From the mid to late nineteenth century a small number of London hospitals established training programs for nurses. The London Hospital first did so in 1880. Candidates for nurse training at the London Hospital had to be between 23 and 33 years old and pass a medical test for fitness. The London Hospital program consisted of two years' practical and theoretical training with time spent in the wards carefully allocated to give each probationer a wide variety of experience. In 1896, under its well-known Matron, Eva Lūckes, the London Hospital moved into the vanguard by establishing a seven-week preliminary course comprised of lectures, practical work, and distinctively, an examination at the end. The preliminary training took place away from the wards, at Tredegar House on Bow Road. Twenty-eight probationers at a time were taught anatomy, physiology, bacteriology and hygiene. They were also shown how to read temperatures, bandage, keep reports of special cases and other nursing skills. In the seventh week they were examined in these subjects. The advantages of the preliminary course were many: When the probationers arrived on the wards they were able to perform routine tasks which might otherwise have taken months to master. New probationers were introduced to the discipline of hospital life while still in a home surrounding, and the course gave the hospital and the probationer time to decide whether the probationer was suitable for a nursing career. During their seven weeks in the preliminary course, the probationers were referred to as pupil-probationers.
The theoretical training consisted of three courses. The first course, on general nursing, commenced each autumn and was taught by Miss Lūckes. The second course, elementary anatomy and surgical nursing, and the third course, elementary physiology and medical nursing, were taught by medical staff. Lectures were given once a week in the evening. Nurses on night duty were expected to attend before going on duty. An examination was held after each course. At the end of the first year probationers took their final examination on their coursework. In their first year of practical training, probationers focused on learning the duties of a nurse; in the second year, they acquired experience and were tested on their qualifications. Second year probationers were given increased responsibility nursing special cases, covering staff nurses’ holidays and sick leave, and taking staff duty under supervision.
In the London Hospital hierarchy, Assistant Matrons were responsible for different areas of the Matron's duties. Ward Sisters were responsible for nurses and probationers on their wards or in their departments and each made a daily report to Miss Lūckes on probationers’ work. Details were entered in the Register of Probationers kept in Miss Lūckes' office. The Register recorded the age on arrival of each probationer, her previous experience or occupation, an account of her work each day in the hospital, her holidays and sick days. In addition, each probationer kept a little black memorandum book for recording time spent in each ward and department which was signed by the Ward Sister in charge. On the last day of the month these books were handed in to the Matron’s office where they were checked and stamped and the information entered in the Register. Miss Lūckes also entered an assessment of each nurse’s character in the Register based on the reports of the Ward Sisters.
Probationers at the London Hospital were required to sign a four-year contract. When probationers completed their two-year training they were still under contract for two more years and became staff nurses or joined the private nursing staff.
Florence took her two-year training from February 1911 to February 1913. The Register of Probationers shows that Florence was 24 years old when she arrived at the London Hospital. Her previous experience was as a mother’s helper (which may have been outside the home, helping her mother with Godfrey, or both). During her training, she cared for patients with gallstones and an “ovariotomy.” Florence received three two-week blocks of annual leave during her training. She took only four days of sick leave. Florence’s work was judged satisfactory and her conduct very good. She was marked as late to meals twelve times. In sick room cookery, Florence was awarded a 2nd class grade in theory and 1st class in the practical exam. Florence achieved “honours” in her final exams. When Florence completed her two-year training she first became a staff nurse. She was assigned to the Mellish Ward on March 22, 1913. On April 24, 1914, she transferred to the hospital's Private Nursing Institution.
|
The upper and middle classes still regarded hospitals as charitable institutions for the poor. The demand for “trained” nurses to care for the privileged in their homes grew in response to the reputation of the trained nurse. Hospital medical staff were pleased to recommend to their private patients nurses who were properly trained and reliable. The demand for the London Hospital’s private nurses always exceeded the supply. Nurses on duty away from the hospital on a private case were expected to write Miss Lūckes each week reporting on the case. Miss Lūckes believed that this kept the nurses in touch with the hospital so that they did not feel isolated. The nurses were also able to discuss aspects of the case or their domestic arrangements. In a 1915 letter Miss Lūckes wrote:
I gather considerable knowledge of the individual characters of the nurses by the ‘tone’ of their letters. Human nature must have an outlet, and when a nurse has an anxious case or is strained by having to deal with difficult people, it is a great help to her to feel that she may write freely to me without betraying confidences . . . being kept in close touch with the hospital stimulates the nurse’s loyalty to it, and makes her eager to bring back good reports and do it credit.
Miss Lūckes reminded the private nurses that they were the London’s ambassadors, representing her and the hospital in their standards and behavior. Between cases the private staff worked on the wards of the hospital. Miss Lūckes regarded this as an important part of the success of the Private Nursing Institution. Unlike the majority of private nurses, who lost touch with hospital practices, the London Hospital's private nurses were kept up to date by regular ward work.
While on the private nursing staff Florence visited ten patients, travelling to care for them in their homes in Essex, Surrey, Hertfordshire, Suffolk, Norfolk, and London. Her patients had a variety of conditions including gallstones and colic, appendicitis, cellulitis, septic purpura and meningitis, senility, bronchitis, varioceles, glaucoma and gastroenterostomy. Florence was on duty from one to ten weeks caring for her patients. Of her ten private duty patients, seven recovered, one stayed the same, and two died.
|
During her post-training two-year contract with the London, Florence also took maternity training, from November 1914 to February 1915. She attended a total of 35 lectures--10 by resident midwives, 8 by resident accoucheurs (male midwives!), and 17 by obstetric physicians--and delivered 44 cases! Assessments of Florence's performance in the Register of Pupil Midwives were very positive, but the reviewers' comments on her manner remind us of her sheltered upbringing in the Forest of Dean, and just how far she had come!
A most curious manner...but a very good nurse, and a thoroughly reliable woman, in every way. Liked by all, and always willing and cheerful. A most restful person to work with. A good midwife, and most interested in the work; quite a pleasure to teach. Will make an excellent midwife and can be absolutely relied upon in all her work. Rather a quaint little manner. The District patients always spoke highly of the way in which she looked after them. Quite good practically, but found the theoretical work more difficult. Quiet and gentle manner. Very at home in the District houses, as she took such a kindly interest in the work. Reliable. |
Florence successfully completed her training and passed the Central Midwives Board exam on April 22, 1915.
Florence’s final assessment was initialed by Miss Lūckes (E.C.E.L), but it was written in a different hand and likely was prepared by an Assistant Matron. (Miss Lūckes was unwell with arthritis towards the end of her life and confined to a wheelchair; she died in 1919.) Florence was described as
. . . [a]n excellent worker. She took great pains with her duties and she developed into a capable nurse. She worked hard at her classes and though she was only fairly well educated she managed to gain ‘honours’ at her final examination, a fact much to her credit. Her health was excellent throughout her two years. She took staff duty for six months in a women’s medical [ward], and sister was very satisfied with her. She kept her ward in good condition, she was methodical and looked after her probationers and was very attentive to her patients.
Florence was awarded her hospital certificate on June 25, 1915 and became an official "Londoner," a name used to this day to describe nurses who trained at the London Hospital. The London Hospital did not have badges until 1929, and it wasn’t until 1942 that nurses were presented a badge upon successful completion of their training. Based on the style, size, and maker of Florence’s London Hospital nursing badge, she would have purchased it sometime after 1933.