STANDING ORDERS FOR THE TERRITORIAL FORCE NURSING SERVICE 1912
Dame Sidney Browne, Matron-in-Chief, TFNS, during the Great War [image courtesy of the Royal College of Nursing]
Published under, and subject to, the conditions laid down in paragraph 1884 King’s Regulations
*Paragraphs 1 to 27 are extracted from Regulations for the Territorial Force (Appendix XX111)
1. The T.F.N.S. is formed for the purpose of maintaining an establishment of nurses willing to serve in general hospitals in the event of the mobilization of the Territorial Force.
Rolls will be kept of matrons, sisters, and nurses who are willing to serve in the hospitals to which they are allocated.
2. The establishment consists of a matron-in-chief, principal matrons, matrons, sisters and nurses.
The TFNS is required for 23 general hospitals, located as follows: 4 in London, 2 in Glasgow, and 1 at Aberdeen, Edinburgh, Newcastle-on-Tyne, Leeds, Sheffield, Manchester, Liverpool, Lincoln, Leicester, Birmingham, Oxford, Cambridge, Cardiff, Bristol, Portsmouth, Plymouth, and Brighton.
The nursing establishment for each hospital of 520 beds consists of 92 members, and no larger number will be called up for duty on the mobilization of the Territorial Force unless the number of beds be increased; but in order to ease liability for duty and to suit the special conditions of the nursing profession in civil life, the number of members borne on the roll of each hospital will be 121.
The ranks of the 121 members borne on the roll will be as follows:
Principal Matron 1
The ranks of the 92 members to be called up for duty will be as follows:
Principal matron 1
3. In order to provide for the establishment of a similar system of control in each hospital an Advisory Council is appointed.
The Advisory Council will frame rules for the admission of nurses into the nursing service, and will make such recommendations as may seem necessary for the administration of the service, and for the appointment of matrons, sisters, and nurses thereto.
Lists of appointments, promotions and resignations will be forwarded at the end of each quarter, by the secretary of the County Association of principal matron concerned, to the matron-in-chief, TFNS, War Office (80 Pall Mall, S.W.), for submission to the Advisory Council. In the case of the appointment, etc., of principal matrons and matrons, the lists will be forwarded to the war Office through the general officer commanding-in-chief concerned.
When the lists have been confirmed by the Advisory Council, and approved by the Army Council, the matron-in-cief will forward the enrolment parchments, copies of badge directions, Standing Orders, and uniform instructions to the principal matron for distribution, to the new members.
No appointments, etc., below the rank of matron will appear in the London Gazette.
The roll of sisters and nurses for each hospital will, after revision by the Local Committee (see paragraph 4), be forwarded each year to the Advisory Council, who will have the power of removing from the roll, after full inquiry, the name of any member who may prove to be unsatisfactory.
4. A Local Committee is formed at each hospital centre, by the County Association administering the unit, to receive the names of nurses wishing to join the Service. The Committees should consist of ladies nominated by the County Association administering the unit. Neighbouring County Associations which desire to be represented may also nominate ladies as members, with the concurrence of the Association forming the Committee. The principal matron, and the matrons and superintendents of the principal hospitals and larger nursing institutions in the areas of the County Associations represented on the Committee, should be included, and any other ladies interested in nursing and likely to be in touch with suitable nurses. Representatives living at a distance need not necessarily attend the committee meetings unless they wish to do so, and their travelling expenses will not be paid from public funds, but they will be able to see the nurses living in their neighbourhood and to forward their names to the principal matron. The main duties of a committee are to enrol the sisters and nurses who are willing to serve in time of imminent national danger, to revise the roll annually, to submit the names of the matrons whom they recommend for appointment to the Territorial Force hospitals, and to serve as a nursing committee on the mobilization of the Territorial Force.
In nominating candidates for the appointment of matron, and in recommending sisters and nurses, Local Committees will be guided by the instructions laid down in paragraph 7.
5. The matron-in-chief will be required to make herself acquainted with the organization of the service, and to exercise general superintendence in time of peace. She will perform such other duties as may from time to time be determined by the Army Council, and will be a member of the Advisory Council. She will keep the service records and confidential reports of the principal matrons, matrons, sisters, and nurses. She will submit to the Advisory Council recommendations for the appointment, distribution, retirement, and dismissal of members of the TFNS which have been forwarded by principal matrons, and will take action in connection with such measures as are approved.
In the event of the mobilization of the Territorial Force, the matron-in-chief under the direction of the D.G., A.M.S., will perform such duties as may be allotted to her, including general superintendence, inspection and co-ordination of the nursing service in the general hospitals of the Territorial Force, and will receive pay and allowances as laid down in para. 21.
6. Principal matrons may be called upon by County Associations administering general hospitals for advice on nursing matters, and for this purpose may be appointed co-opted members or be invited to attend meetings of the Associations at which these matters are under discussion.
They will receive the applications of matrons, sisters and nurses wishing to join the nursing service, and will obtain the necessary references, submitting them, after approval by Local Committees, to the advisory Council at the beginning of each quarter. They will also forward recommendations for transfers, resignations, and dismissals.
They will keep the roll and the addresses of members up to date, and obtain references as to the continued suitability of candidates. On the 1st April each year they will forward a copy of the roll to the Advisory Council.
They will forward a statement of their accounts every quarter to the matron-in-chief.
They will endeavour to prevent the uniform of the nursing service being worn without permission.
They will be called up for duty on the mobilization of the Territorial Force, but will only be required to give such time as they can spare from their civil duties, and will not be asked to leave their own hospitals.
They will be required to inspect the nursing arrangements of the Territorial Force general hospitals from time to time, give advice on any nursing difficulties that may arise, and enrol such additional nurses as may be required.
They will forward during mobilization confidential reports upon the matrons serving under them to the War Office through the usual channels. These reports will be forwarded at the termination of the matron’s service in connection with the hospital, or annually if the period of mobilization be prolonged.
CONDITIONS OF APPOINTMENT
7. A candidate for appointment as a matron must have held a responsible post in a civil hospital either as matron, assistant matron, or sister, and must be willing to be called up periodically in accordance with paragraph 25.
A candidate for enrolment as sister or nurse must have had 3 years’ training in a recognized hospital or infirmary, and in the case of a candidate employed in hospital, the consent of her matron must be obtained. A sister or nurse must not be under 23 years at date of enrolment.
A candidate whether for appointment as matron or for enrolment as sister or nurse, will be required to fill in the form of application supplied to the Local Committees by the Advisory Council, and also, if her services are accepted, to sign a declaration of willingness, in the event of the mobilization of the Territorial Force, to serve if called on in the hospital to which she has been allocated. She will also be required, on the 1st January in each year, to return the parchment enrolment certificate to the principal matron of the hospital to which she is allocated, notifying on it her address, rank, and present position, etc., according to the instructions on the certificate; the principal matron will initial it and return it to the member if her suitability has been certified.
8. Sisters and nurses, when on duty in a Territorial Force hospital, will be required to conform to the ordinary discipline of a civil hospital and to such military rules as may be necessary. (See Appendix D). The nursing establishment will be under the control of the matron, who will arrange the duties and work of each member.
9. A principal matron or matron will be required to retire at the age of 60, or earlier if she relinquishes her civil appointment.
A sister or nurse will be required to retire at the age of 55, or earlier should she have given up nursing for two years, but, subject to the age for retirement, will be eligible for re-admission if she again takes up nursing work.
10. The purchase and wearing of uniform is optional in time of peace, and it may only be worn when members are officially present at any special function as members of the Territorial Force by permission of the matron-in-chief, acting through the principal matrons.
No allowance in aid of provision will be made from Army funds in time of peace.
The uniform must be of exact TFNS pattern and of correct material, and must be worn according to the regulations, with the exception of the cloak, which is optional in time of peace.
11. Dress. – Blue-grey material, braided and faced with scarlet.
12. Dress. – Blue-grey material the same colour as the cape, with two rows of braiding on the sleeves. Cloak. – Blue-grey material lined with scarlet and braided. Scarlet collar with silver ‘T’ at each corner.
13. Dress. – Blue-grey material the same colour as the cape, with one row of braiding on the sleeves.
Cloak. – Blue-grey material lined with scarlet, with three bars of braid across the front, and scarlet collar with silver ‘T’ at each corner.
14. Dress. – Blue-grey washing material the same colour as the cape, with a band of the same material edged with scarlet, worn on the right sleeve six inches above the wrist, to wear on duty in the hospital. Warm dresses to match the cloaks are also authorized for wearing out of doors.
Cloak. – Blue-grey material with band of scarlet on collar and silver ‘T’ at each corner.
Apron. – White linen, with white belt fastened with white studs. (N.B. – Not to be worn with outdoor uniform.)
15. Dress. – Blue-grey washing material the same colour as the cape, to wear on duty in the hospital. Warm dresses to match the cloaks are also authorized for wearing out of doors.
Cloak. – Blue-grey material with scarlet corner to collar and silver ‘T’ at each corner.
Apron. – White linen, with white belt fastened with white studs. (N.B. – Not to be worn with outdoor uniform.)
16. Cape. – Blue-grey with scarlet facings with silver ‘T’ at each corner.
Bonnet. – Blue-grey straw, with blue-grey velvet bow and ribbon strings.
Collars and Cuffs. – White linen.
Cap. – A square of white muslin.
Gloves. – Grey.
Silver badge. – Of the service
17. – Mess dress. – A mess dress of the same colour as the working dress, but made of different material, may be worn by all ranks. Aprons are not worn with this dress. The purchase of it is optional, and it is not required on active service. Particulars of this dress can be obtained from the matron-in-chief. Blue-grey waterproof cloaks are also authorized.
Warm coats and hats of the regulation pattern can also be worn on active service abroad.
18. The silver badge of the service must be worn on the right side of the cape, dress or apron, and is always to be worn when in nursing uniform wit the permission of the authorities of the hospital or institution to which the member belongs. The badge is the property of the State, and must be returned by the member to the principal matron when the member leaves the service.
Non-Military Badges and Medals
19. No badges or medals, except military ones, are to be worn when in the uniform of the service, except those laid down in para. 1755 King’s Regulations.
REPLACEMENT OF LOST BADGES
20. Application for the replacement of a lost badge should be addressed to the Secretary, War Office, giving full particulars of how it was lost, and what steps have been taken for its recovery. A certificate from the principal matron that the applicant is a member of the TFNS should be forwarded with the application. The charge for replacement is one shilling and ninepence, which amount should accompany the application.
[There are two amendment slips in the document, as follows:
Price of badge increased to 2/9d.
Board and washing allowances increased to 19/- a week at home and 25/- abroad.
Members below the rank of Matron, signing for service abroad, receive £20 a year in addition to the pay noted above to commence from the beginning of the second year.
Matrons and acting matrons who sign an agreement to serve for so long as required during the present emergency may be eligible to receive the additional pay of £20 per annum after 12 months continuous service.
These amendments have not been dated, but are likely to be after 1916.]
PAY AND ALLOWANCES ON MOBILIZATION
21. The following will be on the scale of pay and allowances on mobilization:-
[Pay scales during the Great War were identical to QAIMNS]
In addition to the above, servant allowance will be issuable when the necessary establishment of servants is not provided.
22. Charge pay will be granted on the undermentioned scale to a matron or sister in charge of the nursing arrangements in a hospital where the number of equipped beds, as certified by the deputy director of medical services, amounts to -
100 to 199 beds £15 per annum
200 to 299 beds £25 per annum
300 beds and over £30 per annum
23. A member of the TFNS employed in a Territorial Force military hospital on mobilization will also on the cessation of her employment from causes beyond her own control, receive a gratuity, provided that she is certified by the assistant director of medical services and matron under whom she has served to have rendered satisfactory service for more than one month, exclusive of sick leave. If her employment has extended beyond one year, she will be granted under the same conditions and at the same rates a further gratuity for every complete year of further service, broken periods to be calculated accordingly. If she has relinquished her employment for reasons not satisfactory to the Army Council, she will forfeit her title to a gratuity.
The following will be the rates of gratuities:
Matron, £15 Sisters, £10 Nurses, £7. 10s.
24. When called up for service on mobilization, and on the termination of such service, members will be entitled to their travelling expenses between their place of residence and the hospital.
25. Principal matrons and matrons will be liable to be called up for training in a military hospital for 7 days, periodically. The number so trained will not exceed 23 per annum.
General officers commanding-in-chief will submit to the War Office, annually, not later than 1st May, the names and units of principal matrons and matrons whom they have selected for training in communication with County Associations concerned, stating the military hospitals at which it is proposed the training should be carried out, and the dates.
As the numbers which may be trained annually permit of one principal matron or matron attending from each general hospital, the names should be selected in rotation so as to give facilities to all principal matrons or matrons to undergo training every third year.
The training will take place in selected military hospitals, notified from time to time from the War Office,* and will be carried out in accordance with Appendix A.
*The hospitals at present selected are:-
The Cambridge Hospital, Aldershot; The Connaught Hospital, Aldershot; The Royal Herbert Hospital, Woolwich; Military Hospital, Colchester; The Queen Alexandra Military Hospital, Grosvenor Road, S.W. (limited to not more than eight principal matrons or matrons annually); The Royal Victoria Hospital, Netley; Military Hospital, Devonport; The Alexandra Hospital, Cosham; and Military Hospital, Shorncliffe.
EMOLUMENTS OF PRINCIPAL MATRONS AND MATRONS DURING TRAINING
26. Matrons called up for training during peace will, except as provided in paragraph 10, receive army pay and allowances at minimum rates, and will travel at the public expense. Principal matrons will receive the pay and allowances of matrons.
27. Each principal matron and matron is furnished with a copy of ‘RAMC Training,’ and ‘Standing Orders, T.F.N.S.’ In the event of a matron becoming non-effective, these books should be returned to the administrator of the general hospital to which she belongs, for the purpose of being re-issued to her successor.
An issue is also made of one copy of ‘Regulations for the Army Medical Service,’ and ‘Standing Orders for the R.A.M.C.’ to each of the hospitals shown in footnote to para. 25, for the use of principal matrons and matrons undergoing their periodical training at these hospitals.
SYLLABUS OF INSTRUCTION FOR PRINCIPAL MATRONS AND MATRONS, TERRITORIAL FORCE NURSING SERVICE
SEVEN DAY COURSE
(Beginning in June and extending till October)
The relative rank of the officers, warrant officers, N.C.O.s and men of the Imperial Forces, and their respective positions and duties in a military hospital.
The regulations applying to military hospitals respecting the discharge of the Matron’s duties and those of her nursing establishment.
The distribution of the personnel
The monthly return of A.F. 340
The method of conducting official correspondence and keeping accounts.
Sanitation, ventilation, and warming of premises.
Routine procedure in connection with the nursing of infectious cases.
SUMMARY OF SISTER’S DUTIES
The responsibility and care of equipment. Regulations concerning exchanges, accidentals, repairs, etc. The different departments from which various articles are supplied.
The various ward emergency and store cupboards, and their contents.
The safe custody of valuables.
The use of the various Army Forms and Books supplied for ward use.
The Treatment Book.
Various notices and lists rendered.
The arrangement of patients’ meals.
The correct ordering of diets and extras and their distribution.
The arrangement of off-duty time-tables for the nursing establishment.
The day and night reports.
OUTLINE OF NURSES AND ORDERLIES’ DUTIES
Times on duty; distribution of work; the care of the patients; how extras, linen and medical stores are drawn; how exchanges ar effected; accidental certificates; the method of taking over ward equipment, bed-linen, and medical and surgical appliances; the various books.
DOCUMENTS AND REPORTS REQUIRED FROM A MATRON
Church list; patients’ requisitions; visitors’ passes; orderlies’ half-days and days and nights off.
Distribution of patients and nursing establishment; pay sheets; engineers’ and barrack repairs; exchanges; equipment inspection; inspection of beds, bed-linen, and crockery; the sweep.
Reports on orderlies’ work; A.B. 300 to be filled in; barrack inspection.
Confidential reports on nursing establishment; A.B. 300 to be completed; official report on the year’s work in the hospital; annual arrangement of leave for nursing and domestic establishment; arrangement of furloughs for N.C.O.s and men of the Nursing Section.
MATRON’S DUTIES IN CONNECTION WITH THE NURSES’ HOME.
The supervision of the Home and its domestic economy; the equipment, housekeeping, and upkeep of Home; care and management of the nursing and domestic establishment; the official method of dealing with the establishment when sick; arrangement of their respective duties and times off; the regulations with regard to pay, warrants, travelling, and other claims, arrival and departure reports.
THE VARIOUS OFFICIAL RETURNS
Beds, sick nursing establishment, sick officers.
List of orderlies on duty.
List of those dangerously ill.
List of soiled linen.
Day and night reports.
PATTERN AND MATERIAL OF UNIFORM
The following instructions are published for guidance in connection with the purchase and provision of uniform:
Cape 4s. 10d
Cap 1s. 3d
One pair silver-plated ‘T’s’ 0s. 4d
Postage and packing and fixing ‘T’s’ 0s. 6d
Total 6s. 11d
The rest of the uniform can also be obtained at the following prices:
Dress material (serge), for principal matrons and matrons. Price 3s. 11d. per yard. Width 50 ins.
Dress material (washing) for sisters and nurses. Price 8½d per yard. Width 28 ins.
Dress material (warm). Price 3/11 per yard. Width 54 ins.
(Patterns of the dress material can be obtained from the firm supplying the uniform if members prefer to purchase it elsewhere.)
Aprons 2s. 9d. each
Belts 11d each
Bonnets 9s. 11d each (trimmed)
Principal matrons 1. 18s. 10d.
Matrons 1. 17s. 10d.
Sisters and nurses 19s. 10d.
Waterproof 1. 5s. 0d
Collars 6d. each
Cuffs 6½d per pair
Gloves 2s. 6d or 3s. per pair
II. The Sisters’ and Nurses’ dresses must be made according to the following directions:
The skirts must not be gored but gathered into the waistbelt at the back, and the material must be cut on the straight.
The skirt must clear the ground by 2 inches and have two tucks at the bottom.
Bodices must be quite plain, with coat sleeves buttoned to the elbow, and with belts of the same material as the dresses, to be worn without buckles. Sisters to have band of same material, edged with scarlet, on the right sleeve, six inches above the wrist.
Collars and cuffs to be fastened with white studs, and to be worn outside by sisters and nurses.
Directions for making warm outdoor dresses for sisters and nurses:
Skirt – quite plain
Bodice – plain, no buttons, with pleat down the front, to be worn with a band of the same material.
When ordering the cloaks and capes members must give the following measurements:
Neck. Bust. Bust and arms together. Height.
Note. – The establishments selected to supply the above will be intimated by the Matron-in-Chief, T.F.N.S., War Office (80 Pall Mall, S.W.)
ACTIVE SERVICE EQUIPMENT
The following articles are to be provided by all members when proceeding on active service abroad. Uniform only is to be taken; no plain clothes are required. An allowance of £8. 5s. for active service equipment, and £7. 10s. for camp kit will be given to each member.
1 Trunk not to exceed 30 x 24 x 12 inches
1 Cushion with washing covers.
1 Pair gum boots
1 Small candle lantern
1 Small oil-stove and kettle
1 Looking glass
1 Roll-up, containing knife, fork, dessert-spoon, and teaspoon
1 Cup and saucer
1 Tea-pot or infuser
1 Securem tent strap
2 Pairs scissors
2 Pairs forceps
2 Clinical thermometers
1 Portable camp bedstead
1 Bag for ditto
1 Waterproof sheet, 7ft. by 4ft. 6in.
1 Tripod washstand with proofed basin, bag, and bath
1 Folding chair
1 Waterproof bucket
1 Valise or kit bag to hold the above-mentioned articles with owner’s name painted upon it.
Nurses are requested to note that no furniture is provided for their individual use on active service in the field; it is therefore imperative that they provide themselves with the above camp kit.
INSTRUCTIONS FOR MEMBERS OF THE TERRITORIAL FORCE NURSING SERVICE
1. As regards medical and sanitary matters and work in connection with the sick, the matrons, sisters, and nurses are to be regarded as having authority in and about territorial military hospitals next after the officers of the R.A.M.C., and are at all times to be obeyed accordingly, and to receive the respect due to their position.
2. The matron will be responsible for the general nursing arrangements of the hospital, for the due performance of their duties by the sisters and nurses, and for the maintenance of good conduct, efficiency, and discipline amongst all members of the nursing establishment, as well as for the cleanliness and good order of the wards under their charge. She will not be responsible for nursing in wards which are set apart by the administrator of the hospital for cases which he may consider unsuitable for female nursing.
3. She will be responsible to the administrator for demanding sufficient supply, and for the good condition and cleanliness of the bedding and linen in the nurses’ quarters and the wards under her nursing charge.
4. She will take over from the quartermaster or steward the equipment shown on the ward inventories in wards nursed by the T.F.N.S., and will be responsible for the same to the quartermaster.
5. She will take over from the steward the regulated quantity of bedding for each ward nursed by the T.F.N.S., and will keep a bedding book (A.B.54), in which all bedding drawn from or returned to the store will be accounted for. All transactions must be entered and signed in this book as they occur, and she will be responsible for the balance of bedding shown therein.
6. She will frequently inspect the equipment and bedding to ascertain whether any damage has been done thereto, and will check them with the inventories periodically.
7. She will see that all orders and instructions of the medical officers treating the cases are duly carried out by the sisters and nurses.
8. She will detail a sister or nurse to prepare instruments and dressings at operations, and to assist at all operations in sisters’ wards.
9. In all instances she will apply to the administrator, who will render her every assistance in the performance of her responsible duties.
10. When she is informed of any neglect of duty or impropriety of conduct, whether on the part of sisters, nurses, N.C.O.s or men of the R.A.M.C., patients, or visitors, she will at once report it to the administrator.
11. She will fix the hours of duty, meals, and recreation for sisters and nurses, subject to instructions from the matron-in-chief, in such a manner as will comply with garrison standing orders.
12. She will see that proper medical and nursing attendance is provided without delay for sick members of the nursing establishment.
13. She will keep the books and accounts connected with the nursing establishment; and a monthly record of the messing will be kept, together with a statement of the cost, vouched by bills of expenditure; the special allowances drawn by the nursing establishment under the Regulations for the Territorial Force (see paragraph 21, Standing Orders for the T.F.N.S.) being entered in liquidation thereof. The register is intended as a permanent record, and will be vouched by the signature of the matron, and inspected periodically by the matron-in-chief.
14. Should the period of mobilization be prolonged, she will make arrangements for the annual leave of sisters and nurses, reporting thereon through the administrator to the matron-in-chief.
She will forward a confidential report upon all sisters and nurses serving under her. These reports will be forwarded through the principal matron and the administrator to the War Office, and will be made when a sister or nurse is transferred from one hospital to another (except for temporary duty), and on the termination of her services, or annually if the period of mobilization be prolonged.
*These paragraphs also apply to nurses
15. Every sister in a territorial military hospital will be under the immediate supervision of the matron, and directly responsible to her in all matters relating to conduct and discipline. She will receive and carry out such orders and instructions relative to the treatment of the sick as she may receive from the officer in charge of her wards, whom she will accompany in his visits. She will be responsible for the nursing of the patients in her wards, and for the cleanliness, ventilation, lighting, warming, as well as good order of her wards and annexes.
16. *Before going off duty each sister is required to put in writing in the night memorandum-book any notes on special cases, or other important matters which may be necessary for the guidance of the night-nurses and orderlies, or which it may be desirable to bring to the notice of the night-sister. The night-sister will see that these instructions are carefully carried out, and will record the hours of her visit to each ward, noting in the night memorandum-book any information she may wish to bring to notice.
17. Sisters will be detailed in rotation for duty as night-sister for a period of not less than two or three months, as the matron may decide. When only one sister or nurse is on night-duty, she may be detailed for one month. A night-sister will report herself to the matron to receive instructions; she will visit the wards frequently through the night, and, on coming off duty, she will report to the matron on the condition of the patients.
18. A sister must comply with the instructions of the matron and officers. She must daily report to the matron as to the condition of her wards, or of the various departments of which she is in charge. She must be careful to mention any irregularities which may have occurred, or other matters to which her attention should be directed.
19. Any neglect of duty, or impropriety of conduct, whether on the part of nurses, N.C.O.s, orderlies, patients, or visitors, will be reported by her to the matron. In cases of emergency she will apply for the assistance of the officer or N.C.O. on duty.
20. When in doubt or difficulty in any matter she will at once inform the matron, who will, if necessary, bring it to the notice of the administrator or, in his absence, to the officer on duty.
21. *A sister is not, at any time, to go to wards in which she is not working, except on special business; she is not to remain in her own wards, or visit in any other wards, when off duty.
22. *A sister may not allow nurses or orderlies to visit in her wards, except on business, or by special leave of the matron.
23. *She is to adhere punctually to her time-tables, and to be most particular in returning to her wards at the exact time specified.
24. The sister is personally responsible for the correct measurement of all drugs employed for hypodermic injections, sleeping draughts, and strong poisons.
25. She will ensure that all poisons and external applications are kept in their appointed place, and that the special poison-cupboard is kept carefully locked, and the key removed.
26. She will keep the keys of such store-closets and lock-up places in the wards as may be required for the carrying out of these duties.
27. She will herself take part in the nursing of all patients seriously ill.
28. A sister must always be present (unless, in special circumstances, her presence is not required) when an anaesthetic is administered. Should the sister be off duty, and no other sister be readily available, the nurse in charge of the patient must give immediate notice to the matron, that the necessary assistance may be supplied.
29. The sister must give the matron the earliest possible information of any serious cases or operations connected with her wards, or of any other matters of importance affecting the welfare of the patients under her care.
30. If a sister deems a special nurse or orderly necessary, she must immediately report the fact to the matron. At night the night-sister will act for the matron, mentioning full particulars in the report.
31. She will take over from the matron the regulated quantity of bedding for her wards, and the equipment shown on the ward inventories, and will be responsible for the same to the matron.
32. A sister must take care that there is no waste of provisions, coals, gas, water, or other articles. Hospital forms must not be used for notes, etc. She must exercise the strictest economy compatible with the adequate supply of the patients’ needs, in the use of mackintosh, bandages, tow, lint, cotton-wool, and all surgical dressings.
33. A sister is responsible for the linen allotted to her ward, and for its good condition.
34. *In cases of fresh admissions into her ward she will ascertain when the patients last had food, and see that they are not kept waiting for suitable nourishment.
35. She will cause to be drawn from the steward the personal equipment required for each patient on admission, and will be responsible that it is returned into store on the patient’s discharge or death. A list of these articles is given in Standing Orders for R.A.M.C.
36. When a patient is able, she will obtain his signature on the counterfoil on A.B.42, as an acknowledgment of having received these articles, but when he is so ill as to be unable to look after his equipment, she will cause the ward-orderly to endorse the book.
37. When a patient is too ill to look after his regimental clothing, the sister will cause the articles to be handed into the pack-store with the clothing, and will countersign the cheque from A.B.182.
38. When any case of illness or accident is brought to hospital or in the event of any accident, emergent illness, or attempted suicide resulting in personal injury, occurring in the hospital, she will cause a medical officer to be at once informed, and, pending his arrival, will take such steps within the limits of her training as may appear to her to be necessary to meet the requirements of the case.
39. She will be responsible that patients who have been allowed up throughout the day are in bed by 8 p.m. in winter and 9 p.m. in summer.
40. She will see that the discharged men leave her wards in sufficient time to be present at their parade.
41. She will visit her wards at meal times and see that the diets are properly distributed and served, and that the patients conduct themselves in an orderly manner. She will communicate any irregularity to the officer on duty.
42. The sister will daily receive from the steward the wines, spirits, or malt liquor ordered for the patients in her wards, and be responsible for their correct distribution, in accordance with the orders of the officers.
43. When the daily diets and extra have been entered on the diet sheets by the officer, she will complete and sign the Diet and Extra Sheet Summary (A.F.734). She will then check and countersign these forms and transmit them to the steward.
44. She will immediately report to the quartermaster all damages or deficiencies, as well as breakages of crockery or table glass, or any damage to library books.
45. She will submit all applications from patients for writing materials, tobacco, etc., to the officer in charge of the ward for approval, and will arrange for such indents and for letters to be sent to the administrator of the hospital for disposal. Requisitions will be made on A.B.38.
46. She will be careful that money, articles of food or drink, books, tracts, pictures, or articles of equipment are not introduced into the wards without the previous sanction of the administrator.
47. Sisters and orderlies should unite in showing special sympathy and kindness to the friends of those patients who are on the ‘dangerous list.’
48. Sisters are earnestly requested to interest themselves in the home circumstances of men being invalided as permanently unfit, and make such representations as may be necessary to the matron for the information of the administrator.
49. When a death takes place the sister in charge of the ward will see that the body is reverently prepared for the mortuary, and will then inform the senior N.C.O., who will proceed in accordance with Standing Orders, R.A.M.C.
50. *A sister is not permitted to accept presents of any kind from any patient, or friend of any patient, whether during his illness or after his death, recovery, or departure.
51. A sister is prohibited from utilizing the services of nursing orderlies for any but nursing and routine ward work. She will, by every means in her power, afford the orderlies ample opportunity for learning their duties, and endeavour to awaken their interest in all that pertains to nursing.
52. The sister is held responsible for reporting to the matron if any of the nurses serving under her are not well, and if they appear to need medical or surgical attention.
53. Uniform is to be worn on all occasions, both indoors and out of doors, except when on leave out of garrison, or by special permission of the matron.
54. *Sisters are not to visit each other after 10.30 p.m., but must retire to their rooms by that hour, unless special permission for late leave has been obtained. Their bedrooms are to be neat and orderly, and all lights are to be extinguished therein by 11 p.m., unless special permission be given.
55. *A sister is not to absent herself from meals without permission. Except at the recognized ‘off-duty’ times she will not absent herself from the hospital or quarters without permission.
56. A nurse will obey the orders which she receives from the matron or sisters, and in the absence of a sister from a ward, the senior nurse present will be held responsible for the performance of the duties ordinarily performed by a sister.
57. When in doubt or difficulty nurses will refer to the sister in charge of their ward, and will abide by her decision.
SISTERS’ TIME TABLE
7 a.m. Called
7. 30 a.m. Prayers
7. 35 a.m. Breakfast
8. 15 a.m. Wards
1. 30 p.m. Lunch
2 p.m. Wards
4 or 5 p.m. Tea
5 p.m. Wards
8 p.m. Dinner
10. 30 p.m. Bedrooms
11 p.m. Light out
Three hours every day, from 2 to 5, or 5 to 8
Half-day every week, from 2 to 10 p.m.
Saturdays from 2 p.m. to Sunday 10 p.m., once a month.
Sisters on night duty
Hours from 8 p.m. to 7a.m.
Two nights off every month
STAFF NURSES’ TIME TABLE
6 a.m. Called
6. 30 a.m. Prayers
6. 35 a.m. Breakfast
7 a.m. Wards
9 a.m. Light lunch and dress
9. 30 a.m. Wards
12. 30 p.m. Lunch
1 p.m. Wards
4 or 5 p.m. Tea
4. 30 or 5. 30 p.m. Wards
8 p.m. Dinner
10. 30 p.m. Bedrooms
11 p.m. Lights out
Three hours every day, from
9. 30 to 12. 30 or
2 to 5
5 to 8
Half a day every week from 2 to 10
A whole day every month from 6 p.m. previous day to 10 p.m. following day.
Staff nurses on night duty
Hours from 8 p.m. to 7 a.m.
A night off once a month
Two months consecutive duty
Time tables for orderlies (Nursing Section and General Duty Section) are in R.A.M.C. Standing Orders.
ADDITIONS TO STANDING ORDERS, 1917
In the autumn of 1917 Miss McCarthy, as Matron-in-Chief in France and Flanders, found it necessary to amend the Standing Orders for Queen Alexandra's Imperial Miltiary Nursing Service. While the existing orders were suitable for the regular peacetime QAIMNS, the enormous expansion of the nursing staff, particularly the untrained members of Voluntary Aid Detachments led to situations previously unknown to the sedate and genteel pre-war Service. Particular importance is placed on sick and convalescent nurses and the problems of social interaction and discipline.
26 September 1917
[Army Medical Services Museum, RAMC 728/2/14 (1) ]
In addition to the Standing Orders of the Q.A.I.M.N.S., of which I enclose some copies, will you please note the following regulations:-
A.1 The Matron must keep a register of her unit with:
a. The name in full of each Sister
b. The Training School; date of joining Army Service, and date of arrival in France
c. Particulars of the duties they have done.
d. Their efficiency and capabilities
A.2 On the transfer of a nurse to a new unit, the Matron should forward to the Matron-in-Chief, B.E.F., a report on her work and efficiency, with the dates of joining and departure. A report should also be forwarded on all Nurses who have completed 3 months’ service with the unit, this being submitted on report form ‘A’.
A.3 The Command Paymaster, Base, and the Officer in Charge, Post Office, must be at once notified of any arrival or departure from a unit.
B.1 Sisters in charge of Divisions will report at the Matron’s office at a fixed time daily, bringing in writing:-
a. List of operations for the day.
b. List of off-duty times for Staff Nurses and orderlies.
B.2 At a fixed time daily Sisters on duty will bring a brief written report on recent operation cases; also the progress of the patients on the ‘Seriously’ or ‘Dangerously’ ill lists must be reported on.
B.3 In the Night Sister’s report all patients on the ‘Seriously’ or ‘Dangerously’ ill lists must be reported on.
C.1 Matrons in charge of units where Sick Sisters are nursed should immediately notify the Matron of her Unit when a Sister is to be discharged hospital or transferred to England, and the information should without delay be transmitted to the Command Paymaster, Base. Now that so many patients are admitted belonging to other branches of women workers the Heads thereof should be notified at once, and they should be kept informed of progress, discharge, etc.
C.2 Any member of the Nursing Service unfit through ill-health is to be sent to the hospitals where accommodation is provided for Sick Sisters, and is not to remain sick in quarters for more than 24 hours.
C.3 Sick Sisters from Dieppe should be transferred to No.3 or No.16 (?) General Hospital, Le Tréport, according to the case, from Calais to No.14 General or No.14 Stationary Hospital.
C.4 Names of members of the Nursing Staff dangerously ill must be telegraphed to the Matron-in-Chief, B.E.F., and in every case relatives must be informed.
C.5 Any member of the Nursing Service who is in need of a rest can be accommodated at one or other of the following Convalescent Homes:-
Hardelot (Lady Gifford) – (Also takes B.R.C.S. and V.A.D.’s). Applications should be made to the A/Principal Matron u/c D.D.M.S., Boulogne.
Le Touquet Merry Lodge. Applications should be made to the A/Principal Matron, u/c D.D.M.S., Etaples.
Etretat Villa Orphée. Applications should be made to the A/Principal Matron, u/c D.D.M.S., Havre.
All Officers of the Women’s Army Auxiliary Corps will be admitted to Convalescent Homes for the Nursing Staff. The rank and file of the W.A.A.C. will be admitted to Convalescent Homes opened for them. (At present only W.A.A.C. Home running is in Etretat).
E. The Matron should make certain that all her staff have been inoculated, and should notify the Matron-in-Chief, B.E.F., if any member joining her unit has not been done.
F. All matters of importance in connection with the Nursing Staff must be reported to the Matron-in-Chief, B.E.F.
All official applications from the Nursing Staff must be passed through the Matron of the Hospital to the C.O.
G. In the case of a patient put on the ‘Dangerously Ill’ list, the Sister in charge of the Division will cause the Officer Commanding and the Matron to be informed. She will report whether the patients has been seen by the Chaplain of the denomination to which he belongs. The Matron should also write to his nearest relative, and, should the patient die, should write again, giving all the details available; an official record of this should be kept in the Matron’s Office: any personal belongings of the patients should then be immediately handed over to the Quartermaster.
H. Special attention should be paid to the Mortuary.
I. Sisters in Charge of Wards should by every means in their power endeavour to train Military probationers and V.A.D’s in their duties, and they should submit to the Matron the names of those Probationers and V.A.D’s whom they consider capable of doing charge duty under a sister.
J. Regulations governing on and off-duty times must be strictly adhered to, and no member of the Nursing Staff, whether on or off duty must visit stores, kitchens, offices, etc. Should any deficiency or irregularity occur which needs attention, she should report it immediately to the Matron.
K. At all times on Active Service regulation uniform only must be worn, and Matrons will be held responsible that all uniform is in good condition and worn according to the season. Winter uniform should be worn from October 1st to April 1st.
L. No member of the Nursing Service must absent herself from meals without the permission of the Matron, and all should return to their wards five minutes before the time specified, so that the hours of meals can be strictly adhered to.
M. Whilst on Active Service, in order not to create an unfavourable impression, or give any opportunity for adverse criticism, it is not desirable for members of the Nursing Staff to go to public places of amusement without permission. Neither is it permissible for them to accept invitations to dine or go out driving, etc., with officers, either patients or friends.
R. Lest there should be any doubt on the matter it must be understood:-
a. That members of the Nursing Staff are not permitted to visit other areas.
b. That they are not permitted to visit Officers’ Messes.
c. That Dances are not permitted and are against the regulations
S. It must be thoroughly understood in all units that great pressure of work will forcibly demand longer hours of service, and will necessitate at times the foregoing of ‘off-duty’ hours for some period.
T. It should be understood that any member of the Nursing Staff who is in any difficulty or doubt whatever should be given an opportunity of seeing the Matron.
(signed) E. M. McCarthy, Matron-in-Chief, British Expeditionary Force
H.Q., L. of C.