ma, GOOD NURSE BY T ^S H. McBRIDE m . m* : A I >"- : - : *. UNIVERSITY OF CALIFORNIA AT LOS ANGELES GIFT OF CAPT. AND MRS. PAUL MCBRIDE PERIGORD THE GOOD NURSE An address delivered to the graduating class of College Hospital JAMES H. Mc.-r.RlUE, M. I). LOS ANGEF.KS, CAi,. iit MKHiCAL RKO'KDKK SF.P n-:Mi;i- K UNIVERSITy of CAIJPCWN7 AT RTG3 p- 6 THE GOOD NURSE. BY JAMES H. McBRIDE, M. D., Los ANGELES, CALIFORNIA. AN ADDRESS DELIVERED TO THE GRADUATING CLASS OF COLLEGE HOSPITAL. To you who now leave the Training School, this evening seems important as marking the end of a long struggle. To those of us who look back to graduation day across decades, the occasion is significant rather as one from which yon will date another and a longer struggle. The event is an epoch in the life of each of you such as comes to all of us in some form and more than once, and through which we gather up results and go on to new duties. As he alone is a good captain who has studied the coast charts and knows all the perils of the sea, so only are they equipped for special work who have considered its duties and accepted its tasks, and this you have of course done in choosing your profession. If chere is any reason why I should warn you of possible mistakes, or counsel you of your duties, it is that an experience of many years has taught me something of the qualifications of a good nurse. I shall not advise you to be industrious, for that you are here is a certificate of industry. I shall not advise you to be conscien- tious, for that belongs to qualities of character that were formed before you came here and which advice would not reach. I shall not suggest that you avoid gossip, tor I am sure you have too much self respect to carry the rubbish of the trivial incidents of life into the homes of your patients. I shall not ask you never to rehearse to one patient the ills of another patient, for only rude and unthinking people do this, and you are neither. I wish to make use of one sentence to say to you that the incidents of the sick room are to be considered sacredly private, and when you leave" it you leave it under the solemn obligation to keep inviolably secret the entire history of those trying and pri- vate hours. I have known nurses who did not observe this, but the nurse who fails here makes a serious mistake, for she sins not only against her patient but against herself and the ethics of her profession. This is one of the moral obligations of your profes- sion, of which there are many. And it is well to remind you here that your duties, as are everybody's duties, are hedged about by moral considerations. At bottom all questions are moral ques- tions, and in the great army of thoughts, purposes and volitions 13988 that make up our minds' interests the moral sense does picket duty. Our daily work in life of every sort, whether our place be great or humble, is work whose ends are moral, whatever we may ourselves intend they should be. This view makes your work of a high order, and indeed it is. If you have a high moral purpose in what you do your work will be easier done, more cheerfully done and better done. Don't, therefore, do your work for the sake of the money only, but for the sake, also, of the service to others. We who are now living in the world are debtors to others who preceded us and who, in living honest and self denying lives, made our lives possible, and we owe it to society to render, by unse 1 fish service, something in re- turn for this great inheritance. In addition, therefore, to the money interest and the pride which we have in our work, there should be in us something of the spirit of the missionary, and we should keep steadily in view the fact that we are serving not ourselves but humanity. This is rather a high ideal, but it is not too high, and it helps us to do good work and honest work. Honest work makes honest men and women, shabby work makes dishonest men and women. Back of every stroke there is a purpose, either good or bad. Work makes money, but more than that it makes character. We owe it, then, to the memory of the silent and nameless thousands who have gone before us, and of whose faithful lives we are heirs, we owe it to those for whom we work, we owe it to our- selves and, too, we owe it to society of whose complex and en- folding life we are a part, to always do our best, to see that we at least put no false threads into this loom in which men's character is made. Your occupation is hardly second to any in importance; you are only less essential than the doctor as the limbs are less than the tree or the hand less than the body. It is possible for the doctor in some cases to get on by hook or crook without you; but with you, if you are careless or incompetent, he cannot get on except by the grace of luck; a septic instrument, an infected cloth, a soiled hand, and the most carefully treated wound becomes an opening into which poison is poured into the blood stream. There is no work in which faithfulness in little things has larger results than yours, for when you are engaged in a fight with microbes that fill the air like dust in August to be careless is to be criminal in everything but intent. This is only one suggestion of which you may make many applications. You cannot afford to fall short of perfection. You must not forget, you must not be careless, you must not trust yourself to sleep on the watch. A life may hang upon a single heart beat. If the lighthouse keeper sleeps ships are wrecked ; if you sleep a life may be lost. There is no person that walks the street except the physician who has such immediate power over human life as you have. Some of you may think that your education as nurses is finished. If so, let me assure you that yon are vastly mistaken. Your work of learning is only just begun; many things you know now you will either unlearn or learn better in a few years, if not in less time. All knowledge is in flux, everything is changing, and you must grow, grow, grow, or you will be dropped and no apologies offered. If you are studious and progressive, every year will make your mental equipment larger, your judgment surer, your hands more deft, your services more valuable. There are many things about which you have as yet had no experience; there are many mistakes that you may make, some blunders perhaps and days of regret. That which is valuable you will learn, and learn only in the sickroom. You cannot read skill into your head, nor can doctors teach it to you. You must do the thing over and over to know it. It is the same with all professions. The doctor gets i.- his skill at the bedside. The lawyer acquires a practical knowl- ^ edge of law in court, and it is especially true of your work, that depends so much upon quick adaptation, that you learn your work *< thoroughly only by repetition, and that, too, a thousand times. You must be students, you mast continue to learn. Every * case is an object lesson in nursing and you should quit each patient a better nurse than when you begin with it. Never allow your- self to think that your training is finished. The better nurse you are the less likely you are to think this. Never allow yoiirself to think you are as competent as you ought to be or as you might be. The chances are you will always be a little behind what you might be. It is the case with most people. Few people, very few, do their work as well as they might do it. There is a little laziness in the blood of all of us; the inertias of life hinder us on every side. We need ambition, we need the whip and spur of necessity and competition, we need to be driven by the compulsions of life or we slow our speed and are content with half we might do. Therefore I am justified in saying you have much to learn, indeed I might say you have most of your business yet to learn. You arc only at the beginning. You have learned but the titles of the chapters of the book of your profession. You should read the latest books on nursing, you should take a magazine on nursing. Get new methods from your reading, from physicians, from your own experience. Don't be afraid to discard old methods. Don't I get set in certain ways. There are better ways than yours if you can only find them. If you pursue this course you will be a better nurse every year you follow the profession ; you will grow, and to grow in knowledge is one of the most difficult things in life as it is one of the best tests of character. Your work calls for qualities more important than talent, it calls for heart; it calls for sympathy; it calls for quick insight into character; it requires that you grasp the individualities of people by a sort of divination and with an alertness of wit adapt yourself to all demands. It requires that you know thoroughly every detail of your work and that you do it not only quietly and quickly, but with a delicacy and deftness that soothes and gives pleasure. There are some trades for which men and women may be fitted by a trained adaptation though having little taste or ability for them. The work of a nurse does not belong to this class. The good nurse is born, not made, and the training that you get here only develops and sharpens those inborn qualities which no art can simulate and no training give. The care of the sick is a sacred charge for which the society, strange as it may sound, holds you to a strict account. I believe that it is well for all of us to realize that whatever we may be doing that in a very real sense the eyes of the community are upon us. We are, of course, not always conscious of this, and it is well that we are not, but when we think of it we must know that all our work is public, that whether we do our duty or neglect it is a matter in which society has an immediate interest and even if we would we could not conceal either our motives or the results. If we reckon, therefore, at its true value our relation to society we feel the essen- tial dignity of our occupation, whatever it may be. You have no right to consider your profession inferior in any sense. Duty knows no grades in occupation. There will be plenty of opportu- nities for you to show the highest qualities of character. The nurse who by intelligent care gives the baby a healthy start in life, or who pilots the patient through the fever's crisis has done in an unobstrusive way what when done conspicuously is called heroism. And in your own occupation people have come to recog- nize the importance of your position. Everywhere the name of nurse has become a synonym for efficiency, for intelligent assistance in time of greatest need, and it has become so because a select class of young women has been trained in a special line of work so that they could displace the clumsy and careless amateurs. You enter upon your duties with the universal respect of the public, and though people may not come to you in crowds and tell you so, yet it is a fact that there are none who minister to humanity for whose work there is greater respect. We are apt to be unmindful of the interest people have in us, the unexpressed but genuine sympathy which they feel for us, and which is the working in unseen ways of the spirit of human brother- hood that is growing everywhere. It is well, therefore, that we realize and keep in mind the love that there is in the world of man for man, how real, how tender and how sincere it is, for we can then see the benevolence that operates beneath humanity's rough exterior; that in this busy, hurrying, careloaded world be- sides the friends we know by sight and the praise we sometimes hear, that there are many friends whom we may never know, eyes turned toward us which ours may never meet, kind thoughts of us which will remain unspoken, prayers for us of which we will never hear. The world, however, silent and indifferent it may seem concerning us and our affairs, is in intimate sympathy with our every honest purpose, and however lonely life may some- times seem it is consoling to know that there are millions of men and women who are struggling with the same problems, offering the same prayers, and who know us and speak to us, and clasp our hands across the silent intervals of life. In reckoning the value of human action, let us get a correct view of life. The test of life is in its faithfulness, its value is in the work that is well done. Not that its faithfulness be conspicu. otis, nor its work on a large scale, but that single minded devo- tion and honest efficiency work together for the common end. The genius is valuable, but he can be spared; without the statesman the world would go a little slower and would make more mistakes, but in the end it would go in much the same way; the great man can always be spared, but there is one man whom the world can never spare, and that is the average man. He is essential because he represents the great mass of humanity that is doing the neces- sary work of the world. The average man is not conspicuous, indeed, he is rarely visible. And yet: his honesty and his stead- fastness have held humanity to its sober tasks, have made society possible and have age after age help to purify the stream of the races' moral life. Who conquered at Santiago? Was it Shafter? No. It was the untitled and unreported heroes who charged and won, and have now dropped back and disappeared in the common life. You and I belong to the great average of men and women, and if, in our obscurity, we are sometimes tempted to rail at fate, we may take comfort in the thought that the world could not get on without us for a single day. The humble worker is, therefore, the essential worker, and the important thing is that he should do his duty willingly, knowing that as he lightens the load of burdened lives, he is helping to make the world a little better. The relation of the nurse to the patient is a delicate one, for besides your ability to do your work qualities of character are also necessary that have much to do with your success. You should like your work. You will not do it well unless you do. You may wish to escape some of its disagreeable features; there are unpleasant things in all work. There is drudgery in your work; there ought to be. It is not the ease or the luxuries of life that keep us to our duties; it is drudgery, it is the compulsions that tie us down to duty when we would wander; that train us and drill us in life's routine; that day after day and year after year hold us to a course that develops persistence, courage, determina- tion and that finally give us the victory over the small things and the large things. Drudgery means compulsion, compulsion means discipline, and discipline if rightly used means character, character means success; the person of character can never fail. You should strive persistently to be intelligent. There is no reason why you should not be cultured, there are many reasons why you should be cultured. Your occupation does not forbid it. Plato sold oil in Egypt. Socrates was a stonecutter. The celebrated Dr. Thomas Dick kept a bake shop. Thoreau worked as a laborer on Walden pond, and lived on $100 a year, and even then regretted his extravagance. Each of us has faculties that atrophy from disuse, square roods of capacity lying waste for lack of energy to cultivate them. Develop habits of intellectual indus- try, read good literature, know what the world is doing, have an interest in things that are not trivial, and then don't be anxious to show what you know. It is not for display; it is for the uncon- scious benefit it will be to you. There is nothing that improves one so much and enhances the value and the loveliness of the per- sonality as an interest in things that arc abgve the level of the ordinary. It is not easy to live in the higher altitudes of life; it requires a struggle, but you can do it if you will. Von cati be coarse or you can be refined, you can be ignorant or you can be intelligent, you can be a gossip or you can have ideals that refuse to be on speaking terms with that poison monger; you can idle away your spare hours or you can fill them with occupation that makes for character and culture. An interest in good things and high things shines through the commonplaces of life. You cannot have such interests and not. show it in your manner, for it enters into everything you Bay or do. If you are intelligent and cult tired you will be not the less useful, but more useful ; you will be com- panionable for cultured people, without perhaps knowing why you are so; you will have opportunities for employment that otherwise would pass you by. The world is this very evening in search of nurses who answer to these simple requirements. Each of you should try to answer the highest demands of a good nurse. The good nurse is discreet; she not only knows what to say but she knows that far more difficult thing, what not to say. She has learned the lesson of self restraint in speech. She has that quality by which she looks ahead and sees the consequences of the unspoken sentence. She thinks of her own comfort only after the patient is provided for and every order executed. The good nurse never leaves things in disorder for her associate nurse to arrange. She has that fine sense of justice that leads her to do a little more than her share. How much better t.his world would be if each of us did a little more than was expected of us. There is no higher praise than to have it said, she did more than her duty. The good nurse likes her patients and is repaid by their friendship. Value friendship; it is a tender plant and none too common. The good nurse speaks well of her competitors. Of all the microscopic meannesses of life there is nothing more petty than professional envy. If you have all the virtues and lack this one of generosity you are mean. The good nurse speaks well of people; she knows that the habit of criticism is the habit of a pickpocket and she scorns it. She tries no experiments of her own; she recognizes that she is the doctor's hands, not his head. The good nurse knows all the delicate touches that shield the patient from minor discomforts and that protect the weakened brain from irritation. She will not allow a patient to lie facing a light; she keeps bottles and instruments out of sight and fills their place with flowers. She knows that not only disease is contagious, but that health and good spirits are also catching, so that her coming to the sickroom is like a fresh breeze on a sultry day. If you are proud of your profession and you ought to be if you. ; eire conscientious, and you surely are, you will realize that the sure way to achieve success, the only way to achieve it is to do your duty promptly, fully and cheerfully. Don't stop to ask why but do it; don't wait to be asked, anticipate, I say again, anticipate; and once more I say, above all things, anticipate. Don't think of something a thousand miles away, focus your mind for short dis- tances, keep it on your patient. Don't write nor read letters in your patient's presence. The hearing of sick people is sensitive. Be alert but keep quiet, be speedy but don't rush, do your work neatly but don't be fussy. Learn to be always ready. Few people are. Learn to concentrate. Keep your mind in order and you will keep things in order. Be prepared for tomorrow. Don't stop for the night until everything is made ready for the morning. If you are ready you will etart right and the right is important. The competent nurse is in part competent because she can meet emergencies, because she can master the unexpected problems that arise and which no instruction could anticipate and no books could catalogue. Remember one little thing that in the sickroom if not elsewhere is a big thing, that an agreeable voice is an im- portant part of a nurse's equipment. Don't key your voice too high. A pleasant voice will slow the heart beats, reduce the tem- perature of a fevered patient and shorten an attack of sickness, or if not it will come as near it as anything a nurse carries into the sickroom. Your manners are not unimportant. You will be with refined people. They have a right to expect refinement of you. Manners do not make the man, but man makes his manners; manners are a soul index, they are an echo of character. We are made of malleable metal, the events of life are hammering us to a final shape. What we are is the result of what we did; what we shall be is limited by what we wish to be. We cannot outgrow our past, it is part of us; we rise out of it with its mistakes, its sor- rows and its triumphs. What we like and what we think, what we say and how we say it, what we do and our manner of doing it, all these are daily influencing us, and the results of which we cannot escape. Don't think to get a pleasant manner by sham- ming the niceties of life. Refined hypocrisies are offensive, and honest people hate them. Avoid pretences of every kind. Love humanity, be direct, sincere and simple, and you can hardly fail to have a pleasant manner. Remember that your patient's character has been changed by sickness, and not for the better, for the normal restraints are weakened by disease and the frailties that health hides will meet you hourly. They demand calmness and tact and the patience that looks beyond the present hour to the day when .you will >yin. Remember that however competent and faithful you may 6e your patient may not keep you. Accept it kindly and show by not being offended that you are a lady. Such experiences come to all of us who serve others. Remember that there will be accidents and trying moments that will demand the steady nerve and cool head of a soldier. Have that quiet courage that is sure of every resource. The requirements of the Greek physician apply to you, that he have an eagle's eye, a lady's hand and a lion's heart. 1 3 This book is DUE on the last date stamped below JUL IS JUN8 L 2 ? 195; , -T75 r '" fB1 21959 ft DEC Form L-9-35m-8,'28 A 001410671 o M 00 NOT REMOVE L BOOK CARD 5 . Urt ve,sity Research UWary fft