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                        Living in America vs England

Subtitle

Nursing at the Horton- The Way It Was- When Care to the Local People Really Mattered

Preface

As someone who has worked in the NHS myself since 1977, having qualified as a State Registered Nurse (SRN) in 1979, how often have I heard a nurse comment, that their life and working experiences would one day be put in a book. I am delighted to have the pleasure of meeting Dawn Griffis who has done exactly that, remembering her happy days at the Horton General Hospital, some 44 years ago!

The fact that Dawn has dedicated her book to all the State Registered Nurses, who trained at the Horton General Hospital, is a reflection of the camaraderie in which Nursing was undertaken, in a much loved local general hospital. I believe there will be many NHS staff, both past and present, who will give a wry smile in recognition of many of the stories and experiences encountered by Dawn, and equally, many of us will reflect on some of the difficult working experiences, encountered by Dawn, before leaving for the USA in 1965.

One cannot fail to be unimpressed by Dawn’s adaptability of life in the States, and her efforts to carry on with her Nursing career. For my part, as the current Executive Director of the Horton General Hospital, I am delighted Dawn had returned to see “her” Hospital, and to hear how positive she was about some of the environmental changes, but no less determined than most of the local population, as to what the future holds for the Horton General Hospital in an ever changing NHS.

Mike Fleming, Executive Director,

Horton General Hospital 2008

Nursing at the Horton - continued

Nursing Education what some of it involved:

The pre-nursing education at the Horton, was that we had to work in all departments of the hospital, before going near a ward. The concept was; that there is more to running a hospital than wards and nurses. If we have some understanding of what the other departments were doing, and the importance of their work, it would lead to a better-run hospital. It made perfect sense to me; not that my opinion counted for much in those days.

The last of my pre-nursing student days was spent on the ward known as, Holbech, prior to going into preliminary school. This was educational, and a valuable step prior to starting our training proper. Mousey, Pickers and I, all started at the same time on the ward in December. Mousey and Pickers were going to start their prelims in January, because of how their birthdays fell. I wasn’t going to start until March, because I wasn’t going to be 18 until February. We hated it that we were going to be separated this way, even though we were still classified as being in the same school year.

Sister Stewart was less than 5 feet tall, and was an excellent nurse and teacher, as was the senior Staff Nurse Margaret Mac Cue and the junior staff nurse Vera Clifton. They ran Holbech. The ward was in the oldest part of the hospital, so the windows were high like those in Aynhoe School. I believe the two most important things that were taught to us, and were on-going throughout our training were - the most dangerous nurse in the world, was the one that did everything by the book. That we were to consider the textbook as guidelines for the basis of nursing and medical knowledge, not the be all and end all; that the human being that fell into the true text book situation, was rare to non-existent. If our minds were locked into that mind set, we would lose, or harm, a lot of patients. I wish the students were taught that today.

The second thing taught was the importance of being observant; that this, along with an open mind, would save a lot of lives. We were taught to start off practicing this as a game. To glance at a person, and then to tell a companion all that you noticed in that glance, from the clothes they were wearing to any physical attributes, from face shape, colour, hair, complexion etc. We used to test each other with this everywhere we went. It does not take very long, and you can become very good at it, to the point you do it without even thinking about it. To this day, all I have to do is think back to where I was on any given day or place, and I can give that information on just about anyone I saw. I can do the same thing with whatever was said too. This can be very disconcerting to some people. The next step with observation, after we had this off pat, especially as we learned more about diseases and the signs they show, was to now look at people, and figure out what we thought might be wrong with them. Of course, some are very obvious, as in the patients with jaundice, but there are others much more subtle. Such as the Dresden china complexion of a TB patient, or the eggshell complexion of the pernicious anaemia patient, to the dull expressionless overweight appearance of the hypothyroid patient, and the hollowed sunken eye appearance, and sallow complexion of the person with cancer.

We would see these people on the streets and play this game. Because Banbury was small enough in those days, it was not unusual for us to come across these people that we had seen in town and to find out just how accurate we were. This often gave us a funny feeling, as to: “Should we stop them and tell them?” We thought about it, but we never did. The observation skills we learned though, have stood me in good stead throughout my career. My hope is for the betterment of my patients. It definitely goes a long way, to be able to diagnose a patient’s illness. That is along with a good history and physical. This is so that tests are only ordered, to confirm ones suspicion as to the diagnosis, rather than to randomly order tests, in the hope of hitting on the right diagnosis. Sadly this is the way it is frequently done nowadays. Maybe this is reason for the rising cost of health care.

English nurses are taught the signs and symptoms of a disease, how to diagnose and treat it. This is not the way it is done in the US, where the nurses are only allowed to just give what they call nursing diagnosis; it is still that way even today. The only exception to that, are the Nurse Practitioners. It makes me wonder if the physician’s egos are so fragile, or if they are so insecure that they are frightened the nurse will outshine them. The American nurse is never to presume to say it is “so and so.” That is the physician’s prerogative only. What do they think we are? Morons? Nurses, in the US for example, have to say a patient appears to be dead etc. Come on now dead is dead! Just about anyone can recognize that.

English nurses, in those days, were also taught, and had the total responsibility for; when dressings needed changing, sutures removing, drains shortened and removed. We also decided what diets the patients was given, and when they were to be progressed to normal diets. We also decided when patients were ready for discharge home. We would tell the physician, and he would write the order. A physician would never presume to make any of those aforementioned decisions. And woe betides any physician who even considered touching a wound! Once surgery was over, that was our territory. Physicians were always known as the great contaminators. Even in the operating theatre, the nurses watched the surgeons closely, to make sure they did not contaminate themselves orthe operating site.

Christmas at the Horton - my first Christmas working on the wards was going to be on C-Ward, just before I was due to be changed to B-Ward,- women’s medical.

On Christmas day no-one is allowed to be off duty. We worked either a twelve-hour day or night shift. We are there to make Christmas as enjoyable as we possible can for the patients. Each ward has a head physician or surgeon. They were expected to, and did participate in this, with very special duties. Their wives and children were also expected to attend, along with the town Mayor and his or her family.

Preparation for Christmas starts weeks ahead. Each ward or department has to be decorated in a special theme, all of which is made by the staff and patients, and is kept top secret from all the other wards. Whatever the theme is, then a costume has to be made, for the head physician or surgeon to wear, while he carves the turkey and serves it to each patient. This is followed by the Christmas pudding. The rest of the meal is served to each of the patients by the doctor’s family members, and the head nurses on the floor. Between courses, while the patients are eating, the doctor is expected to entertain the patients appropriately, according to what their costume dictates. Lots of fun was had by all.

The themes varied incredibly. The children’s ward usually had pantomime themes, such as Dick Whittington, Aladdin or Cinderella. The adult wards could be anything from pirates to Robinson Crusoe. In the later years, and with the start of the space age, they even got into that. My last Christmas at the Horton, I was working in the operating theatre. All we could decorate there was Sister’s office, so we did it as a witches cave with stalagmites etc. And a menu for witches brew, that incorporated all the nurses and surgeons names, that were working there at the time

The patients had full Christmas dinners. The nurses got cold cuts and pickles, but most of us didn’t bother to go to the dining room to eat. The private rooms on each floor were turned into a room for all donated snacks - food and drinks - which was laid out for the nurses. During this time of the year, the donations to the nurses were incredible. Each ward would receive so much, that it could have stocked a store and an off license with the food, wine and liqueur. Yes, on Christmas Day, all staff were allowed to drink alcohol on duty, but to drink sensibly. Staff from all the wards would visit others to admire or comment on the decorations, and each one who visited would be invited into the “nurses’ room” to share refreshments. No one drank too much it was all very proper and dignified.

Patients and visitors were also allowed alcohol to drink, as long as there was nothing wrong with them that it could cause a problem, or as long as they were not too young. In Britain, the legal drinking age was 17 if someone else buys it for you, and 18 for you to be able to buy it.

Visiting for patient’s friends and family, was all day after about 11:00 am, which was to give us enough time to get everything done for the patients. This way they could just relax and have fun. Most of the patients and families said it was more fun than being at home. In fact some of our NFA (no fixed abode) patients, used to plan on being in the hospital for Christmas. They used to come up with some incredible complaints, so as toguarantee getting in but not limit what they could eat.

Ward Cleaning:

At the end of our 12 weeks of working on B-Ward, the other studentnurses were rotated off, but I wasn’t. It was almost like I was forgotten. The other strange thing was, the five student nurses that replaced the others were all from the same class, and from the class just two before mine, so they had just gone into their second year. Bearing in mind how the jobs were delegated, according to the student’s level in training, problems loomed ahead. Especially since Sister Cook was the kind that was very wishywashy, and told the students to decide between themselves who did what.

Well, let me tell you; no-one was going to volunteer to do the menial tasks, and let their other classmates do the jobs of the higher ranking students. They fought constantly. The staff nurses on the ward were no better than Sister Cook, for stepping in and taking charge. So, you know who got left doing all the menial work; the one that was still a first year student, namely me. I put up with this for two weeks, with no signs of me being transferred to another ward.

The weekly ward cleaning day was raising its ugly head again, and I wasn’t going to be stuck like I was the previous week, doing it all while they fought amongst themselves. So I climbed out of my bedroom window and caught the early bus to Oxford, knowing full well when I got there, there would be a telegram telling my mother to send me back. Which of course she would. But, by the time I got back, the ward cleaning would be over and those other students would have had to do it.

I will explain what weekly ward cleaning involved: but first let me set the scene for this particular time, and it had been this way for about two weeks. The ward was full of patients, plus the 4 extra beds were up in the middle. Of these 40 patients, only one could get out of bed, and then only with assistance. So obviously they all required total care, including bedpans every 2-3 hours, or bed changes because of incontinence. Now; for what the ward cleaning entailed. All of the beds had to be pushed to one side of the ward, so the high dusting could be done, without dust falling on the beds. The radiators were the old fashioned coil radiators. These were behind the heads of the beds, and they had to be individually scrubbed. Then the medicated sand was thrown onto the floor, so dust wouldn’t fly, and then swept up; followed by the floors being scrubbed with an electric scrubber. This was done by a porter. While the porter was doing the scrubbing, we had the back end of the beds that were visible to clean; they were lifted on to blocks so we could scrape and scrub the wheels. Remembering of course, during this time, the patients' are still in their beds. When the first side of the ward is done, then it is repeated on the other side. When the beds are back in their regular places, the same is done through the middle of the ward, and the bottom of the bed wheels are done for both sides. After which all the furniture that remains in the centre of the ward is polished. As you can imagine, when there are four additional beds in the middle of the ward, it adds to the difficulty.

The week before, when all these students were arguing as to who was going to do the different jobs, with none of them wanting to do what they thought was beneath them, I was stuck with it all. Sister always took the morning off on ward cleaning day. The staff nurse hid in sister’s office all morning.

I enjoyed my bus ride to Oxford, more than any time before or since. Of course, everything was as predicted. The telegram was there. Mum asked me what was going on, and I told her. She didn’t pass any opinion, but she did tell me I should have lunch before I went back. The telegram said I was to go to Matrons office when I returned. I did have the bus ride back to think about that, and to plan what I was going to say to her.

Dutifully I went to Matrons office and she took me to another office. She asked me why I did what I did. So I explained to her about the student nurse situation, and how unfair it was. Adding that I did not like working on B-Ward. She said that Medical wards were the hardest to work on, but that a “true nurse” would enjoy it. I looked her straight in the eye and told her: “Then I can’t be a true nurse, because I hate it. In any case, my contract for training was to rotate through the wards twelve weeks at a time, and I have been on B-Ward fourteen weeks; which is beyond what is required of me.”

She just looked at me, and didn’t say anything for what seemed an eternity. She just looked at me, and didn’t say anything for what seemed an eternity. Then she told me to go back to the nurses’ home, and to report to her office in the morning, to find out where I was to go. The following morning I was told I was to finish out the week on B-Ward, and to start my night’s rotation at the Elms the following week. In all fairness to Matron, she never put me back on to a medical floor, until my third year as a student. I didn’t mind one bit.

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