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their lot. An idea of the number and nature of the major operations performed by the visiting staff
and of the minor operations performed by the resident staff may be gathered by reference to table
No. 82.
After the visiting staff have left, and not infrequently they do not leave before 12 and 1 o'clock*
it is then only that the resident staff can start their day's work. In times of pressure it has frequently
proved impossible for them to carry out the latter, either in reasonable time or with reasonable satisfaction
to themselves.
Nursing Staff.
I would now draw your attention to the question of the nursing staff and the heaviness of the
work exacted from it.
Increased accommodation for patients was added to the hospital to the extent of 56 beds 18
months ago, and at the same time a considerable addition was made to the nursing staff, but, contrary
to what was expected, the number of patients admitted, and, incidentally the nursing work, increased
out of all proportion to the number of beds added to the accommodation. I have shown that the total
bed accommodation in the hospital is quite insufficient to deal with the number of cases, and I have
hinted also that the present number of nursing staff is equally incapable of satisfactorily treating these
patients. Before the accommodation was increased, and when the hospital was used for isolation
purposes only, the proportion of nursing staff to beds was 1 to 5. At the present time, when the
hospital treats general cases as well as infectious cases, the proportion remains practically the same.
A proportion of 1 to 5 beds was possibly adequate when the hospital was admitting infectious cases
only, for the convalescence of most infectious cases is protracted and little nursing is required after the
acute stages are past. It is a very different matter, however, with patients admitted for general
medical and surgical ailments. All of them are admitted for urgent reasons, and necessarily they
require a great deal of nursing as long as they are in hospital, and immediately they require none, it
may be said in most cases, they are ready to be sent home. The proportion of cases requiring special
nursing in the general wards here, I find, is never less than 30 per cent. (in the maternity wards it is
never less than 50 per cent.) of the total cases, but in the infectious wards it is questionable if it ever
exceeds 15 per cent., and then only in the autumn and winter months. These figures show how heavy
the general wards are as compared with the infectious. I would suggest, therefore, that the general
wards be given 1 nurse to every 3 beds, and that the infectious wards 1 nurse to 5 beds, the present
proportion. Of the 220 beds in the hospital say 100 are required for infectious cases and the balance
for maternity and general diseases. This would mean a total of 60 nurses, or an increase of 14 nurses
on the existing number, which is anything but high. In connection with the present nursing staff,
which is 46 roughly, or 1 nurse to 5 beds, may I set out the conditions under which it is working. A
proportion of 1 to 5, it is to be noted, does not mean that proportion is ever available—allowance has
to be made for off-duty time and for sickness. In connection with the former, as each nurse has to be
given 2 or 3 hours (according to rank) off duty each day, and half a day each week, if follows that each
nurse has in the aggregate at least. one whole day off duty a week, making no mention of the whole
day a month to which she is entitled. In other words, out of 46 nurses on the staff, off duty time, alone,
reduces the available number each week to practically 39.5 nurses. That number, it is conceivable,
might serve temporarily, but, over and above the loss through off duty time there is still the loss
through sickness to be considered. As to that the following figures, as they work out for the past year
may prove of value.
Sickness amongst Staff.
Amongst a total staff of (80 nurses and female staff only) there were 236 cases of sickness during
the year, and of these 66 were off duty for periods exceeding 24 hours at a time. The aggregate
number of days these 66 members were off duty amounted to 922. Of these 66, 44 were nurses,
and included amongst these 44 are 4 nurses with Scarlet Fever, 2 with Diphtheria, and 26 with
Tonsillitis. Taking now the aggregate number of days these 44 sick nurses were off duty, it works out at
414 days or the equivalent of 1¼ nurses per diem throughout the entire year who were not available.
If one takes the proportion of nurses sick during the latter months of the year, the figures are even more
glaring. In the month of October 9 nurses were off duty for an aggregate of 114 days, the equivalent
for the month of nearly 4 nurses each day. In November 7 nurses were off duty for 79 days, an
equivalent for the month of 2½ nurses per diem, and in December 12 nurses for 85 days, the equivalent
for the month of 2¾ nurses per diem. These numbers (2½ to 4 nurses) added to that which represents
the number of nurses off duty on leave each day (7½ nurses) means a daily loss to the hospital during
these months of from 10 to 11½ nurses. If this number is subtracted from the full staff, which is fixed
at 46, it leaves 34½ to 36 nurses on duty, or a proportion no longer of 1 nurse to 5 beds but of 1 to 6
beds or thereabouts. Can it be wondered at, therefore, that the aggregate number of days the nursing
staff alone was off duty sick was as much as it was, i.e., 414 days, or that that number of days is practically
equal to the aggregate of days the entire female staff were off duty sick for the previous year ?
I maintain that there is complete proof that the staff were overworked, and that before another
winter the proportion of nurses to beds should be increased so as to give a total of 60, as compared
with the 46 nurses of to-day.