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NURSING AS A NATIONAL SERVICE

THE LANCET

LONDON: SATURDAY, FEBRUARY 4, 1939

THE interim report of the Inter-departmentalCommittee on Nursing Services, discussed on

another page, is no less valuable because it doesnot present a balanced and comprehensive surveyof the problem. The committee makes concrete

suggestions designed to stimulate recruitment andto minimise wastage through dissatisfaction withworking conditions and prospects, and it disposeseffectively of the bogy that measures planned tosecure a much larger number of candidates for

training could possibly cause the supply of nursesto exceed a rapidly growing demand. A question-naire has been issued to all hospitals and theanalysis of the answers should yield more preciseinformation on the needs of institutions than isat present available ; but the committee concludesfrom evidence already submitted that it is in

hospitals that the existing shortage is most acutelyfelt and most of its present recommendationsare concerned with this branch of nursing.An important exception, which affects the whole

profession, is the elaborate discussion of theeducation of the prospective nurse from the timeof leaving an elementary or a secondary schoolto the stage when she passes the first part (anatomy,physiology and hygiene) of the divided pre-liminary state examination. The pre-nursing courseshitherto established did not attract many girlsbecause they offered no tangible advantage in theway of progress towards the goal of state-

registration. Now that the General Nursing Councilhave agreed to allow part of the first professionalexamination to be taken before entering hospitalthe committee contemplates that after a transitionperiod the usual method of entry to the professionwill be by way of pre-nursing courses which willtake various forms : full-time courses for seniorpupils in secondary schools, and longer part-timeevening courses for ex-elementary-school girlsemployed during the day. The establishment ofsuch courses (which should continue the generaleducation of the students as well as providingspecialised instruction) by local education authori-ties throughout the country is regarded as themost effective method of bridging the gap betweenschool and hospital. The estimate that 12,000probationers a year are required to meet the needsof hospitals recognised as training-schools has con-vinced the committee that it is at present impossibleto obtain enough recruits from secondary schools.,The committee is realistic also in its assumptionthat hospitals will continue to rely largely onstudent labour; the alteration of the status of theprobationer from that of an apprentice to that of

a pupil is evidently not contemplated. The com-mittee recognises moreover that almost from themoment of entry to hospital the probationer givesvaluable service ; it observes that in 1937 theL.C.C., in view of the difficulty of obtaining staffnurses, engaged a number of first-year probationersin excess of establishment in order to release

fourth-year probationers for staff-nurse duties.No change then is suggested in the pattern of

the training of nurses, or in the reduction of thenumber of registers, general and supplementary,kept by the General Nursing Council; the recog-nition of a second grade of nurses would indeedadd another register (or roll) to those now existing.Some disappointment may be felt that more

specific proposals are not made for the recom-mended increase in the salaries of trained nurses

pending the appointment of national committees ;that the relative merits of different methods of

reducing hours of work are not discussed ; andthat comment on the syllabus and scope of thefinal state examination is postponed. But all willwelcome the fundamental message of the report:that nursing must be recognised as a service of

outstanding national importance and that thesocial and industrial structure of the nation has

undergone such radical changes during recent yearsthat a "sense of vocation" can no longer berelied on as the chief stimulus to recruitment.Remuneration during active employment, provisionfor old age and conditions of service must be so

improved as to enable nursing to compete withother careers open to women. Many of these

things have been said before in vain, but therecommendation of grants from national funds tomeet the heavy cost of some of the proposed changeswill, if adopted, succeed in implementing them.One thing remains to be said. The final

report of THE LANCET Commission appeared at atime when the industrial slump had enhanced theattractions of a professional training that costs

nothing except in labour and provides pocketmoney as well as board and lodging from theoutset. An influx of candidates in 1931 and 1932reassured many hospitals and prevented them fromputting their houses in order. This interim reportappears at a time when the desire of young womento equip themselves for service in case of war hasin some places led to an increase of applicants forhospital training. It would be a calamity if an

. urge which is likely to be only transitory shouldpostpone action which is essential for the protectionof hospital services in normal times.

THE CLINICAL SCIENCE CAMPAIGNDURING the last twenty years Sir THOMAS

LEWIS has made a series of contributions to medi-cine which are outstanding in their originality,simplicity and precision. Most of them concernthe circulation, and they range from his earlierwork on disorders of the heart, through his classicalinvestigations of the blood-vessels of the humanskin, to his later studies of the Raynaud pheno-menon and other vascular disorders of the limbs.

They all bear directly on disease. They all depend