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unruffled as the proverbial mill pond. Seeing the family
problem from different angles and approaching it with -ser-
vices that overlap at least in their physical setting, it is
almost inevitable that the two workers, however firm their
professional ethics, should develop "edges" in their contact.
But to bring these edges into the open where they can be
examined and perhaps banished by frank facing, you must
LIU, as I did, to the stair-climbers of both professions.

If you are patient, if you are able to discount the passing
irritation of incidents and to dig steadily for the reasons for
them, be they reasons of personality, of over-zeal or of mu-
tual under-confidence, you will begin to see, after a good
many for-heaven's-sake-don't-quote-me interviews, just what
the "edges" are and why.

The nurses take no self-righteous stand in their com-
ments on their social work colleagues. To emphasize the
social workers' frailties beyond their own is no more than
human. On the other hand they concede certain definite
rights to the social workers, things which they have a right
to expect from the nurses.

These begin with a fundamental: that the nurse must
practice professional ethics in her relationship with the so-
cial worker not unlike those she practices in her relationship
with the private physician, meaning that she must accept
the social worker as an authority in her field. They agree
that the social worker may expect the nurse to recognize
social problems and to know when to refer a case to a
social agency, and that the nurse must help interpret social
work to physicians and laymen.

To support these generalities the nurses point to specific
ways in which the nurse should cooperate with the social
worker. If a nurse refers a family to a social agency, the
social worker assigned to the case has a right to expect from
the nurse a case history giving the health picture of the fam-



ily, the nurse's reason for visiting it, the health plan de-
veloped by the nurse and family, any information the doctor
may have given on the prognosis of the case and, if the
doctor permits, the diagnosis. Likewise, if the social worker
has referred the case for nursing care she has a right to
expect from the nurse a report on the care given and the
health plan made, and a notification of any change in tha*
plan or of the closing of the case by the nursing agency.

HAVING examined conscientiously what the social
workers may expect, the nurses turn to their own
rightful expectations. They are not dissimilar. The social
worker, they say, must recognize the community nurse as a
specialist in her field ; must be aware of health as well as of
social and economic problems and must know when a nurse
should be called on a case. In specific instances, if the case
has been referred by the nurse to the social agency, the nurse
may expect a report on the action taken or plan made ; notifi-
cation of any change of plan, of referrals to other agencies or
of the closing of the case ; and in an emergency, a telephone
message that help has been given or if not, why not. When
a case comes to the nurse through a social agency the nurse
should be able to count on receiving a case history including
information on home conditions, family status, problems
presented and the reasons for the agency's activity, and a
statement of the social worker's plan for the family. While
the case is being carried jointly by the two agencies the
social worker and the nurse should consult on any problems
or plans that affect the health situation of the family.

Though these expectations seem eminently reasonable
the nurses maintain that neither the nurse nor the social
worker lives up to them consistently. It is suggested that
perhaps a certain professional defensiveness causes each to
lack appreciation of the function of the other. Admitting
that they themselves are guilty of many of the errors of
which they complain, the nurses present a long list of "little
ways" of social workers that cause them to see red. Fore-
most among these is the failure to recognize nursing as a
profession. This is evidenced by the worker who sees nurs-
ing only as bedside care and considers herself wholly com-
petent to handle any preventive work that is indicated. The
result, say the nurses, often is unauthoritative or "half
baked" health advice. In the same category belong well-
meant but ill-informed suggestions pertaining to birth con-
trol, advice on which, the nurses maintain, belongs in the
health and not the social area. This lack of confidence is
also manifested by the social worker who is unwilling to
yield ground in a situation where the delegation of the
entire responsibility to one worker seems desirable.

A community nursing service cannot fulfill its obligation
unless the social workers in the community recognize health
problems and use the service intelligently. The nurses claim
that many social workers are not alert in this respect. Often
they neglect to report to the nursing agency a new illness
or a pregnancy in a family which they know had previous
nursing service. When they do recognize a health problem
they tend to refer patients to a clinic without consulting
the family physician, who usually holds the nurse responsi-
ble. They are careless in interpreting the nursing agency to
the family and community. Sometimes they cause embar-



MARCH 1938



73



rassment by promising more service than the agency can
give.

Aside from misunderstanding their function, social work-
ers, the nurses complain, neglect clear-cut routine proce-
dures with resulting unnecessary difficulties in relationships.
Even when they report to the nurses on plans for their
families the case workers frequently fail to explain the
reasons for their decisions. Consequently the nurses cannot
appreciate their plans nor understand such delays as may
follow. Most annoying and perhaps most serious is the
failure to present clearly to the family the reasons for
withdrawal from the case, thus unwittingly, of course
leaving the nurse to struggle with the explanation of some-
thing which she herself does not understand.

The matter of denying or withdrawing relief from a
family seems to be a pretty constant bone of contention
between nurse and social worker engaged on the same case.
The nurses say that they are willing well, usually to
accept the social worker's judgment, but they do not always
follow the social worker's reasoning and they just plain do
not like the way she brushes aside their estimate of the
situation. "Snooty" is what they call it.

There is a sure antidote, say the nurses, for the irrita-
tions and misunderstandings that arise under the pressure of
the day's work. They and social workers must have a better
knowledge of each other's fields and must have an objective
attitude toward their services in the community. It must
never be forgotten, they remind themselves as well as social
workers, that the promotion of the patient's or client's wel-
fare, and not the promotion of any agency, is the goal of
every community worker whether nurse, social worker or
what-have-you. Therefore the individual workers of the
two groups must have confidence in one another if the con-
fidence of the family in both of them is to be maintained.
Plans must be made jointly and respected in spirit and in
letter else one worker will undermine, inadvertently to be
sure, what the other has built up and the family will be left
with divided counsels. For real cooperation to flower, the



workers must know each other's language or be able to
strip their discussion of technical terms.

Living up to their reputation for practicality the nurses
do not dwell on the nostalgic note of ideal cooperation but
offer definite proposals for its accomplishment. Primary
among these are the twin suggestions that training both in
community nursing and in social work should have some
orientation to the other field, and that, for the further
education of trained workers, there should exist an exchange
of new ideas and reading material in both fields. To bolster
this background the social and nursing agencies should come
together to formulate a definite plan for a joint staff educa-
tional program to be carried out through joint staff meetings.

For particular cases the idea of a mutual consultant ser-
vice is offered. With a nurse sitting on a case committee of
a family agency to interpret the health implications of the
cases discussed and a social worker available for advice to
nurses on the social problems that daily confront them, a
better understanding of functions and a stronger profes-
sional confidence would result. Supplementing this service
should be frequent conferences between the social worker
and nurse assigned to the case, regular reports to each other
on long term cases and interviews, the two of them to-
gether, with the physician. The nurses even advise an inter-
change of family case histories, accompanied, of course, by
an intelligent use of this confidential material.

Nurses do not charge that any one social worker is guilty
of all the sins of omission and commission which they pile
up, but, they say, almost any one of them, if completely
candid with herself, will admit that some of the counts
strike pretty close home. "Not that we are without sin,"
they hasten to add. "We have poor nurses too and the good
ones among us have to take the gaff for the poor ones. Why
don't you circulate among the social workers and find out
what's wrong with the nurses they meet on the job?"

Miss Close has "circulated" and her second article, OH,
THOSE NURSES! in which social workers have their say
about community nurses will appear next month.



Board Member Soul Searching

By RUTH HYDE HARVIE

President, Association of the Junior Leagues of America



A LOT of advice and a good deal of education have
been directed these last few years to the board mem-
bers of welfare agencies, all of it designed to clarify
and strengthen board member functions in relation to their
own organizations and to the social planning of their com-
munities. They have been told of the importance of a broad
knowledge of modern social theory and of modern practices
and standards, and of the wisdom of preceding board activ-
ity with volunteer experience. They have been urged to
become real participants in planning and carrying out
agency programs and to' become the interpreters of the
community to the professional workers and of the profes-
sional program to the community. Not always have they
been advised how to tackle the immediate and often con-
fused problems of relationships within their own agencies.
Many welfare agencies, once conducted largely by volun-
teers, find themselves today with problems created by the
growth of large professional staffs. These agencies cannot
survive in their communities without volunteer boards and



committees, nor can they function adequately without the
services of professionals. Yet the relationship between the
two groups and the balance of responsibility between them
have grown up, all too often, like Topsy and are not the
result of clear understanding nor of conscious planning
for the integration of the volunteer and professional
contributions.

Because my own organization, the Association of Junior
Leagues of America, has spent the past two years on an
analysis of its own volunteer-professional relationships I
venture to suggest as a new role for board members that
of students of their own organization. The course I propose
is not one of those introductory affairs to give new board
members light on the whys, wherefores and hows of their
agency, but a seminar which digs deep into the past, mi-
nutely analyzes the present and looks ahead to a broader,
richer program in the future.

The Association of Junior Leagues was a completely
volunteer organization until 1926 when it acquired an



74



SURVEY MIDMONTHLY



nployed staff of one. Nn\\ \\<- liiul oursrlvrx uith an
executive staff of fifteen including six trained social work-
ers, and a large clerical force. We too had grown like
T"p\v and found ourselves wondering whether our volun-
teer and professional groups were functioning together
sufficiently well to carry the present program effectively
and to be adaptable readily to future contingencies.
The problems which faced us are familiar:

Conflict of responsibility between board and staff; board and
executive committee.

Lack of understanding of the different contributions which
these groups have to make.

Duplication of effort in board and committee work.

Poorly defined personnel policies and procedures.

Faulty organization resulting from divided responsibility for
staff and organization matters.

Assuming the role of students of our own organization
we elected a committee of board and staff members these
last named by the professional group to review the present
administration, management and organization with special
reference to the relationships of board, committees and staff
to each other and to our member leagues, and to the ex-
pressed policies of the association. We did not expect this
committee to evaluate the program of the organization, but
we were confident that its recommendations to the board
would indicate a basis for future development.

We secured an expert in administration and management
to guide us, but may I suggest here that much of the pur-
pose of such a study is lost if a board hires an expert and
forgets all about the study until his recommendations
are presented. No outsider can come in and clarify the
volunteer-professional partnership. Professionals and volun-
teers, side by side, must do the digging themselves if a
permanent, satisfactory working relationship is to be
established.

The first job of those who undertake a seminar course
in their own agencies is to secure a complete picture of their
organization as it exists in the minds of those responsible
for its policies and management. The essentials for this
picture are:

The organization's by-laws and standing rules.

Analyses of the functions, duties and relationships of officers
and directors, committee chairmen and members of the profes-
sional staff.

Job analyses of clerical positions.

A statement of the present organization, board and commit-
tee policies and of administration, office and financial policies
and procedures.

I need not go into detail here of how these essential points
were translated into questions designed to set thinking all
the board and committee members and the staff. The pur-
pose of the questionnaire was to challenge complacence, to
stimulate self-analysis and to clarify personal attitudes. It
wa- "accepted in the spirit in which it was meant" and was
answered candidly and in full detail. Naturally it revealed,
along with much clear and definite thinking, a good deal of
confusion particularly in the direct and indirect inter-
relationships of board, committees and staff.

With this mass of material in hand came the committee's
hardest task to sort out and evaluate the vital problems
revealed and to frame recommendations for their solution.
Remember that this was a committee made up of both
volunteers and professionals, working side by side, arriving
at conclusions by a process of joint thinking. These conclu-
sions as to problems and proposed solutions, together with



a digest of the material from which they were drawn, were
then presented to the board.

Out of this experience I can bear witness that nothing is
more stimulating to a board or more conducive to satisfac-
tory working relations between board and staff than to have
a committee submit to it for discussion such recommenda-
tions as that:

The by-laws be amended to become a true reflection of pres-
ent policies and practices.

The board pass upon the job analyses of hoard members,
committees, and staff, and that the analyses as approved be-
come the bases for working manuals relating to all positions
within the organization.

The board adopt a statement of its present functions indicat-
ing the general division of responsibility between board and
executive committee, between board and staff, committees and
board, and so on.

The board formally adopt a set of personnel policies and
procedures dealing with such matters as working hours, sick
leaves, arrangements for professionals' studies, vacations, dis-
missal wages and personnel records.

All policies of the organization in effect at the present time
be assembled so that the board may review them as a whole
and proceed to adopt a set of policies which may be considered
as a basis for the entire program of the organization.

The classified records of the actions of the board be kept in
an historical file of policies, classified by subjects, and as poli-
cies are rescinded or revised, a record to this effect be made
under the proper classification.

Such recommendations cannot be put into practice in a
day, but by charting a course they obviously exert a salutary
influence on an organization's procedures and inside rela-
tionships. Take for example the confusions which frequently
becloud the functions of board, executive committee and
paid executive. What board member has not sat through
hours of discussion of matters of minor procedure, hours
which might better have been spent in examining the policies
from which procedures emanate? Or what executive com-
mittee has not hashed over a difficulty connected with a
certain position when, if personnel policies had been clearly
defined, their application to the case in question would have
been the responsibility of the paid executive?

The result of such practices is obvious. The paid execu-
tive who must refer every office problem and staff compli-
cation to his executive committee ceases to be an adminis-
trator. Why pay his salary if the matters with which he
presumably is competent to cope must be turned over to the
mercies of a committee without professional experience?
And why go through the red tape of having an executive
committee if the board insists on applying policies as well as
formulating them ?

Such a study as I have described should define affirma-
tively the ground which board, executive committee and
executive occupy. Experience indicates that sound divisions
of responsibility run something like this:

The function of a board of directors is to provide for the
most efficient administration of an organization under its stated
purpose. The board should offer leadership in thought and
action in the formulation of new policies and the abandonment
of old, in the creation of new programs and the change of old.

An executive committee should be responsible to the board
in the capacity of supervisor for the practical application of
policies and programs adopted by the board. But

The actual working out of techniques and details should rest
solely in the hands of the trained executive and his staff.

Since the choice of an executive rests so often in the hands



M\RCH 1938



75



of lay people it may not be amiss to give here a few high-
lights of the conception of an ideal executive as developed
by joint lay and professional thinking:

The ideal executive secretary shall be responsible for carry-
ing out such programs as he and the board of directors, work-
ing in partnership, have agreed upon.

He shall supervise and coordinate the work of the staff, de-
velop each member to increase his capacity, study the demands
of all staff positions and suggest lines for their development.

He constantly shall consider the organization's program as
a whole, concerning himself with long time planning, suggesting
to the board the need of new policies or the modification of
old ones, and finally

He shall give thought and attention to such board education



as will promote an effective volunteer-professional relationship.

With divisions of function stated as simply as this, one
may question if such a seminar as I have suggested is a
necessary part of board education. May I say that the defi-
nitions of function created by the thinking of one organiza-
tion need re-cutting before adoption by another; that it is
the process of the study as well as its outcome which is
invaluable to laymen as interpreters and as co-planners with
the professionals in the development of adequate social ser-
vices for their communities.

This article is drawn in part from a paper presented by
Mrs. Harvie at the last meeting of the New York State
Conference on Social Work.



The Poorhouse Persists

By HELEN GLENN TYSON
Family and Child Welfare Division, Public Charities Association of Pennsylvania



GOVERNORS may tell the world that they have
"abolished the poorhouse" when they sign old age
assistance bills, but a small cash pension, which can-
not buy medical and nursing care, does not answer the need
of hundreds of aged persons today. Needy old folk do not
hear the governors' optimistic words as they crawl into
the only institution that will shelter them. Though poor-
houses or almshouses as they are more generally known
are completely out of step with modern public welfare, and
though some states have taken steps to abolish them and to
substitute appropriate care, a large proportion of the 2300
such institutions enumerated a few years before the depres-
sion still remain. Old age assistance has saved some old peo-
ple from the poorhouse, but it has not abolished that deso-
late institution.

A monument to waste and degradation, the poorhouse is
and always has been a kind of lower hell in this new and
developing country. Keeping "off the town," at whatever
cost to health and decency, is still the constant preoccupa-
tion of the old and needy. For its hatefulness to poor and
taxpayer alike, the almshouse has been pushed back into the
shadows of neglect and inattention, but its very existence
is a potent weapon, still raised on occasion to threaten the
recalcitrant and demanding poor.

Before federal appropriations for relief of the unem-
ployed began to flow even into remote rural communities,
this weapon was used with deadly effect. The shadow of
the poorhouse hung darkly over more victims than at any
time since the founding of the country. The logic of the
petty local official was simple ; as simple as that of the early
pioneers whose unquestioning acceptance of "the crime of
being poor" followed naturally the pattern of the early
English workhouse, where paupers and petty criminals
were housed together and forced to work in the hope that
they would be converted from their evil and idle ways. No
one, reasoned the overseers of the poor, could be starving or
cold so long as he refused to swear that he was a pauper and
apply for admission at the local poorhouse, where by law he
must be given food and shelter of sorts.

The public's forgetfulness and neglect of this institution
can be explained partly by its location and partly by the type
of person concerned with its administration. When land
was cheap and almost everyone depended for a livelihood
upon its cultivation, hardworking settlers logically conclud-



ed that "poor taxes" could best be held down by combining
farm land and paupers. The poor farm, therefore, was lo-
cated outside town, often "back from the road" so that the
sight of paupers, supported at public expense, might not
disturb the peace of mind of the passerby. A farmer was
appointed as steward and the paupers set to grubbing their
living from the earth.

Time has cast doubt on this method of saving the money
of taxpayers. Although some 300,000 acres are connected
with poor farms, some of them very rich land with a high
cash value, only about half are cultivated and those but
poorly. The farm appears frequently to have no more use-
fulness to the poorhouse than would a farm attached to a
city hospital. A recent study of almshouse farms in Pennsyl-
vania showed astonishing mismanagement, some farms with-
out any inmate labor whatever, failing to produce even
sufficient vegetables and dairy products for the needs of the
institution. The office of "director," "overseer," or "farm-
er," at first honorary and unpaid in many communities, has
degenerated into a petty political job for which the highest
objective has come to be keeping poor taxes down without
permitting the paupers actually to starve to death. Candi-
dates have campaigned for reelection on this issue. For the
most part new thinking and practice in institutional man-
agement and in care of the chronically ill and disabled, have
passed the poorhouse by, untouched.



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