How It Was Then - A personal look back at nurse training

I read a lot these days about nurses struggling to survive on low pay, having too much responsibility, difficulties with adequate recruitment and short-staffed hospital wards resulting in dangerous levels of patient care.  There seems to be constant unrest among NHS staff over conditions of work which leave the general public concerned about the treatment they might receive in hospital.  I trained as a nurse in the 1960s and find there’s an immense lack of knowledge about nurses’ work and status fifty years ago. Some of today’s health professionals consider that our training and experience was decidedly second-rate and suggest that nursing was merely ‘just a job’ then rather than a profession.  So to clear up a few points I've decided to write briefly about how it was then for me, as a student nurse training in London.

     I started my nurse training in March 1967. There were no huge health trusts then - you chose your hospital on its history, reputation, specialty, and whether you might get accepted. On the whole, five GCE ‘O’ Levels would get you in to most hospitals though the basic requirement was for just two, English and Maths preferred. It has to be remembered that higher education was rather different at that time and almost entirely academic – the same 5 GCEs were also the standard for admission to many teacher training colleges. The more prestigious the hospital, the higher the educational requirement and a few of the top London hospitals had a preference for candidates with ‘A’ Levels. There was no shortage of applicants for nurse training and the majority of large hospitals both in London and the Provinces turned away a percentage of suitable applicants as they were usually over-subscribed.  Nursing was a popular and attainable profession for young women, with the security of a guaranteed job at the end of three years.  Our Matron had a rather liberal view on what constituted a good nurse. Consequently she was willing to accept women who had the right personal qualities even if lacking in educational certificates, and that was rare in London.

     We worked a forty-four hour, five and a half day week with one weekend off each month. My first month’s pay was fourteen pounds, but as we were all required to live in the nurses’ home our board, lodging and uniform were also included. At least two days each week would be ‘split shifts’ - coming on duty at 7.45 a.m. and finishing at 9.15 p.m. and with the dubious benefit of having three hours off in the afternoon between 2 p.m. and 5 p.m.  It was never easy to finish on a ‘late’ and have to be on duty again the next morning.  By the end of my second year pay had increased and working hours reduced as a result of national agreements, though not by much.  I rarely remember complaints about money and there were only limited things to spend it on. We had no cars, no televisions, no phones or gadgets, no families to support, no food to buy. In many ways we were the servants of the hospital.

     The first twelve weeks of our training were spent in Preliminary Training School where we learnt to take and record blood pressure, to bandage, set trays for dressings, enemas and catheterisations, to wash, move and lift patients. There were no lifting aids whatsoever in hospital so the ability to lift heavy adults safely was a necessity. We had lectures in anatomy, physiology and medical and surgical nursing from our nurse tutors and also from members of the hospital’s medical staff.  During that time we spent one day each week working on the wards at the hospital and before my twelve weeks in PTS had finished I’d already given an injection under supervision and taken some stitches out.  Once out of PTS we rotated to different wards every eight weeks to get the maximum range of both medical and surgical experience.  We were never ‘supernumerary’ but always part of the active nursing team – today that would be dismissed as just ‘pairs of hands’ but to us it was how it was - our nursing life. A further four weeks were spent ‘in block’ in the school of nursing at the end of our first and second years and also prior to our final examinations, making a total of twenty-four weeks theoretical and practical teaching in three years.

     Each ward had a hierarchy of staff - Sister, either one or two Staff Nurses, and a mix of 3rd, 2nd and 1st year students. The senior students were frequently in charge of the ward, particularly in the evening and at weekends and there were many hours each day when there was no trained nurse on duty.  It would have been a rare nurse who reached the end of her first year without being competent in giving enemas, passing flatus tubes, inserting urinary catheters, monitoring IV infusions and doing a variety of surgical dressings.

     After six months a student was considered to have enough experience to step over the threshold of other important areas. One of these was night duty, which we worked on a rotational basis, one week in four, and which continued to the end of our training. The rota was seven nights on, four nights off and then back to day duty for the rest of the month until nights came round again. At night, wards were always in the charge of student nurses with visits and support from a night sister. Ward Staff Nurses didn’t do night duty as a rule and were too valuable to release from their daytime duties.  As a junior on nights you waited in suspense to find out who your senior would be and by the end of your second year you were usually the ‘senior’ yourself.

A summary of my ward experience

     Our hospital was one of the country’s ‘centres of excellence’ and patients came from all corners for cardiac and renal surgery. Because the Intensive Care Unit was tiny – just six beds – there was only enough space to cope with the first few critical hours of patient care following surgery. This resulted in side rooms on general medical and surgical wards being used for patients being nursed on ventilators who needed ‘special’ nurses to be with them at all times. Second year students upwards would be allocated this role with all its implications and none of today’s electronic helpers. We monitored blood pressure, transfusions and naso-gastric tubes; performed any wound and tracheostomy care, the latter usually under the supervision of the ward Staff Nurse. We reported to each visiting doctor and quickly learnt when to do something useful in cases of emergency or cardiac arrest, and when to stand back and just hold our breath.

     I can remember standing in the shadows while a recently opened chest was re-opened to perform internal cardiac massage.
     I can remember standing in the shadows as kidneys were removed from a just-dead man in a Casualty cubicle, hopefully suitable for a waiting patient – among ourselves we used to talk of that as a ‘smash and grab.’
     I can remember my second Christmas, in charge of an acute surgical ward at night, climbing on to the roof to bring down a confused man.
     I can remember night-duty as a third year student in charge of a medical ward, managing among other things eleven patients on continuous peritoneal dialysis, night after night.

     It’s possible to look back and gasp at how unsafe much of this could have been for both patients and staff. But that’s how it was then in many hospitals. Not all of it was drama and there were many mundane periods of testing urine, washing lockers and cleaning stainless steel bowls. We learnt to be both practical and intelligent women who were taught always to ‘look around and see what needs to be done.’  We finished our training as complete as three years could make us with an enormous range of practical and life skills at our fingertips.

Prizegiving 1970 with the late Rear Admiral Michael Le Fanu

     When I read of long hours, poor pay, responsibility and low morale, I have to wonder how today’s nurses would have fared then. Nothing can be compared of course. Society and expectations have changed so much – it’s a different world now. But please don’t pass off yesterday’s nurse training as something second-rate – it certainly wasn't that. It was intense, innovative, challenging, cutting-edge for the time, and it produced a generation of strong women with the ability to cope with life and all its problems.
   
     If you want an all graduate profession and feel that the current way of nurse training is the right way, then surely it has to be accepted that there will never be enough nurses on the wards – the numbers can never add up. If you want an all graduate profession then salaries will never be enough as graduate expectations will always outstrip pay scales.  Increasingly trained nurses will look for posts as specialists and in education, research and management. The profession has undoubtedly become safer in the last fifty years but through education and training it’s transformed itself into something that might not be  sustainable as an adequate system for either patient care or staff satisfaction. But that’s just how it is now and I have a feeling that it’s never going to return to how it was then.