Saturday, 10 February 2007


Most nurses practising today have gone through a three year training. Some have extended that period with a few additional bells and whistles, but in the main, a three year training has been the 'norm' for a long time, although the content of that training has varied, and gone up and down with the hemlines. But training wasn't always like that. In fact, there was a time when training 'wasn't' at all.

Until the Nurses Registration Act of 1919, there was no registration of nurses, no regulation or standardisation of training, no examination to prove, or dis-prove competence. Anyone could call themselves a nurse, and as long as they worked within the law, that could not be challenged.
Florence Nightingale fired the starting pistol of nurse training when she opened her school at St. Thomas' Hospital in 1860. Her mixture of 'ladies' and probationers underwent a one year training in order to receive their hospital certificate, and until the 1880s, this one year was considered adequate time to produce a woman capable of meeting all the challenges that hospital and home nursing would throw at her. But by the 1880s, suggestions came from several quarters that this period should be extended, and in 1887 the British Nurses Association started to campaign both for a three year training, and also for national standards to be laid down.

At the turn of the century, there existed a confusing mixture of women, some of whom had a one year's certificate; some a three year training, which could have been good or bad; some a one or two year training in children's or fever nursing; some in the words of Brian Abel-Smith had learned their trade 'on the hedgerow of experience.' But there had developed an unofficial 'gold standard' which laid down that a full training of the best kind came from three years in a general hospital of more than one hundred beds.

When Queen Alexandra's Imperial Military Nursing Service came into being on 27 March 1902, it employed the strictest standards. Not only did it insist on the full three year training, but also that it's applicants met the highest standards of educational attainment and social standing. With so few women in Great Britain even coming close to meeting that standard, they always struggled to maintain their full establishment. But they were never willing, for a moment, to let those standards slip. In 1902, there was already an Army Nursing Service, many of the nursing sisters had years of devoted service in military hospitals, but even they had to re-apply to be accepted by the new service, and prove that they were fit to continue to serve the Army.
One of those women, Isabella Jerrard, was in for quite a shock, when she applied to transfer to the new service in 1902. At that time she had served for 24 years and 2 months in the Army Nursing Service, reaching the rank of Superintendent (equivalent to a Matron), but (Oh horror!) it was discovered that she had never received nurse training of any kind, and therefore could not be allowed to transfer to QAIMNS.
However, shortly afterwards, her case was reconsidered, and the Advisory Board recommended:

In admitting candidates from the existing Service, the Advisory Board thinks that regard should be paid rather to the manner in which they have performed their duties as Army Nursing Sisters than to the qualifications required of them at the date of their admittance to that Service.

The Nursing Board had to make a U-turn, and find a place for this middle-aged maverick, and in confirming her position as a Matron in QAIMNS stated:

The Nursing Board desires to inform the Advisory Board that Miss Jerrard was declined for QAIMNS, not only on the grounds of insufficient training, but because the evidence before the Selecting Committee made it clear that she was not suited for the post of Matron – the only position in the Service for which she could be considered eligible after her 24 years’ service. On reconsidering the case the Nursing Board, on account of her age and long service, is willing to recommend that Miss Jerrard be retained in her present position until she has completed the period necessary for the pension due at 50 years of age.

This case is a good example of how a three year training had become the standard for the professional nurse, and one which even in 1902, the Army would insist on above all other considerations.

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