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A plea for bedside nurse training
Copyright, 1951 by ‘The American Journal of Surgery, Inc.
A
PRACTlCAL
JOURNAL
BUILT
ON
MERIT
Sixtieth Tear of Public&on
UARY,
1951
NUMBER TWO
Editorial A PLEA FOR BEDSIDE NURSE TRAINING*
W
In the changing scenes of today we have arrived at a time of decision. It is important to decide whether we are to have two types of training schooIs for nurses. Is the program to be a patient-centered nursing program or is it to be a nurse education-centered program? Are we to have nursing education institutions as distinct departments of universities or will we continue to have hospita1 training schools which wiI1 attempt to coordinate nursing service and nursing education. The primary purpose of the hospita1 schoo1 shouId be to train nurses to give the best possibIe nursing service. Institutions whose primary function is education shouId provide training for those who wouId be directresses, supervisors and nursing educators. We are faced with many serious facts. There are at the present time over I,GOO,OOO hospita1 beds in the United States. There were over I 6,000,000 admissions to hospitals during I949. Are the universities prepared financiaIIy and have they physica pIants and facuIty to staff such institutions? WiIl highIy educated individuals be willing to do bedside nursing or wiII we see them wiIIing onIy to take executive positions in hospitaIs, teaching positions in coIIeges, pubIic health positions and positions as psychoIogists to chiId guidance clinics; or will they, as has been suggested, be wiIIing onIy to devote themselves to research probIems and to writing? What wiI1 be the effect upon the acutely sick in hospitals? There is a1read.y a trend to
E want progress. We need an orderly evohrtion and not a revolution. By orderly evoIution progress can be made without disturbance. Revolutionary changes find us unprepared for the obhgations ahead and experiments, if unsuccessful, may Iead to undesirabIe consequences. The present trend in nursing education is to create nursing education schooIs within Universities and to train subsidiary groups of trained practica1 nurses for bedside nursing. The hospita1 schoo1 of nursing which has been preparing nurses for bedside nursing may have to go out of existence. No one wouId decry the importance of nursing education, but one can seriously question whether it wouId be possible to suppIy the pubIic needs for bedside nursing through a prolonged educational system. It is important to realize that in genera1 education the Ieaders have cIearIy shown that a11 of us are not We must have in nursing, “coIIege material.” as in a11 we11 organized service groups, those who Iead and teach and those who proudIy render service. Let no one belittIe those who stand by the bed and who, under supervision of the doctor in charge, aid in the battIe for recovery of the individua1. No one will deny the need for socioIogists, socia1 workers, community heaIth workers and psychologists. The individua1 trained to be a bedside nurse does not need prolonged coIIege training to be an efficient aIIy of the doctor in the battIe for the recovery of the acutely iI individua1. * Address to the Graduating
Class, Baton Rouge General Hospital,
I47
Baton Rouge, La., July
17,
1950.
148
Editorial
develop practica1 nurse training schooIs. Those who take these courses wiII be considered as auxiliary workers and subordinates to the so-called professiona nurse. One asks himseIf: What is the future of the present group, the registered nurses who have had three years of preparation in hospitaIs? I made the statement that this is the time of decision. The basis for discussion for a Iong time wiI1 be a report prepared for the NationaI Nursing CounciI by Dr. Esther LuciIe Brown, Director of the Department of Studies in the Profession of the RusseII Sage Foundation in 1948. In the introduction Dr. Brown, a Doctor of Philosophy, not a nurse or a doctor of medicine, states, “For a quarter of a century Ieaders of nursing education have striven to create a sound and sociaIIy motivated form of nursing education. Long ago they became convinced that a system of apprenticeship, such as existed in the majority of the training schooIs was no Ionger adequate to prepare nurses either for the increase of institutional nursing or for that vast new fieId of community nursing which was in process of deveIopment.“’ The foIIowing are brief abstracts of the Brown report which may be of interest: “The fact has Iong been apparent that there are proportionateIy too few nurses prepared to give more than genera1 bedside care. . . . Many thoughtfu1 persons are beginning to wonder why young women in any Iarge numbers wouId want to enter nursing as practiced or schooIs of nursing as operated today. . . . By no conceivabIe stretch of the imagination can the education provided in the vast majority of some I ,250 schooIs be conceived of as professiona1 education. In spite of improvements that have been made in most schooIs over the years, it remains apprenticeship training. . . . Many hundreds of hospitaIs stiI1 operate schooIs, as they have in the past, to avai1 themseIves of the services of student nurses. RegardIess of the improvements that they have been forced to make by the trend of the time, their primary interest is not in education. Were such hospitals vividly interested in professional development tbey would tomorrow relinquish their schools to auspices whose exclusive junction is education.” Under the heading of Education for the 1Brown, Esther LuciIIe. Nursing for the Future, p. I 1-181. Report to the NationaI Nursing CounciI of the RusselI Sage Foundation, 1948.
Professiona Nurse in the Brown report we find the following: “AImost without a dissenting voice those who are conversant with the trend of professiona1 education in the United States agree that preparation of the professional nurse belongs squarely within the institution of higher learning. It is important that the schoo1 be accorded the same recognition as other professiona1 schooIs, and that the director be given the status of Dean and a seat at the conference tabIe on the highest executive IeveI. . . . The university schoo1 shouId enter into reIations with other institutions excIusiveIy to obtain necessary cIinica1 Iaboratories, and not to belp provide nursing service for patients. . . . Because professiona education in nursing has to be buiIt almost from the ground up in many parts of the country, suppIementary federa assistance is viewed by a Iarge proportion of informed nurses as necessary and desirabIe. . . . As a goa toward which to work during the next decade, we recommend that efforts be directed to buiIding basic schooIs of nursing in universities and in coIIeges comparabIe in number to existing medica schooIs, in a sound organization and financia1 structure, adequate in faciIities and facuIty, and we11 distributed to serve the needs of the entire country.” In summary, one wiI1 note that emphasis is Iaid on nursing education and not on nursing service. The report recommends the estabIishment of independent schools of nursing education within the university. The need for providing these faciIities wiI1 necessitate a buiIding and facuIty, and program, both physica recommendations are made that efforts be made to obtain federa and state funds for these purposes. Even if the suggestion of the university IeveI of education were to be carried out, it wouId not be possibIe to provide an adequate number nurses” with degrees for of “professiona nursing service. The Director of Nursing Service at VanderbiIt University cIearIy stated her position? “A concept of hospita1 nursing service, the functions it fuIfiIIs, and its program of work evoIve from the organization in which it is pIaced and the objectives inherent in the organized purpose. The objects in our situation are education, research and service. The school of nursing is 2HOLTZHAUSEN,ERMA A. Nursing service in a teaching hospita1. Am. .I. Nursing,
American
46: 550-534,
Journal
1946.
of Surgery
Editorial no part of our hospital organization; this is the first factor in Iiberating it from the weakness that for years hampered nursing education. In nursing education the student is at the center whereas hospita1 nursing of the program, service revoIves about the care of the patient. In teaching hospitaIs nursing service shouId be evaIuated on a different basis from that in non teaching hospitaIs where practicaIIy the entire time of ward nurses is given to care of patients.” It should be noted that Miss HoItzhausen has emphasized that the system or organization of a particuIar institution is dependent on its objectives. Even though educators have decried the “in-service” or apprentice type of nursing, Miss Holtzhausen states specifically, “The worth of learning by doing is stiI1 an undisputed principle in nursing education but, it is the misuse of this principIe in terms of money saving to the hospital that has frustrated the best interests in nursing education.” In spite of the insistent demands that “the modern hospita1 must reIinquish its contro1 of nursing education to institutions whose primary purpose is education”3 and in spite of the fact that committees and counciIs to study nursing education are agreed that the threeyear hospita1 schoo1 of nursing must be eliminated, we find some voices raised in favor of hospita1 schooIs which are attempting to train nurses for bedside care particuIarIy. J. MiIo Anderson” in a recent articIe in Modern Hospital stated, “It is not necessary to destroy the present system or to make the registered nurse a dispIaced person in order to improve nursing education.” Anderson and others agree that nursing education for service can be improved. Anderson said, “Bedside nursing is a ski11 which must be Iearned and taught IargeIy. by the apprentice method. Supervised chnrcal experience is an important part of the nursing curricuIum and must be given proper emphasis. This can and is being done we11 in hospital schooIs.” The vaIue of bedside instruction is emphasized by Miss Margaret Conrad, Associate Dean and Director of Nursing, CoIumbia Presbyterian Medical Center, New York? p PIKLER, GENEVEVE, and PIKLEK, ROY. Mod. Hosp.,
“Group instruction and cIass demonstration have a vita1 pIace in any educationa system, but the best education for patient care takes pIace with a wise and experienced nurse on one side of the patient and a novice on the other. The fundamenta1 principIes of nursing and heaIth become effective at the bedside or in the clinic or in the hospita1. No amount of pressure should shake one’s firm conviction on this point.” Sister Henrietta, Director of the SchooI of Nursing Service at Charity HospitaI in New OrIeans in 1948, said, “The nursing department which we are going to organize wiI1 be buiIt to serve the patients; in other words it wiI1 become a patient centered department. The statement is heard frequentIy that better education of students wiI1 result in better care of patients. But, does it?“6 One of her concIuding remarks was, “When as much emphasis is placed on standards of nursing care as is pIaced on nursing education, I think that we can hope for improvement. The first requirement for estabIishing a patient-centered nursing department is to grasp the idea of nursing service as an entity unto itself. The pIace where nursing service and nursing education overIap, nameIy in the cIinica1 experience of the student, is the scene of a host of probIems. Our nursing service needs are taking precedence over the aims of the nursing school. Leadership service demands expertness in in nursing bedside nursing aIong with the other quaIifications needed by an executive.” Let it not be forgotten that hospitais, the medical staffs and the pubIic in need of nursing service are vitally interested in the preparation of those who are to aid the physician and surgeon in his work. The hospita1 in its desire to render service and the pubIic who are to receive this service are not unmindful of the training of the nurse. Nursing educators shouId not be unmindful of the fact that the surgeon has more to Iose than anyone except the patient himself when poor nursing service is rendered. In 1947 the American SurgicaI Association after a study of the nursing probIem concIuded,r “The opinion is wideIy heId that the profes-
September, ,949. 4 ANDERSON, J. MILO. The degree doesn’t make the nurse. Mod. Hosp., 73: 5660, 1949. b CONRAD, RIARGARET. Am. J. Nursing, 49: I IO--I12,
s SISTER HENRIETTA. Organizing the nursing department to serve the patient. Am. J. Nursing, 48: 285-287,
‘949.
February,
xg$x
1948. 7 NAFFZIGER, HOWARD C. Report J. A. M. A., 133: 1168-1169, 1947.
of the Chairman.
EditoriaI siona1 aim of the nursing profession has been to eIevate the nursing profession and to increase the educationa content of training. They have Iost sight of the need of the sick for adequate nursing care. As more of the nurse’s time has been devoted to forma1 class instruction, the nursing care of the patient has become Iess satisfactory. There was aImost compIete unanimity in the feeIing of the surgical profession that the increase in the required training for nurses beyond the three year IeveI has not improved their abiIity to care for the sick and that it had not promoted cIoser cooperation between the doctor and nurse in the care of the sick. The need for adequate bedside nursing care is manifest and urgent; and whereas, there is no indication that these needs wiII be met by estabIished schooIs of nursing; and whereas, it is the concensus of this body that experience has shown that proIonged periods of education are not essentia1 for the training of bedside nurses; therefore, be it resolved that the American SurgicaI Association go on record as approving the use of personne1 trained specificaIIy for bedside care and, be it further resoIved, that it urge the immediate estabIishment of short courses for the training of bedside nurses.” The American MedicaI Association in 1948 advocated two main cIasses of nurses, nameIy, professional nurses and trained practica1 nurses. The professiona nurse group was to be subdivided into nurse educators and cIinica1 nurses. The cIinica1 nurse was to be comparabIe to the present day general duty or private nurse. The committee recommended that the course of training for the cIinica1 nurse be reduced to two years. They recommended that uniform standards of training for trained practical nurses be deveIoped. They aIso recommended one year of training of which three months were to be for theoretica and nine months for practica1 training. It is evident that if the trend of nursing education for the professiona nurse continues to deveIop, the present genera1 duty nurse or registered nurse wiI1 be aImost compIeteIy displaced by the so-caIIed practica1 nurse. As a middIe-of-the-road individua1 who beIieves in Iooking upon things in a reaIistic way, Iet me remind you that it wiI1 not be possibIe over night or in a decade to finance and buiId both physical faciIities and facuIties for university IeveI independent nursing schooIs.
It is true that suggestions have been made that federa aid be obtained. I, for one, hope that from the “cradIe to the grave” paternaIistic type of government for regimentation of education and other activities of Iife wiI1 not soon be a reaIity. So much criticism has been IeveIed at the in-service or apprenticeship type of training of nurses that it might be worth whiIe to discuss this brief3 y. There was a time not so Iong ago when the medica curricuIum was IargeIy fiIIed by didactic Iectures. Today bedside cIinica1 cIerkship and supervised training has IargeIy repIaced didactic Iectures. Even graduate training in medicine is IargeIy based today on supervised in-service experience. In our great pubIic institutions the medica staff seeks added experience and training for themseIves Iong after they have become recognized in their particular specia1 fieIds. No amount of didactic or Iaboratory training can ever be a substitute for cIinica1 experience under supervision at a bedside. No amount of psychoIogic didactic teaching or reading can repIace the opportunities gained by study of the patient and his family under trying and distressing conditions. If this method of training is good for students of medicine, it shouId be good for nurses. I am reminded of the story of the distinguished scientist who went out in a boat with fishermen. The men rowed for a few minutes when the scientist said to the fishermen, “Have One poor you ever studied astronomy?” fisherman did not know what astronomy was and of course he said, “No.” The scientist then asked if the fisherman had ever studied geoIogy. He repIied in the negative and the professor said, “You have missed haIf of your Iife.” Just about that time the fisherman saw a squaI1 coming up and he turned to the professor and said, “Have you ever studied how to swim?” The professor said, “No” and the fisherman repIied, “Then you have missed your whoIe Iife.” I trust that you see in nursing a vocation dedicated to human service. It is the hope of your friends that you of the graduating cIass wiI1 use your training for the benefits of mankind. May your efforts bring happiness to those entrusted to your care and may each of you enjoy the satisfaction that comes from duty we11 done. ISIDORE
American
COHN,
Journal
M.D.
of Surgery
A
PRACTlCAL
JOURNAL
BUILT
ON
MERIT
Sixtieth Tear of Public&on
UARY,
1951
NUMBER TWO
Editorial A PLEA FOR BEDSIDE NURSE TRAINING*
W
In the changing scenes of today we have arrived at a time of decision. It is important to decide whether we are to have two types of training schooIs for nurses. Is the program to be a patient-centered nursing program or is it to be a nurse education-centered program? Are we to have nursing education institutions as distinct departments of universities or will we continue to have hospita1 training schools which wiI1 attempt to coordinate nursing service and nursing education. The primary purpose of the hospita1 schoo1 shouId be to train nurses to give the best possibIe nursing service. Institutions whose primary function is education shouId provide training for those who wouId be directresses, supervisors and nursing educators. We are faced with many serious facts. There are at the present time over I,GOO,OOO hospita1 beds in the United States. There were over I 6,000,000 admissions to hospitals during I949. Are the universities prepared financiaIIy and have they physica pIants and facuIty to staff such institutions? WiIl highIy educated individuals be willing to do bedside nursing or wiII we see them wiIIing onIy to take executive positions in hospitaIs, teaching positions in coIIeges, pubIic health positions and positions as psychoIogists to chiId guidance clinics; or will they, as has been suggested, be wiIIing onIy to devote themselves to research probIems and to writing? What wiI1 be the effect upon the acutely sick in hospitals? There is a1read.y a trend to
E want progress. We need an orderly evohrtion and not a revolution. By orderly evoIution progress can be made without disturbance. Revolutionary changes find us unprepared for the obhgations ahead and experiments, if unsuccessful, may Iead to undesirabIe consequences. The present trend in nursing education is to create nursing education schooIs within Universities and to train subsidiary groups of trained practica1 nurses for bedside nursing. The hospita1 schoo1 of nursing which has been preparing nurses for bedside nursing may have to go out of existence. No one wouId decry the importance of nursing education, but one can seriously question whether it wouId be possible to suppIy the pubIic needs for bedside nursing through a prolonged educational system. It is important to realize that in genera1 education the Ieaders have cIearIy shown that a11 of us are not We must have in nursing, “coIIege material.” as in a11 we11 organized service groups, those who Iead and teach and those who proudIy render service. Let no one belittIe those who stand by the bed and who, under supervision of the doctor in charge, aid in the battIe for recovery of the individua1. No one will deny the need for socioIogists, socia1 workers, community heaIth workers and psychologists. The individua1 trained to be a bedside nurse does not need prolonged coIIege training to be an efficient aIIy of the doctor in the battIe for the recovery of the acutely iI individua1. * Address to the Graduating
Class, Baton Rouge General Hospital,
I47
Baton Rouge, La., July
17,
1950.
148
Editorial
develop practica1 nurse training schooIs. Those who take these courses wiII be considered as auxiliary workers and subordinates to the so-called professiona nurse. One asks himseIf: What is the future of the present group, the registered nurses who have had three years of preparation in hospitaIs? I made the statement that this is the time of decision. The basis for discussion for a Iong time wiI1 be a report prepared for the NationaI Nursing CounciI by Dr. Esther LuciIe Brown, Director of the Department of Studies in the Profession of the RusseII Sage Foundation in 1948. In the introduction Dr. Brown, a Doctor of Philosophy, not a nurse or a doctor of medicine, states, “For a quarter of a century Ieaders of nursing education have striven to create a sound and sociaIIy motivated form of nursing education. Long ago they became convinced that a system of apprenticeship, such as existed in the majority of the training schooIs was no Ionger adequate to prepare nurses either for the increase of institutional nursing or for that vast new fieId of community nursing which was in process of deveIopment.“’ The foIIowing are brief abstracts of the Brown report which may be of interest: “The fact has Iong been apparent that there are proportionateIy too few nurses prepared to give more than genera1 bedside care. . . . Many thoughtfu1 persons are beginning to wonder why young women in any Iarge numbers wouId want to enter nursing as practiced or schooIs of nursing as operated today. . . . By no conceivabIe stretch of the imagination can the education provided in the vast majority of some I ,250 schooIs be conceived of as professiona1 education. In spite of improvements that have been made in most schooIs over the years, it remains apprenticeship training. . . . Many hundreds of hospitaIs stiI1 operate schooIs, as they have in the past, to avai1 themseIves of the services of student nurses. RegardIess of the improvements that they have been forced to make by the trend of the time, their primary interest is not in education. Were such hospitals vividly interested in professional development tbey would tomorrow relinquish their schools to auspices whose exclusive junction is education.” Under the heading of Education for the 1Brown, Esther LuciIIe. Nursing for the Future, p. I 1-181. Report to the NationaI Nursing CounciI of the RusselI Sage Foundation, 1948.
Professiona Nurse in the Brown report we find the following: “AImost without a dissenting voice those who are conversant with the trend of professiona1 education in the United States agree that preparation of the professional nurse belongs squarely within the institution of higher learning. It is important that the schoo1 be accorded the same recognition as other professiona1 schooIs, and that the director be given the status of Dean and a seat at the conference tabIe on the highest executive IeveI. . . . The university schoo1 shouId enter into reIations with other institutions excIusiveIy to obtain necessary cIinica1 Iaboratories, and not to belp provide nursing service for patients. . . . Because professiona education in nursing has to be buiIt almost from the ground up in many parts of the country, suppIementary federa assistance is viewed by a Iarge proportion of informed nurses as necessary and desirabIe. . . . As a goa toward which to work during the next decade, we recommend that efforts be directed to buiIding basic schooIs of nursing in universities and in coIIeges comparabIe in number to existing medica schooIs, in a sound organization and financia1 structure, adequate in faciIities and facuIty, and we11 distributed to serve the needs of the entire country.” In summary, one wiI1 note that emphasis is Iaid on nursing education and not on nursing service. The report recommends the estabIishment of independent schools of nursing education within the university. The need for providing these faciIities wiI1 necessitate a buiIding and facuIty, and program, both physica recommendations are made that efforts be made to obtain federa and state funds for these purposes. Even if the suggestion of the university IeveI of education were to be carried out, it wouId not be possibIe to provide an adequate number nurses” with degrees for of “professiona nursing service. The Director of Nursing Service at VanderbiIt University cIearIy stated her position? “A concept of hospita1 nursing service, the functions it fuIfiIIs, and its program of work evoIve from the organization in which it is pIaced and the objectives inherent in the organized purpose. The objects in our situation are education, research and service. The school of nursing is 2HOLTZHAUSEN,ERMA A. Nursing service in a teaching hospita1. Am. .I. Nursing,
American
46: 550-534,
Journal
1946.
of Surgery
Editorial no part of our hospital organization; this is the first factor in Iiberating it from the weakness that for years hampered nursing education. In nursing education the student is at the center whereas hospita1 nursing of the program, service revoIves about the care of the patient. In teaching hospitaIs nursing service shouId be evaIuated on a different basis from that in non teaching hospitaIs where practicaIIy the entire time of ward nurses is given to care of patients.” It should be noted that Miss HoItzhausen has emphasized that the system or organization of a particuIar institution is dependent on its objectives. Even though educators have decried the “in-service” or apprentice type of nursing, Miss Holtzhausen states specifically, “The worth of learning by doing is stiI1 an undisputed principle in nursing education but, it is the misuse of this principIe in terms of money saving to the hospital that has frustrated the best interests in nursing education.” In spite of the insistent demands that “the modern hospita1 must reIinquish its contro1 of nursing education to institutions whose primary purpose is education”3 and in spite of the fact that committees and counciIs to study nursing education are agreed that the threeyear hospita1 schoo1 of nursing must be eliminated, we find some voices raised in favor of hospita1 schooIs which are attempting to train nurses for bedside care particuIarIy. J. MiIo Anderson” in a recent articIe in Modern Hospital stated, “It is not necessary to destroy the present system or to make the registered nurse a dispIaced person in order to improve nursing education.” Anderson and others agree that nursing education for service can be improved. Anderson said, “Bedside nursing is a ski11 which must be Iearned and taught IargeIy. by the apprentice method. Supervised chnrcal experience is an important part of the nursing curricuIum and must be given proper emphasis. This can and is being done we11 in hospital schooIs.” The vaIue of bedside instruction is emphasized by Miss Margaret Conrad, Associate Dean and Director of Nursing, CoIumbia Presbyterian Medical Center, New York? p PIKLER, GENEVEVE, and PIKLEK, ROY. Mod. Hosp.,
“Group instruction and cIass demonstration have a vita1 pIace in any educationa system, but the best education for patient care takes pIace with a wise and experienced nurse on one side of the patient and a novice on the other. The fundamenta1 principIes of nursing and heaIth become effective at the bedside or in the clinic or in the hospita1. No amount of pressure should shake one’s firm conviction on this point.” Sister Henrietta, Director of the SchooI of Nursing Service at Charity HospitaI in New OrIeans in 1948, said, “The nursing department which we are going to organize wiI1 be buiIt to serve the patients; in other words it wiI1 become a patient centered department. The statement is heard frequentIy that better education of students wiI1 result in better care of patients. But, does it?“6 One of her concIuding remarks was, “When as much emphasis is placed on standards of nursing care as is pIaced on nursing education, I think that we can hope for improvement. The first requirement for estabIishing a patient-centered nursing department is to grasp the idea of nursing service as an entity unto itself. The pIace where nursing service and nursing education overIap, nameIy in the cIinica1 experience of the student, is the scene of a host of probIems. Our nursing service needs are taking precedence over the aims of the nursing school. Leadership service demands expertness in in nursing bedside nursing aIong with the other quaIifications needed by an executive.” Let it not be forgotten that hospitais, the medical staffs and the pubIic in need of nursing service are vitally interested in the preparation of those who are to aid the physician and surgeon in his work. The hospita1 in its desire to render service and the pubIic who are to receive this service are not unmindful of the training of the nurse. Nursing educators shouId not be unmindful of the fact that the surgeon has more to Iose than anyone except the patient himself when poor nursing service is rendered. In 1947 the American SurgicaI Association after a study of the nursing probIem concIuded,r “The opinion is wideIy heId that the profes-
September, ,949. 4 ANDERSON, J. MILO. The degree doesn’t make the nurse. Mod. Hosp., 73: 5660, 1949. b CONRAD, RIARGARET. Am. J. Nursing, 49: I IO--I12,
s SISTER HENRIETTA. Organizing the nursing department to serve the patient. Am. J. Nursing, 48: 285-287,
‘949.
February,
xg$x
1948. 7 NAFFZIGER, HOWARD C. Report J. A. M. A., 133: 1168-1169, 1947.
of the Chairman.
EditoriaI siona1 aim of the nursing profession has been to eIevate the nursing profession and to increase the educationa content of training. They have Iost sight of the need of the sick for adequate nursing care. As more of the nurse’s time has been devoted to forma1 class instruction, the nursing care of the patient has become Iess satisfactory. There was aImost compIete unanimity in the feeIing of the surgical profession that the increase in the required training for nurses beyond the three year IeveI has not improved their abiIity to care for the sick and that it had not promoted cIoser cooperation between the doctor and nurse in the care of the sick. The need for adequate bedside nursing care is manifest and urgent; and whereas, there is no indication that these needs wiII be met by estabIished schooIs of nursing; and whereas, it is the concensus of this body that experience has shown that proIonged periods of education are not essentia1 for the training of bedside nurses; therefore, be it resolved that the American SurgicaI Association go on record as approving the use of personne1 trained specificaIIy for bedside care and, be it further resoIved, that it urge the immediate estabIishment of short courses for the training of bedside nurses.” The American MedicaI Association in 1948 advocated two main cIasses of nurses, nameIy, professional nurses and trained practica1 nurses. The professiona nurse group was to be subdivided into nurse educators and cIinica1 nurses. The cIinica1 nurse was to be comparabIe to the present day general duty or private nurse. The committee recommended that the course of training for the cIinica1 nurse be reduced to two years. They recommended that uniform standards of training for trained practical nurses be deveIoped. They aIso recommended one year of training of which three months were to be for theoretica and nine months for practica1 training. It is evident that if the trend of nursing education for the professiona nurse continues to deveIop, the present genera1 duty nurse or registered nurse wiI1 be aImost compIeteIy displaced by the so-caIIed practica1 nurse. As a middIe-of-the-road individua1 who beIieves in Iooking upon things in a reaIistic way, Iet me remind you that it wiI1 not be possibIe over night or in a decade to finance and buiId both physical faciIities and facuIties for university IeveI independent nursing schooIs.
It is true that suggestions have been made that federa aid be obtained. I, for one, hope that from the “cradIe to the grave” paternaIistic type of government for regimentation of education and other activities of Iife wiI1 not soon be a reaIity. So much criticism has been IeveIed at the in-service or apprenticeship type of training of nurses that it might be worth whiIe to discuss this brief3 y. There was a time not so Iong ago when the medica curricuIum was IargeIy fiIIed by didactic Iectures. Today bedside cIinica1 cIerkship and supervised training has IargeIy repIaced didactic Iectures. Even graduate training in medicine is IargeIy based today on supervised in-service experience. In our great pubIic institutions the medica staff seeks added experience and training for themseIves Iong after they have become recognized in their particular specia1 fieIds. No amount of didactic or Iaboratory training can ever be a substitute for cIinica1 experience under supervision at a bedside. No amount of psychoIogic didactic teaching or reading can repIace the opportunities gained by study of the patient and his family under trying and distressing conditions. If this method of training is good for students of medicine, it shouId be good for nurses. I am reminded of the story of the distinguished scientist who went out in a boat with fishermen. The men rowed for a few minutes when the scientist said to the fishermen, “Have One poor you ever studied astronomy?” fisherman did not know what astronomy was and of course he said, “No.” The scientist then asked if the fisherman had ever studied geoIogy. He repIied in the negative and the professor said, “You have missed haIf of your Iife.” Just about that time the fisherman saw a squaI1 coming up and he turned to the professor and said, “Have you ever studied how to swim?” The professor said, “No” and the fisherman repIied, “Then you have missed your whoIe Iife.” I trust that you see in nursing a vocation dedicated to human service. It is the hope of your friends that you of the graduating cIass wiI1 use your training for the benefits of mankind. May your efforts bring happiness to those entrusted to your care and may each of you enjoy the satisfaction that comes from duty we11 done. ISIDORE
American
COHN,
Journal
M.D.
of Surgery