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There has also been a considerable change in the attitude of the nurse herself towards
her work, which she now tends to regard more as a professional career than a vocation.
Hence the nurse with a private life of her own no longer looks to the district nursing
associations to provide accommodation in a residential home. By the end of 1961,
excluding superintendents and midwives, only 81 nurses (16.6 per cent.) were living in
district homes.
The bicycle has remained the normal means of transport of the home nurse in London
but cars have been made available by the Council, in the first instance to associations
undertaking midwifery and later also to other associations for the use of superintendents
and other stalf. In some cases where local conditions warranted or when unusually large
areas had to be covered, as is often the case with the male nurse, car allowances have been
paid to nurses who have used their own cars. Mileage allowances are paid to any nurse
who uses her own scooter and crash helmets provided by the associations have ranked for
grant.
Midwifery and maternity nursing—Ten district nursing associations undertake domiciliary
midwifery as agents of the Council, employing 43 midwives for the purpose. This number
includes the supervisory staff who do relief work for the practising midwives within the
association. Reciprocal relief is also supplied by the Council's own midwives.
In 1931 four teaching hospitals in London arranged for district nursing associations to
nurse midwifery cases after home delivery by medical students. These arrangements have
long since disappeared, although since 1960 the Metropolitan District Nursing Association
has again taken medical students from Charing Cross hospital to their patients on the
district. The nursing organisations were also called upon thirty years ago to nurse cases
of puerperal fever and maternity complications referred from the domiciliary midwifery
service. Only the occasional pyrexia of unknown origin is now referred from the domiciliary
midwifery service.
On the other hand, there has been a growing tendency for maternity hospitals to discharge
patients 48 hours after delivery because of the tremendous demand for beds; in London
this is far in excess of the 70 per cent. recommended by the Cranbrook Committee. It
has for long been the practice for hospitals to refer patients discharged before the tenth day
to the superintendents of district nursing associations, as each has some stalf with the
qualification of the Central Midwives Board who can be deployed to nurse these cases
under the guidance of the general practitioner.
With ever-increasing pressure from the maternity hospitals the Council, having in mind
the necessity for the pre-selection of cases for early discharge, has tried out pilot schemes
with Hammersmith, St. Mary's and Lewisham hospitals of acceptance of cases for
maternity nursing by the Council's own midwives. By the end of 1961 it was decided to
recruit part-time relief midwives to the Council's stalf, in the proportion of one to six
full-time midwives. These part-time midwives will provide relief to cover the extended
holiday period awarded by Whitley Council and the week-end off-duty period for each
midwife once per month proposed by the Council, and will take over the nursing of
maternity patients discharged before the tenth day from maternity hospitals. When the
full number of part-time midwives has been recruited, the district nursing associations not
undertaking midwifery will be relieved of the duty to take maternity nursings.
Training—The Queen's Institute of District Nursing at 12 district homes and the
Ranyard Nurses have provided general district nurse training for many years. The Council
has now adopted the shortened courses recommended in the majority report of the Working
Party on the Training of District Nurses, 1953. In this connection it is perhaps interesting to
reflect that Dr. Hogarth in her report in 1931 said 'six months seems a long period of
training for a nurse who has completed three years' hospital training, and more often than
not has in addition taken her C.M.B. certificate involving another period of six months'.
In 1961 the Queen's Institute of District Nursing and the Ranyard Nurses combined to
give a joint theoretical training at two district homes, the nurses taking their practical
course on the district as before; 64 nurses had district nurse training during 1961.
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