Team Nursing in the 1970's

The purpose of this article is two-folded.

1. It provides an historical and personal account into team nursing practiced at St Vincent’s Hospital Darlinghurst, Sydney - New South Wales (Australia) - during the late 1970’s.

2. It highlights the roles and responsibilities of their student general nurses during the three-year journey to becoming a registered general nurse (RN) within a hospital based training system.

Introduction

After successfully completing three months training at the Preliminary Training School (PTS), adjacent to St Vincent’s Hospital, student nurses worked an eight-hour rotating shift, which included night shift, on the wards with a patient load. After eight weeks they were moved to another ward or speciality area, on site or off site, for more practical experience.

At the time, the on site facilities of the hospital comprised of the "New Wing" and the "Old Wing", as they were known then and the Cameron Wing. Off site facilities included Caritas at Darlinghurst – a psychiatric unit, Babworth House at Darling Point - an after care unit and St Margarets Woman’s and Children’s Hospital at Surry Hills.

Student nurses underwent yearly hospital examinations to obtain a higher rank. The number of rank buttons worn on their uniforms signified their rank. First year wore no rank buttons, second year two rank buttons and third year three rank buttons.

At the completion of three years practical experience and study, student nurses undertook State Board Examinations and if successful, became Registered General Nurses within the State of New South Wales.

Team Nursing

A ward in the new wing comprised of 36 patients, with 18 patients either side of the central nurses station. On a good day, each side had a team of three student nurses of all ranks, with each nurse being allocated 6 patients.

During the morning shift, the two teams were under the control of the Charge Nurse and up to two registered nurses. The afternoon and night shifts were under the control of up to two Registered nurses, but on occasions senior student nurses could find themselves in charge of a ward during night shift. In that case IV medications and fluid replacement had to be attended to by the night shift nursing supervisor. Note: Only medical officers and pathology technicians performed cannulations and the taking of bloods.

Student nurses within a team worked together to complete day-to-day tasks, with junior nurses relying heavily on the more experienced second and third year student nurses to complete certain tasks. The two teams also worked together, where possible.

They were also required to perform the duties of other nurses in their team, while that team member was away or performing duties elsewhere. One such case would be if the student was handing out medications for the team.

This form of team nursing occurred in other wards, no matter what wing the nurses were in.

Roles and Responsibilities of Student Nurses

This table reflects not all but the majority of the growing roles and responsibilities of student nurses as they obtained first, second and third year ranks. From day one senior staff and nurse educator’s performed face to face and indirect supervision of the student nurses, but as they progressed through the ranks this type of supervision was only required if senior student nurses were not able to assist their junior partners.

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PTS Student General Nurse

Same duties as first year nurse but with more supervision No rank button

First Year Student General Nurse

No rank button Observations Feeding patients Stable patients Nursing care plans Personal hygiene Pressure care Simple dressings Making up beds Inserting indwelling urinary catheters Cleaning Eye dressings Physiotherapy Nursing notes Knowing patient's provisional diagnosis by heart

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Second Year Student General Nurse

Two rank buttons All the duties of a first year nurse Liaise with medical doctors, charge nurse and after hours nursing supervisor in the absence of an RN Supervision of first year nurses Serious patients Operating room – instruments Inserting indwelling urinary catheters without supervision Complex dressings In charge of ward if RN not present ECG’s Eye dressings Speciality wards – intensive care Oral medications for the team or ward Ward shift supervisor

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Third Year Student General Nurse & Student Graduate Nurse

Three rank buttons All the duties of a second year nurse Serious patients Supervision of first and second Year Nurses In charge of ward if RN not present On successful completion of the NSW Nursing Registration Board Exams, the nurse was awarded the title of Student Graduate Nurse This allowed them to perform all the duties of a registered nurse under supervision To signify the rank they wore the hospital registration badge as well as the three rank buttons

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What all student general nurses hoped to achieve at the completion of three years hard work at St Vincent's Hospital, Sydney.

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To be continued...