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Nurses' and Midwives' Legislation.

By the passing of the Nurses' and Midwives' Act, in 1925, the training, examination and registration of nurses and midwives was established on a new footing. The Nurses' and Midwives' Board was set up by this Act, and the functions of the Board definitely laid down as follows:—

(a)	To determine courses of training to be undergone by candidates for examination as nurses, midwives and maternity nurses under this Act;
(b)	To approve hospitals or other institutions at which approved courses of training may be received;
(c)	To conduct examinations under this Act; to appoint examiners and make all other necessary arrangements for the purposes of such examinations; and to issue certificates of having passed such examinations to persons entitled thereto;
(d)	To receive applications for registration under this Act; and to authorise registration in cases where the conditions of registration have been complied with;
(e)	Generally, within the scope of its authority, to do what ever may in its opinion, be necessary for the effective administration of this Act.

The Board was composed of:—

(a)	The Director-General of Health;
(b)	The Director, Division of Nursing; who ipso facto was Registrar of the Board;
(c)	A registered medical practitioner;
(d)	Two persons, of whom one shall be a registered nurse, and one shall be a registered midwife, each appointed on the recommendation of the New Zealand Trained Nurses' Association, or other Association or Society approved by the Board for the purpose.

In 1930 an amending Act increased the number of members of the Board by two, one to be appointed on the recommendation of the Hospital Boards' Association, and the other on that of the Trained Nurses' Association or other similar approved Society. Unofficial members of the Board hold office for three years, but are eligible for reappointment.

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The personnel of the first Board was:—

• Dr. M. H. Watt, Deputy Director-General.

• Dr. W. Young.

• Miss H. C. Inglis.

• Miss L. Kohn.

• Miss J. Bicknell (Registrar).

The Act, together with the regulations gazetted thereunder, provided that all nurses and midwives whose names appeared on the respective registers should appear on the registers under the new Act, but also provided for a new class of obstetrical nurse termed a “maternity nurse,” for whom a new course of training was approved. In addition, it provided that all those women, not being qualified by examination, but who for not less than twelve months before the commencement of the Act, had been regularly engaged in practice as maternity nurses in New Zealand, were entitled to registration under a separate section of the Act as maternity nurses provided they applied for registration within one year of the passing of the Act. By this means some 650 women obtained registration. The newly recognised maternity nurse carries out the duties of a midwife with two restrictions, i.e. she cannot attend a case unless that case is under the charge of a registered medical practitioner, nor can she be licensed to conduct a maternity hospital.

The Act also provided a penalty for persons not so registered carrying out the duties of a midwife or maternity nurse. Provision was made for the Medical Officers of Health to exercise supervision over all midwives and maternity nurses in the practice of their profession, the Board having power to strike off the register any nurse, midwife or maternity nurse convicted of any offence punishable by imprisonment or who, in the opinion of the Board, had been guilty of such conduct as to render her unfit to continue the practice of her profession.

An appeal is provided for in the event of any person being refused registration or being struck off a register.

One of the first duties the new Board was faced with was the granting of approval to the various institutions to function as training schools and most of those institutions which had been training schools under the old regime were allowed to continue as such. The Board's ideal, however, was to limit training to those institutions at which nurses, midwives or maternity nurses could be given a thorough training, both theoretical and practical, and at which there would be an ample sufficiency of clinical material. Gradually, the smaller institutions were deleted from the list of approved training schools and the smallest of those left approved as “B” grade schools.

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Provision had been made for the Board to approve of hospitals as “B” grade training schools where there could be given a certain amount of the training, although not considered large enough or well enough equipped to give a complete training, and these institutions are affiliated with large “A” grade training schools who take their pupil nurses for such period of their training as decided by the Board. Although similar provision was made for partial training schools in maternity nursing as well as pupil nursing, the Board considered it inadvisable to have subsidiary training institutions for maternity work. In 1930, the Board decided to restrict the training of midwives to the St. Helens Hospitals at Auckland, Wellington, Christ-church and Invercargill.

At the commencement of the training a course was available by which trained nurses could take a straight out midwifery training of eight months, whilst the untrained woman required to train for twelve months as a maternity nurse, and on obtaining registration had to practise as a maternity nurse for a period of twelve months, and then do a further four months' training as a midwife before obtaining registration. Finally, however, the courses were arranged as follows:—

For the General Trained Nurse:

• Six months' training as a maternity nurse.

• Six months' training as a midwife.

For the Untrained Woman:

• Eighteen months' training as a maternity nurse.

• Six months' training as a midwife.

In each case the training in midwifery cannot be commenced until the trainee has been registered as a maternity nurse.

The Board desired to raise the standard of the examinations and in the case of the general trained nurse divided the medical and surgical papers into two, four of the questions in each paper to be set by a doctor examiner and two to be set by a nurse examiner, the marks being 100 for the doctor's questions and 50 for the nurse's questions, a candidate being required to obtain 75 marks in each of the medical and surgical papers in addition to 50 per cent, of the total marks in the oral and practical work. Partial passes were abolished.

The Board has given considerable time to the question of raising the standard of training in the various institutions and as a result of its decisions and recommendations teaching material, libraries of text and reference books and other equipment, have been gradually increased and improved in most of the training schools. The syllabus of training for general nurses was carefully revised.

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The period of training as stated above, and the syllabus and course of practical work for midwives and maternity nurses, have been altered on several occasions but the practical work and system of lectures both for untrained women and trained nurses undertaking their obstetrical course, has been finalised and set out in detail.

The establishment of a Post-Graduate Course and the subsequent appointment of Sister Tutors in the larger hospitals has been the means of raising the standard of education given to the pupil nurses.

In 1930, the amending Act provided for the recognition of private hospitals with public sections as training schools for pupil nurses providing that they could comply with the requirements laid down by the Nurses' and Midwives' Board, and also that there was no possibility of interference with the reciprocity with the General Nursing Council of England, but so far only one institution has been approved as a training school.