NAPIER HOSPITAL MANAGEMENT

Hawke's Bay Herald-Tribune, Issue 138, 28 June 1937, Page 8

NAPIER HOSPITAL MANAGEMENT

l ■ * « — — ~~ ; DR. JOHN CAIRNEY'S ADVICE

Spheres of Authority and Staffing CONCLUDING EVIDENCE Suggestions for the more efficient odministration of the Napier Public Hospital and for the affiocation of epecific spheres of authority to the different heads of the board's staff •were heard hy the Roy.ll Commission before its adjournment on Saturday from Dr. John Cairneyf . assistant superintendent (medical) of the Wellington , Hospital. Methods for the admittance of patients to the hospital, staffing, hours of work for nurses, and other aspects of organisation wero re▼iewed hy Dr. Cairney in his evidence. The commission then adjoumed to Wellington, where it will hear evidence from officials of the Health Dfpartment. Dr John Cairney, superintendent (medieal) at the Wellington Hospital. In reviewing several matters hrought before the commission, said that in his opinion the delay in admitting the boy Berry to the hospital in no way contributed to hi3 ■ fatal illness. ' Such delay s, liowever, should not be condoned. The system at Napier was that all cases arrivijig for admission "wefe first seen in the outpatients departinent. "Witness considered that the system was an "excellent one if a ddctor wero ayailable there at all honrs of the day. If this wero so, it would be wise to consider the alternative of a senior member, of the, nursing staff to decide ueon her otui initiative to which ward a patient should be sent, and to send hina there withoot delay. It was important that X-ray (iJms •hould be readily acce§gible for medical purposes at all times, said witness in connection with the fourth part of the ©rder of reference, In Napier the films wero under lock and key, the k#y being In the possession of one sister only. It was obvious that she could not be •Iways available to produqe the films lphen they were required, but it was often necessary to produce films at •hort notice. 1 'I might add that it seems to me •urprising that the medical superintendent, as the head of the hospital, should b© deprived of the possession of a k'ey to that particular room," lie mdded. Treatment of Sick Nurses Touching upon the question of treatment of sick nurses and the detection of ill-liealth .among them, witness said ke considered that measures adopted in the Napier Hospital were similar to those adopted elsewhere in hospitals, and he-saw no way in which they could be improved upon. The nurses were enccuraged to report sick, and if there was any break-down it appeared largely the fault of the individual. In regard to hours of work for nurses, said Dr Cairney, tendency was to give pupil nurses a day 'off each week in most of the hospitals in New Zealand, reducing the number of working hours to 48. In Wellington, both trained and untrained nurses had a 48hour week, whlle nurses in the tubercular hospital nearby enjoyed a 40hour week, and the sisters of the Xray department 35 hours a! week, in accordance witb the rapidly-increasing ▼ogue of reducing hours for nurses. In regard to the proportion of nursing staff, witness said some years ago it used to be one nurse to 2,5 patients, but of late years the tendency had* been to settle down at one nurse to two patients. The Dominion average last year was oue nurse to 1.9 patients. New Plymouth, with an average of 173 beds, had a staff of 98 nurses. Jn regard to the average of oue to 1.9, the > proposal to bring the staff at. Napier to 95 would be about riglifc. Then again caine the proportion of trained to untrained staff. The New Plymouth hospital had 31 trained with 67 untrained on its staff. Ihe trained ■taff now in most hospitals was close on one third of the total staff. At Napier 30 or 31 trained nurses could be expeqted to be on the staff.. That proportion of trained staff was paiticularly important in Napier in view of the construction of the wards, which cbnsisted of nearly all side rooms witb very small wards. Witness considered that in each of tlfe wards there should be * sister, a senior charge nurse, and a charge nurse, making tbree trained nurses to each ward. Timo for Lectures. " When it was considered that the nurses worked in tbree shifts, the question of arriviug at a suitable time for lectures become difficult, continued witness. It would be found thafc one shift of nurses would be sleeping at 'almost every hour of the day. Lectures held at seven or eigbt o'clock in the evening would be suitable in certain cases, but witness did not .advocate that the lectures should continue for rery long into the evening. Regarding the salaries paid to the trainees. witness considered that they wer6 as generous as those paid elsewhere. In regard to staff nurses, it was becoming recognised that ' they . would have to be increased and made more attractive in order that .the trained staff should be retained. 9 The organisation of the hospital was rovcrvd by the board's by-laws, whicli had been. very fully; discussed, said Dr. Cairney. Those byylaws wero by no nieaus peculiar to Napier. This organisation appeared to pro▼ide for three >t'parale hcads, being ihe nredii'al supormlendeufc, the marton and thc roanaging-secretary. "Taking these in turn," he contmued, "tlie marton is defined as the fcead of the nursing and domestic staff. Und-is not in the by-laws placed under the control of thc xnedical superintendent. There are certain matiere, how-

ever, which she may do only tbrough reference to the medical superintendent," The raatron was called upon to consult* with the medical superintendent in regard to the cbanges oi nurses. She was required to report to ■ him a vaeaucy caused ,by the resignatiou of a sister. The matron was responsible to the board and not to the medical superintendent for the discipliue of the nurses. The managing-secretaiy was the eontrolling officer of'all the staff except the medical and nursing staff, said witness. There was nothing which caused him to refer any matters directly to the medical superintendent. The only persons under the direct control of the medical superintendent, according to the by-laws, were the house-surgeons, dispenser and bacteriologist. Superintendent 's Autnority. Witness considered that the medical superintendent was regarded as the otficial head of the institution by the board. "In i'act, 1 will go so far as. to say that on the by-laws as they stand, with the exception of the few l have mentioned, members of the staff could refuse to carry,out any instruction of the medical superintendent," he added. The chairman: Are you'not entering upon legal matters, Dr. Cairney? Witness: I 6hail -be finishetl with them soon, Sir, and am only going to say that even a porter might put up a very good case' pn these by-laws for holding oiit against a direction from the medical superintendent. These conditions. witness repeated,. were not peculiar to Napier. He did not think that these conditions were conductive to the smooth running of a bpspital. Where there was no delinition of an official head of an institution there was a possibility of all sorts of difficulties. • . The chairman: I would like to get the doctor'a views as to what he thinks should be done., Witness, in replying, said he considered that there was need for a stronger organisation, and the medical superintendent should be defined as head not only in thcory but in fact. "The simplest alteration that I can suggest, ' ' continued Dr. Cairney, "would be that the medical superintendent should be the head of the institution; that in addition to the other members of the staff the matroa should be responsible not to the board but through him to the board, and that the same position mdght apply to the managing-seeretary with the exception of the purely clerical 6ide of the institution," he continued. "Tliat would give the medical superintendent full control of the whole of the side of the institution having anything "to do with the treatment of the patients." Slmpler Names. Sir Janies Eliiott: Would it not h'elp to cut out the double-barrelled naine and call him simply the secretaTyl Witness: I wouju agree with that. Would it do any harmf— "None at all." Would dt do any harm to call the bouse-manager house-^tewardj — "Not at all. At Wellington the housosteward is an important officer." Mr Eoden: Do you think that the medical superintendent should have soniething direct to do with the treatment of patients? , Witness: I .consider that the superintendent should have charge of a few wards. It ' would there by tend to sticngthen his status in regard to thc honorary members of the stalf, and give him a direct interest in the treatment of some of the patients. That would also check the tendency for him to be looked upon as a sort of manager or a glorified office boy. Might not the. effectivcncss of the i'orm of the organisation suggested by you be uulliiied by . the board? — "i would rather lcave thut to the. commission. It would, hovvcvor. be subject to alteration by a lay-board. The chairman: We will have something to -say about that. Witness: I woufd like to add that 1 am satisfied that what I have suggested could be carried out efficientfy provided that there wus uot too uiuch board interference. Mr Foden: What have you to say regarding the size of the honorary staff of this hospital? Witness: By the incroase of one 1 think that dt could be run by a stipendiary staff., I.am not advocating that. At New Plymouth there is only one more than herc. Large Honorary Staff Not Needed. 'That, continued Dr. Cairney, indicated that a large honorary staff^waa uot necessary. There were four surgcons, with a consulting surgcon who did a" certain amount of operatiug, and each appeared to have patients in all the honorary wards, and made dt ditlioult for the house surgeon to acconipany them on the rounds. If the medical superintendent were a physician, then two physieians and three honorary surgeons would be sufficient. If , however, the superintendent were in charge of a few surgical beds, tben thrpe physieians and two surgeons would be sufficient for tho houorary staff. Sir James EJLnott: Do you think that a part-tiine visiting staff with honornoraria woilld be better than a purely honorary staff? Witness: I believe it would. It would enable the visiting time to he regulated by the board? — " Yes, I think it would. Having an honorary staff attached to the hospital assists the medical and surgical practice of the district. It does not want to be so big that they would be getting in each other's way." Do you think that a lay board is competent to select a technical staffa— .'No, I don't. 'They may be subject to outside influence." Do you think that it is advisable that Hospital Board meetings should be reported as fully as, say, Parliament is? — "I think" that with any little incidont which might bo unduly magnified the medical superintendent should rcquost the chairman to have tho matter taken in committee." Do you think that it would be conducive to the -splendid running of St. Bartholomew 's Hospital, London, if all the petty little differences were fully reported in The Times? — "I should say not." . 8 Mr Lawry; Does the eight-hour day

for nurses includc time for meals or not? Witness: At Hawera I think that the board made a donation of meal times. • To Mr Grant witness said he was surprised at the X-ray room being locked up. He did, not think tha't such a state of things would exist any where to ma Ifo locking up cssentiab. Even in Wellington there might be oecasions when a film was not aA'ailablo when required. 'The Cat Might Take It?" Sir James Eliiott: The cat might take it? Mr Grant: You will adniit that there have been a few cats about the Napier Hospital^ Witness: That might get us into legal argum'ent. To Mr Grant, witness said he regarded the practice of a member of the honorary staff taking a nurse out as qot advisable and to be deprecated. Mr ferant: You speak of the medical superintendent as the head; where does the board come in? „ Witness: The board, of course, is the titular heard. In setting the order that I had previously referred to I did iiot think of the setting-out of a generalogical tree. In tho absfencd-of the board the seeretary is the board? — *'No; I would not say. that. He is the channel, that is pH." In a hospital like this the medical superintendent is a busy man; can he be expected to supervise the things that you have suggested? — "I think that he should." Do you think that . a broken pipe should have.to be icpor*eJ to the superintendent? — "No, but.in such cases as au ambulance being late he should be able to instruct the secretary to make inquiries." . ■ " Who should appoint the honoraries, a-boar-l of laymen or the honoraries themselves? — "That" is all very difficult, and I don't know the answer. The .honor* aries may app' int the, welv'es in perpetuity and not give others 'a chanco. " To Sir James Eliiott, witness said .hc considered that a board of consultants wtih the medroal superintcndort making o reccmmendation to the Hosnital Board was the better way of appointing hoh--oraries. Mr Grant: There are some objectioi.s to honoraries. Do you think tbp objections outweigh the advantaues? . W tness: I think that ?n a hospial of this size honoraries are of great assistance. We have a rule whereby any patient has the right to be attended by the medical superintendent rather than by the honorary for the week; what do you tliink of that ? — ' ' Much depends upon the local eircumstances, but I don-'t think it is advisable to have too many doetors'in the wards." To Sir James Eliiott witness said he did not favour a choice being made as suggested. Ke did not thirik that it added to the efficiency in running the hospital. There was the feature that popularity of doctors would be a factor with many patients.