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The above table does not include holidays and does not include the intervals between an
officer leaving and her successor taking up duty which are now considerable (e.g., Miss Cotton left
8/4/20. Successor not on duty till 21/4 20. Miss Anthony left 5/4/20. Successor not on duty till
23/4/20).
It is therefore clear that a relief Health Nurse is needed at each Clinic.
In order to lessen as far as possible the intervals between an officer leaving and her successor
coming on duty, it would be an advantage if the Council would give authority for the issue of advertisements
and appointment of Health Nurses immediately on the occurrence of vacancies as in the case
of Hospital Sisters and Nurses.
Causes and Results of Absences.
It is not easy to understand why there should be so much illness amongst the Nursing Staff
of the Council, but the conditions of work which appear to bring this excessive illness about are :—
(a) Work at full pressure always and yet the work is never up-to-date.
(b) The Health Visitors do a considerable amount of work at home in order to keep relatively
abreast with their work, and
(c) The annual holiday is the minimum practically allowed to any class of worker, and is
less than the Health Visitors being fully trained nurses have ever had before—
the standard holiday for trained nurses being 4 weeks.
The results are :—
(а) Over fatigue for the whole staff.
(b) Additional work to be shared by the staff on duty owing to absences of other members.
(c) Hopeless collection of over-due visits for a member returning from sick leave or holiday.
(d) Lack of energy to keep properly up-to-date in the latest developments and aspects of
Health work.
(e) The natural dissatisfaction which results from the knowledge that they cannot possibly
cope with the work that requires doing, and that the training and knowledge they
possess might be of so much greater service and effectiveness had they only sufficient
time at their disposal to do the work as it should be done.
(f) Constant changes in the staff—some of the best workers have resigned because of the
insufficient holiday and because the effort to keep up with the work was making them
physically unfit (e.g., Miss Prickman and Miss Roberts).
Dental Visiting.
The arrangement of separate Dental Visiting Nurse is not altogether desirable, as it leads to
overlapping in home visitation, duplication in cards, and to cases being overlooked for considerable
periods.
It is better that one Health Visitor only should be responsible for each family in her district,
as she then has complete knowledge of all the facts affecting them and they have only the one person
visiting them.
Supervision.
The Supervision of Health Visitors' work needs more care and time given to it. With a large
staff as there now is, there are sure to be frequent changes, and it needs a person available at each
Clinic to teach each new comer the various methods, etc., in operation, and the various facts which
require to be looked out for and recorded. The filling in of forms and recording of salient facts needs
supervision to see that it is carefully, systematically and uniformly done.
At present it is only with difficulty and expenditure of considerable time that it is possible
to get required information from the records.
It also needs supervision to see that the various summaries and lists are kept uniformly, that
the cases in each district are being properly worked off, that a reasonable number of new cases come
under observation, and that cases are not marked off until duly completed.
The Assistant Medical Officers have not time to carry out this work as it should be done,
and further it is more particularly the medical aspect of the individual case that concerns them.
A Senior Health Visitor is needed at each Clinic to carry out this portion of the work. She could
then keep the balance as between the Medical and Dental work so that this could be done by the
same district Health Visitor, and ensure that all the various branches of the work received their
due attention.
At present the above work is carried out as far as possible by the Clinic Doctors and Matrons,
but it is not possible for them to keep proper supervision over the work, and the Matron's time is
necessarily constantly interrupted by interviews with patients, etc., and looking after the general
arrangement and well ordering and co-ordination of the various departments of the Clinic.
Practically all additional and extra work and difficulties, etc., come on the Clinic Matrons.
The difficulties of an ever changing staff (both medical, nursing, and cleaning) are constantly increasing
the Matron's difficulties. At neither Clinic is there any person who could satisfactorily take the
Matron's place in case of absence or resignation.