British nursing because for the first time it fixes national salary scales covering every grade of nursing staff and every type of hospital (with the exception of mental hospitals where nationally negotiated salary scales already apply). Nearly two years ago the Minister of Health announced the intention of the Government to secure national scales for nurses on similar lines to the Burnham .scale for teachers, and as an earnest of that resolve he increased the rates for members of the Civil Nursing Reserve employed in hospitals. This led both municipal and voluntary hospitals to increase their scales, adding about one million a year to the total nursing cost. When the Rushcliffe scales now proposed come fully into operation--for many nurses they will take effect on April 1st next--they will mean a further increase of between one and a half and two million pounds a year, and the Government is prepared to meet half the increased expenditure. The grades of nursing staff are so many, and the scales in existence among hospital authorities are so various, that it is difficult to put shortly to what extent the average nurse--if there be such a person--will benefit. But if we take the general trained staff nurse in a general hospital, the Rushcliffe scale will be £100 rising by annual increments of £5 to ~140, to which must be added emoluments, in the shape of board, residence, and laundry, to the annual value of £90. Two
PUBLIC HEALTH, March, 1943 years ago the British Hospitals Association recommended voluntary hospitals to adopt a m i n i m u m of £90 for a nurse of this grade, and £95, rising to £110, is paid by some municipal hospitals. The ward sister in a general hospital will receive under Rushcliffe £130, rising by £10 to £180, and after ten years' service she will have one year's additional service increment of £20. T o this must be added emoluments equal to £100 a year. I n general, again, this will mean a considerable increase on the salaries now paid to ward sisters. As for the matron in a general training hospital of 400 to 500 beds, she will receive £400, rising by £30 to £580, and the total value of her emoluments can be estimated at a further £200. T h e present salary of such a matron may be £250 or rather more, rising to £400. The staff nurse in an infectious diseases hospital, if on the " general " part of the State register, will receive £100, rising by £5 to £140, with emoluments of £90, and the salary of the superintendent or head nurse in a public assistance institution of 400 or more sick beds will have £240, rising by £15 to:£360, and emoluments valued at £140. It is not proposed to set up any cost of living bonus, but the scales may be reconsidered at the request of either the employers' or the nurses' national panel. Another recommendation is that all nurses below the rank of assistant matron or tutor shall receive an additional payment of £5 a year if they possess a university diploma in nursing. I n addition the report makes recommendations on other matters perhaps as important as salary in the nursing service. It recommends that there should be a 96-hour fortnight day or night, that" continuous periods of night duty should not be longer than six months for sisters and staff nurses and three months for students, and that the charging of fees to student nurses on their entry for training in a hospital--which is a practice adopted by some authorities---should be discontinued. There are several matters on which the Committee has still to report. These include the salaries and emoluments of male hospital nurses, of health visitors and school nurses employed by local authorities, of district nurses, and of nurses in day and residential nurseries. Another technical problem on which conclusions have not yet been reached is superannuation provision, and on this an expert sub-committee is now sitting. These new benefits will attract recruits of the right type into the profession, and they will not make it less of a vocation. Another thing which a national scale will do will be to eliminate the undesirable competition for nursing staff between different hospital authorities. Congratulations are due to Lord Rushcliffe and his Committee, which included representatives of the Association of Municipal Corporations, the County Councils Association, the Urban and Rural District Councils Associations, and the National Association of Local Government Officers, as well as the British Hospitals Association, the Trade Union Congress, and nursing bodies. Cities a n d Shires of To-morrow The structure of local government in this country is a patchy and complicated affair, not nearly as efficient nor as economical as it might be if it were simplified. That it has functioned so well on the whole is a tribute to our public spirit rather than to our faculty for logic. Few people understand all its woIkings except those actually engaged in it, and even those engaged in it are not always knowledgeable. I n the large revision which must be looked for after the war one body well qualified to offer expert guidance is the National Association of Local Government Officers, which has brought out an interim report on the subject.* With most of " Nalgo's " arraignment of the defects of the present system we are in agreement, although we rather challenge the statement that public apathy about local government is largely owing to the narrow and rigid areas of local authorities. Have they never witnessed a ward election in some little old town, with the candidates sporting party colours, or the making of a mayor, when the smaller the borough the greater the solemnity ? Will a citizen of Oakham who has taken no interest in his town suddenly develop an * "Nalgo," 27, Abingdon Street, S,W.1. 6d.