The Work of a Small Hospital (1969)
Maggie J McDonald
The location of a small General Hospital depends very much on the activity therein. Roodlands General Hospital is situated in the Royal Burgh of Haddington, East Lothian. Before the National Health Service in 1948, it was an infectious diseases Hospital. Patients are admitted from a wide area, from Prestonpans around the coast to south of Eyemouth and inland to the Lammermuir Hills, the boundary being Tranent, though emergency admissions arrive via the Bed Bureau, from Dalkeith, Pathhead and Musselburgh, which are all places outwith our area, and does, I may add, cause inconvenience and expense to relatives who have to visit from such a distance away.
The A1 main road from Edinburgh and London passes near the Hospital and this necessitates a well equipped and staffed outpatients and Casualty department to cope with the influx of casualties.
Nearby are a few factories which appear to have a number of accidents and likewise the local schools keep the department busy on sports’ days and Saturdays – playing rugby football and cricket etc. etc.
Being near the seaside, during the holiday period, many visitors are treated with badly cut feet, the result of broken glass in the sands and the many fractured ankles and wrists from accidents with people walking along the slippery rocks and climbing the crags around the coast.
There are four Surgical Clinics, three Medical Clinics and one Gynae Clinic weekly. One diabetic and dietetic Clinic is held monthly.
The visiting physician for this Clinic brings his own dietician with him. There are one and sometimes two outpatient sessions of minor Surgery operations done weekly to help relieve the pressure from the main theatre. It is arranged that relatives accompany these patients because they have had anaesthetics. Some require ambulance transport and others have their own transport. The Medical O.P. Clinics are staffed by the Medical Ward staff and are in a separate area from the Surgical area.
In 1967 the number of attendances to O.P. was 23,561, including 240 minor operations.
Staff: One Sister; sometimes one part-time S/N; one Senior Enrolled Nurse; two Enrolled Nurses and two pupils. Every patient seen in Outpatients is usually x-rayed, a porter is available to accompany the patient to the department and to bring back the films to be seen by the doctor. There is a small canteen in O.P. for the patients and relatives, staffed by W.V.S.
There are three operation days, plus one Gynae. list. Emergency work is done day or night.
Staff: one Male Charge Nurse; two Senior Enrolled Nurses; two E/N; one or two pupils and one theatre orderly. Theatre and Outpatients work together and their off-duty Rota is made up to make sure at all times there is complete staff coverage at meal times and at weekends.
The sterilizing for both departments is done in O.P.D.
In 1967 there were 713 major operations (291 of which were Emergency), and 487 minor operations. In total there were 1,200 (and increasing in 1968).
Doctors: one Consultant Surgeon, Full time; one Registrar, Full time; two House Surgeons.
Their off-duty is made up to give coverage at weekends and a Surgeon is on call to help the Registrar if any emergency arises. He usually comes from Edinburgh as do all the anaesthetists. House Doctors have every third weekend off.
There are 66 beds in the Hospital, 42 Surgical and 24 Medical.
The Female Surgical Ward has 21 beds. One Ward has eight beds, another twelve beds and one Single Room. With one Gynae operation weekly, six beds are kept for the gynaecologist. There are two List days, and otherwise any day for emergency work.
Staff: one Sister; one Full time S/N; two part time S/N; one E/N and three pupil Nurses.
The Male Surgical Ward has 21 beds. One Ward has eight beds, another twelve beds and one Single Room. This is a very busy ward when accidents come in.
Staff: one Sister; one S/N; two part time S/N; one E/N; three pupils.
These two wards are beside one another on a main corridor, and the Sisters have alternate off-duty to ensure there is always a trained person on duty interchanging with the S/Nurses. The up-patients enjoy the comfort of TV rooms and sitting rooms and may sit outside on a veranda – weather permitting. Seats are provided around the Rose Gardens.
The Operating Theatre completes the suite, and is at the end of the corridor.
The Medical Ward has 24 beds, eleven male beds plus one side ward, and eleven female beds plus one side ward.
Admissions and discharges or transfers for Convalescence occur almost daily.
Staff: there are two visiting Consultants and one Registrar who covers E.F.H. (East Fortune Hospital) and Belhaven; one comes Tuesday and Thursday, one comes Monday and Friday and extra times anytime.
They have their Medical outpatients’ sessions three times per week. One Registrar is a radiologist wishing to get more experience, and so he visits East Fortune Hospital and Belhaven Hospital.
One House Physician; his off-duty weekends are covered by one of the House Surgeons.
Money was available recently, and verandas on both wards were upgraded. They were wasted spaces before; leaking glass roofs, and ill-fitting windows with steel frames and inadequate heating made it quite impossible to use for the patients. They were re-roofed, other walls were built and double glazed windows inserted; flooring, Parker Knoll chairs, tartan rugs, tables, and library cupboard and TV were installed and now this space is used as a sitting room for the up-patients; an electric fire gives adequate heating.
Part of this area was also used for a Store Cupboard for bed accessories etc. And on the male side, a part of the veranda was furnished for a typist to cope with the medical notes.
So great was the pressure of work in the Surgical Department it was felt necessary to keep the physicians’ secretaries separate, though all notes are ultimately filed in the main office.
Staff: one Sister; one Full time S/N; one Part time S/N who works 9-1.30 (except Saturdays and Sundays); two E/N (Enrolled Nurses) and six pupils. When patients to go x-ray they are taken, if by chair, by a porter, but if on a trolley they must be accompanied by a nurse – otherwise portable x-rays are done in the ward.
Staff for Night Duty: for the whole hospital: two Sisters, one Part time S/N; nine pupils but if possible an Enrolled Nurse in each department. A ward Sister works eight nights on, six off; Nurses work six nights on, four nights off – ie 9pm-9am, less 11/2 hours for meals, that is 84 hrs per 2 weeks.
Classroom: usually two-four pupils plus pupils from East Fortune Hospital. Two pupils go for two months’ training to Belhaven Geriatric Hospital, Dunbar, for experience in this field of nursing.
Holidays: it is arranged to have two Sisters off at the same time, usually two Enrolled Nurses off and three pupils.
Chiropody and Dental Care is arranged if necessary for the patients, either O.P. or if needed from the wards.
Details of Supporting Staff
Two Radiographers who have a tremendous load of work, as well as all in-patients, they have a steady demand from the local Doctors for x-rays and the school children’s chest checks etc. are all done at regular intervals. The staff are x-rayed yearly, all employed by the Hospital.
One Full time physiotherapist and one part time; two Telephone operators; four porters and two gardeners; five Secretaries, working throughout x-ray, Surgical, O.P., etc.
From the Clerical Officer.
The wards and departments each have their own stock. Linen condemned and replaced weekly by two serving maids. New issues checked by the Matron.
Food dry stores daily from the stores.
One Assistant Catering Officer spends most of her time at Roodlands; one Group Catering Officer – visits occasionally; three Cooks; three Dining Room Maids; nine Kitchen Maids.
Nine full time Maids; two part time Maids.
Nurses’ and Doctors’ Homes: eight full time Maids; two part time Maids.
Ordered weekly by the Ward Sisters or by phone if any urgent supplies required. The dispensary is at East Fortune Hospital.
Matron has a tremendous amount of paper work to do. She checks all the time sheets and submits all information pertaining to salaries and wages to the local Board Office. She holds all interviews for Staff. She deals with the records of the Nurses in training, and the changes to be planned for the various grades in training. Holiday Rotas are planned by her. Roodlands Hospital is a training school for assistant nurses and was one of the first to be established in Scotland.
The post-Graduate Surgeons have for many years had their examinations on the Surgical Wards.
A valuable van service is used for our Collection of Specimens and shared by the General Practitioners – 100 miles daily run.
By 10.15 am, any Bacteriology specimens have to be ready for East Fortune Hospital.
1.15 pm: all other specimens collected for Edinburgh
Any blood needed from the transfusion service, which is required for Surgery is ordered two days before the operation and is ready for collection evening before required.
The laundry employs 20 with a Manageress in charge. It copes with the laundry for seven hospitals.
The volume of work done in the Small Hospitals is not generally known as they are overshadowed by the large hospitals in the cities.