Medical Services in New Zealand and The Pacific
V: Recruitment of Nurses
V: Recruitment of Nurses
At a meeting of the National Medical Committee on 15 June 1938 a Nursing Council was formed, as already stated, to advise the committee on all matters pertaining to army and civilian nursing in time of war and to link up the activities of the Red Cross Society of New Zealand and the Order of St. John in the training of voluntary aid detachments, both male and female.
The Nursing Council first met on 31 August 1938. It then drafted a scheme covering the enrolment and organisation of the registered nurses of the Dominion in the event of a national emergency. This scheme was based on the assumption that the public hospital system of New Zealand would be the nucleus of all arrangements. It was forwarded to the National Medical Committee on 6 September 1938. At a meeting of the committee on 26 September the report of the Nursing Council was considered, amended in some details, and then adopted as amended.
It was further agreed that the matter of voluntary aid detachments and a representation of appropriate bodies on both the Medical Committee and Nursing Council be the subject of a memorandum to the Secretary of the Organisation for National Security.
The situation in regard to the Army Nursing Service in 1938 was that there was a Matron-in-Chief, the Principal Matron and three other matrons, and a list of 114 staff nurses, none of whom had been promoted to the rank of sister. This list of staff nurses was most unsatisfactory, in that it was made up partly of women who had been on active service during the First World War and were page 365 therefore too old to be sent overseas again. Another group was comprised of recruits who had answered an appeal by the Matron-in-Chief some four or five years previously, and who at that time were not asked for any medical certificate, with the result that some were not medically fit, while others were then over 50 years of age.
It therefore seemed to the Nursing Council that the logical course was to revise the list, retiring women who were over age or were not fit, and from the list to promote some to the rank of sister and then to call for recruits on a new basis. As the public hospitals of New Zealand would be used for the care of sick and wounded in the country, it was decided to call a certain percentage from the employ of each hospital board, leaving the selection of that percentage to a committee within the hospital – perhaps the chairman of the board, the Medical Superintendent and the Matron – a system used in England in some of the hospitals, for instance, the London Hospital. Instead of there being a Territorial reserve, each hospital would undertake to supply a certain number of nurses. On this basis nurses would only be taken on active service from the public hospital system.
The representations of the Nursing Council on the reorganisation of the Army Nursing Service as approved by the National Medical Committee were passed on to the Organisation for National Security on 5 October 1938. The latter body referred the draft scheme to the Army Department, which approved that the establishment of the active list of the NZANS should be as follows: Matron-in-Chief, Principal Matron, 4 matrons, 2 assistant matrons, 30 sisters, and 30 staff nurses.
By July 1939 the matrons and sisters had been appointed. On 22 August 1939 the Registrar of Nurses, Department of Health, who was also chairman of the Nursing Council, asked all branches of the New Zealand Registered Nurses' Association to compile a list showing all the registered nurses who would be available in times of national emergency.
Developments on Outbreak of War
With the outbreak of war the Nursing Council met again, on 5 September 1939, and gave consideration to the matter of recruitment of nurses for the New Zealand Army Nursing Service, and to the necessity of supplementing the required nursing staff of hospitals should this become necessary. A summary of the recommendations is as follows:
Examinations for appointments of matrons and assistant matrons for army service to be temporarily waived.page 366
Existing personnel of the active list, Army Nursing Service, to be medically examined and power given to replace any member on the active list found to be physically unfit.
Nurses on the army list who are employed in key positions in the Health Department and in public hospitals not to be released for service in Camp Hospitals.
All applications from nurses for enrolment in the Army Nursing Service to be referred to the Director, Division of Nursing, Department of Health, and a register of names of nurses so applying to be kept by the Department of Health, and the final selection to be made by the existing Nursing Council.
Sufficient senior staff to be retained in public hospitals so that training of nurses is continued on a satisfactory basis.
Should there be a demand for nurses to serve overseas the selection to be based on:
That in view of the fact that it is known that there are approximately 300 New Zealand registered nurses in England, a register of New Zealand nurses volunteering for service with any British military unit be established at the High Commissioner's Office, London.
That in view of the present shortage of nurses in New Zealand, permits for travelling overseas should not be granted to New Zealand registered nurses unless the circumstances surrounding the application are for urgent private reasons.
The report was submitted by the Director-General of Health to the Minister of Health (Hon. P. Fraser) on 7 September 1939, was approved by him on 8 September, and was approved by the Minister of Defence (Hon. F. Jones) next day. This authority provided the basis for the reorganisation, recruitment and development of the NZANS during the war.
The Matron-in-Chief (Army and Air) was informed of the approval of the Nursing Council's recommendations by the Ministers of Health and Defence, and steps were taken by the Department of Health to forward to her a copy of the register of nurses applying for enrolment in the NZANS.
On the question of the final selection of nurses required for the NZANS, the Nursing Council recommended, and the National Medical Committee on 16 January 1940 approved, an alteration in method to the following:
Each hospital matron, the nursing adviser to the Plunket Society, and the Director, Division of Nursing, Health Dept., will hold a list of their own nurses who have volunteered and who have been approved by the page 367 Nursing Council, such list being divided into those suitable for Sisters' and Staff Nurses' positions. As further nurses are required, in order to assist the controlling authorities of the various hospitals and nursing services, instead of the Nursing Council calling them up individually, the final selection will be left to the various controlling officers to make from the approved lists.
Amendments of 8 September and 26 October 1939 to the Standing Orders for Mobilisation 1939, Appendix XXIV, set out the medical requirements and defined the ages for the acceptance of members on the active list of the NZANS for service within New Zealand and overseas. For overseas service the age limits were set down as matrons, 35–45 years, sisters, 25–45 years, and staff nurses, 25–40 years.
The question of uniforms for the NZANS demanded the immediate attention of the Matron-in-Chief. A limited amount of material was held by the Director of Ordnance Services. Arrangements were completed for this to be made up into uniforms and for the securing of further supplies and the production of more uniforms. The matter of a uniform allowance was taken up, both for home and overseas service, and an outfit allowance of £40 and an upkeep allowance of £10 a year was approved.
The badges previously used by the NZANS for nurses proceeding overseas were reinstated as the official badge in December 1939.
It was found that, without any particular stimulation, the rate of volunteering for active service by nurses far exceeded the demand. By 4 December 1939 there were 340 suitable nurses to draw on.
There was an estimated number of 350 New Zealand nurses in the United Kingdom and elsewhere and it was approved that these nurses should also be considered for overseas service. (A few joined 1 General Hospital when that unit was in England with the Second Echelon but very few were recruited after that, partly because they were required for the emergency medical service in the United Kingdom and for military service with the British Forces.)
In December 1939 the DGMS (Army and Air) recommended that three NZANS nurses should accompany each transport going overseas with the First Echelon, for the reasons that they could assist at any surgical operations, they would be available in the event of an epidemic among the troops, and they could, at their destination, be attached to British hospitals pending the arrival of a New Zealand general hospital and so gain valuable local knowledge.
The first group of eighteen members of the NZANS went overseas with the First Echelon in January 1940 and were attached to a British hospital in Egypt until Helwan hospital was established. All transports leaving New Zealand with troops during the war carried a small staff of nursing sisters.page 368
By May 1940 over 1200 nurses had volunteered for service overseas. These had been classified by the Nursing Council into nurses in the employ of hospital boards, private hospitals, Health Department and the Plunket Society, and those engaged in private nursing.
In deciding how nurses should be best recruited without interfering with the home service to too great an extent, it was decided by the Nursing Council that nurses should be called up on a pro rata basis, not only in regard to the service in which they were employed, but also in regard to the district in which they lived. By May 130 nurses had been medically examined and had either been called up or were in the process of being called up for military duty. Of these, 52 had gone overseas and 18 nurses were on duty at camp hospitals. In calling up nurses for overseas hospital staffs consideration was given to the need for special experience in operating theatre, dietary, X-ray, orthopaedic and infectious diseases services so as to ensure that the hospitals were staffed adequately.
In some districts refresher courses were arranged for non-active nurses to ensure that they would be familiar with the local hospital and with modern hospital conditions.
Publicity was increased in May 1940 to encourage suitable girls to enter the nursing profession. This, together with the war position, resulted in waiting lists at all training schools being considerably increased. At Auckland and Wellington Hospitals additional classes of nurses were taken in to the Preliminary Training Schools. At Auckland an additional class of forty had entered by May and a further additional class of forty was proposed. At Wellington an additional class of seventy-five had already entered. In Dunedin an increase had been made in the usual class and in Christchurch a training school for nursing aids was opened at Burwood Hospital.
With the development of Air Force stations in New Zealand there was a call in 1941 for sisters for the station hospitals. It was arranged to appoint senior women, preferably former military sisters, to these posts, so that they could act in any emergency in the absence of the medical officer and could be responsible for the discipline of the hospital. The first few of these women were all appointed charge sisters as they were all sisters of the higher rank on the reserve.
The functions of these sisters seconded to Air Force station hospitals were rather different from those in army camp hospitals and were regarded as relatively more important for the reasons that: (a) There was usually only one sister; (b) The remaining staff were VADs (or their equivalent) or men; and (c) the sister had to conduct sick parades in the absence of the medical officer.
The number of secondments to the RNZAF eventually totalled 26 (19 in New Zealand and 7 in the Pacific). By this time it had page 369 become necessary to enlist younger sisters in view of the more trying conditions of overseas duties.
In 1943 three sisters who had been appointed to the Naval Base hospital in Auckland from the staff of the Health Department were transferred to the NZANS in order to give them rank while dealing with sick naval personnel.
The Nursing Council continued to function as a valuable adjunct of the National Medical Committee throughout the war. It controlled the intake of registered nurses and masseuses for the armed services. The staffing of five general hospitals and a casualty clearing station for 2 NZEF overseas, military camp hospitals, naval and Air Force hospitals in New Zealand, and hospital ships made a serious drain on the trained nursing personnel of the Dominion. As many as 375 sisters were serving overseas at one time – in the Middle East and Italy, in the Pacific and in hospital ships.
During the war 602 members of the NZANS served overseas, while some 65 positions in home service medical units were staffed by the NZANS – at military camp hospitals, Air Force station hospitals, naval base hospital and the Polish children's camp hospital.
Care continued to be taken to call up nurses from districts on a population basis as well as according to their branch of nursing. In utilising this method the Council withheld approval of volunteers in key civilian positions until other nurses were trained to replace them. This maintained a core of skilled staffs, thus avoiding disruption of hospital routine, and protected the training of student nurses.
In addition, consideration had to be given to the increased demands of civil hospitals, which had to cope with the influx of hundreds of returned service patients and the added work due to the social security hospital benefit. In the facilitation of administration and the avoidance of undue hardships the Nursing Council was a most valuable supplementary body to the National Medical Committee.
A Civil Nursing Reserve was established in New Zealand in March 1943. Its purpose was to provide a reserve of registered nurses and voluntary aids from which hospital boards could obtain temporary assistance to overcome staff shortages. The staffing problems had become acute because service patients in New Zealand were nursed in civilian public hospitals, new wards and new hospitals were being opened, and at the same time staff requirements fluctuated, thus preventing continuity of permanent appointment in some cases.
The Civil Nursing Reserve was administered by the Health Department and controlled by the Nursing Division of that Department. Enrolments were dealt with by the Regional Nursing Officers in the District Health Offices, who interviewed all applicants and page 370 forwarded medical and X-ray reports, but allocations and assignments to hospitals were all made by the Nursing Division of Head Office. Voluntary aids were recruited through the organisations of the Order of St. John and the Red Cross – in every case the applicants were recommended by their commandant and had obtained at least two certificates and undertaken sixty hours' training in hospital.
During the four years in which the reserve functioned it fulfilled a very useful purpose. At its peak it employed fifty registered nurses and over 400 voluntary aids and was assisting over thirty different hospitals, many of which could not have carried on without this supplementary staff.