RULES OF THE Training School for Nurses OF THE WOMAN’S HOSPITAL of Philadelphia North College Avenue and Twenty-second Street North of Girard College RULES OF THE Training School for Nurses OF THE WOMAN’S HOSPITAL of Philadelphia North College Avenue and Twenty-second Street North of Girard College COMMITTEE ON TRAINING SCHOOL Mrs. Earle Mrs. Price Mrs. Mohr Rebecca White Miss M. C. Biddle Miss Irvine Mrs. Halloway Jane P, Downing Miss Laing Mrs. Taylor Mrs. Shoemaker Mrs. Shipley Physician-in-Charge of the Hospital Mary A. G. Dight, M. D. Superintendent of Nurses Miss Anna L. Petting Woman’s Hospital of Philadelphia RULES OF THE TRAINING SCHOOL FOR NURSES (Founded in 1861.) INFORMATION FOR CANDIDATES Application for admission to the School must be made to the Super- intendent of Nurses, The course of training occupies three years, two months of which is probationary, without pay. After she is received into the school each pupil receives eight dollars, cash, perjnonth, during the first year, and ten dollars per month for the second Fifty dollars of this amount is retained from the first year payments until the two years’ time of service is completed. This allow- ance enables nurses to provide themselves with uniform, books, ther- mometers, and other articles needed for their work, and is not intended as a salary, the instruction given being regarded as a proper compensation for their services. Applicants must be between twenty-one and forty years of age. They shall be intelligent women who can read and write well and who have sufficient knowledge of arithmetic to meet the requirements of the work. They shall be of good character and good habits, for which satis- factory testimonials are required. During the probationary months and previous to obtaining membership in the school, candidates must be pre- pared for examination as to scholarship. The Superintendent of Nurses shall have full power to decide as to the fitness of candidates for the work, and as to the propriety of retaining or dismissing them at the end of the probationary months. She shall also, with the approbation of the Physician-in-Charge, have the right to suspend a nurse for carelessness or misconduct, and she in conjunction with the Nurse Committee has the right to discharge a nurse, if in their judgment it is thought best. 3 4 During the probationary months candidates are boarded and lodged in the Hospital, at its expense, and have fuel, light, and their washing furnished them, but receive no allowance in money. When coming from a distance they must provide themselves with money sufficient to meet their demands until such time as they receive their allowance, viz., the end of the third month of their stay. Money for return traveling expenses, if not received into the school, and suffi- cient to purchase books, thermometer, and medicine glass, if received, will be essential. During the probation candidates are not permitted to wear the uni- form, but must wear plainly-made dresses of washing material, for use in the wards. All clothing must be plainly marked with the owner’s full name. After the probationary months, pupils are required to wear, while on duty, the dress prescribed, which is of blue and white striped Ameri- can seersucker, simply made, white apron, cap, and slip sleeves. Material for them and directions for making must be obtained from the Superin- tending Head Nurse. Candidates who prove satisfactory will be accepted as pupil nurses after signing the following ; I promise to remain years in “The Nurse Training School ” of “The Woman’s Hospital of Philadelphia,” and to observe all rules of the School. The day nurses are on duty from 6.30 A. M. to 6.30 P. M., with time off for breakfast and dinner. They have one afternoon in each week and part of alternate Sundays at their own disposal, unless emer- gency shall require their services. It is expected that nurses will assist each other in carrying out this rule. This time of recreation shall be forfeited for carelessness or misconduct, at the discretion of the Super- intending Head Nurse. The hours for night nurses are from 6.30 P. M. to 6.45 A. M., and during this time they will have a night supper. During this service they shall have the day for rest unless an emergency should require a deviation from this rule. The night nursing is continued but for short periods of time. // A vacation of weeks will be given during the years. Nurses who for any reason are obliged to ask an extension of time will be expected to make up double the time of their additional ab- sence to the Hospital in return for the inconvenience which is thus caused. Time not allowed off duty will be recorded as “ lost,” and must be made up at the end of a nurse’s time. In sickness pupils will be cared for gratuitously for a length of time dependent on the judgment of the school authorities, but the applicants should remember that only women physically able for the duties of nurs- ing should enter the Training School. All dentistry that she may require must be attended to before an applicant enters the school. THE COURSE OF TRAINING 1. Application of bandages. 2. Making of patients’ beds and changing linen. 3. Preventing and dressing bed sores and arranging positions. 4. Massage—manner of application, duration and repetition. Elec- tricity and methods of application. 5. Application of cups and leeches. 6. Fomentations, poultices, blisters, etc. 7. Dressing of bruises, sores, and wounds. 8. Administration of enemata. 9. Use of catheter. 10. Method of giving baths, partial and general; their temperature and duration, including moist air, dry air, and medicated baths. 11. Attention before, during, and after parturition. 12. Care of new-born infants. 13. Methods of ascertaining and noting pulse, temperature, and respira- tion. 14. Ventilation. 15. Disinfectants—their preparation and use. 16. Method of stopping hemorrhages. 17. What to do in emergencies and accidents. 18. Observation on the general condition of patient, with regard to appetite, skin, secretions, appearance of eruptions, chill and fever, effect of medicine and diet. 19. Fever nursing. 20. Surgical nursing, including abdominal operations. 21. Preparation of food for the sick. 5 FORM OF APPLICATION TO THE Nurse Training School of the Woman’s Hospital Please answer these questions in your own handwriting, on another paper, and send to Miss Anna L. Petting, Superintendent of Nurses, Woman’s Hospital, Philadelphia, Pa. 1. What is your name and present address? 2. What is your age ? Give the date. 3. State whether you are married or single. 4. If a widow, have you children? How many? Their ages? How are they provided for ? 5. What is your present occupation ? Why do you leave it ? 6. What is your state of health? State any defects or deficiencies. Have you had any womb trouble ? Give your height and chest 7. Have you good sight and hearing? Do you wear glasses? Why? 8. Were you educated ? In what grade of school ? To what religious denomination do you belong ? 9. Please give reference as to character, neatness, order, thoroughness, etc. Send the certificate of a physician as regards your physi- cal qualifications for work. 10. Do you intend to devote yourself to the profession of nursing? measure. 6 RULES FOR SUPERINTENDENT OF NURSES 1. The Superintendent of Nurses shall, under the direction of the Physician-in-Charge, have a supervision of the Nurse School, and shall see that the work of all nurses is properly performed, and their deportment correct; also, that all rules pertaining to their duties and conduct are carefully obeyed. 2. She shall also direct the supervising nurses of the different depart- ments in the principles and practice of nursing and ward management, aiding them in maintaining the cleanliness and good order of their wards and seeing to the proper provision of beds, bedding, furniture, and all utensils belonging thereto. 3. She shall superintend and shall daily visit the wards and linen- rooms in the Administration Building and Nurse House, and see that these several places are well conducted and kept in order, and that there is no unnecessary waste in any part of the house. 4. She shall superintend the sending out of nurses in response to out- calls, and, on their return she shall direct them in the matter of proper disinfection of themselves, and appoint them to their rooms and house duties. She shall see to sending out the valises of out-nurses and respond to the many calls from them in relation to their work. 5. She shall keep all records connected with the Nurse School, such as data concerning nurse pupils and their work, both in the Hospital and out-practice, records and receipts of nurse salaries, income from out- nurses, etc., and she shall present a monthly report of the same to the Nurse Committee. The moneys and checks received from the out-practice work shall be paid in promptly by her to the Physician-in-Charge, after a record of their receipt has been made, in order that they may be deposited without delay in the bank. 6. She shall arrange the work for the different nurses—in consulta- tion with the Physician-in-Charge—seeing that each has her proportion of the varied kinds of work. 7. She shall arrange for the nurses’ outings and appoint substitutes for those off duty—consulting with the supervising nurse in each depart- ment as to the propriety of releasing the nurse at the time. 8. She shall keep a record of the loss of time of each nurse while on duty. 9. She shall report to the Physician-in-Charge when any nurse is taken ill and appears unfit for duty. 10. She shall see that nurses observe the rules laid down for their conduct in the Nurse House, and have a supervision over their dress and general appearance. 7 8 11. She shall give such class instruction to the nurses, as may be assigned her. She shall assign ward patients to their respective places in the different wards, sending word concerning the same to the supervising nurse of the ward. She shall see to the reception of private patients and the selection of their rooms, assignment of their nurses, etc., in consultation with the Physician-in-Charge. 12. She shall, in connection with the linen-room matron, have charge of the linen-rooms connected with the different departments, and arrange for a systematic distribution of the clothing. 13. She shall, with the aid of her assistant nurses, make a list of all soiled clothing from wards and patients sent to the laundry. And she shall see that especial provision is made for the proper disinfection of clothing which requires it. Such clothing must be sent at once to the laundry and placed in proper disinfecting tubs and covered with antisep- tic solutions, kept provided. Any neglect shall be reported to the Physician-in-Charge. 14. She shall arrange for the management of visitors during visiting hours. 15. She shall on Saturday of each week make the rounds of the Hos- pital, for the purpose of collecting the weekly payments of patients’ board, of which she shall keep a careful record. All money and jewelry belonging to patients shall be consigned to the care of the Superintend- ent of Nurses, and a receipt for the same shall be given at the time of its deposit. 16. She shall keep a record of needed repairs in her department and report the same to the House Committee, and shall supervise the work- men sent to make such repairs. 17. She shall be present at all laparotomies and, when possible, at the noon surgical clinics of the Hospital, to direct the younger nurses as to their duties. 18. She shall have the personal direction of the preparation of dressings, utensils, etc., and arrangement of room for all laparotomy cases. The charge of the laparotomy room, with the provision of sup- plies, shall be consigned entirely to her. 19. She shall give as much personal supervision as possible to the nursing of the very sick cases in the Hospital, directing her assistants in the proper management of them. 20. She shall direct the supervising nurses in the different depart- ments as to the preparation of bodies for burial, and shall arrange for their removal from the Hospital. 21. She shall make a daily report of the work in the various depart- ments to the Physician-in-Charge—at the hour appointed. 22. For leave of absence from the Hospital she shall consult with the Physician-in-Charge and report to her the time of her return. RULES FOR FIRST ASSISTANT TO SUPER- INTENDENT OF NURSES The first assistant to the Superintendent of Nurses shall be prepared to represent or to act as substitute for the Superintendent of Nurses—when the latter is of necessity otherwise occupied. Her chief duties shall be in a direct supervision of the nursing throughout the house, and in giving the necessary directions concerning their work to the supervising nurses in the Surgical House, aiding them in maintaining cleanliness and good order and in doing efficient service both as nurses and teachers of pupil nurses. She shall, when possible, accompany the Physician-in-Charge in the morning rounds, and be present during the visits of staff physicians. When she is not able to be present the supervising nurse of the ward shall be responsible for all directions concerning treatment then given. She shall be directly responsible for the care of critical operative cases—giving the closest superintendence to the nurses in charge of the same. The Superintendent of Nurses and her assistant shall not both be absent from the Hospital at the same time. She shall assist the Superintendent of Nurses in the carrying out of all details pertaining to the supervision of nurses and patients, and is to be guided as to her immediate duties by the requirements of the Super- intendent of Nurses. She shall give such class instruction as may be assigned to her. She shall not leave the Hospital without permission of the Superin- tendent of Nurses. RULES FOR SECOND ASSISTANT TO SUPER- INTENDENT OF NURSES She shall be prepared to act for the Superintendent of Nurses or her first assistant when left in their places as substitute. Her chief duties shall consist in making all preparations for opera- tions done in the house, including abdominal sections. She shall be in charge of the sterilizing room,—preparing the neces- sary dressings, sterilizing instruments, etc., under the supervision of the Superintendent of Nurses; and shall be responsible for the cleanliness and neatness of operating and sterilizing rooms. 9 10 During operations she shall direct the younger nurses as to their duties and herself prepare all instruments, sutures, etc., needed, hand- ing them to the operator as required. After operations she shall see to the proper cleansing of instruments and their return to the instrument closets in good condition. Instru- ments needing repair shall be taken by her to the office of the Superin- tendent of Nurses—a list of the same being kept for reference. She shall keep an inventory of all instruments belonging to the surgical closets under her care, and see that no instruments are lost or misplaced. She shall see that all surgical dressings, bandages, antiseptics, solu- tions, etc., through the house are kept in stock. She shall be responsible for the condition of instruments used by doctors and nurses in giving ordinary treatment, during rounds, etc., on the different floors. She shall have the charge of the quizzing of night nurses from five to six on the appointed lecture days. In operations done in the private operating rooms she shall be the chief attendant. She shall not leave the Hospital without the permission of the Super- intendent of Nurses. RULES FOR SUPERVISING NURSES OF WARDS GYNAECOLOGICAL AND GENERAL WARDS MATERNITY AND CHILDREN’S WARDS 1. The Supervising Ward Nurse shall be on duty in the wards in time to see whether the nurses in her building are on duty promptly at 6.30 A. M. She shall mark as late those who are not on time, and report their names to the Superintendent of Nurses. 2. She shall see in the mornings that the nurses go systematically about their work, and that proper attention is given to the ventilation and heating of wards before the patients rise, reporting insufficient heating to the Matron at once. During winter the temperature of rooms must not fall below 68-70°. 3. She shall supervise the cleanliness and order of the rooms under her care, and give such directions as are necessary to the nurses in charge. Should any attention be required that cannot be given by a nurse, she shall report to the Superintendent of Nurses, who shall see that the matter is referred to the proper authorities. The first assistant of nurses shall discriminate in cases of emergency as to whether the Resident Interne or the Physician-in-Charge shall be called to attend the patient. 11 4- She shall supervise the distribution of the patient’s trays at meal time, directing the nurses as to serving them in a neat and orderly man- ner. She shall also see that there is sufficient food supplied—also, that there is no waste. If the food is not properly cooked, or is in any way unsuitable for the patients, or insufficient in quantity, it shall be reported to the Diet Matron by the First Assistant of Nurses. 5. The First Assistant and Supervising Ward Nurse shall make the morning rounds with the Physician-in-Charge and shall take the direc- tions for treatment and the making of new boards for the day’s work. She shall instruct nurses how to make out reports, and shall daily look over their reports, marking errors in spelling and in fact. She shall make a report of the character of the work done through the week by each nurse under her charge to the Superintendent of Nurses. 6. She shall arrange the work of the wards in such a way that one nurse, at least, shall always be in the wards to attend to physicians or visitors as they enter the room. She shall arrange for the order in which all treatment shall be given, the nurses that shall go to the rubbing room, the order in which they shall go, and the length of time they shall stay. She shall give the new nurses special lessons in anything they may under- take for the first time, and shall keep up a careful supervision of their work until they have learned to do everything well. Deficiencies must be reported in the weekly reports which shall be given to the Superin- tendent of Nurses. 7. She shall supervise personally the preparation of the patients for operations, giving careful directions to the nurses under her and seeing them fully carried out. She shall not go down to the operating room except to see the patient taken there, when the clinic nurse will take further superintendence. 8. In examinations done in the private treatment room she shall be the chief attendant. 9. She shall receive all new patients and direct the nurses as to tak- ing their “items” for record and preparing them for reception into the wards. She shall take the patient’s clothing and other articles which it is not necessary for her to keep, and shall have a book in which she enters a list of such articles before sending them to the store-room for safe keeping until the patient is discharged. She shall then obtain the articles and compare the list with the articles returned, seeing that each patient receives all her property. Money and jewelry shall be kept by the Super- intendent of Nurses, and a receipt for the same shall be given the patient. 10. The Supervising Ward Nurse shall attend the nurse lectures and see that the teaching in the wards is in accordance with them. She shall aid the Superintendent of Nurses in seeing that the nurses observe the rules for their government, in the manner of dressing and in all that per- tains to their discipline. She shall assist the Matron and Superintendent of Nurses in their attendance upon the nurses at table during meal time if necessary. 11. She shall receive visitors to patients during visiting hour and shall communicate such messages as they desire to send to patient or doctor. 12 12. She shall superintend the treatment in massage, electricity, or bandaging devolving upon each nurse until she feels assured that the nurse is competent to manage the work alone. 13. She shall distribute each week the envelopes for the weekly remittance paid by patients, which shall be collected by the Superintend- ent of Nurses on Saturdays. 14. She shall be entitled to one afternoon each week and a part of every other Sunday, unless the work of the Hospital demands her presence. When the work of the Hospital permits, a portion of each Sunday may be accorded her. 15. The hour for closing the Hospital doors is 10 P. M., and no one is expected to remain out after this time without especial arrangement with the Physician-in-Charge. This rule applies to all who are resident in the Hospital. SPECIAL RULES FOR SUPERVISING WARD NURSES MATERNITY WARDS AND CHILDREN’S WARDS The above rules applying to the supervising nurse in the general wards—apply as well to the maternity nurse and children’s nurse. The supervising nurse in maternity is expected to be present at each confinement and to give the pupil nurses such instruction as they may need in the performance of their duty. The supervising nurse in the children’s wards is governed by the same general rules as the other ward nurses. Special rules for her govern- ment will be found framed and hung in the office connected with the wards. RULES FOR SUPERVISING CLINIC NURSE 1. The Clinic Nurse and her assistant shall be on duty at 6.30 every morning. They shall first see to the ventilation and heating of the clinic rooms and to having them in perfect neatness and order for the reception of patients. 2. The clinic nurse shall unlock Clinic Hall door at 7 A. M. 3. Hot water and towels shall be placed in the different rooms, as required; batteries shall be in order for the day and all supplies provided for the opening of the clinics by 7.30 A. M. 4. The clinic nurse shall assist in the medical and surgical clinic rooms, or wherever directed by the Chief of Clinics, during the morning, getting patients ready for examination, helping them to dress and undress, cleaning instruments, bandaging, preparing solutions, waiting upon the doctors, etc. 5. When the noon clinics are in progress she shall have the patients whom the Professors are to see made ready for examination or operation. 6. She shall see that Clinic Hall is properly heated for the noon clinics, and have ready soap, nail brushes, towels, basins, and antiseptic solutions; with such instruments, sponges, and dressings as the doctor shall give her to have in readiness. 7. She shall get patients ready for examination or operation, loosening and arranging clothing, etc., and be prepared to supply the wants of the doctor in attendance upon the clinics. 8. On days when the noon clinics are held she shall make as much haste with the morning’s work as possible, in order that the clinic rooms may be in nice condition for any patients whom the Professors may wish to see before their clinics. 9. After the clinics are over she shall see that every room is put in perfect order, instruments cleaned and replaced, medicine cases and shelves set in order, soiled towels and clothing counted and carried to laundry. 10. During the afternoon she shall see to the making up of pledgets, wrapping cotton-sticks, preparing bandages and splints, and other sup- plies that may be needed. 11. She shall clean daily the cellar and see that it is kept locked, where the urine is examined. 12. She shall inspect daily the Morgue, keeping it in order, acting under the direction of the clinic doctor. 13. She shall inspect daily the water-closets in Clinic Hall; also the morgue shute, and attend to their proper disinfection. 14. The glass instrument case shall be cleaned at least once in two weeks. The locked instrument closet in the treatment room must be cleaned weekly—other closets shall be looked after daily, and needed supplies reported to the Chief of Clinics. 15. The clinic filter must be cleaned once or oftener a week and the supply of sheets, towels, etc., watched, and signs of wear reported to the Superintendent of Nurses—and she will report the same to the House Committee. 16. Battery fluid is made by the treatment room doctor. The clinic nurse must notify her when it is needed. 17. The batteries must be examined every morning; the small Faradic batteries filled on alternate mornings regularly. 18. Supplies of bandages, gauze, towels for noon clinics, shall be prepared weekly. On Mondays bi-chloride gauze shall be prepared. On Tuesdays bi-chloride towels shall be prepared. Gypsum bandages and iodoform gauze must be prepared as required. Sponges must be cleaned and kept on hand ready for use; cat-gut, both plain and chro- micized, silk, silk-worm gut, and wire shall all be prepared as required 14 under the direction of the clinic doctor. All antiseptic solutions shall be kept in full supply, the bottles being filled daily. 19. The clinic nurse shall be the chief attendant at all operations, done either at the noon clinic or in the clinic rooms during the after- noon. She shall supervise the work of the younger nurses, giving them the instruction necessary for attendance upon operations. This rule applies to house operations as well as those done on clinic patients. 20. The clinic nurse shall be responsible for the lighting of the lecture room on lecture nights and for preparing any articles needed by way of illustration. 21. The clinic nurse shall see that all persons coming to any of the clinic rooms at any time of day receive proper attention, and that they are not kept waiting. She shall see, after clinics, that all patients get their clothing, have their prescriptions filled, and understand the direc- tions that have been given them. RULES FOR NURSES General rules for the conduct and work of nurses are herewith ap- pended. Special rules for the varied kinds of work as adapted to speci- fied places, conditions, and occasions will be found put up in various places throughout the Hospital, and are expected to be frequently read and must be obeyed. 1. Rising and Retiring. Each day nurse must rise when called in the morning at SA. M. and be on duty at 6.30 A. M. She must air her bed thoroughly before dressing and make it up before leaving her room. She must hang up her night dress, towels, etc., and arrange her room, leaving it in good order. Night nurses must be in their rooms by 8.30 A. M. and must not go out without the permission of the Superintendent of Nurses. When they have permission to go out, it must not be earlier than 3P. M. when they will be called. Night nurses shall be called up by 4.45 P. M. for lectures. 2. Hours for Meals. Day nurses, breakfast 6 A, M. Night nurses, breakfast at 6.45 A. M. First lunch, 12 M. ; second lunch, 12.30 P. M. First dinner, 6 P. M. ; second dinner 6.30 P. M. The night nurses shall attend the first dinner before going to their posts. Nurses must be punctual in coming to their meals, and must not linger in the dining room after meals. No food is provided for the nurses out of the appointed time except when ordered by the House Matron. No eating is allowed in the Nurse House. 3. Lessons. Unless Hospital duties prevent, and nurses receive per- mission to be absent, they shall attend all lessons and lectures. These will be given on Monday, Tuesday, Thursday, and Saturday evenings, from 7toß P. M., by the Physician-in-Charge and her assistants. Night nurses will have their lessons on the same days from 5 to 6 P. M. During visiting hour the nurses, unless appointed to some special duty, may sit in their wards and study. 4. Sickness. When a nurse is sick or ailing she shall report to the Superintendent of Nurses, who will refer her case to the Physician-in Charge, when she will be' prescribed for if necessary. Nurses will not be allowed to obtain medicines from the drug stores for their own use, unless by permission of the Physician-in-Charge. 5. Recreation. When the work of the Hospital will permit, each day nurse will have one afternoon in the week for recreation; also a part of every other Sunday. 6. Neatness. Nurses are expected to keep themselves neat and clean, paying special attention to hair, nails, and breath. All nurses on duty in any department shall wear cotton dresses of regulation uniform, without trains or crinoline, also white aprons, caps, and sleeves. They shall change their dresses once a week or as often as neatness may require. 7. Shoes. They shall wear soft shoes that do not creak. Felt slip- pers or knit bed-room shoes shall always be worn at night. 8. Marking of Clothing. The nurses must have each of their garments marked with their names in full. The Superintendent of Nurses shall see that this rule is carried out. 9. Laundry Work. No clothing that goes to the Hospital laundry can be ruffled, tucked, or flounced. The number of garments for each nurse must not exceed 18 per week. 10. Distribution of Clothing. The Superintendent of Nurses will appoint a day when the nurses may come to her for their clothing, or, if she has sufficient help, she can see to its distribution in the nurse- rooms. 11. Change of Bed Linen. On Saturday morning the bed linen is changed in the Nurse Dormitories by a nurse appointed by the Superin- tendent of Nurses. 12. Soiled Clothes. Soiled clothes shall be put in a bag provided for the purpose. Soiled napkins should be washed out and put on the grass back of the maternity building to dry, or may be hung on lines there before they are sent to the wash. The soiled clothing of the nurses shall be ready for the wash by Tuesday morning of each week. 13. Bath Rooms. The bath rooms shall be kept in good condition; no soiled clothing, etc., hung there. The closets must be kept flushed. 14. Care of Nurse House. Nurses shall be held responsible for the neatness of their rooms. A nurse shall be appointed by the Superin- tendent of Nurses daily to attend to the necessary sweeping and dusting. 15. Sitting Rooms. It is advised that the nurses sit in their rooms as little as possible in the evenings, as the air becomes vitiated by the gas. Studying can be done in the nurse sitting-room or in the lecture room, where also the nurses may practice bandaging on the figure whenever they have leisure. 16. Evening Outings. Nurses having permission to go out in the evening must be back by p.jo so that they can be in bed by 10 o' clock. The early hour for rising makes it necessary to have an early hour for 16 retiring. Nurses not in on time must be reported by the night nurse on duty as door attendant. The night nurse acting as door attendant shall report all persons entering the Hospital after 10 P. M., the following morning, to the Superintendent of Nurses. 17. Lights must be put out promptly at 10 P. M. Nurses neglect- ing to do so shall be reported by the night nurses on duty in the main building. 18. Maternity Rules. When placed on duty in the Maternity Wards the nurses shall be transferred to the Maternity Building, occupy- ing the rooms on the third floor when on day duty and those in the attic when on night duty. 19. Conduct, The nurses must avoid all loud talking and laughing even when off duty. Gentleness, kindness, and politeness toward all are strictly enjoined. Personal remarks and criticisms are forbidden, espe- cially with regard to patients. No forebodings are to be expressed—no comparisons with or descriptions of other cases. 20. Protection from Damp. In cold or rainy weather the nurses must protect themselves by wearing water-proofs, etc., in coming over from the nurse-house. A place is provided for umbrellas and wraps in the bath room on first floor Maternity Building. 21. Out-Nurses, while in the house, shall have their rooms and duties assigned to them by the Superintendent of Nurses, to whom they shall report on first coming in. When on night duty they shall occupy the beds provided for the night nurses. 22. Out-Nurses coming from contagious cases must not go over to the nurse-house before reporting to the Superintendent of Nurses, who shall direct them as to disinfecting their clothing and persons, before going on duty. A place is provided in the out-nurse-house for the dis- infecting bath and the disinfecting of clothing. 23. Out-Nurses shall respond promptly in response to calls, having everything in readiness to leave within fifteen minutes after notification. They shall take with them to their cases a thermometer, a catheter, a medicine glass, a hypodermic case, their letter of appointment, and blanks for keeping records of their cases. These reports shall be brought in by them for the inspection of the Superintendent of Nurses. Their letters of appointment with the payment made for their services shall be returned to the Physician-in-Charge. The nurse uniform shall be worn in full at all out-nursing. 24. Penalty. Any nurse forgetting or violating any of the above rules shall be reported to the Superintendent of Nurses and will forfeit her next afternoon off duty, or have to pay such other penalty as is deemed suitable in her case.