THE SHORTAGE OF NURSES IN SOUTH AFRICA. PART I. 1. WHY THE FOUNDATION DECIDED TO INVESTIGATE THE P O S IT IO N.

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1 THE SHORTAGE OF NURSES IN SOUTH AFRICA. PART I. 1. WHY THE FOUNDATION DECIDED TO INVESTIGATE THE P O S IT IO N. a) In June, 1948, there was much public concern in Johannesburg over the shortage of nurses. The press at that time published pictures and stories of whole wards in P ro v in c ia l Hospitals standing empty fo r t h is reason. b) Although the Foundation's direct field is promotive health matters such as nutrition, recreation, education of the literate and illite r a te in basic health matters, creation of a sound public opinion, e t c., it is interested in all questions concerning the health of our people. In matters outside its direct fie ld, it undertakes to find out the true facts, where necessary, and in co-operation with the Authorities or Voluntary Organisations concerned, to act as a 'pressure-group in order that health conditions may be improved. c) The F o u n d atio n s direct interest in the question of whether su fficient nurses are available arose through the fact that, after long delays, an Ir is h Order withdrew an offer it had made to set up and staff a 60-bed hospital to serve Alexandra Township, Johannesburg. The Provincial Secretary informed us that the Administrator-in-Executive had already approved in principle the erection of a hospital to serve this Township, but, at a meeting called by the Johannesburg H o sp ital Board on 30th June, , the Chairman of the Hospitals Advisory Board pointed out that besides building d iffic u l t i e s, there was also the shortage of trained nurses to contend w ith. d) The matter was discussed by our Witwatersrand and S. Transvaal Action Committee, and it was suggested that one of the reasons for the shortage of A frican nurses might be the lack of general educational opportunity for Bantu g ir ls. The Regional Technical Advisory Committee was requested to investigate the whole position. 2. PRELIMINARY ACTION DECIDED UPON. a) It was decided that the available supply of European and Non-European female medical and surgical nurses and midwives, present training f a c i l it i e s, e t c., would f ir s t be investigated and, if possible correlated with the demand. As a second stage, the number of Bantu recruits who may be available would be investigated. - b) Discussions were held w ith the R egistrar and A s s is t ant Registrar of the South A frican Nursing Council, the Secretary of the South A frican Nursing Association, and representatives of the South A frican Institute of Race R elations. The generous assistance so w illin g ly given is acknowledged most g ratefu lly. Questionnaires were then sent to the Superintendents of a l l Training Hospitals in South A fr ic a. A summary of the replies, together w ith additional information, is contained in the following pages. 3. /. #

2 3. IS THERE, IN FACT, A SHORTAGE OF NURSES? a) The Report of the National Health Services Commission states (in paragraph 8 2, page 69) "That there is a chronic shortage of nurses is admitted on all sides..." b) L a t e r,(in paragraph 22, page 88) it goes on "The Secretary for Public Health, in a. recent article published in the 'South A frican Nursing Jo u rn a l', estimated that 2 0,0 0 0 nurses and midwives would be required for South A frica on the basis of 1 to every 500 of the population. It is questionable whether, for a very considerable time, this ratio w ill be required, but with increased demand for Western methods of treatment on the part of the Native population, there is lit t le doubt that it w ill come sooner or la t e r." This report was written in Using the latest (1946) Census figures, this ratio would mean that, to provide adequate health services, we now should have 2 2,7 8 4 nurses and midwives; 4,7 4 5 to care fo r Europeans and 1 8,0 3 9 to care for Non-Europeans. c) The exact ratio at present required would be extremely d iffic u lt to calculate; but it appears that the demand amongst the Bantu for Western methods of treatment has outstripped the supply of nurses. To a very considerable extent the expansion of health services is held up through the lack of.trained personnel. When addressing the fir s t biennial meeting of the South African Nursing Association in Cape Town in November, 1946, the then M inister of Health said that the shortage of nurses was the lim iting factor in present health se rv ice s, and the shortage was bound to become worse as plans for the expansion of national health services were unfolded. d) As at the 30th June, 1948, there were 1 3,5 3 5 registered nurses and 8,7 5 3 re gistere d m idwives. The number of unregistered practising nurses and midwives is unknown, and it is also unknown how many of the registered nurses and midwives are practising. As pointed out by the National Health Services Comiiiission (page 87 of Report, para. 19 e t.s e q.), figures supplied fo r the number of nurses on the Register "do not bear any easily ascertainable relation to the actual number of such nurses in p ra c tic e, because " ( i ) Registration occurs only once, and is not annually renewed: consequently, large numbers remain on the register long after they have ceased to practice. Amongst female nurses the numbers who retire from p ractice owing to matrimony is very g re a t. ( i i ) There is duplication of registration as between trained nurses and m idwives, the same names appearing to a very large extent under both categories, as a large number of trained nurses are also qualified in m idw ifery." e) The Commission calculated that, at the time their Report was written (May, ), there were probably about 5,0 0 0 nurses and 2,5 0 0 midwives in actual practice. At - t h a t /..

3 that time, there were 7,2 0 5 nurses and 5,6 4 4 midwives r e g is tered. If we take the same proportion of those registered to-day, we may assume that approximately 9,4 0 0 nurses and 3,8 0 0 midwives are at present in actual p ra ctice. f ) To summarize, then, we need about 22,784 nurses and midwives for adequate health services, and we probably have some 1 3, The exact number required for our health services in their present stage of development is unknown, but there is no doubt that there is a shortage of practising nurses, and that expansion of health services depends largely on an increased number of trained personnel becoming a v a ila b le. g) When addressing the Transvaal Hospitals' Congress in September, 1947, General J. J. Pienaar pointed out that the real problem lies in providing nurses for the non-european community. They did not yield more than one student nurse out of every 1 7,0 0 0 souls, against one in 600 amongst Europeans. h) Later, when addressing the Conference on Nursing Education held in Pietersburg in August, 1948, General Pienaar said that student nurses should consist of onequarter Europeans and three-quarters Non-Europeans. The actual proportions of the present strength of student nurses were the reverse. If the European nurse shortage was to be overcome, mnre non-european nurses must be trained. There was a serious lim iting factor, however, in that the bulk of the Native population was equipped n either by school education nor by tradition or culture for producing daughters suitable for training for the f u l l qualifications and responsibilities of a nurse. The number of really suitable native girls was very lim ited. The number of European nurses w ill, accordingly, for many years to come have to be higher than the strict proportions of the population. They must provide fo r the nursing of the Europeans and the superv is io n of the non-european se rv ice s. 4. REASONS FOR THE SHORTAGE 0E NURSES. a) The N atio nal Health Services Commission stated (on page 69, paragraph 82 of its Report) : - MWe conclude therefore that the shortage of trained nurses is due in the main to six facto rs :- " (i) Student nurses abandoning their training either through having missed their vocation, d issatisfa ctio n with the conditions of service, or marriage; ( i i ) Wastage through marriage and retirement of trained nurses; ( i i i ) The fact that hospitals train only su fficient for their own needs and that enough are not trained to make up fo r the wastage which is inevitable in any feminine profession; ( iv ) Married women are not employed; (v) Increased avenues of employment for women. (v i) Lack of preliminary training schools and of accommodation for su fficie nt probationers - b) /....

4 b) Some of these factors are gradually b eing e lim in ated. Nursing Colleges are being established, training methods revised, and conditions improved. The main_problems which remain are obtaining and accommodating a sufficient number of suitable Non-European trainees, and imbuing all student nurses w ith a sense of vocation. General Pienaar said at the Pietersburg Conference on nursing education (August, ): You a ll know that our present system of training nurses is unsatisfactory. It w ill be enough if i. say that of every two young women who come to our hospitals to learn the profession of nursing, only one q u a l i f i e s." The cause lay in the fact that we regard n ursin g as employment, and f a i l to recognise it as a profession. The new system of training nurses in the Transvaal, which w ill be considered by the Conference, w ill not profit us, however, unless we can at the same time capture a new s p i r i t. ' 5. PRESENT POSITION IN THE TRAINING SCHOOLS. a) During August, 1948, the Foundation circularised a ll training schools for medical and surgical nurses and midwives in South A fr ic a. b) In the following paragraphs is a summary of the re p lie s re ce iv ed, together with comments from various tr a in ing schools. 6. ' NUMBER Off HOSPITALS CIRCULARISED. a) Questionnaires were sent to the 82 H o sp ita ls recognised as training schools by the South African Nursing Council, and also, as a matter of interest, to 1? Hospitals which have not yet attained the standard of r e c o g n is e d_ training schools. Replies were received from 75 hospitals in the former class and 15 in the- l a t t e r, and we are extremely grateful to the Superintendents and Matrons of these hospitals fo r the a ssista n c e they gave. b) In respect of the 7 recognised training schools which did not reply, the South A frican Nursing Council very kindly supplied us w ith information regarding numbers in training and educational standard required of train ee s. In other matters such as wastage, e t c., a percentage figure has had to be used. 7. EDUCATIONAL STANDARD REQ.UIRED OF TRAINEES. a ) Standard 7 remains the required entrance standard for commencing nursing training, although we understand this may shortly be raised to Standard 8. The majority of recognised training hospitals, however, already demand Standard 8 or higher; and all of them give preference to those applicants w ith the best general education. b) The present p o sitio n is as fo llo w s :- TABLE I. /..

5 TABLE I. Minimum General Educational Standard'Required of Nursing Trainees. PROVINCE TYPE OF TRAINEE No.of he >spiteu Std. 7 S t d.8 s requ i r i n g :- Std. 9 Std 10 Trans VaaL European m edical & surgical N.E. ' " " " European midwives N.E. " Cape European medical & surgical N.E. " j European midwives N.E. « N atal European m edical & surgical N.E. " " " 5 c - European midwives ' N.E. " 4 - O. F.S. European M edical & surgical N.E. ' " " i! - - European midwives i N.E.»' I, UNION Total - European trainees " N.E. " COMBINED TOTAL 18 1 i 81 I accepts Registered Nurses only. c ) A Committee appointed by tlie Adm inistrator of the Cape published, on 1st March, 1946, a "Report on an Inquiry into the Training of Nurses in the province of the Cape of Good Hope'. In this report there is the following interesting statement (Chapter I I I,P a r a.1 0 (1 )) :- There is "a significant tendency for the percentage of failures in examinations to decline progressively with the higher standards of general education". A fter w eighing a l l a v a ila b le evidence the Committee found i i s f "th a t/..

6 "that Standard 8 may be accepted for the present as the minimum general education required to enable a g ir l to train as a medical and surgical n u r s e. 3 ) On the w hole, a higher minimum general educational standard is required of Non-European than of European trainees. According to the totals shown in_table I, 92% of the hospitals training Non-Europeans require J.C. or above, while the corresponding figure for European trainees is 78%. Miss C.A. Nothard, in an address in the U.S.A. in May, 1947, pointed out that the majority of Non-European student nurses come from native areas where they live under conditions entirely different from those pertaining in the average European home. It is often necessary to teach such girls something about the European ways of livin g before they are in a position to assim ilate the contents o f ' the course of nursing training. e) B esides learning the European way of l i v i n g, Bantu trainees also need to acquire the power of thinking clearly, and a higher educational standard is of a ss is ta n c e here. Some Provincial Hospitals have preliminary training schools for Bantu recruits, and some of the Mission Hospitals, find that girls trained in their own secondary schools prove very satisfactory Hospital trainees. The Robert Shapiro Trust (administered by the S.A. Institute of Race Relations) offers a few bursaries each year to Bantu girls who wish to pass Standards 9 and 10 before taking up nursing. The provision of further preliminary training schools or of_ further general educational bursaries would seem essential if the quality of Bantu trainees is to be improved and the wastage consequently decreased. These questions are discussed more fu lly later. 8. SCHOOL SUBJECTS TAKEN BY NURSING TRAINEES. a) In an article published in "The Star" of 2nd August, , it was stated: "From the point of view of b ein g prepared for th eir nursing studies, girls who left school at Standard 8 were not always well equipped. The syllabus at that stage was very w ide, and a g ir l might scrape through the examination and enter as a student nurse without having taken any science su b je c ts. She would then be confronted by the preliminary examination which needed a lot of study, and would probably find it very d iffic u l t. A matriculated g ir l had more opportunity of learning t h e _technique of * swotting. It might be helpful if nursing training authorities stated the school subjects they required of candidates, as medical, law and engineering students were required to have taken stip ulated subjects at sc h o o l." b) In replies to the questionnaire we circulated to training hospitals, several Superintendents or Matrons gave their views on what school subjects would be an asset to g ir ls intending to train as nurses. The f o l l o w ing are their recommendations

7 TABLE I I. School subjects recommended for girls intending to train as nurses. Type of Trainee Subjects recommended Number of hospitals making such recommendation European Medical and Surgical. Science, especially Chemis try 6 Domestic Science 3 Hygiene & F ir s t Aid 3 Latin 2 Maths 1 Non- European Medical and Surgical F irst Aid & Home N u t s ing 2 Domestic Science 1 Science 1 Latin 1 English 1 o) W hich school subjects actually^are taught to Bantu girls in the various standards w ill be discussed in Part II of the Survey. 9. MINIMUM AGE FOR COMMENCING NURSING TRAINING,AND LENGTH OF THE COURSES. (a ) Medical and Surgical Training. a) The S. A. Nursing Council lays down no minimum age for commencing training, but w ill not register a nurse or midwife until she is 21 years of age. The Council permits women to write the fin a l examination up to 6 months before their 21st birthday, so as to f it in w ith examination dates; and they can, in such cases, f i l l in the remaining period by taking courses in midwifery, fever, etc. The preliminary and f i n a l examinations take place three times a year. t>) As the m edical and su rgical course takes 3 - years in a fir s t class and 4g years in a second class Training School, this regulation regarding registration to a certain^extent fixes the minimum age for commencing training at 17g and 16g years respectively. c) The Report on an Enquiry into the Training of Nurses in the Cape of Good Hope states (in Chapter I I I. para 1 1 ( 2 ) ) : The medical and nursing witnesses are almost unanimous in the view that the training as a medical and surgical nurse is strenuous, both p h y sically and em otionally, - and /...

8 and the m ajority of the witness consider that a g ir l should not be admitted to training in a hospital ward until she is at least 18 years of age. There is a tendency amongst the witnesses to regard the age of 19 years or older as the most suitable for the admission of a girl to training. The Committee recommended (in para. 3 ( 9 ) ) 17 as the minimum age for starting p ractical training in the wards. d) Most hospitals f i x their own minimum age fo r commencing training, as follows :~ TABLE I I I. Minimum Age required by Training Hospitals for commencing medical & surgical train in g. Number of Hospitals accepting g irls 16 yrs. 17 yrs. 17 yrs. 18 yrs. 19 y rs. at Transvaal Cape N atal O.F.S TOTAL i 3 e) One of the d iffic u lt ie s in obtaining sufficient nursing recruits is, of course, that girls who leave school after Standard 8 are very often only 15 or 16 years of age. By the time they are 18, such g irls are frequently earning 20 or 25 a month in an o ffic e, and, as The Star, pointed out on 2nd August, 1948, it was not surprising if a g ir l "was reluctant to leave this comparatively easy l ife and go back to hard study, long hours, and discipline as strict as that of her schooldays. To do this she would have to have a strong sense of vocation1. f ) To meet this d iffic u lt y, some hospitals place suitable girls on their waiting lists as soon as they leave school, and enter th e ir names fo r the f i r s t course beginning after they have reached the minimum age required. In the meanwhile the girls may go as "learner nurses to local convalescent homes. (B) Midwifery 'Training. a) The midwifery course at present takes 6 months for trained medical and surgical nurses, and 1 year for untrained women. This, to a certain extent fixes the minimum age for commencing training at 20 and 20 years respectively, since a midwife cannot be registered until she has turned 21. b) Again, however, the hospitals f i x their own minimum age for commencing t r a in in g, as follow s ; -TABLE IV

9 TABLE I V. Minimum Age required by Training Hospitals for midwif ery train in g. Number of H ospitals accepting g irls at :-! 19 years 20 years 21 years -I Transvaal j Cape Natal o.p.s.; - 1 i TOTAL o 1 1 Jt is understood that the length of the midwifery course may shortly be increased l«o S months for trained medical and surgico.l nurses and 18 months for untrained women. As a matter of interest, the National^Hta1th Services Commission advocated a 3 y e a r s training of midwives which would f i t them, "according to the evidence before us, to undertake 90% of a ll midwifery cases without calling in a doctor. Where it is necessary to call in higher advice, it is tbe f u lly trained o b ste trician who should be called in, and not the general p ractitio n e r... At the same time, there is room for the maternity nurse, trained as midwives are.now being trained, to nurse cases which have been conducted by the midwife (Page 134 of the Report,, paras. 21 and 2 2 ) i?tiig q PAYABLE BY STUD ENT NURSES AND MIDW IVES. At all hospitals training medical and surgical nurses, students in training receive salaries. The same applies to hospitals training midwives except A or one m the Cape, where, students are required to pay fe e s. Registration and examination fees are charged, as follows for registration as a student nurse or midwife examination fee for the Medical & Surgical prelim inary examination. 3. 3, 0 to cover examination fee for Medical & Surgical fin a l examination or the Midwifery examination, and also to co'ver registration. 11. SALARIES PA I D. a) P ro v in c ia l H ospitals have to conform to provincial ra te s, which are

10 ( i ) European Medical & Surgical N urses. Trainees S taff Nurses Sisters - 66 x ; plus C.O.L.A x , plus C.O.L.A x x ,plus C.O.L.A. At some Transvaal hospitals, after 5 years on the 320 scale the salary is raised to 360, and a fter another 5 years to 400. ( i i ) Non-European Medical & Surgical N urses. Trainees Transvaal - 36 X 6-60, plus C.O.L.A. Cape 24 X 6-48, plus C.O.L.A. Natal 36 X 6-54, plus C.O.L.A. O.F.S. 24 X 6-48, plus C.O.L.A. S taff Nurses- Transvaal X , plus C.O.L.A. Cape 96 X 6-120, plus C.O.L.A. Natal 105 X , plus C.O.L.A. ( i i i )European Midwives. Trainees - 60 per annum to untrained women,plus C.O.L.A. 80 n n " trained n u rses,p lu s C.O.L.A. Midwives x At Provincial h ospitals, trainees and trained staff receive free board and lodging (or, in the case of trained staff, liv in g out allowance which varies from to 10 per month); also free laundry and shoes and uniform, or a uniform allowance of 15 per annum. (N.B. In some cases p up il midwives have to supply their own uniform.) They also receive r a i l concessions fo r le a v e. Cost of liv in g allowance varies slightly in the different Provinces. There is now reciprocity between the Provinces in regard to Pension schemes, except that in the Cape, a nurse leaving the service is not refunded her pension contributions unless she has served for at least a year. This provision does not apply in the rest of the Union. So fa r, there is no reciprocity between Government and Provincial hospitals in regard to pension schemes. b) M ission and P rivate Hospitals are not bound by provincial rates,and the salaries vary very much, as follows (i ) European Medical & Surgical N urses. Trainees - Commencing salary 36 upwards. Staff Nurses - often 165 x

11 ( i i) Non-European Medical & Surgical N urses. Trainees - Vary from per annum, at commencement of course to 54 per annum, at end of train in g. S ta ff Nurses - Vary from 60 as lower lim it to 132 as upper lim it. ( i i i )European Midwives. Trainees Midwives - Provincial rates generally used. - Vary from 180 as lower lim it to 237 as upper lim it. (iv) Non-European M idw ives. Trainees - Vary from 6 per annum at start of course to 36 at end of training (or 48 for trained n urses). Midwives - Vary from 60 as lower lim it to 132 as upper lim it. Private institutions usually pay C.O.L.A., but are not bound by Provincial rates. They a ls o, in most cases, provide free board and lodging, laundry, uniform and shoes, and often contribute towards ra ilfa re for holidays. c) Both nurses and midwives can often earn more in private practice or in the employment of local authorities or private hospitals than they receive in Provincial h ospitals. To give two examples s (i> A non-european medical and surgical nurse in Cape Provincial hospitals earns 96 x plus C.O.L.A. Recently a Local Authority in the Cape advertised a similar post at a salary scale 192 x plus C.O.L.A. ( i i ) European midwives working on their own often charge from to a week for looking after a mother and ch ild in a private home LEAVE PRIVILEGES FOR TRAINED STAFF. The leave-scales in Provincial hospitals are Transvaal - 30 days' non-accumulative leave plus 14 days accumulative leave per y ea r. At the end of 5 years continuous service, nurses receive 35 days bonus leave. Cape - 30 d a y s vacation leave, 18 days accumulative leave on fu ll pay, and 18 d a y s accumulative leave on h a lf pay per year. Natal - 42 days per annum of which a portion can be accumulated. O.F.S. - Not known. Accumulated leave is not transferable if a nurse moves to another province.

12 1 3. NUMBER OF NURSES a ND MIDWIVES AT PRESENT IN TRAINING. A. TABLE V. European Medical and Surgical Nurses at present in train in g. No. Of hospitals. 1st yr nd yr. 3rd yr. 4th & 5th y r s. TOTAL TRANSVAAL ,4 3 6 CAPE , NATAL O.F S TOTALS 51 1, ,2 8 8 TABLE V I. Non-European Medical and Surgical Nurses at present in T rain in g. No. of hospitals. 1st yr. 2nd yr. 3rd yr. 4th & 5th yrs. TOTAL TRANSVAAL Ca PE Na TAL O.F.S TOTALS TABLE V I I. European and Non-European Midwives at present in trainlngt^ N o.' o f " hospitals European No. of hospitals Non- European TRANSVAAL CAPE Nrt-TAL O. F. S TOTALS I t /.

13 It should be remembered, of course, that the figures in Table V II include a number of trained medical and surgical nurses, who have no intention of p ra c tisin g as m idwives PERCENTAGE. OF PASSES IN EXAMINATIONS. From a graph kindly made available by the Registrar of the S. ^. Nursing Council, of those who entered for the examinations, the follow ing percentages of passes have been worked out TABLE V I I I. Average percentage number of candidates who passed exam inations. 192 to to to 1947 Average over last 3 years Medical & Surgical. Prelim inary Medical & Surgical Final Midwifery Examination ANNUAL Wi-iSTa G E. The Training Hospitals were asked to state the average annual wastage. As stated above, 7 of the 82 recognised training hospitals did not reply, thus to arrive at the overall annual wastage, a percentage figure was used for these hospitals. The result is TABLE I I Average annual wastage of student nurses and m idw iv es.... ' TYPE European medical & surgical Non- European " Number in Training 3, ,6 4 6 Average Annual wastage r Percentage average annual wastage t 19$ 15$ TOTALS % European Mid wives $ Non- European " $ TOTALS COMBINED TOTALS' 5, $

14 1 6. REASONS FOR WiiS.Ih.GB. a) Each hospital was asked to give' the chief reasons for wastage. The following is the result ( i) European medical and surgical trainees. 48 hospitals quoted reasons indicating that the trainees concerned were psychologically or morally unsuited to the profession. Of these 20 hospitals stated : "Find they are not really interested in the work or attracted by the profession". 1 2 hospitals stated: "Pay too low ; 9 hospitals stated: Decide would prefer office work with regular hours and free week-ends". 17 hospitals stated: "Unsuitable for training", or unable to conform to hospital d iscip lin e ". 27 hospitals mentioned marriage (24) or Domestic reasons (3 ). 19 hospitals quoted reasons indicating that the trainees concerned did not possess the necessary intellectual ability or general educational standard, e.g. "Unable to cope with theoretical standard", or "Unable to pass Preliminary Examination". 6 hospitals mentioned ill-health, especially sore feet. 3 hospitals in the smaller towns mentioned: "Too lonely" or "Would prefer bigger hospital where course is 3 instead of 4 years". (ii) Non-European medical and surgical nursing trainees. 19 hospitals quoted reasons indicating that the trainees concerned were psychologically or morally unsuited to the profession. Of these:- 8 hospitals stated the trainees concerned found they were not really interested in the work or attracted by the profession. 11 hospitals mentioned: "Unsuitable for training", or "Unable to conform to hospital discipline". 8 hospitals stated that part of the wastage was through girls becoming pregnant.» - 14 /...

15 14 hospitals quoted reasons indicating that the trainees concerned did not possess the necessary general educational standard or intellectual ability. 9 hospitals mentioned ill-health. (iil) -Suropean Midwifery Trainees. hospitals quoted reasons indicating that the trainees concerned were psychologically or morally unsuited to the profession. Of these 7 hospitals stated the trainees who left found they were not really interested in the work or attracted by the profession. 2 hospitals stated: "Pay too lo w ". 3 hospitals stated: Unsuitable for training, or Unable to conform to hospital d iscip lin e. 1 hospital stated: Tired after General Training. 9 hospitals mentioned ill- health. 4 hospitals quoted reasons indicating that the trainees concerned did not possess the necessary general educational standard or intellectual ability. 4 hospitals mentioned marriage (2) or domestic reasons (2). (iv) Non- uropean Midwifery Trainees. 5 hospitals quoted reasons indicating that the trainees concerned were psychologically or morally unsuited to the profession. 'Of th ese:- 1 hospital stated that the trainees who left found they were not really interested in the work or attracted by the profession. 4 hospitals stated; Unsuitable for training, or Unable to conform to hospital d is c ip l in e. 5 hospitals stated that part of the wastage was through girls becoming pregnant. : Hi - e ^ t 'v-5i!w ;.f :1^ >' *».*; *;.* 2 hospitals quoted reasons indicating that the trainees concerned did not possess the necessary general educational standard or intellectual ability. 1 hospital mentioned ill-health. 1 hospital mentioned domestic reasons. - To/...

16 t>) To tabulate the above TkBLE X. Reasons given by hospitals fo r Wa stage,» No. of aospitals giving these reasons.. - r > European Medipean Mid- N.E. Euro N.E. Medical cal & Midwivewives Total REASONS & Surgical Surgical. Psychologically or morally unsuited Too low educational standard or intellectual ability Marriage or domestic reasons Pregnancies Ill-health Prefer a larger hospital c) Some idea of the number of trainees who leave for each of the reasons mentioned can be obtained by correlating the reasons given by each hospital with, the annual wastage from this hospital. The results are :- ( i) European medical and surgical nursing trainees. Psychologically or morally unsuited 42.9#' To sub-divide this heading : # lost interest in the work or were not really attracted by the profession. 0.4 % considered the pay too low. 8.8 # preferred to change to office work. 13.6# were unsuitable for training or unable to conform to hospital d iscip lin e. Too low an educational standard or intellectual a b ilit y Marriage or' domestic reasons Ill-health Preferred a larger hospital 16.4# 29.2#, 7,.8* 3.7 #

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