RECONSTRUCTION AND REHABILITATION

IN NURSING 1

BY FRANCIS W. SHEPARDSON

Director Department of Registration and Education, Springfield, Ill. Reconstruction and rehabilitation are two words much noticed in the public press to-day. They appear to carry a double meaning. When first used they looked to the future. They had in mind a country in every community of which were to be large numbers of men handicapped in some way by reason of physical losses in the military service. Those who had lost their sight were to be re-educated in work the blind might do. Those who had lost leg or arm were to be prepared for such fields of activity as would be open to them thus crippled. The sudden termination of the war and the assurance that the total number of the maimed would be much smaller than was expected greatly altered the immediate content of the two words.

The other meaning of the words is the one now of greater importance. Reconstruction and rehabilitation now relate themselves to the reorganization of methods which have been followed in the past, but whose values have been brought into question as the outcome of war inquiries and war experiences. For example, a large number of the men who were examined for military duties in connection with the selective service were found to be illiterate. It became necessary in every cantonment to establish a school to train these soldiers in the elements of education. The conviction became clear that the American citizenship of to-morrow should not contain any appreciable number of men and women devoid of the rudiments of education.

The same war experience brought the revelation that there were many real aliens in the country whose sympathies were not with the land from which they were gaining their livelihood and in which they had their homes. That this state of affairs should be remedied, no one doubted. Americanism should be taught to every immigrant as part of a national obligation to future generations.

Still another impression resultant from the war is that the ordinary education hitherto afforded to American boys does not fit them to do specific things which are needed in war time. Special training schools had to be established for many purposes. There was developed a feeling of discontent with the accomplishments of our educational system. So, many people began to talk about reorganization and rehabilitation. It might be easy to enlarge upon this theme, but enough has been said to illustrate the point.

1

Address delivered at the fifteenth annual meeting of the Illinois State Association, Chicago, December 13, 1918.

One of the things connected with the war which has attracted large attention has been the question of public health and sanitation. It was soon shown in experience that an evil more to be dreaded than the bullets of the enemies was venereal disease. The War Department took hold of this subject vigorously and made surveys of conditions surrounding the cantonments and camps. Zones were established from which efforts were made to exterminate the elements connected with the spread of this type of disease. In the minds of many citizens the question has been asked, If such precautionary methods are necessary or desirable for men in the military service of their country, why are they not equally necessary and desirable for the greater number of civilians? If training in topics relating to sanitation and the physical welfare of those who make up the army of the country is desirable, why should it not be equally desirable in times of peace for the citizenship of the land?

Questions like these have led to a large amount of thinking. There is no doubt that one of the best results of the war on American life will be the advance in many phases of community life. Among these the establishment of the community health center seems likely, where there shall be opportunity for the emphasizing of the fundamentals of public health which have been brought to prominence through the selective service military experience.

The natural location of such a public health center in the community will be the hospital. It will be a building constructed on proper lines and large enough to meet the needs of the community in which it is established. It will be a place of pride for the citizens, where the local physicians will find both pleasure and social profit in practice. It will be for public health what the public school is for education; the place where rich and poor, well-favored and ill-favored will find contact. It may prove the most important advance of a century. In an age where results of the most astounding character are attained quickly, no argument based upon the past failures to support such local institutions can be considered to be determinative. No one could have dreamed in 1917 that before the close of 1918 the Kaiser would be in exile, the German Empire in the throes of dissolution, and all the proud boasts of half a century proved absolutely foundationless. If such a community health center and such a community interest in public health seem to any one to be visionary, the answer is that the visions of yesterday quite frequently have become the actualities of to-day.

Should such a notion find development in even a few communities, the relationship to the general problem of the nurses' school is apparent. This is the theme for thought now for a short time.

The administration of the nurses' law in Illinois has not been attended with satisfaction. There has been more friction and more occasion for complaint than in connection with any other licensure law administered by the Department of Registration and Education. The reason for this may be that the law possibly does not recognize those fundamental principles of right and justice without which no law can long prevail. It has also sometimes seemed to me, looking at things from the viewpoint of an outsider, that there is not a sufficiently clear determination of the proper classification of nursing, whether mere occupation or profession. This feeling has been strengthened through listening to many conversations and discussions upon problems relating to nursing. Time and time again, apparently earnest argument for the welfare of nursing has quickly lost its tone of sincerity in an evident consideration of the superior interests of a particular hospital or school of nurses, as if it were far more important to have the required assistance in such a school or hospital than to secure some coveted gain for the individuals enrolled in the school of nursing who are looking forward to a life work. When, under such conditions, a suggestion of this ulterior motive was made and the response came quickly that it was essential that hospitals have the required assistance, the impression mentioned was only deepened.

Is nursing an occupation for personal gain? Is it an employment entered into for the primary purpose of earning a living? Is it one in which an individual, gifted with a peculiar knack or skill, might win distinct success even without much special training? Or is it a profession, into which individuals enter as a life work, with something of a desire to be of service to humanity while engaged in a practice which will at the same time yield a proper personal income?

If this last is to be considered the proper status of nursing, then there comes another question, the answer to which is of supreme importance in connection with any thorough-going discussion of the problem of the nurses' school.

"The Standard Curriculum for Nurses," a volume which has been prepared with care by those interested in the work, indicates quite definitely that a school for nurses must differ essentially from other professional schools in many respects. It declares that it must always be located in a hospital, since the most important part of the instruction of necessity associates itself with the practical work of a hospital. If, now, there must also be a recognition of the need of assistance in the hospital which has been mentioned, then there is no other conclusion than that every hospital which conforms to a certain standard is potentially the location of a nursing school, and that there is no outlook for the teaching of nursing as a profession except through

the existence of a multiplicity of schools. These schools must vary in their strength according to the endowment and equipment of the particular hospital. Should the movement for a public health center in every community, already mentioned, become popular, then the number of nursing schools must increase until in every city, town and village there may be an institution turning out so-called professional

nurses.

Such a prospect makes slight appeal to anyone interested in the development of professional education. It is difficult to imagine a profession to which any particular honor could be attached, made up of such an army of members hailing from every part of a state. But, if that is the inevitable prospect, it should be faced thoughtfully and the best possible made out of what would appear to be a perpetually unsatisfactory situation.

There is another line of thought which ought to be followed, if only for contrast. The great medical profession has constant need of additions to its ranks. These additions come from the student body which is being trained in the medical schools. Several times a year, examinations for state licensure are held and new physicans are given authority to engage in practice, but to meet the medical demands of the entire state of Illinois there are but five recognized medical schools. In the United States, taken as a whole, there are but sixty-nine medical colleges which are recognized. As you appreciate, this number, which supplies the great profession of medicine throughout the land, is smaller than the number of recognized nurses' schools in the state of Illinois alone.

The same showing might be made for pharmacy, for which in Illinois one college is recognized, or for dentistry, where we have three recognized schools in this state. The professions of medicine, dentistry and pharmacy are honored because relatively few are admitted to them. The public understands that those who are entitled to call themselves by the name of doctor, pharmacist or dentist have secured this right as a result of special professional training. If there were schools of medicine or dentistry or pharmacy in every city of ten thousand or more, the number of practioners would be so great as to bring the profession into a state closely approaching contempt, or at least into a condition where, because of the sheer numbers of those entitled to be given a label, respect to any individual practictioner would be definitely minimized.

While my own personal conception of the meaning of a profession leads me to think of it as a vocation for the few and the specially trained, it is entirely possible that the nursing profession, if profession it be, is the exception which proves the rule, and that in

it there must need be an army of people rather than a smaller number of thoroughly trained specialists. But I should dislike to dismiss the subject without at least a question whether it would be possible to have a small number of schools for nurses, say not to exceed ten, from which real professional people might graduate after having had a course of training worthy of professional recognition. Apparently such a proposition is barred, if the general contention of the "Standard Curriculum for Schools of Nursing" is to be considered determinative. Take now the other proposition: "If necessity is to dictate that there shall be a school of nurses in every hospital of any size, is there any plan possible by which there may be clearly divided groups of schools? For example, some are giving the entire instruction needed to satisfy the requirements for the profession of a registered nurse, and others which are limited in equipment and in teaching force, cannot be expected to provide satisfactorily more than a part of such necessary training? No one doubts that there might be such groupings, provided there were established between the different types of schools a working arrangement which would be mutually satisfactory. The small hospital must have its attendants as well as the large. The nurses' school in the small hospital, of necessity, must feel the drain of the nurses' school in the large hospital. The one is put in the position of fighting all the time to retain its helpers; the other in the position, whether intentional or not, of all the time drawing the best candidates from the other. It is slight wonder, therefore, that those who are connected with the small hospitals and the small schools are suspicious of those who are affiliated with the larger ones. A nurses' school in a small hospital which attempts to provide instruction for which it is not equipped is not a desirable thing. Even the supporters of the small hospital and the small school realize that, but self-preservation is the law which forces them to undertake that for which they are not properly prepared.

If now, into the minds of those who conduct these smaller schools there comes a suspicion that the law and the methods of administering the law are working in the interests of the larger schools in the larger hospitals, to the great detriment of the smaller schools in the small hospitals, an element of discord and difficulty is introduced which is bound to produce discontent, friction and sharp opposition to what otherwise might be regarded as a highly desirable law. That these conditions actually exist in Illinois is apparent. A problem of no small importance is to remove any and all grounds for this suspicion and consequent discontent.

When the late William R. Harper, president of the University of, Chicago, gave expression to many notable projects in education, with