NURSING IN THE BRITISH HOSPITAL 

The first British trained Nurses employed by the Committee of Management arrived in 1880, the same day that the only resident Medical Officer contracted typhoid fever. A few weeks later a Revolution was on in Buenos Aires, the conditions prevailing were uncertain and chaotic, and these Nurses didn’t have adequate lodgings, so that they returned home shortly after.  In 1882 Miss E. Taylor was brought out on a 3 year contract: she was very successful and supervised the moving of the Hospital from Bolivar street to the present site on Perdriel and Caseros Avenue. She finally resigned, and in 1889 Miss E. Eames from the St. Thomas Hospital in London was brought out with three other Nurses, who proceeded to establish the first Nursing School in the country the following year. A remarkable fact is that since that Matron, and up to the present, there have been only 11 Matrons since. Over these 117 years, 1616 Nurses have graduated, and have shown high standards of nursing care that have been one of the highlights of this Institution, and a benchmark for other health care facilities.  In 1996 the BH Nursing School became affiliated to the University of Buenos Aires’ Faculty of Medicine Nursing School, with dependence in academic matters only.  In the last decade we have seen a gradual increase in males entering the profession.
 
A research done over the period 1980 to 2000, showed that 50 % of the BH graduates went on to become Licensed Nurses, a 92 % were working in private Institutions (including the BH). A 25 % of these were in leadership roles, reflecting their training and capacity.
 
The first cycle in a Nursing career demands three years training to graduate as a Registered Nurse, permitting them to begin looking after patients, and to practice in Hospitals and other health care facilities. To access this step, they must have completed their secondary schooling, and gone through the CBC (Ciclo Básico Común) which is an obligatory step for anyone contemplating a University career at the state University. The second cycle is a two year course to become Licensed Nurses, which opens the doors for them to play leading roles in their profession. Though specialization as such is not in force as yet, they can then go on to pursue specialized courses (Paediatrics, Intensive Care, Neonatology, Infection Control, Orthopaedics, Bone Marrow Transplantation, Teaching, etc.), to postgraduate Masters degrees and  Doctorates. At present, the Nursing School is completing the preparations to open up the second stage Licensing Career at the British Hospital.
 
One of the outstanding features of training at the BH Nursing School has been, and is, the emphasis on “hands-on” experience in the wards, learning at the bedside, always under supervision of their teaching staff, for longer hours than the University curriculum expects. When they graduate, they are avidly sought after by private clinics, sanatoriums and hospitals for this accumulated job experience.  To this end, the BH provides their meals and uniforms, and a monthly stipend is added as an extra incentive for training in the wards, and avoiding them from taking other jobs in their spare time.  At present there are 81 student Nurses spread out over the 3 year course.

For many years our Student Nurses, came from many different parts of the country and from neighbouring countries, and they were lodged in the building called Nurses Home for the three years of their studies. It was a marvellous experience for most of them, as acquaintances developed into lasting friendships, with facilities for studying, a good library, their own dining rooms, sitting rooms, and even an exclusive swimming pool for use in the summer months.  As more and more educational facilities opened up in the interior, and the academic demands became more stringent, and nursing was becoming a university career, the source of the applicants changed, fewer and fewer coming from the interior of the country, most of them living in the city of Buenos Aires and in the outlying suburbs, so that lodgings gradually became obsolete, and the Home as such was closed down six years ago. The vacated rooms have gradually been taken over by an ever growing demand for space, both for administrative functions, for medical administrative personnel, for doctors with their Clinical Research Programmes, for changing rooms for the Nurses, for classrooms for undergraduates and postgraduate Nurses and Resident Physicians, and a variety of seminars, symposiums and congresses, both Medical and Nursing.   This has not impacted on the area dedicated specifically for nursing education, which is still going strong.
 
After an interview with Matron Veronica Hortis Smith (Director of Nursing) and Lic. Zulma Silva (Director of the Nursing School), and asking them what they considered the most important changes in their profession over the last 10 years, they answered the following:
  • Patients and their families are better informed as to the nature of their illnesses.
  • Patients participate much more in the decision-making with their nurses and physicians.
  • Turnover in surgical patients is much faster, as their stay in Hospital is much shorter.
  • Life expectancy has prolonged, and the average population in Hospital is much older, and patients frequently have one or several pre-existing chronic illnesses, making for more complex medical and nursing care.
  • There are many more guidelines to improve standards of care.
  • Specific training orientation is on the ever increase, such as paediatric nursing, nursing for transplant recipients, for control of infectious diseases, for monitoring prescription of antibiotics, for intensive or critical care, for endoscopy assistance, for assessment of risk control, for the Maternity Wards, for Intensive Care (both children and adults) and for nursing in the Emergency Rooms.
  • Even though the rest are “generalist” nurses, due to new procedures and increasing complexity of surgery and medicine, they are also tending to some degree of specialization, as the Hospital tries to group patients with similar pathologies for better care, such as orthopaedic patients, cardiological cases, and others such as Geriatrics, Major Surgery, Cardiac  Surgery, Ambulatory Day Surgery and Neurology.
  • Permanent need for keeping up with the continuous and stunning advances in Medicine, both technological and in information systems.
  • Changing over their traditional charts and drug dispensation system to electronic systems, which puts ordering medications on-line with the Pharmacy, with stock control and with billing.
  • Increasing participation in Hospital Committees. At present, Nurses participate in the following Committees:  Hospital Safety and Hygiene, Medical Audit, Professional Risk Evaluation, Teaching and Research, Hospital Infection Control, Supplies, Bioethics and Surgical Theatres.  This promotes a beneficial and dynamic interaction in Hospital decision making with doctors and administrators.
  • An alarming lack of both nurses and nursing candidates locally and worldwide.
Among their many activities, Matron and Mrs. Silva, report that, besides their role in policy decision-making, they have to keep a constant watch to maintain adequate staffing, as there are always some nurses who need leave for sickness or maternity; on site education and daily rounds to visit patients and supervise the staff is a constant necessity. They also play a significant role in keeping up with continuous nursing education, with different short updating courses, which also has to contemplate the free time of the five nursing shifts: two during the day, one on weekends and two night shifts. A knowledgeable Nursing Staff with adequate comprehension and judgment for solving ongoing clinical problems, and with skills to manage the fears and worries of patients and their families, is constantly emphasized.
 
As a final remark, the change that Florence Nightingale sparked in her profession was, besides constant care and attention to sick people in an adequate environment, the importance she gave to the need for constant tuition and education. This has led many women to embark on this very hard and demanding profession, putting up with the suffering and the miseries of mankind, working long and stressful hours, having to keep up their information on constant improvements, and working for smaller salaries that they could get in business or other professions. Never the less, their spiritual rewards are enormous, and I would close with a very special tribute to these dedicated men and women, without whom the modern delivery of care to the sick would be impossible, and who deserve the highest commendation by society. 
 
Author:  Dr. John Emery
 
 
Sources:
  • Mrs. Veronica Hortis Smith  -  Matron Director of Nursing
  • Mrs. Zulma Silva  -  Licensed Nurse Director of the Nursing School
  • “The Buenos Aires British Hospital, a History 1844 - 2000l”, by Dr. Hugh Fraser Warneford-Thomson, O.B.E.