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During our nursing training at the hospital we followed the orders of the ward nursing sisters, as junior nurses were required to be supervised by nursing sisters or senior nurses on duty at that time. A charge nursing supervisor would come into the ward occasionally to ask how were things getting along in their wards. At each morning shift, there would be a medical, surgical, paediatrics and operating nursing supervisor on duty. For evening and night shifts there would be a nursing supervisor for the hospital. There was a norm in nursing culture that certain tasks were junior nurses' and senior nurses' duties. As first year nurses we performed many menial tasks which today are completed by cleaners and ward assistance. For example, we cleaned side and overhead tables, changed flower vases, water and water jugs. Whilst on duty, we were expected to be seen working, and talking with patients was a no-no. When a nursing supervisor or tutor walked into the ward we either hid behind the screen or rushed into the pan-room. One day when we were at the nursing school, a group of us sat down and wrote a song:
Hello mudder - hello father,
Here we are at Queen Victoria
All the patients we aren't curin'
Cos we're in a room all day just testin' urine.
Sister Hammond does the teaching,
And our brains she's slowly reaching,
She is just so très efficient,
That in commonsense we all seem most deficient.
We have learnt so many new terms,
Like "bacteria" which means germs,
How you do not spread infection
And today we all gave lemons an injection.
Chorus
Send me cash, oh mudder, fadder,
I've been rash, but I'll work harder,
You'll be proud of me I promise,
When I'm thru, I'll come & care for you.
Dearest parents, this is all,
I see Sister down the hall
Oh my goodness I'm too late
Guess the pan room & the urine are my fate.
Photo: archive ref. B02/000
Nurses were expected to set the right priority for their duties. If there were temperatures to be taken, we took them before cleaning the lockers or pan room. We were also taught to clean up after ourselves in the pan room. If we made a mess, we were expected to clean up the mess and not leave it around. If we spilt urine on the floor, we took a mop and mopped it up. There were no domestic personnel to call upon or follow after the nurses; someone could slip on the wet floor and fall. The charge sister did not like incident reports.
Categorising tasks according to nursing seniority had its advantages and disadvantages. The great disadvantage I saw was that senior nurses would not give junior nurses a hand when they saw that the duties belonged to junior nurses. It was seen to be quite boring and degrading to be testing urine and faeces, giving bed-pans, cleaning the pan room and mopping the floor, and not giving nursing care except when sponging patients and taking their temperature. Senior nurses would not help with these tasks which they thought were junior tasks, unless the junior nurse was their friend. It could therefore be very exasperating when as a junior nurse, we appeared to be working alone without any help. Senior nurses appeared to forget their past experiences as junior nurses after being promoted to senior nurses although there were some exceptional nurses and colleagues who helped and worked as a team in the wards. So when first year nurses saw another Preliminary Group of nurses (PTS) being orientated into the ward, there was always a sigh of relief in the knowledge that the most junior tasks would one day be taken over by another group. We were eager to practise our senior skills which were taught at the school and not repeating the same junior tasks. The advantage in task-oriented nursing was that everyone knew what their jobs were at the level they were at in their training and each nurse was held responsible where they were rostered. Thus when there were problems related to a particular task, the responsible nurse could not blame it on another nurse. The accountably of the nurse was kept in check.
The wards at the hospitals where I undertook my training in the 1960's were divided into the main ward and the balcony. In the main ward the beds were lined on each side of the ward so there were two rows of beds facing each other. At times when the hospital was very busy there were beds placed at the centre of the ward. Fortunately, I do not remember seeing this happen very often. In the balcony, there was a row of beds facing the outside of the ward. Patients who were recuperating were often moved to the balcony as they required less direct observation. Seriously sick patients were often moved nearer to the nursing station to be under close observation. Those days there were no monitors attached to patients. Nurses were expected to watch the patients closely with their six senses. There was no technology to help in picking up slight changes in patient sickness. Nurses were expected to have sharp eyes, use their nose for smells or odours, hands for feeling, ears for hearing, tongue to taste and our mind to predict emotions, type of environments etc.
Often a senior nurse would be assigned to be in charge of one side of the ward and another to the other side of the ward. There would be a couple of junior nurses working under her supervision. The first or second year nurse would help with the nursing care according to their abilities and rank. It was often a relief to the senior nurse when there were more senior first or second year nurses assigned under her supervision. The senior nurse would have less stress performing senior skills as a more senior junior nurse would require less supervision. Precious time would not be taken by the junior nurses when the senior nurses were performing their own duties. Any abnormalities detected by the junior nurse had to be reported to the senior nurse or ward sister, for example, a patient's high temperature. A nurse was expected to know what caused the high temperature. We needed to ascertain whether it was infection which caused the high temperature and not simply a hot drink or exercise before reporting. Therefore, nurses were not only required to possess and be proficient with their psychomotor skills, but also have the knowledge and brains to be analytical. Nursing skills come from many years of experience and knowledge.
The ward sister would be in charge of all the nursing care in the ward. Therefore, the senior nurse would be under the watchful eyes of the ward sisters. If there were any problems, the senior nurse sought the advice of the ward sister. However, during afternoon shifts there would be either one or no ward sister. The senior nurse would have to be in charge and call on the evening nursing supervisor for assistance. The senior nurse would perform duties like giving out oral medications and injections, changing wound dressings, looking after intravenous drips, washouts, etc. Most of the time a ward had two ward sisters working during the morning shift. The assistant ward sister assisted with the supervision and assessments of trainee nurses. Before a nurse could practice nursing skills on their own, she was required to have observed and be performing the nursing skills under the supervision of a nursing sister and be deemed safe. If the nursing skill was performed satisfactorily, the nurse then could have the nursing sister's signature in their Blue Book with the stated nursing skill. Only then could a nurse perform the signatured skills alone, without supervision. Of course any skill performed might not be straight forward and a nurse could ask for more supervision until she had confidence to perform the skill on her own.
The ward sister or sister-in-charge of the ward would be responsible for the overall running of the ward. The matron or assistant matron of the hospital would come every morning to say "hello" to the ward. Often the ledges of windows would be checked for dust by the matron running her fingers across them. Nurses would be ordered to wipe off dust if any was found. Bed wheels and pillow placement were checked as well. The wheels of the beds were to face inwards to avoid people from tripping and the openings of pillows should be facing away from the ward entrance to make the ward look tidy. It was the ward sister's responsibility to accompany the matron around the ward. The matron would be introduced to all the patients and the patients were asked how they were feeling and whether or not they were satisfied with their nursing care. Any nursing problems would be directed to the matron if the nursing sisters were not happy, for example, if there was a shortage of nurses to perform satisfactory nursing care. I often wonder how the matron knew all the patients at the hospital.
It was the responsibility of the assistant matron to assign trainee nurses to the wards. The nurses in the ward requested the shifts they liked to work. The annual vacation each year was handed to the assistant matron. The assistant matron would grant the vacations as requested to the best of her abilities. The requests for days off were the responsibility of the ward. There were times we were not given what we requested; we then were asked to negotiate with other nurses.
Image: Lai Fun's first progress report during first year PTS training (23 September 1963, archive ref. P7/08a)
It was also the responsibility of the ward sister to attend to the doctors when they were on a ward round seeing to their patients. The ward sister reported to the doctors any patient changes, for example high temperature and vomiting. Any changes to patient treatment would be made by the doctor according to their examination, the sister's report and patient's complaints. The ward sister noted the change of treatments and changed the nursing care plan for the patient accordingly. The thing I personally disliked about the ward round was that patients' medical issues were discussed without much consideration given to them. In a teaching hospital, there would be a number of medical students around with the specialist. The doctors would not include the patients in their discussions and examinations. Permission was not asked, and the rights of the patients seemed to dissipate when the doctors were around.
During our second year of training, nursing tasks included wound dressings, injections and giving out oral medication, if there were no third year nurses on duty. There were times we were required to perform junior first year duties if there were no junior nurses around. We hardly knew our patients as often they were referred to by their assigned bed numbers when reports were given at hand-over by the most senior nurse on duty. It did appear that nurses did not care for the patients holistically. We referred to them by their bed numbers and were not allowed to talk to them unless administrating nursing care. Patients and nurses treated one another impersonally. Nurses were addressed by patients as nurses and nurses address their patients as patients and not as clients. The patients were not seen to have any psychological problems even when their mind did play a great part in the make-up of the person. A lonely patient might have problems they wished to ventilate and talk to somebody. As nurses we often talked to the patient during a nursing procedure and seldom stayed longer than we should. A patient's spiritual, emotional and all psychological issues were not recognised as being related to their physical problems. When we saw a nursing sister or supervisor coming into the ward at a distance, we either drew the screen around the patient's bed or ran into the pan-room and pretended we were busy. In those days talking to a patient was not considered work. Nurses had to be seen physically working, so work was considered hands-on only.
As second year nurses we were expected to be in charge of the wards. Occasionally we were asked to be in charge even at the end of our first year. It was very testing and stressful especially when the nurse had no knowledge of the patients' diseases as it was not up to her level of training. As a junior nurse, one would be very reluctant to be in charge. However, often there was no choice but to do the best we could do. Today, fortunately, nurses are accepted as professionals and are taught a body of knowledge before they go out to the field. The disadvantage of the college nursing students of today would be that they do not have the amount of practical or hands on skills as the hospital-based training nurses. The big advantage of college educated nurses is that patients or clients are no longer guinea pigs with nurses are no longer performing duties by trial and error.
Many nurses gave up nursing training after PTS or within their three years of training for many reasons. Some were disillusioned with nursing training or had not developed the ability to study. Some had to give up because they were found pregnant. Shift work was another factor which nurses detested. Often they had to forsake a social function and enjoyment of life as a non-shift worker would enjoy. There were, however, many reasons for choosing to do nursing. They included security, an interest in meeting, understanding and helping people, having a family member in the health field, the desire for emotional fulfilment, or for personal growth and fascination with medical technology.
It appears that today, people pursue nursing because it is a profession which will give them the security of employment and financial security. Money plays a great factor in why people are nursing. I often think that is why the standard of nursing has deteriorated. With degree nurses, nursing duties which are seen to be menial or dirty are often resented. From my experience many degree nurses prefer deskwork over rendering nursing care.
During my work experience I have often observed nurses socialising with other medical personnel when more essential nursing duties needed to be done. It was often said that those nurses were better at working with their mouths than with their hands. It would be most frustrating to work with these nurses who did not seem to care about their work and left work to others.
Stress on the ward can be great and I believe mistakes are often made as a result or working under stress. A nurse's power of observation is reduced under stress. Moreover, when nurses are over worked, they tend to be less tolerant with one another. Conflicts can then arise amongst nursing colleagues, bitching between one another thus making the working environment most unhappy. However during my training, my colleagues in the Group 21 student nurses were very cohesive. We supported one another at work and play, and colour, creed, race, wealth and intellect were not a concern. Even today, we hold reunions whenever we can. The last reunion was in Port Stephens, New South Wales in 2003. Despite my experience, amongst nurses as a whole I have observed power struggles amongst the ranks. A lot of gossiping occurred at tea breaks. Nurses seemed to be their worst enemies. On top of that, the pay of nurses used to be poor when compared to other professions. Often after a number of years working, married nurses would give up their work and chose to stay at home or change into another field as they were disillusioned by nursing.
Photo: Reunion with Group 21 colleagues at the Queen Victoria Memorial Hospital centenary celebrations held in Carlton, Victoria (7-8 September 1996, archive ref. B06/009)
Photo: Certificate from Queen Victoria Memorial Hospital upon conclusion of nursing training (26 September 1967, archive ref. P7/17a)
After I had passed my nursing examination, I was expected to return to Malaysia to serve the government for five years. This was the contract I had to sign before taking up my scholarship. The so-called scholarship paid only my plane fare to Melbourne from Malaysia. There was no other pocket money besides the small amount of pay we received from the hospital. When my time in Australia was drawing to a close, I applied for six months extension for some post graduation experiences. I was granted three months, of which I chose to work in the Intensive Care Area. It was then a three bed unit in the Recovery Room. I was given a veil in place of my nursing cap. I felt proud with the veil as it symbolised that I had been successful in my nursing course. However, I could say the veil was an awkward thing to have on your head when there was patient lifting and moving to do. It was heavy on the head and seemed to slip and shift when the head was bend or turned, even though there were a number of hair pins to keep it in place.
On September 23rd, 1966, I completed my nursing training. My first nursing duty as a fully-fledged nursing sister was in the first embolectomy, or open heart surgery, done by Dr. Drew.. Everybody was so excited with the skill at this procedure and the fact that it was a successful operation. The procedure was performed at the Queen Victoria Hospital. Everybody was excited and proud of the achievement. It was hot medical news in the papers. The patient was on a Bird's Respirator and I was to look after the patient. It was terrifying then as I was not taught previously how to operate a respirator. I was fortunate enough that I was working with very supportive members of staff and pulled through the shifts. I remembered during a shift a doctor queried the readings of the blood pressure. The doctors had to be so careful that nothing went wrong. My senior informed the doctor that she trusted my readings as I was a qualified nursing sister and if the doctor did not believe the readings, the doctor should do them himself. The firmness of the nursing sister deterred the doctor from questioning any of my nursing care.
As the only Asian nurse working in a foreign country, I found I met many challenges in nursing. I had to prove to my co-workers that I could do the work assigned to me. Sometimes, I had to strain my ears to listen for instructions as some of the nurses had very strong accents, especially the Irish and Scottish nurses. My accent was difficult for them as well, so I had to speak clearly and slowly. At times I found it exasperating to have to repeat myself several times. Some of the doctor's writing was difficult to decipher because they scribbled what they wrote. As English is my second language, I made doubly sure that I had it right when reading the patients' treatments. I was blessed with good working relationships with my colleagues and time given to me was invaluable. Often a helping hand was given to me willingly and happily. The support given to me when I was under training and learning on the job was great and I greatly appreciated it. Support from others reduced my insecurity and gave me great confidence, satisfaction and motivation to perform and in return I gave my best.
Photo: Letter from Queen Victoria Memorial Hospital acknowledging Lai Fun's achievement in the state final nursing exams as an international student (26 August 1966, archive ref. B02/007)
My post graduation nursing was short and time flew very quickly when I preferred time to move slowly. Since I had accumulated many souvenirs during my three years in Melbourne, I decided to return to Malaysia by ship. A Singaporean nurse who was also my cousin's friend joined me on the cruise back to Singapore from Sydney. I had a great farewell in Melbourne and Sydney. My eyes were dry from the joy of knowing that I would be back with my family and yet there was sadness knowing that I had to leave my Australian friends.
Photos: Lai Fun's farewell party in Melbourne (Oct 1966, archive refs. B01/108-109)
The sea journey on the Fairsky was pleasant if not for the sea-sickness. There was a lot of entertainment on board the ship. We made many friends and at times spent the whole night dancing with strangers. A great celebration was given when we crossed the equator and we were awarded a certificate for the crossing.
On arrival at Singapore, my parents met me at Singapore dock-side. It was nice to see them again after three long years. They had aged since I last saw them but it was not difficult to recognise them as their features were still there. I took them on board the ship and gave them a tour. We had a great two days in Singapore before we took the train back to Kuala Lumpur. We were met at Kuala Lumpur by my brother's friend who took me to the Health Ministry to report my return and be registered as a nurse in Malaysia.
Photo: Lai Fun with her parents in front of the T.v. Fairsky upon arriving at Singapore (9 November 1966, archive ref. B01/126)
Image carousel: Passenger list from Lai Fun's voyage on the Fairsky. The entry for Lai Fun is seventh from the bottom on page 1 (October 1966, archive ref. B01/131)
Photos: Menu from the Equatorial Dinner held aboard the Fairsky on 5 November 1966 and certificate awarded after the equatorial line-crossing ceremony (archive refs. B01/132-133)
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