Chapter 5: Preliminary Training School
Chapter 5 of "Open to Possibilities: The Life of a Young English Nurse"
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Ann bounced down the hallway toward Trish, beaming,
“No more card punching!”
She had accepted an offer for nurses’ aide training. Trish had forgotten all about punching cards at AT&E. Her initial elation had already dissolved into dread as she realized the next thing she had to do was tell her parents she was going into nurses’ training.
She thought her father held old-fashioned views on the role of girls, even for the time. His mother had espoused very traditional views of decorum. Long after her children were adults with families of their own, and until her death in 1956, she had kept a tight hold on the family. Perhaps because of the ongoing influence of his mother, Harold had not softened his views as Trish had grown up. She knew her father would receive her news badly.
It was the middle of the workday when the girls left Alder Hey Hospital, their futures looking quite different from just a few hours earlier. There was no point in going to AT&E, clocking in that late in the day would only attract extra attention to their absence that morning. It was best to just go home.
They parted ways, and Trish went home to tell her mum about the interview. She was relieved she could tell Florence before having to face her dad when he got home from work. Her mum had little to say when Trish told her about the nurses’ training, other than to say Harold would not receive the news well. She was correct on that point.
Her dad was as upset as Trish had imagined he would be. He was angry that she had not been to work that day, angry that she seemed ungrateful for the job he had secured for her, and angry that she accepted the training position on the spot. He said she was selfish for only thinking of herself. Trish didn’t understand how she was being selfish, the training was free, and her small wage covered her room and board. There were no fees required from the family.
Florence stayed silent as Harold vented his anger. Trish wondered why her mum didn’t speak up for her, as she had done years earlier when Trish wanted to go to grammar school. She didn’t understand at the time but reflected on that moment many times later. Perhaps her mum thought she had already done her part to make Trish’s new future possible. This wasn’t her battle to fight.
The nurses’ training didn’t start until September, four long months away. Trish continued working at AT&E until it was time to start her training. Although the work was still miserable, there was an end in sight. When her end date drew nearer, she was pleased to provide formal notice about her impending departure from the job. She felt that was honourable; she appreciated her dad’s strong loyalty to the company and didn’t want to be disrespectful.
Relations at home were tense. She and her dad didn’t speak during those four months, and for some time after she started her nurses’ training. Trish did her best to stay out of the house when he was home, and out of sight when being home was unavoidable. Evenings were particularly troublesome. Although Trish was 17 years old, had finished school and was working, she still had a 8:30pm curfew. She had gotten older, but the curfew had never moved. Her younger brothers, only 11 and 12 at the time didn’t have a curfew. She spent evenings sitting in her room, out of sight, boiling with resentment about the unfairness of it. She couldn’t wait to live away for nurses’ training.
Years later, Trish reflected further on the unspoken impact of her impulsive decision that almost had certainly contributed to the fiery response from her father. Although the nurses’ training was indeed free, and the students drew a small salary, it wasn’t much. It covered their room and board, and enough pocket money to buy the compulsory black stockings that were needed to complete the student uniforms, but little else. When Trish had worked at AT&E, her dad had collected her pay on her behalf and given her an allowance from it. She hadn’t thought about it until much later, but the wages she earned punching cards were helping the family. After Trish began her training at Alder Hey Children’s Hospital, her mum started a menial job at AT&E. She washed dishes in the cafeteria where the factory bosses took their lunch. Trish’s two young brothers were growing boys, and the family had depended on Trish’s pay from AT&E to contribute to the family finances. Florence never commented on it, but when Trish realized the impact of her decision, she felt regret that she hadn’t given more thought to the reality of the family’s circumstance.
Finally, after four long months of anticipation, the first day of nurses’ training came. Not unlike the start of grammar school years earlier, the uniform proved to be the most concerning issue of the day. Although there was a process to get measured for the uniform - a green dress with white button-on cuffs and collars that needed to be starched - the dresses seemed to only come in one size. Trish, petite at 5'3" and slightly built, grimly concluded that the dresses were obviously sized for 7-foot-tall, 18-stone footballers. A green belt was part of the uniform, a critical element, Trish thought. The problem was, the belts were only issued to second-year and third-year students. Although the uniform fittings occurred in the sewing room, there was only so much alteration that was possible on such a large garment that was to be worn by such a slight person. By the end of the session, Trish accepted she would be swimming in her uniform, but at least it had her name carefully sewn into the collar. A small stack of white aprons, and a rather puzzling starched white piece of material with a button on one end, and a buttonhole on the other completed her uniform issue. The latter item was a nurse’s cap, and the staff member assured Trish it was more straightforward to wear than it appeared in its freshly laundered form.
There was also a heavy black cloak that Trish found more use for as a blanket in her unheated room in the residence than for anything else. Wearing the uniform outdoors, and particularly off the hospital grounds, was unhygienic, so there was little need for the cape. The last details of the uniform, ones that students needed to purchase for themselves, were black shoes and black stockings with a seam up the back.
Trish received the instruction that students must place their soiled uniforms in a laundry basket along with everyone else’s to be collected by the porter and taken to the hospital laundry for washing. When clean laundry was returned to the nurses’ home, Trish could identify her uniforms by the name label sewn on each item by the sewing room staff.
Once inside the nurses' home, where students lived during their training, Trish found the accommodations were adequate. Each student had their own room that had the basics: a bed, a wardrobe for their belongings, and a desk for their studies. Students had access to a communal bathroom. Third-year students had a sink in their rooms, so that was something to anticipate in the future. The rooms lacked heating, but the girls threw their heavy uniform cloaks over their beds when it was chilly.
The Home Sister, an administrative nurse assigned to manage the nurses’ home, assisted students with any issues that arose as the new cohort settled into their rooms. For most of the girls, this was their first time living away from home.
The first eight-week segment of nurses’ training was Preliminary Training School, or PTS as it was more routinely referred to. It was lead by Sisters (senior nurses, usually in administrative or teaching roles), and served as an orientation to the first-year nurses’ training and began with classroom sessions where the students learned the basics of the nursing profession. They studied the history of the discipline all the way back to Hippocrates, and the St. John’s Crusaders. The students learned about Florence Nightingale, considered the founder of modern nursing.
They listened to lectures about etiquette in a nursing context - for example, who is senior to a PTS student? The answer to that was easy - everyone was - even the cohort of students just ahead of you. A PTS student needed to give all senior students and staff the right of way in corridors, they needed to hold open doors for them, and they needed to always be polite, in all circumstances.
They studied the various roles and hierarchy within the medical staff. There were porters, nurse’s aides, staff nurses, Ward Sisters, Night Sisters, and the Matron. There were medical specialists, known as “consultants”, to be referred to as “Doctor”. Surgical consultants were addressed as “Mister”, or “Miss”, - there were a few female surgeons working in Liverpool.
The Sisters who oversaw PTS taught most theoretical lessons in a formal classroom, but sometimes students were required to perform a task while they listened to a lesson. On one occasion, Trish recalls sitting around a table rolling dozens of bandages that had just come from the laundry, while listening to a lecture on etiquette. While she rolled bandages, she learned the “Golden Rules” of nursing conduct, for example, nurses do not run. It does not matter what is happening, do not run. Nurses may walk briskly, but they do not run. Nurses always maintained a calm demeanour, regardless of what was occurring around them.
The values espoused by the nursing profession in that era were simple and bound in tradition. Doctors wrote orders and nurses carried them out. A nurse's job was to nurse people, to make a patient clean and comfortable, and carry out the doctors’ orders. There were no housekeepers, only nurses’ aides, nursing students, and staff nurses to keep the wards and medical equipment clean and serviceable. Besides medical care, nurses provided personal care, such as helping patients with bedpans and bathing.
In a training hospital such as Alder Hey, student nurses completed many of the day-to-day care related activities, particularly the cleaning, feeding, and hygiene tasks. As a student nurse worked her way up the ladder there was always a new crop of more junior students who took on the most menial tasks. The senior students had time for more and more complex tasks. It was just the way it was. Trish and her classmates realized quickly that their next few years would be full of cleaning and many other menial tasks. Trish was unconcerned by that notion; cleaning was better than punching cards in a factory. She could see past the most junior phase of the training to the time when she would work more directly with patients, as a third-year student, then as a qualified staff nurse.
Trish settled into the routines of PTS and life in the nurses’ home quickly. The days started early, breakfast began at 7:00am. She needed to be up well before that to wrangle her bulky uniform and tame her hair adequately to set her cap in place. The moments between waking up and getting out of bed were difficult. Bed was warm, and the rest of the room was cold and uninviting. Once Trish flung the covers back and sat up, there was no longer a choice but to get up and start the day. She hurried down the hallway outside her door to take her turn in the communal lavatories. Thankfully, there were enough facilities that she rarely had to wait in a queue.
Back in her room, she donned her uniform. She learned she could roll up her uniform dress at the waist to make it the right length, just below the knees. She awkwardly secured the bulky roll of fabric with safety pins, straining to reach behind herself to pin the roll at the back of the dress as well. The hem had to be straight and the pins secure; the roll could not come loose during her daily activities. A white apron went on over the green dress, hiding most of the messy roll and safety pins.
She pulled on the required black stockings. The seams of the stockings that ran up the back of the leg had to be perfectly straight, and holes in the stockings were unacceptable. Trish lamented that most of her pocket money went toward buying new stockings, but it was unavoidable. Sisters would send student nurses back to the residence to fix a seam that had gone askew, or to change into new stockings if a ladder or hole was visible while they were in class or on duty. There was a nearby shop where Trish could buy new stockings, and she could buy a pair from Home Sister in an emergency.
The last element of the uniform was the white cap. The nurses’ cap came from the laundry as a starched, flat, white form. To wear it, Trish folded it as she had been shown, then pulled the ends together and buttoned them. She placed the cap on her head, and began the futile task of using white hair pins to secure the cap onto her head, with her hair neatly inside. Students could not have their hair showing. This was a constant problem for Trish, who had a lot of fine, curly hair. It just wouldn’t stay secure. She had already experienced a Sister sending her back to her room during the day to control her hair.
“Lewis, go fix your cap!”
Drat! From the front of the room, the Sister had noticed Trish’s cap was askew, and her hair was escaping. Trish had to leave what she was doing and return to her room to fix her cap. To prevent that happening again, each morning she added more and more hair pins to keep it secure. By the time she was done, it felt like she was wearing a helmet, rather than a nurses’ cap.
Before leaving her room to join classmates for breakfast, she inspected her reflection in the mirror. She concluded the young face looking back at her was as ready for the day as it was going to be.
Closing her door behind her, she joined the group of students who were lingering in the hallway, they usually all went to breakfast together. The dining room was on the ground floor of the hospital, so the students exited the nurses’ home and crossed the grounds to the main building. The dining room was large with many tables. Each table had room for eight people, more if they squeezed in. The main dining room was for students, staff nurses, and other hospital staff. Doctors and Sisters had their own dining rooms. Trish and the others queued to collect their breakfast as it was passed out on trays through a hatch in the wall on the near side of the dining room. They carried their meal to another area further along the wall, where they got their tea. The first girl to have collected her breakfast and tea scanned the room for free tables that had enough room for all of them.
Once breakfast was done, Trish and her classmates made their way to the first class of the day. Often the first class in the morning was theory-based. Such classes usually started with a quiz on the content covered in the previous day’s class. There were also practical aspects of nursing that needed to be mastered by the end of PTS. Practical lessons were conducted in a training ward. The training ward was an extension of a classroom, equipped with beds and other training aids for the new students to practice skills. Specific skills Trish recalls from the early days of training were how to make a bed with speed and precision, and how to do basic bandaging. To make beds, students needed to work in pairs. Sheets must be straight, with bottom sheets tucked in tightly with nary a wrinkle. Even a small wrinkle could give a bed-bound patient a pressure sore that, besides being unnecessary and painful, could become infected and present a serious problem. The students practiced until the Sister deemed they could consistently make a bed that passed inspection.
When it was time to learn bandaging techniques, Trish was pleasantly surprised to realize that her time in the St. John’s Ambulance Brigade had prepared her well for the skill. There was little new information in the bandaging lessons for Trish, and it was comforting to be confident with her skills, in at least one area.
On the days where there were practical skills to learn, time flew by. It was surprising to find half the day had passed, and it was already time to go back to the dining room for lunch. The girls chatted over lunch about their successes and struggles from their morning class, and speculation over what the afternoon sessions might hold.
After the last class of the day, the girls went back to the nurses’ home to change out of their uniforms and into their regular clothes. There was time to look after personal chores before dinner time. Trish used the time to inspected her uniform dress and the white apron she had worn that day. She could wear the dress for a few days, if the white apron covering it was clean. When the apron was soiled, she put it in the basket to be sent to the hospital laundry room. If it was still clean, she would carefully hang it along with the uniform dress in her wardrobe to keep everything wrinkle-free for the next day. When the porter returned a trolley of clean laundry to the residence, Trish located her items by the name tags sewn into them. She attached the white collar and cuffs to the uniform dress, then hung the fresh uniform in her wardrobe. Finally, she hand-washed her personal clothing items in the sink in the lavatory and hung them to dry.
Although they were tired by the end of the day, Trish and her classmates still had much to talk about over dinner. They discussed details from class, commented on their stiff, itchy uniforms, and shared anecdotes from the day. Evenings in the nurses’ home were times of bonding as the girls studied together, sharing each other’s notes to make sure all the students had a complete picture of the information from the day. They also discussed the qualities and approaches of the various Sisters who provided their lessons day by day. It didn’t take long to settle into routines in their new life in the nurses’ home.
Later in the evening, Home Sister would pass by the rooms of the PTS students, making sure everyone was preparing for bed at a reasonable time. Trish didn’t mind being told to go to her room for the night by Home Sister. Although it was similar to the curfew imposed by her dad that she so resented, bedtime for the PTS students was applied equally to everyone. Trish wasn’t being singled out. Besides, by bedtime most days, Trish was exhausted. Her mind reeled with everything she had learned and experienced throughout the day. When she finally crawled into bed, the sheets were cold. The bed was never as warm and comfortable at night as it would be in the morning, when she would once again get up in the dark, in a cold room, and do it all over.
Although days were long and busy during those initial weeks of training, the two months of Preliminary Training School flew by. All the girls in Trish’s cohort were together on the same schedule during PTS. Some of the girls developed close friendships, many that endured throughout the three years of training, and some that would remain for many years as life took the girls in a variety of directions.
At the end of the eight weeks of PTS, students needed to pass written and practical evaluations in order to move on to the "official" first-year nurses' training. There were several students in Trish’s cohort who didn’t expect to pass those initial exams; either they could not take the rules seriously, they lacked the nerves or skill to perform the skills under the pressure of evaluation, or they just didn’t want to be there. Trish wanted to be there, and she made sure she was well prepared to pass the evaluations. She wanted to move on to be a first-year nursing student.
There was a one week break while the Sisters evaluated the examinations and confirmed the first-year class list. Like the other girls, Trish planned to go home for the break while she awaited the letter from Alder Hey Children’s Hospital that would confirm her acceptance into first-year nursing studies. She was apprehensive about returning home, there had been so much tension between her and her dad. She had not been in communication with her family during the two months of PTS. There hadn’t been time to return home, and the family did not have a phone in the house. Trish didn’t know what to expect when she returned home. The best way to find out, she thought, was to just go home and see what happens.
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Author’s note:
We often see our parents through the lens of their roles in our lives— caregivers, disciplinarians, cheerleaders. Perhaps they are our role models or mentors, but who were they before they became these things to us?"
To better understand who my parents were before they were, well, my parents, I set about interviewing them about their lives before marriage and kids. I started with my mom.
Trish Lewis was 18 years old and desperate to escape a mind-numbing administrative job at a factory in Liverpool in the 1950’s. She made the impulsive decision to join a friend to interview for nurse’s aide training at Alder Hey Children’s Hospital. That decision changed the trajectory of her life and launched her into an interesting and rewarding career as a nurse.
Trish is my mom, and this is her story, as told to me in a series of interviews in 2024. The story is pieced together from Mom’s memory, photos, and documents. As we all know, memory is fallible. In the telling of this story, some names have been changed, either because they could not be recalled, or to protect the privacy of the person. The Journey is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
If you are enjoying this story, you may also enjoy reading my memoir, “Resilience in the Rubble: A True Tale of Aid and Survival in Kashmir”. The book shares my experience as a first-time medical aid worker in Azad Kashmir, Pakistan, after an earthquake devastated the region in 2005. It also tells the story of Nadeem Malik, a local teenager who lived through the earthquake, and his struggle to provide for his family in the aftermath.