17

H.—22a

of his local hospital than any other member of his profession in the land. It is urged by some that members of the honorary staff should be represented on the Hospital Boards. With this I do not in a measure agree, and I certainly think that the teaching staff of a hospital attached to a medical school, such as that of Dunedin, should Ire represented on the Board, either on the nomination of the honorary staff themselves, or by the University. The paramount importance of having the best medical teachers possible at the only medical school in the Dominion is so apparent that it should require no argument. As regards the appointment of matron, there is also every reason why this should be vested in departmental control. Many of you know that a Nurses' Register is kept, in which is recorded the training-school and general-hospital record of each nurse. Now, in going about the Dominion, who is better calculated to ascertain and find out the capabilities and character of a nurse than my assistant, Miss Maclean. She gets the individual expressions of opinion of those under whom the nurse serves., and she can draw her own deductions. But in these appointments it is possible to guard against abuse in this manner : In going about the Dominion I have been at some pains to discover the reasons of the difficulty in obtaining nurses for our public institutions. One of the chief reasons is the little prospect of advancement held out to a nurse if she remains in our publichospital service. If at the completion of her training a nurse remains in a public hospital, and proves herself a capable and conscientious officer, and one whom it is hard to replace (though I do not for a moment suggest that either the hospital surgeon or matron would do anything to blight that nurse's prospects), yet if she was found to be a thoroughly capable person would they be likely to go out of their way to get her a better position in the hospital world 1 I know of just such cases in point, and, again, of excellent matrons who hold responsible positions in some of our smaller hospitals, with very little chance of promotion under the present system. If we want to staff our hospitals with suitable nurses, we must hold out better prospects. This can be done to a certain extent by a classification of hospitals, and getting the matrons to work up from the bottom. For instance, say our hospitals are classified according to their beds into six distinct classes. A nurse should begin in a sixth-class hospital as matron; on the occurrence of vacancy in a fifth-class hospital the Board should apply to the Department to recommend the best matron in the sixth class for promotion, and so on. Under such circumstances matrons could ever have a prospect of advancement in their profession, with corresponding increase of salary, and the varied experience obtained would be very useful to the institutions they would serve. A. system such as I have outlined could hardly be open to abuse, and I certainly commend it to you for your consideration. Of course, in conjunction with the above the hospital would have to be classified as to scales of matron's pay, &c, as well—another very important matter. The difficulty of getting nurses for our public institutions is every day becoming more apparent, and, as the question is a vital one, it may not be altogether inopportune to refer briefly to the cause or causes of the present dearth of nurses, and the measures which it is proposed to take to increase the supply. In the first place, it must be remembered that, comparatively speaking, a few years ago there were few avenues of employment open to women other than of nursing. Such is not the case nowadays, and it is not to be wondered at, especially in a country like this, that we should soon feel the fluctuations consequent upon the popularity or non-popularity of any particular employment or profession. Under the Private Hospitals Act it is very wisely ordained that no private hospital can be registered unless a certificated nurse is placed in charge, and as there are, roughly speaking, some two hundred private hospitals, one of the chief causes of this dearth can easily be seen —in fact, there has also been so much difficulty in getting certificated nurses for these private hospitals that to avoid hardship to settlers in country districts, we have had to throw the responsibility of the license on the nearest medical man. When a nurse in due coui'se passes the State examination, she has two alternatives open to -her-—either to remain in the public service, or to go out private nursing. Now, it must be .confessed that the emoluments to he derived from private nursing are greater than the managers of the public hospitals are at present disposed to give, so the nurse can hardly be blamed for doing the best she can for herself. But this is not all: many nurses at the expiration of their training are for a time only too glad to get away from the very necessary restraints of a public hospital. It is true that many go back to the public hospitals later, but a great many more marry, and this is a cause that we would not remove if we could, as they can serve the countrj' splendidly in other ways. In a measure we can remedy the present dearth of nurses by allowing some of the better private hospitals to train probationers, so that some of their time can climnt towards registration; but that is a matter that will have to be very carefully handled, or New Zealand nurses would not be taken at the same standard in other parts of the world, as is the case at present. But I feel confident that, if nurses are assured a definite prospect of promotion, reasonable pay, and a chance of a pension at the end of so-many years' service in our public institutions, it would go a long way towards remedying the present deficiency. I certainly consider that the time is now opportune to discuss some scheme for pensioning nurses, so that those who have grown grey in their honourable calling need not feel the pinch of poverty in their declining years. I would therefore strongly recommend members of this Conference to consider the question, and especially would I recommend it to those misguided but doubtless well-meaning people who plume themselves on the interest they take in the nurses of their respective institutions. Such gentlemen would find a better field for their energies in this direction than by inquiring of the nurses what they think of the doctor, and what they think of the matron, and by generally assuming towards the nurses an air of patronage which is as repulsive as it is ludicrous. To such misguided efforts are due those breaches of discipline which from time to time bring our institutions into disrepute and occasion the only too popular demand for a hospital inquiry. I now come to a provision in the Bill which I fear has not a single supporter in this room — that is, the proposal to gradually reduce the subsidies. This proposal is directed at the expendi-

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