When I wrote last month about 'The Difference Between' the various grades of nurse, I put:
The grade of 'Assistant Nurse' became increasingly common, and these were women who had previously undertaken formal nurse training, but not to a standard sufficient to join Queen Alexandra's Imperial Nursing Service Reserve or the Territorial Force Nursing Service. They were women who had completed a set training as a fever nurse, a children's nurse, in a women's hospital, or as a midwife. Their pay fell half way between that of the VAD and the trained Staff Nurse, and they were likely to be given more responsibility in line with their training and experience.
While transcribing the war diary of the Matron-in-Chief with the British Expeditionary Force, I've now come across entries which show that this changed in 1918. The diary entry states:
V.A.D. Assistant Nurses: Received from Director General Medical Services copy of Army Council Instruction 214 of 1918 relating to the promotion of V.A.D. Members to the rank of
Assistant Nurses. Before being promoted they must have served two years, must be in possession of the Red Efficiency Stripe and must be recommended by the Officer Commanding and Matron. The letters "A.N." are to be worn on the apron in indoor uniform and on the shoulder straps on outdoor uniform.
The Red Efficiency Stripe was awarded to VAD members who had completed 13 months continuous service in a military hospital under the control of the War Office, and who had satisfactory confidential reports by their Matron and Commanding Officer. After another years' service they could qualify for a second stripe. These stripes should not be confused with the white stripes often seen on the sleeves of VADs, which signified length of service alone, not that they had necessarily reached a high standard in their work [although of course they might have done!].