..she is only the instrument by whom the doctor gets his instructions carried out…

Some people firmly believe that progress is a Good Thing and everything from the past is a Bad Thing…

Recently, I was watching a news report about how boys read more when using a tablet or other electronic gizmo; some ‘commentators’ thought it was great (which it is!) others started batting on about the feel of books etc. I then wondered if anyone said the same thing when schoolchildren started writing on paper… “Oh, it’s not the same as using a slate and chalk…”, or when the inside lavatory was introduced…”Oh, it’s not the same as popping down the garden in the freezing rain…”

So, is the Nurse Associate (NA) role a forward or retrograde step? Well, I would have gone the whole hog and bought back the State Enrolled Nurse (and would also reinstate the State in Registered Nurse, but that will have to wait until I rule the world…). I am rather unconvinced that that a one year ‘training’ is the best way to address the issue of recruitment and attracting those who do not have the qualifications to do a ‘uni’ course immediately. And while organisations can determine the numbers required at a local level, I would very, very strongly suggest that the actual course is heterogenous across the country – you know just like SRN and SEN training used to be – in order that everyone knows what the NA can and can’t do at the end of it.

A couple of years ago, I came across a series of textbooks written by the magnificently monnikered J McGregor Robertson MB, CM, FRFPSG*. These were penned in 1907, and the sections of the duties and qualifications of a sick-nurse would make a perfect template for the NA role. Here is an example or two:

Qualifications of a sick-nurse

  • Intelligent, painstaking, careful, exact and methodical
  • Scrupulously clean & tidy in her ways and appearance
  • Her breath must not be foul-smelling (several recipies for tooth powder and mouthwash are given)
  • All her work must be done  without fuss/noise and without drawing attention to what she is doing
  • She must not be a gossip or a chatterer
  • Her own symptoms and ailments are not to be referred to at all

The nurse’s dress & behaviour

  • Dress must be of soft material that will not rustle, and of a quiet colour
  • A white apron, with a pair of close fitting linen cuffs, and a white cap (quite right too!)
  • She should go about the sick-room…with a decided step…not shaking the floor with her movements…
  • Have warm hands – a cold hand or a clammy hand is an abomination

Duties of a sick-nurse

  • She must begin with the idea firmly planted in her mind that she is only the instrument by whom the doctor gets his instructions carried out – she occupies no independent position in the treatment of the sick person (so no need for a degree after all…)
  • She has no opinions or thoughts
  • Patient observation
  • Recording food/drink intake/output, temperature, (but only bare facts – she will not colour the report with her own explanation)
  • Preparation of food

There we are then. The NA role sorted.

Any applicants?

* Dr McGregor-Robertson, according to his obituary (BMJ March 28th 1925), was a great advocate of the ‘Scottish Nurses’ Association’, and worked tirelessly on behalf of Scottish Nurses, so don’t judge his thoughts too harshly!