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Beyond Nightingale

with the doctors. . . . But as a student we had all that work to do, plus we had to make classes at 7:30 in the morning. If you were on nights, it didn't matter—you made a class at 7:30 in the morning and sometimes you had one at 10:30 in the morning and another one in the afternoon." Occasionally, Coutermarsh would accompany one of the doctors to Woodstock, Vt., to do "tonsillectomies in the town hall." In a foreshadowing of same-day surgery, patients would be sent home to recover with ice bags around their throats. "Once in a while we'd go out on a home delivery," Coutermarsh adds, "but it wasn't standard practice."

The way doctors and nurses interacted with each other hadn't changed much since the late 1800s. "If you saw a doctor, you'd have to stand back against the wall and let them go by," Coutermarsh recalls. But sometimes it was hard for new nurses to distinguish orderlies from doctors, because both wore white pants and tops. "So when you first came in as a probie, you didn't know who people were and you were standing back and letting the orderlies go by," she laughs. When Coutermarsh worked in the operating room, she was the suture nurse and had to be sure to hand the correct thread—there was A silk and B silk, one finer than the other—to the surgeon. "Dr. Bowler used to scream at us if we gave him the wrong silk. He stuttered a lot, so he had difficulty getting it out to us. But we knew what he was saying. No one did correct him," even if he was wrong. The doctors "were disciplinarians," continues Coutermarsh. "They were the ones who gave the orders. They were the ones who made the decisions. . . . Nurses never even thought about disagreeing with a doctor."

To broaden clinical experiences for the students, in 1944, the Hitchcock SON established an affiliation with the New Hampshire State Hospital in Concord, where students did a three-month rotation in psychiatric medicine. Students also were allowed more time for recreation, so they could attend baseball games, go on picnics, ride bicycles, watch movies, go to dances—students were no longer banned from Dartmouth fraternities—and concerts, write for the school newspaper, and participate in student government.

The Hospital adopted a 40-hour workweek in 1953. In 1955, one of the first intensive care units in the country was established at MHMH, and soon there were other specialized units,

Top: This circa 1930 photo shows student nurses in the basement library of the Billings-Lee student nurse residence; the photo was used in a recruitment brochure for the nursing school. Bottom left: Half a dozen student nurses, in their black wool capes, on Memorial Day 1952. Bottom right: A nurse in today's practical scrubs.

where nursing students could get on-the-job experience. One of the major changes that showed MHMH's growing commitment to nursing education occurred in 1957, with the reorganization of the Department of Nursing into separate entities for service and education. Two more affiliation programs were added in the mid-1950s: in obstetrics at Boston Lying-In Hospital and in pediatrics at Boston Children's Hospital. Some students loved being able to spend nine months away from MHMH; others couldn't wait to return.

Sandra Charbono, R.N., a 1960 graduate of the SON, enjoyed her affiliation experiences but was surprised that people behaved more formally than at Hitchcock. In Boston, "you didn't talk to [doctors] unless spoken to," she says. And a nurse was expected to give up her seat to a doctor if there weren't enough chairs for

everyone in a room. But "that wasn't the case at Hitchcock," she says. And when MHMH nursing students appeared in street clothes at a meeting with the nursing director in Boston, "we were sent back to get our uniforms on," Charbono recalls. At Hitchcock, however, it wasn't unusual for students to wear their bathrobes to evening meetings with the director of nursing education.

By the 1960s, nursing leaders across the country were vigorously debating the relative merits of diploma schools (such as Hitchcock's), associate degree programs, and baccalaureate programs. Some argued that diploma schools produced better nurses because they got more clinical experience during their training. But others realized that as medicine became more complex, nursing education belonged within the college system. In 1965, the American Nurses'

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