Function of the Agency
It is the function of the Visiting Nurse Service to give skilled nursing care in the homes and instruction in personal hygiene, sanitation, and the prevention of diseases; also as far as possible, to solve the related social and economic problems that are met in the families under its care either by using the resources of the organization or referring the problems to the proper cooperative agencies.
The maternity service includes prenatal care, postnatal care, and instructions. A 24-hour delivery service is carried on in one area of the city. In addition to the preventative work in the field, health conferences for mothers and babies are conducted in most of the centers.
Cooperation
The Visiting Nurse Service arranges for convalescent care for a large number of cases a year either though other agencies or in the country homes maintained by the Settlement.
It is hoped that the nursing staff will consider themselves as occupying positions of unusual opportunity for promoting the social as well as the physical welfare of their patients. They are expected to report bad housing conditions, violations of compulsory school or child labor laws, etc., and in all ways to regard themselves as serving the family and community as a whole, as well as the individual patient.
New Calls
New calls must reach the District Office before 8:45 a.m. to be visited the same morning; and before 1:30 p.m. to be visited the same afternoon. A nurse is sent in response to every new call, but care continued only when a physician is in attendance.
The nurse is expected to communicate with the doctor in attendance regarding each patient and must strictly observe professional etiquette. A nurse never prescribes for a patient.
Substitute Visits
Field nurses are instructed to inform patients of their expected day off duty, in order to prepare the way for the substitute nurse. Before the field nurse goes off duty, a list of substitute visits to be made is left on a special sheet provided for that purpose.
Procedure in the Field
In visiting all cases, the nurse observes the ordinary rules of courtesy. On the first visit she introduces herself professionally and by name. After finding a suitable place for the bag, coat, and hat, she determines what care the patient requires and learns whether the physician has left written orders or not.
The cuffs are removed and uniform sleeves rolled well above the elbows. After opening the bag and removing the green soap and one paper napkin which is placed on a table or chair, protected by newspaper, the nurse washes her hands and then removes other necessary articles from the bag, arranging them on the paper napkin...
General Care of Patient
The aim of each visiting nurse should be to teach the family to meet its individual needs as far as possible, and to give careful instruction and supervision. Full general care includes the care of the mouth, nails, and hair, and remaking of the bed.
In order that the patient may have the necessary care during the nurse's absence, leave very definite, simple instructions with a responsible member of the family. A written schedule for nourishment, medication, or other treatment to be given between nursing visits is often helpful to the family.
Record of Work in the Home
The record of work is not done until the care has been given to the patient. In order to avoid asking direct questions, it is desirable that as much information be obtained through conversation with the patient and family during the nursing visits as possible. Tact and resourcefulness should be exercised in securing necessary data.
Charge Basis
The cost of the nursing visit is based on the actual cost. Each patient is expected to pay as possible.
Salaries
Field Directors...$2,250 to $2,400/year
Supervisors...$1,900 to 2,000/year
Assistant Supervisors...$1,700 to $1,800 per year
Field Nurses: On admission to staff, $1,400; at the end of 6 months, $1500; and at the beginning of the 2nd year, $1,600/year.
Nurses who have had a 4-month postgraduate course in Public Health at a recognized school or college: $1,500/year
Nurses who have had an 8-month postgraduate course in Public Health would enter at $1,600/year
Graduate nurses who have satisfactorily completed a 4-month undergraduate course with an accredited VNA will be admitted at $1,400 and after the second month receive $1,500/year.
Nursing by Appointment
This special service is offered to those persons requiring skilled care but not needing the full time of a private nurse. Many families wish to pay for this skilled care, but are unable to bear the expense of a full day's service. An effort is made to send the nurse as nearly as possible at the time desired.
To cover the expense of this time adjustment it is necessary to charge $2.00 for the first hour or fraction thereof and 50 cents for each additional 20 minutes.
Vacations
Nurses completing 11 months of service have 1 month's vacation with salary, and 1 month in each full year thereafter. Two week's vacation may be had at the end of 6 months service, when the nurse plans to remain with the organization 1 year.
Telephones
Each nurse is required to have a telephone in her home and to immediately notify the main office and her supervisor of any change of address or phone number.
The above excerpts were originally published in the Bulletin of Instruction, Visiting Nurse Service-Administered by Henry Street Settlement (1921, Rev. 1928)
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