Nursing is a profession steeped in tradition, custom and practice.
The naming of the specially created Covid-19 hospitals after Florence Nightingale immediately evokes images of nurses in starched aprons and frilly hats striding about the wards carrying a lantern, all the better for seeing specks of dust and badly turned bed wheels.
Nursing grew from a military model of rules to support the actions of doctors and, as a result, developed a rich culture of rituals and routines – from ward rounds to drug rounds, from bedmaking to blanket baths.
Following are 6 facts about nursing.
For the best part of the 20th century, nurse training was largely unaltered.
Over time, the emphasis moved from strict discipline and cleaning to a marginally less hierarchical and more technical job, but it remained a three year apprenticeship with much of the learning through example on the wards, bookended with a couple of weeks in the classroom.
Procedure books captured the steps needed for every task, from dressings to enemas, drugs to ward rounds.
Ward rounds were, and are, an important ritual in the life of the ward. Each consultant had their own particular foibles: patients ready and waiting on beds, curtains pulled just so, nurses (apart from the ward sister) out of sight.
By about bed 19 there would be a customary nod from the sister to a junior nurse to put the kettle on so tea was ready for the great man (almost always a man) at the end of the round, when sister would deploy her best china in her office.
The rest of the nurses on the ward would then scurry about offering bedpans or bottles to patients, who were denied them while the ward round was in progress.
The rapid advance of science over the years means that nurse training has changed out of all recognition as the profession has risen to the challenge of modern health care.
It is now a three year degree programme. Nursing students are no longer part of the paid workforce, although 50% of their course is spent on ward placement. They are educated to understand, invited to question and their practice is evidence based.
Traditionally, hospital patients start the day with an early morning wash – sometimes very early.
In the past, beleaguered night staff stumbled about in the dark getting patients washed and the ward immaculate before the morning staff arrived.
Working in the dark means you can’t always see what you are doing – one nurse recalls a colleague washing a patient’s face before realising she had passed away.
Another says she arrived for the morning shift to find all the patients sitting up in bed clean and freshly attired in shrouds instead of hospital gowns.
Handwashing, such a crucial part of keeping infection at bay during the Covid-19 crisis, has always been a mainstay of nursing ritual: hands were, and still are, washed before and after every task.
These days it’s usual to wear gloves for anything that risks contact with bodily fluids but for most of the 20th century gloves were not routinely worn other than for sterile procedures. We were told that it was humiliating for the patients as it made them feel untouchable.
3. The poultice
Lotions and potions have always been a feature of nursing rituals.
At one time, kaolin poultices were used to draw out infection from an inflamed area of the body or from a wound.
In the 1950s, nurses made up a poultice each morning, using methyl salicylate, glycerine, thymol and aromatic oil wrapped in lint and gauze and sheeting.
Stored behind the steriliser to keep warm, a section was cut off whenever a poultice was needed. While the warmth helped to draw out the infection, keeping the poultice warm all day was an invitation for bacteria to set in.
Drug rounds remain a vital part of any nursing day. As in the ‘real world’, the rules and our understanding around drugs in hospital are constantly changing.
References to opium and belladonna can be found in Greek mythology and they have been used for pain relief ever since.
In hospitals in the 1940s, opium was applied on a soft cloth dipped in hot water, known as a stupe.
In the same era, nurses were informed that prescriptions should be written in Latin as this was the ’universal language’ and that very often doctors had poor handwriting.
While the ritual of the drug round continues, the contents of the drugs trolley has changed. During much of the 20th century it was routine to have alcohol on board.
This may have reflected a time when alcohol strengths were lower than today and it was less of a social activity – the soft drinks of today just didn’t exist.
Whatever the reason, it was routine for beer to be offered on the men’s surgical ward to increase their fluid intake.
Likewise, sherry was offered before meals to encourage older patients to eat, a brandy or whisky would be offered on the vascular wards to improve dilation of the blood vessels, and gin was used to stimulate the bladders of those post-operative patients who were finding it difficult to pass urine.
One nurse recalls a patient shouting at her for not ‘tipping the glass and pouring the Guinness slowly’. Something that was not routinely taught in training.
Smoking too, was a part of the social fabric in 20th century Britain and nowhere more so than in hospitals.
It was common for patients to have ashtrays on their lockers and for their smoking needs to be finely balanced with their need for oxygen via the piped supply at the wall.
On one older people’s ward in East London, student nurses on night duty rolled cigarettes for their patients to smoke the next day.
There was little understanding of the addictive nature of smoking and where there was, the view was generally that people should apply willpower if they wanted to stop.
There were no smoking cessation services, drugs or gum to ease their addiction.
It is clear now, during the Covid-19 crisis and in this all-important World Health Organisation (WHO) year of the nurse and midwife, just how valuable nurses are and how vital it is that they are highly educated.
These days nursing is very much its own profession. No more talk of being angels, having a vocation or being doctors’ handmaidens.
Custom and practice, ritual and myth are part of nursing’s history. Nurses these days are about evidence-based practice and safety critical care.
Claire Laurent is an author and journalist specialising in public health, nursing and health policy. Rituals & Myths in Nursing is her first book.