Expanding the military nursing workforce

Context

It was clear from the start of the Boer War there would not be enough nurses to support the force being deployed. The expansion of the nursing reserve force to meet the requirements of the Boer War fell to a committee with representation from the Army Nursing Reserve, the St John Ambulance Association, the National Society for Aid to the Sick and Wounded in War, and the Army Medical Department. This committee became the Central British Red Cross Committee under the chairmanship of Lord Wantage. When the committee first met to discuss plans it was reported that they were inundated with applications from ladies who desired to volunteer for the service, although they only accepted those who were highly qualified. This committee sent out a number of hospitals, ships and trains and were responsible for recruiting the staff, although they came under War Office control on deployment.

The major nursing journals of the period supported the expansion of the military nursing workforce and campaigned for the authorities to take more nurses, and to select those who were qualified. There were debates in the press about what constituted a suitable qualification, and about the need for social standing. Stone described the tension between medical officers and Ladies who had a higher standing in society, and saw this as contributing to tensions reported in the media. However, my research did not support this, so whilst there may have been a perception of nurses with a higher social standing than the doctors, those nurses for whom social class is known were very largely middle class.

When the committee was challenged in the nursing press that nurses were being recruited who were not suitable, Lord Wantage stated that those selected for the Princess Christian’s Army Nursing Service (Reserve) (PCANSR) had references, and had certificates indicating they had undertaken a three year course in recognised hospitals. Those employed locally did not go through the same process. The references Lord Wantage had referred to were those of character rather than nursing abilities, and were usually sought from a medical or managerial person rather than nurses. Sydney Holland from the London Hospital sent this reference to the War Department on behalf of Sister Ethel Hope Becher:

From: London Hospital Whitechapel

Dated: December 12, 1899

I can with the utmost confidence recommend Miss Ethel Hope Becher for the post of Sister or Sister Superintendent for the Army Nursing Reserve.

Miss Becher was received as a Probationer in this Hospital on July 10th, 1893, and holds our Certificate of training. She was sister in one of the Medical Wards of our Senior Physician, Dr. Stephen Mackenzie, and was subsequently transferred to the still heavier charge of a large set of surgical and Accident Wards, containing 63 beds.

Miss Becher is an excellent Surgical and Medical Nurse, and an admirable Ward manager. She has an inspiring influence on her subordinates, and whilst maintaining good discipline, is much liked by those who serve under her.

Miss Becher has been a valued member of our Nursing Staff for about six and a half years. Her technical qualifications are beyond dispute, and she is well fitted in every respect for the work she desired to undertake. I feel confident that those who secure the nursing services of Miss Becher are much to be congratulated.

The nursing press commented frequently on the recruitment process and the lack of nursing oversight:

We learn upon, good authority, that young Mr. Fripp, assistant surgeon at Guy’s, acted practically as nursing adviser to the Ladies’ Yeomanry Hospital Committee, so that the selection of two ladies holding one years’ certificates from that school, as Matron and Night Sister, instead of women holding three years’ certificates of efficiency, need not surprise the nursing world.

A letter published a month later echoed these sentiments:

It is with amazement and incredulity that I hear a rumour that the head of our Edinburgh South African Hospital is to be a lady who has been for upwards of eight years matron of an incurable hospital in Edinburgh, and before that held the same position in a similar, but smaller, institution in Perth, and who, besides being so long out of actual nursing, is neither an Edinburgh nurse, nor holds a three-years’ certificate from any recognised training school, which in these days is so all important.

My research showed many of the nurses were young and inexperienced, and in being thinly spread they may not have had the robust nursing management structures they needed. This may have been brought about by the lack of nursing oversight in the expansion of the Army Nursing Reserve, and also in the employment of nurses locally in South Africa. Those nurses who made their own way to South Africa, like Florence Suttaby, then approached the local Principal Medical Officer who would take them on the strength of one of the hospitals. Although some nurses may have brought their certificate and references with them they would not have been looked at by any senior nurses before any offer of employment was made.

The idea behind asking for character references was that the Army perceived that the nurses should be of a certain class and definitely not working class as had been the case previously. Stone discussed the outcry that met the recruitment of working class women when the reserve was expanded, and that may indeed have been the perception. My research, however, did not show that to be the case. After the comments in the nursing press the rules for the recruitment of nurses were modified, although without advice from the senior civil nurses who were expected to give up staff for the reserve. After these changes, candidates needed testimonials from two medical officers as to their skills, and one from their Matron as to their tact, temper and ability. Nothing was sent from the Army Nursing Reserve Committee to the military superintendents of nursing asking for their view on the nursing qualifications of aspirants. To the nursing profession it seemed that recommendations from people of social position mattered more than the views of those who understood nursing and nursing qualifications.