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152
The nursing work has increased steadily throughout the past ten years, from 44,000
patients treated in 1949 to 62,000 in 1958. It is not unreasonable to assume that many
of these additional patients might otherwise have had to be admitted to hospital. The
character of the treatments given has undergone considerable change with the increasing
use of antibiotics, of mercurial diuretics for cardiac cases and the tendency to get
patients out of bed much earlier. This is reflected in an increase in the average case-load
of the nurse from 16-17 in 1949 to 24 in 1958. During 1958 the number of visits to give
insulin to elderly diabetic patients was substantially reduced by the introduction of oral
therapy.
Staff
In 1949 52 per cent. of all patients treated by the home nursing service were over
60 years of age. This large proportion of elderly patients has tended to increase during
the last ten years. 75 per cent. of all patients are referred by general practitioners.
There is among all nurses a natural desire to live in homes of their own. This
preference has increased very much in the last ten years ; in 1948, except for the
Ranyard nurses, almost all district nurses lived in homes provided by the associations.
In 1958 only 70 out of some 550 nurses were willing to do so, in addition to 67 midwives
and pupil midwives. Some district homes have closed, e.g., Charlton, Stoke Newington
and Shoreditch, and have been replaced by district rooms and offices, and others are
running half empty. This trend is likely to continue in spite of considerable capital
grants paid by the Council for rebuilding or structural improvement of district homes.
The total number of nurses employed, excluding students, has increased from
307 whole-time and 103 part-time nurses in 1949 to 451 whole-time and 88 part-time
in 1958. The employment of state-enrolled assistant nurses has relieved the district nurse
of some of her more routine duties, but a few organizations have shown reluctance to
use them. Male nurses have proved their worth and have become indispensable in most
parts of the county.
The bicycle is still the form of transport most widely used by district nurses in
London, but motor scooters are coming into greater use. Mileage allowance for these
vehicles is paid on demand. In 1952 the Council provided cars on loan to associations
doing midwifery, and has since extended the provision to most of the district nursing
associations for supervisory duties as well as for transport of Minnitt apparatus and
midwifery duties. The Council licenses, insures, and maintains the cars, but running
costs are paid by the associations and rank as approved expenditure. Nurses may be
permitted to use privately owned cars for district duties, but a mileage allowance is paid
only when circumstances warrant, and this applies principally in the case of male nurses
who cover particularly wide areas.
Lighter nursing bags were introduced in 1952 and these replaced existing bags as
necessary.
In 1955 one of the non-medical supervisors of midwives was appointed to undertake
certain advisory and liaison duties in connection with the home nursing service for an
experimental period of one year. The appointment proved most valuable to the Council,
the Central Council, and the nursing associations, and has been continued.
Training
and
refresher
courses
In the same year the Council, which had recognized as approved expenditure the
fees paid by associations for nurses to attend residential refresher courses, decided to
offer all district nurses the opportunity of attending a non-residential refresher course
every five years. The Council itself organised the first non-resident course of two days'
duration, and has since extended such courses to five days. Non-resident courses
organized by the Queen's Institute of District Nursing, Ranyard Nurses, and the Royal
College of Nursing are also attended by district nurses. Student nurses from hospitals
visit district homes and obtain district experience with home nursing staff.
The training of district nurses is undertaken by Ranyard Nurses and by some district
nursing associations approved for the purpose by the Queen's Institute.