1932 NC Board of Nursing Guidelines for Schools of Nursing

NORTH CAROLINA BOARD
 
OF NURSE EXAMINERS
 
 
 
CIRCULAR OF INFORMATION
 
1932.
 
 
 
FOR GUIDANCE OF SCHOOLS
 
 OF NURSING IN THE
 
STATE OF NORTH CAROLINA.
 


 
FOREWORD
 
                It is not the desire of the Board of Nurse Examiners to make it difficult for the schools to meet the requirements for students to wish to become registered in the State of North Carolina, but on the other hand, it is not right for the student to complete her nursing education and find that she is not eligible for registration. If, having secured registration in North Carolina, she is debarred from registration in other states, because our requirements for nursing education are lower than that required in other states, we have treated her unfairly.
 
                She may desire to further prepare herself by taking a special course at a university for an administrative position, teaching or public health; or she may wish to enroll in the American Red Cross Nursing Service, but again she cannot qualify because our minimum standards for accredited schools of nursing are too low to meet requirements for enrollment. In justice to the nurse, therefore, it seems advisable to give our students the sort of preparation that will qualify them for whatever course they may wish to pursue.
 
                If it is difficult for the small school of nursing to give the necessary preparation, the requirements can be met by affiliation.


PRE-NURSING COURSE
 
                Young women who intend to become nurses, and who seek counsel concerning subjects to be taken in their high school course should be advised to take the following:
English
4 Units
Mathematics (Algebra & Geometry
2 Units
Social Science (Incl: History & Civics
2 Units
Foreign Language (Latin or French)
2 Units
Science
2 Units
Electives
4 Units
 
 
 
 
 
 
 
 
 
Suggested Four Year Curriculum
 
(Including Smith-Hughes Home Economics)
 
FIRST YEAR
Periods
Credits
English 1
5
5
Mathematics 1—Arithmetic--Community
5
5
History 1—Community Civics
5
5
Home Economics 1
             or
10
5
Science 1—General
7
5
 
22 or 25
20
       
 
SECOND YEAR
Periods
Credits
English 11
5
5
Mathematics 11—Algebra
5
5
Science 11—Biology
7
5
History 11—Modern European
             Or
5
5
Home Economics 11
10
5
 
22 or 27
20
       
 
 
 
 
 
 
 
 
 
THIRD YEAR
Periods
Credits
English 111
5
5
Latin 1 or French 1
          Electives (two)
5
5
Mathematics 111—Plane Geometry
5
5
Science 111—Physical Geography ½, Industrial and Commercial Geography ½
            
7
5
History 111—Ancient and Medieval
5
5
 
20 or 22
20
       
 
FOURTH YEAR
Periods
Credits
English IV
5
5
Latin II or French II
5
5
History IV—United States History
5
5
Science IV—Physics
7
5
 
22
20
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
MINIMUM REQUIREMENTS
 
For Various Grades of Accredited Schools of Nursing as Recommended by the Standardization Board and State Board of Nurse Examiners. – 1932
 
SECTION A.
 
1.       Every school of nursing to be connected with a general hospital, or if a special hospital, to have a year’s affiliation with a general hospital.
 
2.       That no applicant who has ever been a mental patient or a drug addict be admitted to a school of nursing.
 
3.       Applicant to be a high school graduate or have equivalent credits.
 
4.       Students not to be given special duty except when needed to round out their experience. No charge to be made the patient by the hospital nor the student for this service.
 
5.       The ratio of students to patients to be not more than one student to two patients. Ratio to be based on daily average of patients for the preceding year.
 
SECTION B.
 
1.       The school of nursing to be incorporated.
 
2.       The school to be connected with a hospital having a daily minimum average of twenty patients for Grade B schools, and a daily average of thirty patients for Grade A schools.
 
3.       To have at least ten students.
 
4.       To have a minimum entrance age of eighteen years.
 
5.       The probation period to be not less than four months.
 
6.       The length of the class term to be not less than eight months.
 
7.       The number of hours on duty weekly not to exceed 56, except in case of emergency.
 
8.       The record and application blanks recommended by the State Board of Nurse Examiners to be used, and the records to be available at all times for inspection by the Educational Director.
 
9.       The superintendent of nurses to be registered in the state and to have had at least one year’s previous experience in intuitional work.
 
10.   The night supervisor and operating supervisor, if employed, to be registered in North Carolina.
 
11.   To have an instructor or teaching supervisor whose duties need not necessarily be limited to teaching.
 
12.   To have separate classes for each year’s students.
 
13.   To have qualified dietitian capable of teaching dietetics or dietetics classes to be taught by a qualified dietitian from the high school or elsewhere.
 
14.   The nurses home to be comfortable and separate from the hospital.
 
15.   The superintendent of nurses or one of the graduate staff to live in the nurses’ home.
 
16.   The curriculum and the teaching equipment to meet the recommendations of the National League of Nursing Education.
 
17.   All the schools of nursing in Grade A to have at least three graduate, registered nurses.
 
18.   All schools of nursing in Grade B to have two graduate, registered nurses.
 
A Grade A school of nursing to meet all of the requirements under Section A and B.
 
A Grade B school of nursing may fall short in two points under Section B and still remain a Grade B school.


 
ACCREDITED SCHOOLS OF NURSING.
 
                An accredited school of nursing is one that meets the requirements of the North Carolina Board of Nurse Examiners and the Recommendations of the National League of Nursing Education.
 
METHOD OF ACCREDITING.
 
                Schools of Nursing are visited by the Educational Director as directed by the Board of Nurse Examiners, or upon request.
 
                The Educational Director sends in advance, notice of the proposed visit, with questionnaire enclosed. This questionnaire, if provided in advance be ready for the Educational Director on her arrival. In addition there should be ready for inspection.
                               
1.       The students’ records.
2.       Teaching equipment.
3.       Housing and living conditions of students.
4.       Conditions of word practice.
 
A report of these visits is made to the Standardization Board at its regular meeting, and the Superintendent of Nurses is notified by the Secretary of the Standardization Board, in regard to its standing as a school.
 
If it is shown that the school meets the minimum requirements for accredited schools, it is accredited for a period of one year. Subsequent accrediting is given for an indeterminate period or during the proper conduct of the school.
 
                An institution desiring to establish an accredited school of nursing should be approved by the Standardization Board before such a school is organized.
 
                When a hospital changes ownership the school of nursing is automatically removed from the accredited list until assurance has been given that the minimum standards for accredited schools will be maintained.
 
                If a hospital decides to close he school of nursing notice of this intention should be sent to the Educational Director in advance of the closing so that it may be properly entered in the records, and arrangements made for the transfer of any students remaining in the school.
 
                Recommendations and suggestions for improvement in the educational facilities of the school are made from time to time as is found necessary to meet changing needs.
 
 
 
 
 
 
 
 
GENERAL REQUIREMENTS AND RECOMMENDATIONS
 
                It is not expected that the requirements as outlined in this booklet will be followed blindly, but interpreted to meet the needs and opportunities of the individual schools. They represent only the minimum requirements, and it is hoped that the schools will enlarge and improve on these wherever possible.
 
LENGTH OF COURSE. To be three years.
 
RATIO OF STUDENTS TO PATIENTS. The ratio of students to patients should not exceed one nurse to two patients – the ratio to be based on the daily average of patients for the preceding year.
 
HOURS OF DUTY. Students should not be on duty more than four hours daily during the first two months of the preliminary period, with a gradual increase of time on duty until at the end of this period the total hours on duty per day does not exceed eight. The hours after the preliminary period should exceed 56 hours per week for any student. Night duty hours should not exceed those of the day.
 
SPECIAL DUTY NURSING FOR STUDENTS. Superintendents desiring to give this experience to their students may do so after the student has entered her second year, no charge to be made the patient for this service. No school will be recognized that assigns students to special duty for pay.
 
PRACTICAL NURSES. No practical nurse may be placed on duty in a hospital which conducts a school of nursing.
 
HELPERS, OR MAIDS. With definite non-nursing duties may be employed. It is recommended that colored women be employed for this work as there seems to be less friction when they are used.
 
HOUSING AND LIVING CONDITIONS.
 
NURSES HOME. The nurses residence to be separated from the hospital, attractively, but not expensively furnish, well heated and lighted, and service necessary to maintain a dignified, orderly and homelike household.
               
                There should be a reception room where the nurses can entertain their friends.
 
                There should not be more than two students to the room; and each student should have a separate bed, a closet or locker; and where the student must use her bedroom for a study there should be a desk or table and a reading light.
 
                Special Provision should be made to insure quiet for the night nurse.
 
                Ample bath and toilet facilities should be provided in the home.
 
                As the health and education of a nurse is much affected by her environment it is important that she have comfortable living quarters with provision for rest and recreation.
 
DINING ROOM. The dining room should be well lighted and ventilated and attractively furnished. The meals well planned and well cooked with prompt and efficient service during meals.
FACULTY
 
                Graduate nurses holding positions in schools of nursing should be high school graduates or have equivalent credits, and graduates of accredited schools of nursing. They should have special preparation or some years’ experience before accepting such positions. They must be registered in North Carolina, and should be members of the American Nurses Association, through the District in which they reside, and of the National League of Nursing Education through the State League.
 
                A teaching and supervisory staff sufficient to give careful instruction to the students and to insure properly supervised care of the patients throughout the twenty-four hours, should be maintained.
 
                It is recommended that a Grade A school of nursing employ:
1.       A Superintendent of Nurses.
2.       An Instructor.
3.       A Night Supervisor.
4.       An Operating Room Supervisor.
 
Grade B Schools should employ:
1.       Superintendent of Nurses.
2.       A Night Supervisor.
3.       An Operating Room Supervisor.
 
Members of the faculty should be encouraged to attend State and National meetings for nurses and hospital executives, and go occasionally to Universities for summer courses, or to large hospitals for refresher courses.
 
Institutions asking nurses to take positions in North Carolina should ascertain their eligibility to registration in this State before employing them, as registration in North Carolina is mandatory.
 
FACILITIES FOR CLASS INSTRUCTION.
 
                The minimum teaching equipment should include at least one large, well-lighted and well ventilated class room with desk chairs, large blackboard, charts, skeleton, models, etc.
               
                A demonstration room fully equipped for demonstrations in teaching nursing procedures with bed, demonstration doll, treatment trays, etc.
 
                Laboratories separate from those used in regular hospital services are essential in teaching dietetics and the sciences, unless they are arranged for in other educational institutions.
 
                A good reference library is essential to satisfactory teaching and the students should be encouraged to make the fullest use of it. It should include modern text and reference books, nursing periodicals, good general literature, current magazines and at least one daily paper.
 
                Some plan should be devised for the up-keep, management and increase of library facilities.
 
                Schools unable to provide science and diet laboratories may arrange for such courses with college, technical school, high school, or another accredited school of nursing where proper equipment is maintained.
 
RECORDS
 
RECORDS. It is essential that a good system of records be established and maintained. They should begin with the application of the student and serve as a continuous history of our training, and should be open for the inspection of the Educational Director at all times. They should state the students’ efficiency in work, attendance, and rating in her classes, lectures and demonstrations, the time she has spent in each department (day and night), absence from duty, sickness and vacation. A locked, fireproof filing cabinet should be provided for such records.
 
STUDENTS.
 
                Discrimination should be exercised in the admission of student nurses to the schools. Consideration should be given to their physique, their personality and general adaptability for the work.
 
EDUCATION. All students to be high school graduates with at least 16 standard units’ credit. Two transcripts of high school credits should be sent to the school by the applicant when applying for admission to the school. One transcript to be sent to the Educational Director for approval before the applicant is accepted.
 
AGE. The applicant to be at least 18 years of age before entering the school, and it is recommended that the entrance age be gradually raised to 19 and 20 years.
 
HEALTH. The applicant should be free from organic disease and physical defects, and should furnish with her application a recent certificate of health from her physician, and dentist. Before the end of the third month of the preliminary period she should be given a thorough physical examination by the school physician. Physical examinations should be made annually and before graduation in order that a high standard of health may be maintained. Accurate records should be kept of all matters pertaining to the health of the students.
 
ADMISSION OF CLASSES. Students should be admitted at regular intervals and in classes. It is recommended that only one class be admitted per year – preferably in September. The class work for preliminary students to continue without interruption throughout the preliminary period. This requires that students enter not later than February 1st.
 
                All schools no matter how small, should divide the students into first, second, and third year classes, giving to each the properly graded course of study in theory and practice. Students should not be accepted for entrance more than one week after classes have started.
 
ALLOWANCE. It is recommended that the allowance be discontinued and the money used to improve the educational facilities of the school. To provide more and better teachers, better equipment, and more comfortable living quarters for the students. The Board does not recommend a discontinuance of the allowance, unless a like amount is invested annually in improvements for the schools.
 
TRANSFERS, TIME ALLOWANCES, ETC. No allowance to be made for time spent in a non-accredited school.
               
Students must spend at least two years in the school from which they receive their diplomas except in the case of students transferred through the Board when a school closes.
               
                Students transferring from one school to another to have the transfer approved by the Board. They should not be admitted except at the regular period of admission.
 
                No time to be allowed for incomplete semesters
 


 
GENERAL PLAN OF PRACTICAL EXPERIENCE.
 
PRELIMINARY PERIOD
4 months
MEDICAL NURSING
6 months
SURGICAL NURSING- Including Gyn, E.E.N. & T., Orth
8 months
OBSTETRICAL NURSING
3 months
PEDIATRICS- Including Infant Feeding
3 months
OPERATING ROOM
4 months
DIET KITCHEN
2 months
DISPENSARY or OUT PATIENT DEP’T
2 months
ELECTIVES
2months
NIGHT DUTY
To be included in the above and not to exceed 6 months.
 
PRELIMINARY PERIOD. The general schedule recommended is as follows:
               
2---4 hours daily in practical work on the wards.
3---4 hours daily in class work.
2---4 hours daily in study and practice.
2---   Hours daily in recreation.
 
 
SUBSEQUENT TERMS.
 
                6---8 hours daily in practical work.
                1---2 hours daily in class work.
                1---2 hours daily in study.
                2---   Hours daily in recreation.
                               
No student should be required to spend more than eight hours per day in practical work and should have at least two hours for recreation.
 
                It is recommend that experience in medical and surgical nursing precede training in the special branches, and every effort made to correlate the ward practice with the class room teaching and vice versa.
 
MEDICAL NURSING. This service should have include the care of both men and women, and should provide experience in all of the common medical diseases such as cardiac, gastric, kidney, respiratory, and metabolic conditions, pneumonia, influenza, etc.
 
SURGICAL NURSING. Should include the care of both men and women and should give experience in general surgical, gynecological, urological, orthopedic and emergency work.
 
PEDIATRIC NURSING. Should include medical and surgical conditions of childhood. Experience in the preparation of special formula and infants diets, and wherever possible an opportunity should be given for observation of the normal child.
 
OPERATING ROOM EXPERIENCE. Each student should assist in twenty-five major operations and have careful instruction in aseptic technique. This service should not be given until after she enters her second year.
 
OBSTETRICAL NURSING. This experience should follow the operating room experience. Each student should have the care of at least ten patients during labor, and delivery and their after-care until discharge. They should have the care of ten new born babies.
 
NURSING IN SPECIAL DISEASES.Experience should be given in eye, ear, nose and throat nursing, skin diseases and other specialties.
 
DIET KITCHEN. Should include the actual preparation of all the simpler types of foods and also the preparation and calculation of special diets.
 
NIGHT DUTY. The amount of night duty not to exceed six months in the three years. No student should be put on night duty until she has been in the school at least six months, and then only as a junior nurse. The night duty term should not exceed one month in length and the student should not serve more than two months per year.
 
VACATIONS. It is recommended that the vacation period be at least two weeks, with holidays and occasional days off when it is possible to arrange for them.
 
ELECTIVES. As a means of rounding out the students experience additional time may be given in a service where the students’ previous experience has been a little weak, or as a senior nurse assisting a head nurse or supervisor in charge of some hospital department.
 
 
MINIMUM CURRICULM.
 
                All schools of nursing to have a copy of the recent edition of “A Curriculum for Schools of Nursing” published by the National League of Nursing Education. The outlines given should be used as a guide in planning the contents of the course. Attention is called to the fact that only the minimum numbers of hours are required but this should not be the point at which any school should be satisfied.
               
It is recommended that classes and lectures be given before 7 o’clock P.M. thus leaving the evenings free for study.
               
It will be noted that the courses are based on a 15 hour unit, which usually means one hour a week for 15 weeks, but not necessarily so. A 30 hour course should be given two hours a week for 15 weeks rather than one hour per week for thirty weeks.
 
 
 
 
 
 
 
 
FIRST YEAR
PRELIMINARY PERIOD-Fifteen Hours
Minimum Hours
Recommended by N.L.N.E. Hours
Anatomy and Physiology
30
90
Bacteriology
30
45
General & Applied Chemistry
45
45
Personal Hygiene
15
15
Elementary Materia Medica
15
15
Principles and Practice of Nursing- Elementary
90
90
History of Nursing
15
 
Ethics of Nursing
15
30
Physical Training
 
15
 
240
345
 
               
SECOND TERM- Fifteen Weeks
Hours
Recommended by N.L.N.E. Hours
Anatomy and Physiology
30
---
Elements of Pathology
15
15
Materia Medica and Therapeutics
30
30
Dietetics
45
60
Principles & Practice of Nursing- Advanced
30
30
Psychology (including Mental Hygiene etc.
20
30
 
170
180
       
 
 
SECOND YEAR
Thirty Weeks
Hours
Hours
Nursing in General Medical Diseases
30
30
Nursing in Medical Specialties: Communicable Dis. & Skin
30
30
Nursing in General Surgical Diseases
30
30
Nursing in Surgical Specialties: Orthopedics, Gynecology Urology
30
30
Pediatric Nursing and Infant Feeding
30
30
Modern Social and Health Movements
30
30
 
180
180
 
 
 
 
 
 
 
 
 
 
THIRD YEAR
Thirty Weeks
Hours
Hours
Obstetrical Nursing
30
30
Psychiatric Nursing
30
30
Nursing Diseases of E.E.N. & T.
15
15
Emergency Nursing and First Aid
15
15
Survey of the Nurs. Field & Related Professional Prob.
20
30
 
110
120
 
775
826
 
                Total number of hours for the three years
 
 
a.       A new curriculum to be started with each new class, and the preliminary students to complete the required number of hours in theory and practice before they are accepted into the school as regular students.
 
b.      Written and oral examinations to be given at intervals throughout the course and a passing grade of 75% to be required in all subjects
 
c.       Students failing in the preliminary period may be provisionally accepted into the school if there is sufficient evidence that they will be able to carry the work in the future.
 
d.      No student to be promoted to the next class or given a diploma until she has passed all of the required subjects.
 
COMPULSORY REGISTRATION.
 
No person shall practice nursing as a graduate, registered nurse in the state until he or she has secured a license or permit from the Board of Nurse Examiners.
 
                Institutions employing from other states should inform such nurses that registration in North Carolina is compulsory.  Superintendents should personally see that any applicant for a position is eligible and that she applies promptly to the secretary of the Board of Nurse Examiners for forms.
 
ELIGIBILITY.
 
A.      WITH EXAMINATION.
 
To be eligible for registration the applicant must furnish evidence satisfactory to the Board that he or she:
·         Is twenty-one years of age or over.
·         Is a high school graduate, or has equivalent credits.
·         Has completed a full three years’ course in an accredited school of nursing, or is within thirty years of completing full time in the school. They must have completed all theory.
 
Nurses wishing to practice until the next examination is held should file their application with the secretary upon completion of their full time in training, whereupon a permit to practice will be issued time.
 
B.      WITHOUT EXAMINATION.
 
Registrants of other states who have registered by examination and who individually meet North Carolina requirements at the time of registration, may register without examination by filing the proper credentials with the secretary of the Board and paying the registration fee of twenty-five dollars.
NO FEE REFUNDED AFTER THE APPLICATION IS ACCEPTED.
 
EXAMINATIONS.
 I
A.      TIME AND PLACE.
 
Examinations are held twice a year at the Capitol, Raleigh, unless a change is necessary because of
unavoidable circumstances. Notice of the examination is given in the American Journal of Nursing and the daily newspapers of the state at least thirty days before the examination is held.
 
B.      APPLICATIONS.
 
Applications shall be completed and in the hands of the secretary eighteen days before the dates of the examination.
 
A complete application consists of:
(a)    Application blank properly filled out.
(b)   Record of practical and theoretical instruction.
(c)    Copy of high school credits.
(d)   Registration fee of ten dollars.
 
C.      PASSING GRADE.
 
A passing grade of 75% is required in all subjects.
 
                Students who fail to make a passing grade must re-write the subject failed, at next succeeding examination, unless otherwise arranged with the Board. A first second re-examination may be taken without filing another application.
 
D.      DEMISSION CARDS.
 
Demission cards are sent to applicants at least ten day before the examination ends. No one will be admitted to the examinations without this card.
 
E.       FEES.
 
The examination fee is ten dollars ($10.00). This fee must be paid with the application is filed, and should be in the form of a cashier’s or certified check, or express money order and should be made payable to
NO FEES REFUNDED AFTER THE APPLICATION IS ACCEPTED.
 
F.       PERMITS.
 
Between Examinations. A nurse completing a course or coming into the state between examinations, must obtain a permit to practice until the next examination must take the first examination given. No charge is made for this permit.
 
After the First Failure. For those who fail the first time, a permit to practice until the next examination is held, but not longer than six months, will issued upon receipt of $2.50.
 
After the second failure. Permits will be renewed after the candidate has led for the second time upon payment of $5.00, if the failure occurred within eighteen months of the first examination. Such permits are good for only six-months.
 
 
 
GENERAL STATEMENTS REGARDING REGISTRATION.
 
A)     RECORDING CERTIFICATE WITH COUNTY CLERK.
 
According to the law, registration is not complete until the certificate has been recorded with a Clerk of Court in some county of North Carolina. This must be done within twelve months after the certificate is issued.
 
B)      REGISTRATION.
 
Re-registration is not required in North Carolina.
 
C)      CHANGE OF NAME.
 
Nurses who marry should notify the Board of the change of name. Married name will be carried on the record following the family name, which is original registration name in the files.
 
D)     APPLICATION BLANKS.
 
Application blanks may be secured from the Secretary of the Board of Nurse Examiners.
 
E)      HONOR CERTIFICATES.
 
To the certificate of every candidate who attains a general average of 90% or over will be attached an honor seal (gold).