The Ward Sister

The role of the traditional Ward Sister in 70s and 80s.

The Consultant Rounds.

Transcript

SPEAKER_00 0:00

Well, I've had an awful lot of nurses um speak to me and contact me and um basically blackmail me into they say you can't continue on Nick, you cannot go on into the 90s. You have to go back. We want to hear more about the 70s and 80s, and we want to certainly hear more about the Ward Sisters, the traditional Ward Sisters as they were. So um I did touch on them during one of my episodes, um, and I'll give a more detailed um description and explanation now. Now, this is only from my recollection, I'm not saying this is definitive, but I just give you a few funny anecdotes and a bit of his history, etc., about what was the the ward sister as I knew them, medical and surgical wards in the late 70s and the 80s. Um, so when I was a student nurse and when I was a young staff nurse. Um now to put it all in context, if you're talking about that title, ward sister, ward sister charge nurse, you know they're interchangeable male, female, ward sister charge nurse. But they were mainly ward sisters, obviously. Certainly, you have to see it in the overall management management structure of nursing at that time, and at that time there was the matron, director of nursing, uh, who was over the whole hospital, then she had an assistant matron, and then you had nursing officers over the in different areas, medical, surgical, theatres, etc. And then you had the ward sister. Now, the ward sister bears no comparison, and I mean this in no derogatory way to my current colleagues. The ward sisters of the 70s and 80s bear no resemblance whatsoever to what we call now the ward CNM2, Clinical Nurse Manager 2s, Ward Managers, if you want to give them that title. And that is because well, a life has changed and the world has changed, etc. But also um managerially, the ward sister, the ward sister that I remember from the 70s and 80s was an absolute manager, as in all managerial authority, the coordination, education, supervision, and control of a ward was given to the ward sister. So she was over not only the nursing staff, she was also over the cleaning staff, she was also over the um ward maids, as we called them, like the assistants and the housekeepers and the catering staff. The medical staff also, people don't believe this, but this was a fact. The medical staff actually answered to the ward sister. The only member of the medical profession that didn't was the consultant. And I've as I've said, they were kind of pals. The consultant and the ward sister were generally very friendly on the same wavelength. She ran the ward the way he wanted it medically, and she made sure his doctors did his bidding when he wasn't there. That is the reality. So I know now it's completely separate nursing and medicine. Doctors answer to doctors, nurses answer to nurses. In those days, it was different. Um everybody answered to the ward system. Now, if you were from another ward or department, say a porter or a maintenance guy, as soon as you entered, as soon as your big toe crossed the line of what that ward, the beginning of that ward, as soon as you crossed that line, you were under her jurisdiction. There was none of this line management structure. Oh, I answer to my line manager who's back in an office in a head office or could be two miles away or something. No, no, no. If you entered her ward, you were answerable to her, and that's how it was. It was complete and absolute power. And then, and I find you know, all of us find it very difficult to comprehend that. This is before the days of any other role in nursing, senior roles in nursing. There were no clinical facilitators, there were no clinical nurse specialists, there was nobody doing anything in that ward that that ward's sister did not permit. And that's how it was. So she ruled supreme. She had an assistant, a staphness, who was like her deputy, and she ruled supreme, and nothing happened in that ward without her consent. Any um person, usually female, that was appointed as the ward sister, certainly would have at least 10 years post-registration experience. And most of them, and I think a lot of us have forgotten this now, it's kind of gone by by the way. But when I was a young staff nurse, the the traditional pathway was once you qualified, if you were female, you went and did your midwifery immediately after the state registered nurse training. So you didn't even work as a staff nurse usually, maybe for a few months, but you'd already been accepted into the midwifery training, if you know what I mean. So they tended to do SRN, State Registered Nurse, then they went off and did the SCM, State Certified Midwife. Then if they wanted to come back into general nursing, they came back into general nursing as a staff nurse in what in a ward, and then worked their way up the ranks, and then would be appointed as ward's sister. But um it was a very prestigious role, a very powerful role. Um what's the other word for it? Control is the word out that springs to my mind. They were very much control freaks. Um they controlled everything, and all authority and all decision making was um theirs. There was none of this. Let's have a committee meeting and decide whether whether we're gonna move this here, move that there, or whether that could happen in this water, what time we're gonna do that. And you know, death by committee I call it. No, she ruled supreme, and if she said this was happening at 3 pm on her ward, it happened at 3 pm. Not 3.15 or 2.45, it was 3 pm. And if you didn't like it, she'd soon get rid of you. And they had the power to get rid of nurses off that ward that weren't complying, that weren't worker bees, that weren't um able to do the work that or that she didn't like. Like HR, that's sort of a modern construct, HR. There was none of that nonsense. Um, like if she didn't like you, if you'd had an art, you know, it's something, you know, God forbid, clash and everything. If she didn't like you as a staff nurse, she'd get rid of you. She'd go to the matron, she'd ask for you to be moved, and that staff nurse would be moved off her ward to another ward. And there would be no none of this, going to tribunals and all that kind of thing. It's unheard of. In the hospital I trained in St. Catharines, they um Birkenhead, and it was the same, I think, in most um British English hospitals. The ward sisters wore a navy blue dress, they wore a starched apron, they wore that navy blue dress had long sleeves as opposed to the staff nurse pale blue dress had short sleeves because they were worker bees. The navy blue dress had long sleeves to show that she didn't need to do any clinical work, because that is the reality. And she would have her sleeves down to her wrists, and if she needed to do something clinical, and I saw this many a time, the sleeves would be rolled up, the cuffs would go on, they were in her pocket usually, frilly cuffs to secure the end of the sleeves up at the elbow above the elbow. So that was that. That was that start shaping frilly hat on her head. Um she on her navy blue dress, she'd wear her State Registered Nurse badge from the General Nursing Council for England and Wales. I had one of those for years until it was stolen. But anyway, that's another day's work. Um, from the General Nursing Council for England and Wales. And then she'd also have her hospital badge proudly displayed on her uniform so that you could see where she trained. Now, most of them had trained there in St. Catharines, but we had a few, you know, that were trained maybe in Liverpool Royal Infirmary or in Chester Royal Infirmary or from a hospital in London, maybe, something like that, maybe in Scotland. But um, and they also had these belts. The nurses, the female nurses, wore this belt. She had a navy blue belt around her waist, um, elasticated belt with this buckle. Now, the buckle was very important to a qualified nurse in England. I'm talking about this buckle, they usually bought the buckle themselves from a jewellery shop, and they're usually very, very expensive. It was usually bought for a nurse when she qualified by her family, and that's how it worked. Or it had been passed down, maybe her mother being a nurse or auntie or something like that. This buckle will be passed down, or usually then purchased in a jewellery shop. But they I remember people telling me how much they paid for them. They were very expensive and solid silver buckles. But anyway, she would have this belt around her waist and this solid silver buckle showing, etc. And what they used to do, the Ward Sisters and the staff nurses as well, if they were sitting down and relaxing, shall we say, say, in the staff room for a break or something like that, they used to, and the females would understand this more than me, they used to unhook the buckle and put the two ends of the book of the buckle, because it was a heavy buckle, two ends of the buckle in their pockets so that the belt didn't fall on the floor, if you know what I mean. And that would give them some kind of you know freedom while they're sitting down in the chair and everything, to let the belly out, etc. And while they had their lunches, etc. Um, but that was something to talk about. They had this silver booklet very, very important to the ward sisters, and they used to polish it and everything like that, and all that oh yeah. Now the ward sisters, from my memory, spent most of their time in the sisters' office. There was an office in every ward, and that was the ward sister's office. She spent most of the time in there, except when she was doing rounds or coming out to do something clinical, supervisor would come out to tell you to do something. You know, and um you would knock at the at the door and wait until she said, Come in or enter. You wouldn't just knock on the door and open the door. Oh no, no, no, no, no. That was a no-no. And if there was no answer when you knocked at the door, you went away. You didn't open the door and poke your head in like people do nowadays. Absolutely not. She would take the head off you if you if you put your head in that door. She'd take the head off you. Now, if you were a visitor from another ward, as well as I remember all this, you'd enter the ward, but the first place you would proceed to is the sister's office. And you would knock on the door, and they would say you were a student nurse and you were sent to go to ward D and borrow such and such, blah blah blah. You'd go to ward D, but no, even if you saw your colleagues and your friends ahead of you with all the patients in front of you, and they're smiling at you and hi and waving at you, your feet would not enter that ward without knocking out that sister's office and getting her permission to enter her ward. That's how it was. And if she hadn't answered the door, you would be gesturing, gesturing to people in the ward, the staff, to come to you, come outside the ward so you can speak to them. You would never enter a ward without the ward sister's permission. And if you did, you know, go get to a ward to borrow something, the usual thing she would say to you, and I find myself saying it as well. It's a bad habit, I know, but she they used to say, What do you want? It wasn't how are you, or which ward have you come from? No, what do you want? Because she knew as soon as she clapped eyes on you, you wanted something, because otherwise you wouldn't be there. And they used to get very annoyed and irritated by other wards borrowing things. Like it was an unwritten rule, and I understand this that each ward, you know, is responsible for its own patients. Now, if it was something extraordinary, say it was an emergency on another ward, that was a different matter. But but coming to borrow, you know, you know, things, drugs and things like that, that you should, you know, basic drugs or run to ward deer, ask them for some LASIK IV. They take the head off you. After why you didn't have enough LASIKs on your ward, you know. And that's another thing. The nurses or the nurses that ordered all the drugs was not such a thing as a pharmacy technician. And you certainly were the pharmacist was the person in charge of the pharmacy department. There was only one of them, maybe one or two down in the pharmacy department. They never went to the wards, and we never had any pharmacists on the wards, and we never had any pharmacists. I didn't even know what a pharmacy technician was until about five or ten years ago. There was no such thing. The nurses ordered the drugs. The nurses ordered the drugs. And the nurses dealt with the drugs, administered the drugs, stored the drugs, and put away the drugs when they were delivered. Now we're still doing we're still doing all those things except except that we're not ordering them. That's about it. We're still putting them away. That's another day's work. But anyway, no, that was it. So she would get annoyed if people came to borrow things that they should have anticipated that they needed. Um another way of looking at the water, and I thought about this before I made this um episode, was uh she I I always perceived, no, I might not have at the time because we were terrified of them, to be honest. As student nurses, we were terrified of them. But as a young staff nursing, I think to look at she perceived now. Obviously, you can't generalise, you're talking about hundreds, if not thousands, of human beings, you know. But generally the ward solicitors um perceived the nurses under her responsibility in her ward as like her children. It's very hard to to describe that to uh modern nurses, but that is how I think she perceived them. She her role was to protect them and she protected them, and my God, she protected them from like a ravenous wolf sometimes from people like the nursing officer might you know wanting to move a nurse. No, that wasn't happening while she was on duty. Um something like that. You know, she was very, very protective of them and wanted the best for the patients on her ward and the nurses on her ward. Now just touch on touch on the consultants' rounds. That was a big thing in these awards. Now, in the old nightingale wards, consultants' rounds, you see, the beds in the wards were generally under one or two consultants. That's all. There was none of this admitting multiple consultants' patients to that ward. Each ward usually only had one or maybe two at the most consultants' beds. So you knew exactly when the consultant round was going to be and what time it would be, etc. And say it was and there were scheduled, you know, scheduled, say at 11am on a Tuesday and 11am on a Friday. You knew the consultant would do a round, and it was a big thing, a big entourage going around, etc. Doctors would get very nervous coming up to these rounds because the rounds were very much, and I saw this much more. I don't think it happens over here in Ireland, but the round is very much used as an educational tool um to teach. And the consultant would the doctors knew that their management of medical management of particular patients and things they'd done during the course of the week would be scrutinized and would be open to scrutiny and would be discussed openly in these wards. And the consultant would criticize them. No, you shouldn't have done that. Yes, you should have done that. Oh, that was good, you did that. No, how stupid that was stupid. That was absolutely stupid. Do you know how stupid you are? This is how they talk to the doctors. You you do know how stupid you are, and here you are. You know, you're just looking stupid in front of the nurses, and they would humiliate them and everything. It was absolutely desperate. But um, they would get quite nervous about the uh wardrounds, um and and the doctors would be hovering around, etc. Also, the ward sisters opinion would be asked by the consultant during these rounds. What did she think? And she might say, Well, I I would have given him 60 milligrams. And what she chirp in. Now the likes of any other nurse wouldn't dream of that. But that was the leeway given to them. She was allowed to encroach into medical practice. She'd say, Oh, you should have been x-rayed earlier. Well, this should have should have been stuck a chest strain in earlier. This should have happened, that should have happened. I said I told him this, I told him that, and he wouldn't listen to me, and blah blah blah. And he would then rollock the registrar in front of us all, in front of all the other doctors, and in front of the ward sister. And this is reality, he was more or less teaching the medical staff the pecking order, and the pecking order was him number one, two, the ward's sister, three, then the senior registrar, registrar, it would go down in that order. But if she wanted something done on that ward and they they hadn't done it, there'd be all hell to play. Now the preparation that used to go into preparing the ward for these ward rounds was astronomical. Like I can remember on night duty, knowing it was the ward round the next day, there were certain things you had to do. You had to bed get the very sick patients all bed baths before the morning report. So, you know, you'd be putting on the, you know, going around starting bedbaths at 4 a.m. and things, going from bed to bed to bed, getting changing beds, sitting, you'd sit people out around six o'clock in the morning. The night, the the big lights went on at six a.m. and the medication round would start so that everything was done ready for 8 a.m. when the ward sister came on duty, and maybe the round was due at half past nine, so breakfast had to be over by half past nine, and it was a big M palava. The ward would be immaculate, pillows would all be turned away from the door. That's uh an old thing now, but that was a big thing. You could not have a pillowcase um with its opening towards the door. They all the openings always had to be away from the door to make it look neater. And the hosp the beds would all be made with nice, crisp hospital corners, etc. Now the medical rounds, consultant rounds, that could last for an hour, an hour and a half, depending on what mood he was in and what mood the Ward's sister was in. If they were in good form together and it was like watching um a comedy show sometimes like um it's like watching it was like watching a husband and wife team in action sometimes and sometimes they'd be bickering at each other and things because it was a power play there you know and he'd be getting his way and she or she'd be getting her way and everything we were all spectators to this it's absolutely hilarious sometimes but other ones were very very formal and very serious and everything and the ward would be closed to all activity was no cleaning going on there was certainly no Hoovers no Hoover no telephones would be an answer in fact I something this is a modern and I can't even remember telephones going that much in the in the late 70s early 80s yeah this anyway certainly no telephone would be answered during the rounds there were no deliveries no activity clinical or housekeeping or cleaning or outro there was no interruptions of the rounds there was complete silence during the rounds like even patients would be told off sometimes that they were making too much noise if there were one of them you know reading the newspaper or something down the ward and turning the pages and people would be looking down the ward you know see who made that noise as he turned the page of the of his newspaper and disapproving looks given towards him and they all touch. And that's that's exactly how it was we'd all stand around and God forbid you'd be asked something because the consultant would use it as a teaching thing and he'd be teaching his doctors but he would also teach the nurses and well as well some of them and some of them were very very nice and pleasant and and passed on a lot of information to us you know and it was it was brilliant some of it. But as well as that each patient go from patient to patient it would involve a full physical examination like the consultant wouldn't be doing that but he would expect his registrar SHO to to fully physically examine the patient in front of him and in front of us we round the curtains would be round the patient but he'd fully examine them asclotation and with the stethoscope on the chest and everything and then he'd be asking the doctor's question what did you hear what did you hear what you think what blah do you think this do you think that do you think the other and um the nurses would assist setting the patient forward etc this could go on as I said for an hour an hour and a half and sometimes it was absolutely exhausting for everybody concerned apart from the consultants and the and the um the ward sister but anyway at the end of these rounds believe it or not and now modern nurses wouldn't believe this the consultant and the registrar and maybe SHO and the ward sister and maybe her deputy one staff nurse you know her most senior staff nurse they'd all disappear into the sister's office and the China tea set would be cut out. Each ward sister had a china tea set in her office in a special cupboard you know that would be produced for the consultant and um how did the catering person the ward maid then would make tea and there'd be biscuits and cakes and everything and they'd be in the sister's office and this an ashtray would be produced as well if he smoked now if the consultant didn't smoke but sometimes I saw a situation where the ward sister smoked and he didn't smoke and he tolerated it like she would be smoking away and they'd be having a he and a ha ha in the office and that'd go on for an hour and an hour and a half. No well half an hour or so and then off they'd go you see it was the highlight of his of his week this consultant these ward rounds with the with the ward sister and um the only other thing he was off to do was you know outpatience and things like that. So they weren't as busy as they are nowadays you know and they weren't as overwhelmed with work. Now I'll just finish off with the ward sister to give you a few um examples of of ward sisters that I encountered and I'm going to talk about my own experience but um apart from the the one in the previous in a previous episode that you remember shouting at me Crelly have you got the pence made yes um apart from her there was multiple multiple different types and personalities and things but I remember vividly I remember this um working with the staff nurse now she told me this story from the 1960s and this just shows how things have progressed but this was the 1960s well before my time as a nurse but she trained in Liverpool Royal Infirmary in the 60s she was working as a staff nurse in St. Catharines with me then I was a student she was the staff nurse and um she told me this story of when she was a student nurse back in Liverpool Royal Infirmary in the 60s on night duty she'd worked all night on this award did a surgical ward finished her duty now in those days obviously they wore the dress and this and the starch tape and the hat and everything and stockings the females wore stockings um and I know I'm viewing on territory I'm not familiar with and anyway she told us that she finished her duty she handed all she did the nursing report she she went back to the nursing nurses home next to the hospital changed out of uniform got into bed slept asleep of exhaustion and at 11 o'clock in the morning she was woken up knocking on her door by what they called the home sister there was a like a ward sister who's in charge of the nurse's home that's another episode we'll have to talk about that home sisters but anyway woken up by the home sister urgently answered the door sister wants to see you back on the ward right something's wrong you'll have to go over to the such such a ward oh my god what's what what have I done wrong right you weren't allowed to go into the hospital with without being in uniform and she only had the one pair of stockings which were had been rinsed in the t into a tap hanging on some radiator so she had to put these wet stockings on she was telling us wet stockings on back into the uniform starched apron hat everything had to be immaculate to enter the hospital back up to the went over back up to the ward arrives in this ward the ward's sister said yes sister you want to see me yes nurse er can you tell me where eggs belong on this ward I beg your pardon sister eggs you know eggs where do eggs live on this ward in the fridge sister she said yes they do don't they nurse kindly put them there and that poor girl had to go into the kitchen she'd left the eggs out on the table in the kitchen pick the eggs up put them in the fridge closed the fridge door out back out to the nursing nurse them so that was one element of one was it now I never but that just shows their power and control and I never experienced anybody as bad as that but that's one example and the what the one oh was oh was um I remember from being a student nurse I was a third year student nurse to do an accident emergency in St. Catherine well in the Victoria Central Hospital in Wallace it actually was the accident emergency department um I remember being all excited this day there was an RTA brought in very serious head um head injury was a motorcyclist that had come off his motorbike brought in multiple injuries brought into the resuscitation room and I was helping in there and there was a staff nurse kind of running the emergency and everything they'd intubated him and various things were going on you know to try and save his life etc and in the middle of this the doors of the resource room opened in came the sister you know can't call her a ward sister she was the AE sister and um she said Catherine Catherine and Catherine at that time was drawing drugs up and whatever for this poor man who's been resuscitated Catherine who put who put the stores away this week just like this I never forget this who put the stores away this week and like completely oblivious to what was going on in the resuscitation room and she said oh I oh I don't I don't know sister I don't I don't know she said was it Beth because this is the second time I can't find the yellow bags I'll have to have words with her and she turned on her heels and walked out the resuscitation room and I just thought oh my God I can't believe that that sister the Ane sister was never even asked about the patient or was concerned about him and asked how is he doing everything. Now now after 40 years of of it I understand where she was coming from she was coming from another another place you know in her head and she'd seen that situation multiple times before but that was the first time I'd ever seen anything like that. But remember that so that's one example of of what they were like and different things. And another example I remember being a male a student nurse on this male surgical board and I was trying to catheterize um a man a patient in a in a bed well could I get the unicathetra in no I couldn't get the unicathetra in I try my best no I wasn't that experienced I was only a second year student nurse you know so I was doubting myself and doubting my abilities I'd done it a few times but I was no expert. But anyway I had to stop the procedure because I just could not get the catheter in whether you had a prosthetic problem I don't know but anyway had to stop it abandon it and then you know deglove etc take on the apron go to the sister the ward sister's office knock on the door shoes inside yeah what do you want like this vote you like you were just dirt on the shoe you know some of some of them I'm talking about yeah what do you want like you were some alien being that it intruded into her headspace you know uh sister I can't get this unique catheter in and she's looking at me incredulous you know are you the second year she said to me you the second year I said yes sister what and you can't get catheter in what anyway she hops from down the desk follows me then back to this patient washes her hands put on an apron give me that catheter lubricate that give me that catheter she said in went the catheter she got it in first time um give me the water inflated the balloon connected the thing and everything running perfectly and everything she said there now there now don't she says to me in front of the patient she says to me don't ever tell me you cannot get a catheter in again and she turned on her back and walked out again humiliating me you know in front of the patient or it was so that's the kind of um things we had to dodge and deal with and all that it was kind of like cats and dogs and all kinds of things happening but anyway they had absolute and complete authority and you have to remember as well the responsibilities they had there was no educationalists there were no facilitators there was no practice and development there were no policies and procedures there were no there was none of this there was nobody interfering in her role and nobody telling her how to run her ward god forbid you'd even think of doing that and I I can't even imagine another ward sister would even dare you know mention something that they didn't think she was doing correctly because she uh she that was her her baby you know that ward was her baby and she she ran it as as she thought fit so that is your traditional ward sister no comparison and no linkage really with the current ward managers who who are from what I can see bombarded by people telling them what they should be doing and box ticking and all this kind of nonsense that's going on and none of them able to do the job or very good at telling her how or her or him how to do the job. But anyway that's it for now that is your traditional ward sister. Hope you liked it. Bye bye