DISCIPLINE AND DUTIES

As regards medical and sanitary matters and work in connection with the sick, the matrons, sisters, and staff nurses are to be regarded as having authority in and about military hospitals next after the officers of the Royal Army Medical Corps, and are at all times to be obeyed accordingly, and to receive the respect due to their position.

A roster of members of Queen Alexandra's Imperial Military Nursing Service will be kept at the War Office, and, as a general rule, those who have been longest at home will be the first to proceed abroad.
Every matron, sister, and staff nurse will be provided with the following books:

Regulations for the Army Medical Service
Manual for the Royal Army Medical Corps
Standing Orders for the Royal Army Medical Corps and Queen Alexandra's Imperial Military Nursing Service.

On becoming non-effective she will hand these books over to the officer in charge of the hospital, who will forward them to the Principal Medical Officer for disposal.


MATRON-IN-CHIEF
The matron-in-chief will be responsible for keeping the service records and confidential reports of matrons, sisters and staff nurses.

She will, by frequent inspections, keep herself acquainted with the administration of the nursing service in the various hospitals.

She will submit to the nursing board recommendations for the appointment, promotion, distribution, retirement, and dismissal of members of the service, and will carry out such measures as have been approved.

She will be responsible for maintaining a sufficient special staff for duty in cases of emergency, or for service in smaller hospitals.

She will present every year to the nursing board a scheme for the annual leave of matrons, and shall report to the board the arrangements made by matrons for the annual leave of sisters and staff nurses.

She will perform such other duties as may be from time to time determined by the nursing board.


MATRONS
The matron will be responsible for the general nursing arrangements of the hospital, for the due performance of their duties by sisters and staff nurses, and for the maintenance of good conduct, efficiency, and discipline amongst all members of the nursing and domestic staff, as well as for the cleanliness and good order of the wards under their charge.

She will, in conjunction with the officer in charge of the hospital, furnish an annual report upon these matters to the Nursing Board, which will be submitted by the officer in charge at the same time as his annual return (Army Form A.33). She will not be responsible for nursing in wards which are set apart by the officer in charge of the hospital for cases which he may consider unsuitable for female nursing.

She will supervise the non-commissioned officers and orderlies of the nursing section of the Royal Army Medical Corps in nursing duties.

A register of training of orderlies (see Army Book 300) will be prepared by the matron, and after the officer in charge has recorded his concurrence or otherwise, will be kept with the man’s other documents.

She will take over from the quartermaster or steward the equipment shown on the ward inventories in wards nurse by Queen Alexandra's Imperial Military Nursing Service, and will be responsible for the same to the quartermaster, or to the officer in charge if there is no quartermaster.

She will take over from the steward the regulated quantity of bedding for each ward nursed by the Queen Alexandra's Imperial Military Nursing Service, and will keep a bedding book (Army Book 54), in which all bedding drawn from or returned to the store will be accounted for. All transactions must be entered and signed in this book as they occur, and she will be responsible for the balance of bedding shown therein.

She will make arrangements for the annual leave of sisters and staff nurses reporting thereon through the officer in charge to the matron-in-chief.

In all instances of difficulty she will apply to the officer in charge, who will render her every assistance in the performance of her responsible duties.

When she is informed of any neglect of duty or impropriety of conduct, whether on the part of sisters, staff nurses, non-commissioned officers or men of the Royal Army Medical Corps, patients, or visitors, she will at once report it to the officer in charge.

Applications from matrons and sisters desirous of attending recognized civil hospitals will be submitted to the officer in charge for transmission to the War Office.

The senior matron at a station will be charged with the general supervision of the nursing arrangements of the military families’ hospitals, and will inspect them quarterly, and furnish reports of her inspection through the officer in charge to the War Office.

When a sister or staff nurse is transferred from one hospital to another, the matron will prepare a confidential report for transmission, through the officer in charge, to the War Office. On, or as soon as possible after, the 1st January, a similar confidential report will be forwarded on all sisters and nurses, through the officer in charge, to the War Office. The conditions laid down in the King’s Regulations for similar reports on officers will be complied with.


SISTERS
Every sister in a military hospital will be under the immediate supervision of the matron, and directly responsible to her in all matters relating to conduct and discipline.

She will receive and carry out such orders and instructions relative to the treatment of the sick as she may receive from the officer in charge of her wards, whom she will accompany in his visits. She will be responsible for the nursing of the patients in her wards, and for the cleanliness, ventilation, lighting, warming, as well as good order of her wards and annexes.

*Before going off duty each sister is required to put in writing in the night memorandum book any notes on special cases, or other important matters which may be necessary for the guidance of the night staff nurses and orderlies, or which it may be desirable to bring to the notice of the night sister. The night sister will see that these instructions are carefully carried out, and will record the hours of her visits to each ward, noting in the night memorandum book any information she may wish to bring to notice.

Sisters will be detailed in rotation for duty as night sister for a period of not less than two or three months, as the matron may decide. When only one sister or staff nurse is on night duty, she may be detailed for one month. A night sister will report herself to the matron to receive instructions; she will visit the wards frequently during the night, and on coming off duty, she will report to the matron on the condition of the patients.
 
*In cases of fresh admissions into her ward she will ascertain when the patients last had food, and see that they are not kept waiting for suitable nourishment.

When a death takes place the sister in charge of the ward will see that the body is reverently prepared for the mortuary, and will then inform the senior non-commissioned officer, who will proceed in accordance with Standing Orders, Royal Army Medical Corps.

She will cause to be drawn from the steward the personal equipment required for each patient on admission, and will be responsible that it is returned into store on the patient’s discharge or death. A list of these articles is given in Standing Orders for the Royal Army Medical Corps.

When a patient is able, she will obtain his signature on the counterfoil of Army Book 42, as an acknowledgement of having received these articles, but when he is so ill as to be unable to look after his equipment, she will cause the ward orderly to endorse the book.

When a patient is too ill to look after his regimental clothing, the sister will cause the articles to be handed into the pack store with the clothing, and will countersign the cheque from Army Book 182.

When any case of illness or accident is brought to hospital, or in the event of any accident, emergent illness, or attempted suicide resulting in personal injury, occurring in the hospital, she will cause the medical officer to be at once informed, and, pending his arrival, will take such steps within the limits of her training as may appear to her to be necessary to meet the requirements of the case.

She will be responsible that patients who have been allowed up throughout the day are in bed by 8 p.m.

She will see that the discharged men leave her wards in sufficient time to be present at their parade.

She will visit her wards at meal times and see that the diets are properly distributed and served, and that the patients conduct themselves in an orderly manner. She will communicate any irregularity to the orderly officer.

The sister will daily receive from the steward the wines, spirits or malt liquor ordered for the patients in her wards, and be responsible for their correct distribution, in accordance with the orders of the officers.

When the daily diets and extras have been entered on the diet sheets by the officer, she will complete and sign the Diet and Extra Sheet Summary (Army Form F.734). She will then check and countersign these forms and transmit them to the steward.

She will immediately report to the officer in charge, or to the quartermaster, in a hospital in which one is doing duty, all damages or deficiencies, as well as breakages of crockery or table glass.

She will at once notify any damage to library books to the quartermaster, or the officer in charge of a hospital in which no quartermaster is doing duty.

She will submit all applications from patients for writing materials, tobacco, etc., to the officer in charge of the ward for approval, and will arrange for such indents and for letters to be sent to the officer in charge of the hospital for disposal. Indents will be made on Army Book 38.

She will be careful that money, articles of food and drink, books, tracts, pictures, or articles of equipment are not introduced into the wards without the previous sanction of the officer in charge.

If a sister deems a special nurse or orderly necessary, she must immediately report the fact to the matron. At night, the night sister will act for the matron, mentioning full particulars in the report.

A sister is prohibited from utilizing the services of nursing orderlies for any but nursing and routine ward work. She will be held responsible for carrying out the prescribed courses of nurse-training, and will, by every means in her power, afford the orderlies ample opportunity for learning their duties, and endeavour to awaken their interest in all that pertains to nursing.


STAFF NURSES
A staff nurse will obey the orders which she receives from the matron or sisters, and in the absence of a sister from a ward, the senior staff nurse present will be held responsible for the performance of the duties ordinarily performed by a sister.

*These paragraphs also apply to staff nurses.


These regulations, updated in 1916 were originally set down between 1902 and 1904. It might be of interest to read the original section under the heading ‘Staff Nurses’ which was later dramatically shortened and re-written to suit the needs of the rather different wartime service mainly composed of temporary staff.


STAFF NURSES (1904)
In the absence of a sister from a ward, whether temporarily or permanently, the senior staff nurse present will be held responsible for the performance of the duties ordinarily performed by a sister.

Staff nurses shall obey those orders which they receive from the Matron or sisters.

They must scrupulously refrain from relegating an unfair share of routine ward work to the orderlies, remembering that they are there to be taught nursing, as well as to learn other practical duties, and to assist in the general work.

Staff Nurses must take a full share in duties which are necessary, however unpleasant, and must set an example of cheerful alacrity in attending to the patient’s wants, treating every patient with gentleness and consideration.
Staff nurses must pay constant attention to the personal cleanliness of patients.

When in doubt or difficulty, staff nurses will refer to the sister in charge of their ward, and will abide by her decision.

Staff nurses are not to go into each other’s rooms after 10.30 p.m. Their bedrooms are to be neat and tidy, and all lights are to be extinguished therein by 11 p.m., unless special permission be given.


[1] The National Archives, WO32/6404, updated in 1916
[2] Regulations for the Army Medical Service, The National Archives, WO279/551