An All-graduate Staff in Arkansas

Abstract

A BRIEF questionnaire study of the nursing service in the sixtythree hospitals listed by the Arkansas Hospital Association in 1936 showed that thirteen general hospitals in the state employed either graduate nurses or attendants. These hospitals have a capacity of from seventeen to one hundred and fifty beds with a daily average of from ten to fifty-two patients. In these thirteen hospitals, twenty-seven graduate nurse supervisors are employed, with from one to three in each hospital, their salaries ranging from $40 to $125 per month. These same hospitals employ sixtytwo graduate general duty nurses, with from none to nineteen per hospital at salaries of from $30 to $65 per month; and fifty-nine attendants, with from none to twelve per hospital, at salaries of from $10 to $50 per month. Three hospitals had no graduate nurses on general staff duty and these hospitals reported that they trained their attendants; three hospitals used only graduate nurse service; the other seven used part graduate and part attendant services. So we find that, broadly speaking, half of the nursing care of the patients in these thirteen hospitals is given by attendants. Of course the first reason for this use of attendants is expense. The attendant nursing service does not cost as much as graduate nursing service. Even in the best of times some hospitals would probably not be able to pay the salaries that the graduate staff nurse should receive. I should like, however, to describe the way in which a small hospital has been able to maintain a staff of efficient, satisfied graduate staff nurses. This is a very small general hospital, averaging about twenty-eight patients daily, the only hospital for white people in a town of some 30,000 people and considerable rural territory. The hospital has no endowment; it is entirely self-supporting except for voluntary contributions which during the last year amounted to about one-fiftieth of the expense. It could not afford graduate nursing service if that were an unnecessary luxury. Nursing service is provided by a permanent staff of sixteen graduate nurses who work on a straight eight-hour schedule with two full days off duty each month. The nurses alternate hour schedules each two months. The charge nurse on the 3:00 P.M. to 11:00 P.M. schedule one month may be doing general staff nursing on the 7:00 A.M. to 3:00 P.M. relay the next. As the nursing staff is small, the superintendent of nurses and her assistant, who is also the surgical supervisor, do all the supervisory work and fill in at any place where a nurse is needed at the moment. The diet kitchen is taken care of by a maid under a nurse's supervision. In rush times extra nurses are called from the registry. The beginning salary is $40 per month with full maintenance, increasing to $60. In this area it is not difficult to keep good staff nurses who prefer the conditions of employment and salary (which though small is certain), which are offered, to the less stable conditions in other fields of nursing. Six of the nurses, the anesthetist, and the superintendent of nurses have quar-