As any nurse who worked in the hospitals of yesteryear will tell you, the big event of the day was the ward round, presided over by consultants who often demanded to be treated like gods.
To speed up his round, one gynaecologist insisted that all patients on his ward had to be waiting on top of their beds with their underwear off and covered with a blanket which could be whipped off should the need to examine them arise.
On another female surgical ward, the head man required an unfortunate student nurse to dance attendance upon him, holding a hot water bottle on her outstretched hands so he could warm his own hands before examining a patient.
These days, hospitals are all about team work rather than hierarchy and ward rounds are unlikely to be treated so grandly.
But they were still very much a feature of life when my mother trained in the 1950s and I in the 1980s, both at St Bartholomew’s Hospital in London.
I qualified in 1983 and, after two decades working as a health journalist, briefly returned to nursing, working at a district hospital in Oxfordshire, by which time there had been huge changes in the profession.
Today it is degree-based, with new recruits needing to have three A-levels, to meet the demands of what is now a complex job. I came in at the tail-end of an era in which entry requirements could be fairly bizarre.
They ranged from the quality of your needlework to references from a reverend, with St Thomas’s Hospital in London demanding at one time that the latter should be supplied by no less than three different ministers of religion.
Some nursing schools required you to send in a photo of yourself while others asked for details of your father’s occupation and there is no doubt that my family heritage helped Bart’s overlook my lack of a maths O-level.
The emphasis then was on doing rather than thinking, as reflected in my forthcoming book about the rituals which provided security and comfort for both patients and staff and were, some argue, part of the healing process.
Fortunately, some of the more bizarre rituals have been done away with and today’s nurses question any practice that is not based on scientific evidence.
My research included interviews with former nurses such as Linda who described the preparation for the ward rounds at the Manchester Royal Infirmary in the 1960s.
‘The ward must be tidy, beds made, wheels turned in, curtains back and all patients sitting up in bed, preferably at the same angle.
‘I think that it would have been acceptable to have run around with a feather duster flicking any sign of dust or imperfections from each patient prior to the Great Man’s Arrival.’
The typical ‘Nightingale’ ward contained 24 beds. Once the white-coated entourage had reached No 19, the sister nodded to a junior nurse to put the kettle on, deploying her best china to entertain the consultant to a cup of tea in her office.
Heaven knows how the conversation went following the embarrassing incident witnessed by a nurse named Anne.
‘The ward round set off and, horrors, Sister’s dress was caught in her knickers. Everyone froze.
‘Discreetly, the consultant drew her behind the curtains, advised her of the delicate matter and she emerged red-faced, smoothing her dress. Order was restored.’
By the time consultants made their rounds, patients had often been awake for many hours, with beleaguered night staff rushing to get them washed before the day shift arrived.
Often the wards were still in darkness and staff were unable to see what they were doing.
One junior nurse arrived on a day-shift one morning to find that all the patients sitting up in bed on her ward had been washed but put in shrouds instead of hospital gowns.
Giving a bed-bath was one of the first procedures learned by students. Among the first intake to be trained in the new NHS, Mary was assigned to a medical ward where most of the patients were young men.
‘They were saucy as young men are,’ she said. ‘They used to ping our suspenders!’
Fortunately, the ward sister had advice for reducing what were described to Mary as any ‘tent poles’ that might occur during bed-baths. Apparently, a dab of surgical spirit applied with some cotton wool soon dampened the ardour.
At one time a tiny tablet of soap, toothbrush and toothpaste were provided for those who didn’t own such things or came into hospital as an emergency. Some departments even had washing machines and nurses would do the laundry for patients.
‘I loved being able to wash their clothing, especially when they didn’t have relatives to help,’ remembered one nurse. ‘Once I was asked to wash a homeless man’s sleeping bag. It took five washes to get it totally clean, but he was so chuffed with it.’
Another part of the job was making snacks for patients who couldn’t face hospital food. On my first ward — male medical — I found myself being asked to cook scrambled eggs for the men in our care.
This tested my basic culinary skills to the limit, but others were better equipped for the task.
A former Bart’s nurse described how, when they decamped to a hospital in Hertfordshire during the war, a colleague skilfully prepared breakfast for a whole ward of patients on a single Bunsen burner.
She would call out, ‘boiled, fried or poached’, and we would put in the patient’s order and she would produce a perfectly cooked egg.’
Bed-making could be an equally demanding affair.
At St Thomas’s, one nursing sister carried a set square to check that the hospital corners were at precisely 45 degrees. When a student muttered that it was impossible to get them so exact, she was marched to a bed and guided through making it to show that it was perfectly possible — much to the amusement of the surrounding patients.
The job of keeping the ward clean and tidy also fell to the nurses.
One textbook, published in 1949, devoted 12 chapters to hygiene, one describing how a ward should be cleaned — ‘all the beds pulled out from the wall and the dust swept towards the door, keeping the broom low so as to prevent the dust from flying about’.
There was even advice on flowers: vases needed to be washed daily and filled with clean water and the blooms freshly arranged each morning. Nowadays, of course, flowers are generally banned from hospital wards, although it’s not quite clear what infection risk they pose.
Another daily routine saw nurses going round with the ubiquitous trolleys and a bowl of warm water to clean all the lockers, and wash the ashtrays, standard issue at one time.
This was a chance to chat with patients — something not encouraged unless you were also completing a task.
One nurse, Rosie, used to listen to one old chap’s war stories and happily took the Brazil nuts he offered her from the bag in his locker until his daughter arrived one day carrying a box of Callard & Bowser Chocolate Brazil nuts, at which point Rosie felt slightly queasy.
The daughter glanced at her: ‘You’ve not been eating those, nurse?’ Rosie said she had.
‘Oh Dad,’ said the daughter. ‘I’ve told you not to suck the chocolate off the nuts — it’s a nasty habit.’
Cleanliness was all part of the good order which made running a ward easier, as was the military-style obedience reflected in the smart uniforms we sported in those days before scrubs — the more functional clothing worn today by nurses. These can leave patients unsure who they are talking to, although confusion did sometimes occur in the old days.
It was possible at Bart’s to mistake the visiting barber for a doctor, as he, too, wore a white coat, his job to provide those shaves for the men that were too embarrassing for female nurses to perform.
Hats, for many decades emblematic of nursing, covered the hair and prevented the transmission of bacteria from patient to patient.
But they also had an illicit purpose, described by Linda from the Manchester Royal Infirmary.
‘At morning tea, we had 15 minutes to walk to the dining room — no running allowed — down tea/coffee and biscuits and most importantly have at least three puffs of a cigarette. There was no time to finish it so we cut off the end neatly with scissors and placed it in the front fold of our cap for safe keeping.’
By the end of the 20th century, hats were no longer part of the uniform. Discarded with great reluctance by many, they went the same way as the removable white cuffs which had to be worn when addressing doctors, or officially speaking to Sister (I’m not sure there was any unofficial speaking to Sister).
Ruby, who nursed children with infectious diseases, explained how Matron’s ward round halted the rinsing out of nappies in the cleaning room known as ‘the sluice’.
‘You had to remove your rubber gloves, roll down your sleeves, pull the cuff frills on and stand by the sluice door until Matron had gone past. Then off with the cuffs, up with the sleeves and back on with the rubber gloves.’
Alongside Matron, one of the scariest characters in the hospital hierarchy was the night sister. She had a habit of appearing in the early hours, silent as a cat, and catching you out in a range of misdemeanours, including the wearing of cardigans and the sipping of hot drinks, both deemed ‘unprofessional’ even during long nights spent on often cold wards.
Those wilier than me scattered a little sugar or cereal near the ward doors so that the crunching underfoot would warn of her approach. This gave them time to hide their cups within the top drawer of the desk at the nurse’s station.
But one sister I worked with was familiar with this routine and purposefully slammed the drawer shut. Not easy explaining the spilt contents and ruined paperwork to the ward sister in the morning.
Nights were often an opportunity to chat with a patient over a cup of tea and hear their worries. Such conversations often straddled the bewitching hour of 3am which, science has shown, is when humans are at their lowest ebb.
It’s certainly one of the commonest times for deaths on a ward. While many people fear the embarrassment of having a heart attack during sex, it’s far more usual to succumb on the toilet.
As an 18-year-old, I was horrified to learn that this had been the undignified fate of a man I had been looking after, but my friend Liz had a worse experience.
Three weeks into her first ward, she realised that a patient had died on the loo and fallen forward with his head pressed against the door so she couldn’t open it.
A house officer had to climb over the top of the cubicle and move the patient. ‘We then had to put him in a wheelchair and wheel him through the ward, talking to him as if he were still alive,’ Liz told me.
It fell to Liz and another student to lay out the body, after following the then customary practice of leaving it for an hour, with a window in the room opened, to allow the spirit or soul to leave.
Of course, such traditions might be seen as anachronistic, just like the wearing of hats, cuffs and other adornments, including the blue-bordered badges that signified that you were a State Registered Nurse. Those badges were done away with the year that I qualified.
We became, simply, Registered Nurses and nursing started to move away from the sentimentality of the past. I welcome the modernisation of a complex profession, but I still would have quite liked one of those badges!