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Florence Swift Wright.

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firm and to the association. This plan has the advantage of
assuring the continuation of nursing service in spite of changes
of personnel, and offers supervision to inexperienced workers.
Unless the nurse doing such work spends some regular time
in the plant and becomes identified with it, there may be very
little adaptation of the work to the needs of the iildustry and
less of the close personal relationship which should exist
between the nurse and patient, not because the nurse is a
nurse but because, in addition, she is the personal representa-
tive of the company, or of the organization of workers who
employ her, and is known to have been chosen by them and to
be responsible to them.

In any of these plans great elasticity will be needed to
avoid duplication of work and to maintain the closest possible



THE VISITING NURSE IN INDUSTRY 75

relation between the industrial nurse and those she visits.
Aside from pointing out the relative advantages and dis-
advantages of each method, as they appear to the writer, no
general solution can be offered. The needs of the industry,
the local agencies at hand, the prejudices of the workers and
many other factors will guide the employer in his decision
as to what means he shall take to establish a visiting nurse
ser\ace. Good and valuable work is possible for the nurse no
matter what the details of organization may be.

One prejudice of workers should be considered. In many
towns the visiting nurse association has the name of being a
charity. Where it is not plain that the association serves all
classes and collects pay for service, consideration for the
workers often influences the employer in establishing his own
service with its resulting benefits to the firm and greater
acceptabihty to the workers.

The visiting nurse in industry meets the same problems
and must handle them in the same manner as any other
visiting nurse. The backing of the company is perhaps not so
strong or general as that of a good visiting nurse association
because all the elements of the population are not repre-
sented.^ ^

The local physicians sometimes feel that a nurse has been
thrust upon them unasked but they are usually glad to accept
her services for their patients when they find her obedient to
their orders, quick in reporting a change in a patient's condi-
tion and thorough in her care of the sick.

Her technique should be that of the best visiting nurse
associations ^ and because she is so often without supervision,
she should be careful to make it plain that she can keep up
the standard of her work without example or precept.

^ In this connection, help and inspiration are to be found in Miss
Gardner's " PubUc Health Nursing," Part II, Chapter V, The Nurse
Working Alone.

2 Where the nurse is paid by an association of employes or of em-
ployers with employes, the nurse's backing, at least with her patients,
is all that can be desired.

» " Visiting Nm-se Manual," Edna L. Foley, R. N., page 43 to page 71.



76 INDUSTRIAL NURSING

In a small industrial town, a nurse who expects to do bed-
side nursing in the homes of the workers will gain by taking
the time at first to call on each physician in the community.
In either a small town or in a large city, if there is a visiting
nurse association having standing orders approved by all the
doctors, the industrial visiting nurse will do well to follow
these orders in her work in the homes. If she is the only
visiting nurse and especially if she is a newcomer, it may be
well to obtain if possible such orders through the local
medical society. The advisability of this step will depend on
local conditions. Sometimes one or more local physicians
may take this matter up for the nurse, or her employer
may be willing to do so. After the nurse becomes known
she may be able to do it for herself. Until some standing
orders are provided for her use she will necessarily use great
caution in doing anything for her patients except to make
them comfortable until she has consulted the physician in
charge.

The wise general rule for visiting nurses will be observed:

" It is a wise rule that a doctor shall be in attendance on
every case cared for by public health nurses and it is an
equally wise rule that the nurse should continue on the case
only if it is his pleasure. It will usually be his pleasure if she
does her work well, or if he finds that patients, as often hap-
pens, refuse to call him unless he permits such service. In
case of change of doctor, and every public health nurse is
familiar with the dizzy rapidity with which such changes
take place, it is her duty to put herself in immediate com-
munication with the new doctor, and usually it is wise to
have a word on the subject with the departing one, lest she
become involved in the complexities of the situation." ^

The work of the industrial visiting nurse differs from that
of the ordinary visiting nurse in that most patients visited
are seen in their homes by the nurse before the doctor has
been consulted. Often the worker is not sick but at home for
other reasons. In many cases, though not well, he does not
1 " Public Health Nursing," Miss Mary S. Gardner, page 45.



THE VISITING NURSE IN INDUSTRY 77

consider his illness of enough importance to warrant the
expense of a doctor's visit. The nurse's duty is to persuade
the patient of the wisdom of seeing a doctor if necessary and
then, if illness continues, to see that he understands and
carries out his physician's orders and that he has whatever
nursing care is required, teaching the patient and his family
as would any other visiting nurse.

Every employ^ must be acquainted with the medical,
surgical and nursing services at his command. While nothing
should be forced upon any one, the worker may surely be
taught by a sympathetic friend (the nurse, or if he does not
know her well, his neighbor who has known her longer) to
want what is to be of benefit to him.

When visiting nursing is established in an industry, a
systematic method by which calls come to the nurse is neces-
sary. Calls will undoubtedly come from many sources; from
the emplojmient office, the heads of departments, the workers,
the company physician, and from the families of the work-
ers, as well as from outside sources such as the visiting nurse
association, industrial benefit associations, churches, etc.
However, in order to be really efficient, each absentee should
be visited at least once unless it is definitely known that he is
not sick or that he needs no help. A regular daily system of
notification from the employment office or from the time-
keepers is the only way by which those needing aid can be
promptly reached. In a small town the nurse may "happen
to hear" of those needing her help but, even in the smallest
place, this is an uncertain way of getting work done and
in a city, where the need is often greatest, it is of no value
at all.

Without prompt visits to all absentees, a great amount of
preventable misery is sure to occur, such as the case in New
York City where a cook, employed in a restaurant, was away
from work on Friday. Her absence was reported to the nurse
on Monday morning and in the afternoon a visit was made.
The patient was alone and no one had entered her furnished
room since the preceding week. She was delirious, her



78 INDUSTRIAL NURSING

temperature was 104, two gas lights and an oil heater were
burning and the month was August. No time was lost in
sending the irresponsible patient to the hospital in an am-
bulance, where it was found that she was suffering from
typhoid fever. Her friends had gone to the country for a
vacation and did not appear for several days. This is, of
course, an extreme case, but it is not at all unusual to find a
person ill and in need of care but without the least idea of
how to go about getting help.

The industrial nurse who visits in the homes will not act as
a detective, and the private affairs of her patients will be
treated with the same consideration and confidence as
similar information coming to the attention of the private
duty or hospital nurse. When her patients have learned
confidence in her discretion her opportunities for giving real
help will be greatly increased. Many personal matters are
sure to come to the industrial nurse's attention which concern
no one but the patient or possibly his family. It is sometimes
necessary to get the sympathy and understanding of the em-
ployer or of someone else high in authority and in close touch
with the plant. The privilege of consulting at will with the
employer or general manager is often allowed an industrial
nurse and should be greatly valued by her. If she remem-
bers the many demands upon his time and his great responsi-
bilities, is sure of the accuracy and importance of her facts
and presents them briefly, many an employer is only too glad
to give freely of his time and interest. An industrial 'nurse
should beware of the failing of continually asking favors for
employes. Favors do not bring any desirable results to
anyone.

The visiting nurse in industry will work with the various
family physicians of her patients rather than, as in the first
aid room, solely with the company physician. Coming, as
she often does, without the knowledge of the familj^ doctor or
even before he has been called to attend the patient, she
must make it very plain to both doctor and patient that she is
carrying out the best principles of nursing ethics and the



THE VISITING NURSE IN INDUSTRY 79

best visiting nurse technique. She should be exact and par-
ticular in keeping all bedside notes and records, both in the
patient's home and in the nurse's office at the plant. Her
responsibihty is fourfold: to her patient, to his physician, to
her employer and to herself. Only by the same careful
record of orders, treatments and observations as is required
in a hospital can a nurse protect herself from chance of
criticism. Her continued usefulness in her chosen work may
sometime depend upon promptly recorded facts. The visit-
ing nurse must spend enough time in the plant to keep her
records or to see that they are kept, to get her calls and to see
workers in the plant who may wish to consult her. The noon
hour will often be a good time to see the workers.

The visiting industrial nurse does not finish her duties when
her patient no longer needs nursing care. She will be ex-
pected to keep in touch with him until he is able to go to
work. This attention during convalescence is an important
factor in keeping the worker patient until he is fully recov-
ered and in adjusting him to his work later. Arrangements
for medical examination by the company doctor should be
made when necessary to prevent the worker returning too
soon or while in a condition to be a menace to others. Many
firms make such an examination a routine requirement, and
where this is not the case, the industrial nurse should assure
herself, as far as she can, through consultation with the
family physician, that the patient is able to return and that
he has suitable work. This precaution is of special impor-
tance where the illness has been long or obscure, where indus-
trial disease has not been excluded, and in all respiratory
diseases.

After return to work many patients should be kept under
friendly observation by the first aid room nurse. Some will
need to be reminded to return to their doctors; perhaps the
foreman will have to be asked for a time allowance for the
visit. Some may be ordered treatment by their doctors which
will have to be given by the nurse in the first aid room.
Others may not seem strong and the nurse may make some



80 INDUSTRIAL NURSING

excuse to get them to her office from time to time in the noon
hour. Young persons and others will have weight cards kept
so that the nurse will be able to give the doctor valuable in-
formation in sending a patient to him. The first aid nursing
and the visiting nursing are inseparable if good team work is
to be done.



CHAPTER IX



THE DAY S WORK



The First Aid Room: — The first aid room nurse or her clerk
will, in most plants, be expected to open the first aid room
when work begins in the morning. Where, as in urgent war
work, the plant runs continuously, the first aid room will
probably never be closed. Some firms, under these condi-
tions, employ a male attendant for the night work. There is,
however, no more reason to exclude a nurse from night work
in an industrial first aid room than to expect hospital order-
lies to do all the night work in a hospital. Nevertheless such
use of a woman's time might be considered a violation of the
labor laws of some states. With three shifts of nurses, a
comfortable time schedule would be possible and the night
workers, who are surely not less hable to injury and illness
than the day force, would have the same protection. Em-
ployers, who have had experience with both nurses and male
attendants, are unanimous in saying that the former are more
efficient, more interested and to be preferred even in estab-
hshments where the employes are all or chiefly men.

Any objection a nurse might have to such employment,
aside from the disadvantages inseparable from any night duty,
vanish when she learns how much respect even the roughest
man has for a trained nurse. The writer has yet to hear of
even one instance of intentional rudeness or disrespect from
any male employe to any industrial nurse at any time. It
would, nevertheless, be wise in choosing trained nurses for night
work to select women of exceptional dignity and mature years.
A well placed first aid room will not be in an isolated location
and, if used at night, care should be taken to have it where
all that goes on within may be easily observed from without.

In a plant requiring continuous first aid service, the indus-
trial nurse will probably be fully occupied with first aid work
and redressings, together with the care of workers who are

81



82 INDUSTRIAL NURSING

taken sick in the plant. In order to have any time at all for
other work, or even for acquiring a general knowledge of the
industry, most careful planning of work is necessary. If all
possible routine duties are attended to in the early hours,
emergencies are more easily handled and time is more likely
to be found for developing and improving the service. First
aid room work increases and decreases with the seasons, with
the pressure of work throughout the plant, with the weather,
even with slight changes in factory routine or department
management, so that at times there may be comparatively
little to do. When these times come, the nurse, whose routine
work is always finished at as early an hour as possible, will
find leisure to study her problems and improve her methods.
Getting the workers to return for redressings at the exact
time they have been instructed to come will often be a diffi-
culty. In one place this was overcome by giving a printed
shp at the first visit. This slip the patient took to the fore-
man who kept it on file and sent it back to the first aid room
with the patient at each visit. The same paper served until
the case was closed, when that fact was entered for the
further information of the foreman. Sample slips follow: —

^^>An Qce, No. 2S3. Dept. 60.
Remarks, ^aui Ae i>vA» aoaale^ ueiiei^i/au.

Injured, (f/^^. 19/<i', ^0 ,^.^^. Nature of in jury, «»8^<»«>^<*!«w/
Disposition, ienf &> iSi. S^i^.



/lerman,.



incapacity, Ayoww/u onlw lo-dau, iee doc/or^ r^A^ir/i

Return to first aid room ? yes.

To return to Dr. at A. M. P. M.

Send to first aid room 6\ys ^ ai m»^ g s^. ^.

Zi^. ji:. ^., Nurse.



THE DAY'S WORK 83

Or—

^^m» £4. 19/<f
^y^ar^ 5/inid, No. 35. Dept. 3.
Remarks, Mc/;, toi// ie« ^imi/u. e/oc&^r.

Injured, /f/s*, \^^s. ^Ios0^. ^i Nature of injury, ^^^^^ //;«.

Disposition, i^movecl ^/inle^, ien/ Aom« iecanie iicJc.
Incapacity, comA/ele of Aiieient, it'<im MneM nof ituui^.

Return to first aid room ? em I'eAttvi. lo nu/^.

To return to Dr. at A. M. P. M.

Send to first aid room viiOin^ Tu^ne 6> cal^ da 0^. ^.

J^ ^. ^., Nurse.

A new date for return is entered at each visit unless the
case is closed, then "HEALED" is written diagonally across
the sheet and it is sent again to the foreman. The returns are
checked up by means of the day book and patients' individual
cards which will be described. The careful following up of
those who do not return when expected is a necessary part
of the duties of the first aid room nurse, both for the safety of
the patient and for the protection of the company from
accusation of neglect or from possible unjust claims. The
first aid nurse need not go to the patient's home but she
should be able to send some reliable person. It is, however,
more satisfactory for the nurse to go herself. A patient need-
ing slight dressing might become ill from other causes and no
home visitor would know the right thing to be done or do it as
well as the nurse. In cases where there is doubt as to whether
the illness had itsorigin from the injury, the nurse will see that
the patient is again placed under the observation of the com-
pany physician. She will be able to assist the foreman, the
employment ofiice and the compensation department by



84 INDUSTRIAL NURSING

weeding out those workers who, having suffered a small
injury, stay at home and, without notifying the employer,
take work elsewhere or even move out of town.

When workers are taken ill during working hours, the nurse
will often be obliged to follow them to their homes in order to
make sure of excluding contagion from the plant. Where no
regular visiting nurse service is provided, the jfirst aid nurse
will have frequent reason to know that workers who should
have help and advice are at home and not likely to get either
unless their condition becomes alarming to the inexperienced
family or indifferent landlady.

Much interesting follow-up work, for which nurses find the
need in the first aid room, must wait until, a visiting nurse
service is established. The nurse must return to a room full
of workers who need prompt attention to avoid loss of time,
idle machines, personal loss of money to piece workers, con-
fusion in the departments of the plant and an upsetting of the
whole system by which a busy day may go through without
worry, haste or confusion.

After a little experience, the first aid nurse will know about
how many dressings she can do in half an hour, and the ap-
pointments for the workers may be so arranged that time is
not wasted. In some departments, it will be easier for the
foremen to send all his people to the first aid room and have it
over with. In other departments, where machines might be
idle if several workers left, cooperation will be easier if the
workers are allowed to come to the first aid room one at a
time. These things can only be learned by experience in the
industry itself. Thought and consideration in these matters
will be part of the nurse's contribution to good team work.
In opening a new first aid department, some confusion is
inevitable, but much can be avoided by thought and, after a
week or so, the return of patients should be so systematized
that it is accurately accomplished with little trouble and
almost no friction.

For the quick handling of many small dressings, mostly
fingers, the following plan works well.



THE DAY'S WORK 85

The automatic return of the patients having been assured
and everything in the dressing room being ready, the clerk
sits at a table near the door with the daybook, patients'
individual cards, pad of return slips for foremen, duplicate
book for writing notes to the company doctor, duplicate
book for sending reports to the main office and any other
forms that may be required by the particular plant. The
clerk enters all names in the daybook as the patients come
in, takes the slips which they have brought from their fore-
men, and fills in the proper spaces in the daybook as the
nurse tells her what to write. She marks the foremen's slips
as directed by the nurse and has them ready to give to the
patient as he leaves the room. In odd moments she will,
perhaps, be able to assist in sterilizing instruments, in keeping
the dressing table in order and in putting on some bandages.
A few lessons in bandaging will interest her and the knowl-
edge will be useful. In a busy room, however, the clerk will
be fully occupied with the record table until the routine work
is finished.

The nurse stands between the stationary basin and the
dressing table, the dressing table on her right. The dressings
will then be done as rapidly as possible. Even so the nurse
will find opportunity to teach the patients many things.
Where the dressings are of a simple nature, it helps to have
as many persons waiting in the first aid room as possible.
There is little to be said about first aid, the necessity of
prompt visits to the first aid room and the folly of neglect to
use all safety devices provided, that will not be more im-
pressive if heard by the workers in groups. The feeling, as
the workers often say, that "the nurse won't like it" is a
strong factor and not to be overlooked in maintaining proper
discipline. Nevertheless, while this sort of publicity may do
good in a mill or with young people, it is, doubtless, totally
unsuited to some other industries or to people who are shy.
It has no use or excuse in any dealings with the personal
affairs of anyone. Where such groups are together nat-
urally and comfortably, workers and nurse have a chance to



86 INDUSTRIAL NURSING

become acquainted, the workers learn a good deal, especially
as to what they must not expect the nurse to do for them, and
the nurse, if she is not easily confused, enjoys the informal
"meeting."

A conspicuous sign in the first aid room to the effect that
the nurse will be in her office between twelve and one to see
any one who wishes to consult her will make that a busy
hour and will do much to leave the early hours free for the
routine work of the plant.

A sample page from a first aid room daybook will give an
idea of what may happen during an average day in a plant
employing five thousand or more. Purposely, a day was
chosen in which no startling accidents occurred. Very serious
injuries are uncommon in modern plants and, while almost
anything may happen, such occurrences would make a day
anything but average. The names are, of course, fictitious.

Where a daily report is sent to the general manager, the
main office or elsewhere, a book with duplicate pages and
carbon paper permits the day's record to be used as it is for
the report, while the carbon copy remains in the book for a
permanant record and for use in writing up the patients'
individual cards.^

The daybook is planned to record all that happens during
the day: the patients seen, the treatments given, outside
visits of the nurse, unless there is a regular visiting service,
in which case convenience may require separate records and
a special daybook for the visiting work.^

^ See Chapter X, Records.

*The National Organization for Public Health Nursing has devised
an excellent system of day book and record card for visiting nursing
which is adaptable to the requirements of many industrial nurses.



THE DAY'S WORK



87



Cotton, Wool & Company
First Aid Room



Dallas Branch


Daily Report


Dec. 23rd, 191S


Time


Return


Name


No. Depl.


Disability


Disposition, Treatment, Remarks


8


12/24


J.Lee


3 Spin.


Crushed 1 f. L.


Wet boric. To Dr. Chief. Caught
in frame.




12/24


A. Brown


Mach.


Nail torn
tip th. L.


Returned to work. — Accident
at home, 6:30 a. m. 3% iodine,

dry ster.




12/24


B. Smith


6 Dye.


SI, bum top L.

foot
Burn L. eye


Moist boric. Dye slopped.




12/24


C. Coe


10 Bleach.


Flushed in dept. Wh. wine vin.












Eye specialist. Emptying drum












of caustic soda carelessly.


9


12/24


H. Hoe


14 "


Burn L. foot, si.


Water, vin. B. A. Oint.
Did not take time to put on
boots. Caustic soda.




Healed


M. May


56 Carp.


Redressing


As before. Order Dr. Chief.




Healed


N. Kay


87 Paint.


Spr. ankle


Massage, bandage. Order Dr.
Chief.


10


12/24


C.Tate


98 Office


Lac. 1 f. 1.


3% iodine, dry ster. Sharpen-
ing pencil.




~


I. Butts


6 Twist.


Hysterical


Rest in bed, taken home.
Brother had enlisted and left
for Canada to-day.




12/24


F. Fay


90 Tool


Emery, cornea, L.


Sent to eye specialist.


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