General Hospital Nursing in Sheffield During the Early Years of the NHS, 1948-1974 Judith Hilary Redman Phd Department of Histor
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General Hospital Nursing In Sheffield During The Early Years Of The NHS, 1948-1974 Judith Hilary Redman PhD Department of History September 2005 Judith Redman General hospital nursing in Sheffield during the early years of the NHS, 1948-1974 Summary This study examines the history of general hospital nursing in Sheffield between approximately 1948 and 1974 - the first 26 years of the operation of the National Health Service (NHS) in England. The availability of nurses in quantity and in quality, their knowledge and skills, working practices and organisation, are themes that endured during this quarter-century. This was a period when administrative and therapeutic innovation was juxtaposed with - and constrained by - resource limitations. In particular, the inability to match nursing availability to patient needs caused operational and strategic problems in developing and delivering hospital-based health care. These problems were exacerbated when innovations in nursing and medical care required new approaches to the organisation of hospital beds and equipment, which also had to be implemented in nineteenth century buildings with inadequate basic facilities. Making extensive use of archived records of Sheffield’s hospitals, the present study explores how the coalescence of these factors influenced nurses and their work, and how this contributed to continuity and change in nursing in the city’s general hospitals. 2 TABLE OF CONTENTS SUMMARY............................................................ 2 TABLE OF CONTENTS........................................................... 3 TABLE OF FIGURES.............................................................. 5 ABBREVIATIONS..................................................................6 ACKNOWLEDGEMENTS......................................................... 7 INTRODUCTION................................................................... 8 Research Questions and Outline of Thesis............................................................... 16 Sources and Methods...................................................................................................20 1. SHEFFIELD’S HOSPITALS AND THE NHS, 1930-1974.................30 1.1 The Origins of the NHS........................................................................................ 30 1.2 Pre-NHS Hospital Services in Sheffield..............................................................40 1.3 Establishing the NHS -1948 to 1962................................................................... 48 1.4 Building on the Foundations -1962 to 1974...................................................... 71 2. NURSING IN THE NHS, 1948 TO 1974......................................81 2.1 Nursing Availability, 1948-1974........................................................................... 81 2.2 Nursing Knowledge and Skills, 1948-1974........................................................100 2.3 Nursing Practice, 1948-1974............................................................................... 107 2.4 Nursing Organisation, 1948-1974...................................................................... I l l 3. ‘THE SAME OLD DIFFICULTY’ - RECRUITING AND RETAINING NURSES TO WORK IN SHEFFIELD’S GENERAL HOSPITALS, 1948-1974 117 3.1 The Nursing Workforce in Sheffield, 1948-1974..............................................118 3.2 The Availability of Nurses in Sheffield, 1948-1974..........................................121 3.3 Demand for Nursing Care, 1948-1974............................................................... 136 3.4 Managing The Availability Of Nursing Time In Sheffield, 1948-1974........ 139 3 4. THESE VERY UNCERTAIN DAYS’ - NURSE TRAINING IN SHEFFIELD, 1948 TO 1974....................................................................172 4.1 Nurse Training in Sheffield - the Sheffield School of Nursing......................173 4.2 Nurse Training in Sheffield - The Nurse Training School at the General ...180 4.3 The Gradual Amalgamation of Nurse Training in Sheffield, 1963-1974..... 185 4.4 Recruiting and Retaining Student and Pupil Nurses...................................... 187 4.5 Pre-Registration Nurse Training....................................................................... 197 4.6 Post-registration Nurse Training.......................................................................200 4.7 Training of Nursing Auxiliaries......................................................................... 207 5. ‘YOU CANNOT MECHANISE NURSING’ - NURSING WORK IN SHEFFIELD’S GENERAL HOSPITALS, 1948-1974......................... 211 5.1 The Content of Nursing Work........................................................................... 213 5.2 The Context of Nursing Work........................................................................... 218 5.3 Nursing Work and Non-nursing Work - Redefining the Boundaries......... 231 5.4 Changing Relationships with Medical Colleagues.......................................... 237 5.5 Changing Relationships with Patients...............................................................242 5.6 Nurses’ Changing Relationships With Visitors To The Hospital..................248 6. ‘WE ARE DEALING WITH PEOPLE AND NOT THINGS’ - MANAGING NURSING IN SHEFFIELD’S GENERAL HOSPITALS, 1948-1974......... 253 6.1 Nurses in the NHS Hierarchy............................................................................ 254 6.2 The Matrons.........................................................................................................270 6.3 Preparation for the role of Matron...................................................................275 6.4 Matrons and Non-Nurses................................................................................... 278 CONCLUSIONS................................................................. 290 BIBLIOGRAPHY................................................................ 307 Primary Sources.........................................................................................................307 Secondary Sources.....................................................................................................314 4 TABLE OF FIGURES 3.1 Nursing Staff in Post, The General - General Nursing Wards, 1951,1962 120 and 1970 3.2 Nursing staff in post, The Infirmary, 1951, 1962 and 1970 120 3.3 Percentage of Registered Nurses, Enrolled Nurses and Nursing Assistants 148 employed on a part-time basis at City General/Northem General Hospital, 1951,1962,1971 3.4 Percentage of Registered Nurses, Enrolled Nurses and Nursing 148 Auxiliaries employed on a part-time basis at the Infirmary, 1951, 1962, 1971 4.1 Table of prior occupations declared by students of the Royal Hospital 189 Sheffield, 1948, 1953,1958, 1963 and 1966 4.2 Numbers of students completing and not completing nurse training at 193 Royal Hospital Sheffield, 1948-1966 4.3 Reasons for non-completion of training: students from Royal Hospital 194 Sheffield Unit, 1948, 1958, and 1966 5 Abbreviations BG Board of Governors BMA British Medical Association CHSC Central Health Services Council CNO Chief Nursing Officer Fir Vale Fir Vale Infirmary The General City General Hospital [to 31 March 1967]/ Northern General Hospital [from 1 April 1967] GNC General Nursing Council for England and Wales HMC Hospital Management Committee The Infirmary Royal Infirmary, Sheffield NAC Nursing Advisory Committee NHS National Health Service NPHT Nuffield Provincial Hospitals Trust PIB National Board for Prices and Incomes PNO Principal Nursing Officer RCN Royal College of Nursing RHB Regional Hospital Board The Royal Royal Hospital, Sheffield SEAN State Enrolled Assistant Nurse SEN State Enrolled Nurse SNAC Standing Nursing Advisory Committee SNO Senior Nursing Officer SRN State Registered Nurse SSEN Senior State Enrolled Nurse USH United Sheffield Hospitals Abbreviations used in the footnotes: PRO Public Record Office SA Sheffield Archives TNA The National Archives 6 Acknowledgements Thanks are due to all those people who have helped me in preparing this thesis. Most of them I have met only through the records of the hospitals and health authorities held in the archives that I have consulted. However, in addition to those who may never know the crucial role that they have played in my work are those who are well aware. I am especially grateful to my supervisors, Dr Flurin Condrau and Dr John Woodward, whose patience and practical advice have been essential to completion of the project - and to Dr Clare Griffiths, who was on stand-by to assist if required. My family - Haytham, Munya, Alistair, Jane and Peter - and many friends, colleagues and nursing students have encouraged me to keep on working even when I have felt tempted to give up. Angela, Jan and Jane proofread my work - thank goodness! Staffs of the Sheffield Archives, Sheffield Local Studies Library and the University of Sheffield’s Special Collections and Archives have been unfailing in their guidance towards sources of information. It is customary to absolve all of the above of any responsibility for errors or omissions in what follows, and this I gladly do. 7 INTRODUCTION Despite scrutiny of the National Health Service (NHS) by historians and policy analysts since its early days, the contribution of nurses to the service and its impact on them and their work are still relatively neglected issues in the historiography. General political histories of the development of the NHS consider primarily the contribution of politicians, administrators and the