Since you may not feel that your force is large enough to warrant (at least at first) a full-time physician and nurse, we suggest a grouping of small plants so that with a relatively small expense adequate skilled service can be secured. Later on as individual plants become more systematized in this work, it may be desirable to develop a central bureau for examination and employment. In this way much work could be accomplished regarding the turnover of labor and temporary transfers, and a standard of medical supervision developed which would greatly increase individual plant efficiency. THE WORK AND SERVICE OF THE FACTORY NURSE IN MANUFACTURING PLANTS BY NATHALIE C. RUDD.1 While any manufacturer who has established in his plant a welfare service or nursing department (the title is immaterial) will tell you that he "wants to feel that his people are cared for," this is but the expression on his part of the general attitude of managers nowadays that they wish to get at the mind of the people to learn the underlying causes of industrial dissatisfaction. It seldom shows a knowledge of real conditions and needs. They have come to realize that a better mutual understanding must come about between employer and employe. I think that the nurse, perhaps better than any other woman worker, placed in the midst of a body of working people, can offer the keynote for the betterment of conditions and the furtherance of harmony. Hospital training alone will not have given a woman the ability to serve in this capacity; but where that vast opportunity for studying human nature at its frailest has been used to widen the sympathies to "get the response" from all classes and conditions of people; and where it is added to a natural democratic spirit, an appreciation of the business viewpoint and an executive ability (in fact, the right personality) the nurse in her professional capacity has a wide sphere of usefulness before her in industry. Her qualifications might be tabulated as follows: a. Has human sympathy and wins confidence c. Has learned the value and dignity of work d. Knows the necessity of cheerfulness, unselfishness and enthusiasm in daily intercourse e. Is accustomed to look for symptoms as a means of diagnosis, and naturally uses this faculty in looking for causes that have produced certain effects 1For five years engaged in starting work of this character at The Plimpton Press, Norwood, Mass. A SCHEDULE OF WORK VALUABLE I believe that every nurse now engaged in industrial work was attracted by the thought of a new and great field of service, where wonderful reforms could be achieved. Where she has failed or lost courage it has been due to one of two reasons-either because the lure of the easier hours and the steadier salary than that accompanying general nurses' work has sapped her enthusiasms and weakened her efforts; or because the problems arising in the industrial world were so many, so conflicting, so apparently without solution, that she felt her work was without effect, and allowed it to become so. For the former class there is nothing to say. To the latter I would recommend the conscientious following of an outline or schedule of work: not for the checking up of achievements, but because in the following of such an outline one loses the feverish unrest which comes in trying to grasp the whole of the problem at once, and finds that the daily round of work, faithfully performed and studied, furnishes a mass of data-a knowledge of conditions and needs, which leads directly to results. 1 Treatment Room Work Outline Methods: Few drugs. Show personal interest in every case. Instruction proper medical and surgical care 2 Visits throughout factory, covering every department frequently a. Follow-up on cases seen in treatment room b. Detection of incipient troubles c. Ventilation-cleaning-safety d. Orderliness and sanitation in toilets, lockers, etc. e. (Most important) General effect-"On the Job" 3 Calls on sick or absentees Not as spy, but as friend, a spirit always welcomed 4 Coöperation with doctors, clergy and outside interested parties 5 Help or advice in family troubles—medical, moral, social 6 Development of work in interest of employes: bank, library, lunch room, news 8 Coöperation in any work for civic betterment Following such an outline furnishes plenty of occupation; occupation leads to a quiet mind; and it is only the quiet mind that can achieve. What use is to be made of all the various phases of human needs and peculiarities noted? Out of the knowledge and experi ence of the nurse, seeing the people in this new relationship, should come some valuable contributions towards the establishment of the much desired harmony. It seems to me that in looking for causes of disharmony our investigators are usually looking too far or too high. The causes of tremendous troubles are often very little things. Whole departments are upset by the ill-temper or arbitrary actions of one person-some little lack of consideration-perhaps partly justifiable. This is where the nurse fits in. She stands as the friend of the people; she sees things with their eyes; and then, because of her broader training and experience, and her wider viewpoint, she can often locate the festering spot that is the underlying cause of disturbance. She will stumble into things that show a great unfilled want in the lives of the people-things which may lead to the development of schemes to fill these needs-schemes bringing the employer and employe together and out of the development of which, greater mutual understanding is evolved. THE DETAILS OF A DAY'S ROUTINE Let us follow this outline a little way. The employes visiting the treatment room may number ten or one hundred a day (if the latter, the nurse needs an assistant from the start). Many of these cases will be minor accidents or infections. There may or may not be work to do in the investigation of the cause of the accident. It may be due to gross carelessness on the part of the injured person; it may be due to the nervousness produced by the over-arduous "boss"; it may be due to another's carelessness in leaving utensils in the way; it may be a defect in machinery. There, at any rate, is something to do in the line of instructions for proper surgical careexplanation of methods used a little correction of the prevalent ideas as to the value of cobwebs or onions for surgical dressings. Some of our patients may have chronic disorders of stomach or head and seek a daily remedy. Such troubles may frequently be traced to neglected teeth, to eye strain, or to atrocious habits of diet, and it will take a long time to break down some of the traditions found in different industries and convince a man of the value of modern medical science. One has at times the worker who craves a stimulant to enable him to perform his task, and investigation shows a home condition that makes a night's rest impossible. I have had one employer, about to start elaborate "welfare work," say to me, "I don't care anything about a man's sick babies or his outside affairs, I just want him well and happy here." That statement will not bear analysis, because it is doubtful if a man can be well and happy at his work if there are sick babies at home. And the nurse who follows every clue to a sick baby or other home conditions that affect the worker in the factory is fulfilling her highest obligation to her employer in his quest for well and happy employes. The same thing applies to the hysterical or frequently ailing girl. Tragic things may be discovered in the life of the listless, uninterested factory girl. It is only fair to the management as well as humane to the girl to investigate these conditions, for the employer in the eyes of the world is usually bearing the blame. It is not enough even to locate the cause of the pallor and listlessness in the all-night dance. The good work is not ended until healthier pleasures and rational living are substituted; and it has been proven that the average girl can be made to see this from the health and the business standpoint. It was the frequent discovery of this condition in my recent work which led to the organization of a girls' club which met this need in the lives of over a hundred girls, and which furthermore taught them the principles of democracy, self-support and self-government. Does a girls' club seem remote from the employer's purpose in establishing a nurse in his factory? There is really a very close connection. More than one girl said in relation to her enjoyment of the club, "I have so much more to think about now. I can work better and the day goes faster." The day that goes fast is never a day of loafing. The daily visits throughout the factory are a very essential feature of the work. Apart from the purpose of these trips as tabulated, they are absolutely necessary in order to produce a fellowfeeling. I do not know that the day will come when the man who sits in his office and wears his coat and his collar will cease to be an object of apparent disdain but real envy, among those honest people who labor with their hands. The nurse should early recognize this and let nothing interfere with a routine inspection of factory and workers. The management should grant this privilege and should give frequent opportunities for conferences with the nurse in relation to her findings or recommendations as to better sanitation or working conditions. Here, too, the nurse should be on her guard lest her suggestions lose force through a too strictly professional interpreta I |