Chapter 6 - First Year Nurses' Training
"At Least We Will Get Clean Cupboards,"
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Trish twisted her hair absentmindedly as she stood at the bus stop near the front gates of Alder Hey Children's Hospital. She had her first break from training and was going home to visit her family. Alder Hey was only a ten-minute bike ride from the Lewis family home, but Trish didn’t have her bike. Her dad had kept it when she left for Alder Hey. Her bike was better than his; it had gears. The bus pulled in and Trish boarded, then after one change, she arrived at the bottom of her street.
She hadn’t been home in two months, the demands of Preliminary Training School had been overwhelming. Weekdays were busy with classes, and on weekends Trish and the other students were doing their washing, buying fresh stockings, and studying. So much studying. The Lewis family didn’t have a telephone at the house, so she had not spoken with her mum in two months. She wondered if everything would be as she remembered at home. Had the household changed? Had she changed? Was her dad still angry with her?
The house at 2 Crofton Crescent was familiar and active when Trish returned. Her brothers were 11 and 12 years old and they kept everyone busy with their antics. The boys were well into a new school year and came and went from the house in the evenings. Trish was dismayed to learn that the 8:30pm curfew that her father maintained for her was still in effect. She had nowhere specific to go in the evenings; but the fact that she wasn’t allowed felt unjust. At the nurses' home, the rules were also rigid, but they were fair between all the students. Day to day, Trish and her dad continued to ignore each other. Her mother kept Trish busy, and that gave her a means to avoid him as much as possible.
Midway through the week-long break, Trish received the letter she had been waiting for from Alder Hey. She had passed the final Preliminary Training School evaluations. The letter formally invited her back to begin First Year Nurses’ Training. She was delighted! She couldn’t wait to get started on the next phase of her training to become a nurse. A local family doctor who cared for Trish and her family through the years sent her a message to say he and all the doctors at the local surgery were very proud of her. It was all so exciting!
Returning to the residence at Alder Hey after the break signalled the beginning of nurses’ training in earnest. The girls who remained in Trish’s class were now officially First Year nursing students. Soon they would get their first ward assignments, and they needed to know where everything was in the hospital. The Alder Hey grounds were vast, and the main hospital building with its annexes and outbuildings filled a significant amount of that space.
The main building had three floors, and each floor had a long hallway that ran the length of the hospital. The hallway was very long, and at night it seemed even longer as it was eerily dark. The various wards branched off at intervals along the hallways. Most wards had a similar layout. There was a kitchen on the left as soon you entered from the main hallway corridor, with a linen room on the right. Next, a swing door led into the main ward. Most wards had one or two private single rooms, and the Ward Sister's office immediately inside the doors. The sterilizer for instruments sat just outside the Sister’s office. Cots and beds lined the ward on both sides, each with curtains around them for privacy. A few large tables usually ran down the center of the ward.
In the long-term wards, like the orthopaedic ward, there was often an aquarium and other visual distractions to keep the children occupied. The sluice, which held the bedpans and trolleys, was on one side while the toilets were on the other. The dayroom spanned the entire width of the ward. It was filled with tables and chairs, a toy box, and shelves of books and puzzles. The hospital teacher held classes in the dayroom or sometimes at the patients' bedsides in the long-stay wards.
The distances a student nurse might cover in a day were significant, yet the golden rule of ‘walk, never run’ was absolute. Ward Sisters often sent student nurses on errands to other wards, or to the Porter's Lodge, which was in the gatehouse of the hospital grounds. The nurses’ residence was in a building on the property near to the main hospital building, and a student may need to return there during the day. It all added up to a lot of miles. Trish was grateful she was fit from years of field hockey and riding her bike, it helped her keep up the pace through the day.
First year training involved blocks of theory distributed between three-month rotations on the hospital wards. Students would do rotations on several wards, each caring for children based on the discipline that was treating them. Some of the biggest wards such as the medical, surgical, and orthopaedic wards were separated into two; a boys’ ward, and another for girls. All other disciplines had boys and girls together on a ward; ENT (ears, nose and throat), ophthalmology, the burns unit, and an isolation ward. There were two operating theatres, a Neonatal Surgical Intensive Care unit, and an emergency department, formally known as Accident and Emergency, but more commonly referred to as “Casualty”. Opposite Casualty there was a dental department, and in a separate annex, there was a psychology department, but they weren’t part of the rotation for nursing students. Trish was curious about most of the wards, but she fervently hoped she would not get selected to work on the burns unit, as she knew she would have to refuse. She didn’t yet know much about the work of each ward, but she knew the burns unit was not for her. Fortunately, her first assignment was the ENT ward, which she was pleased about. She was keen to work with actual patients.
As Trish grew older, her nervous habit of chewing on her school tie developed into a more physical response to stress, and it became a nuisance during her time at Alder Hey. Whenever she started on a new ward as part of her training, she experienced laryngitis for the first week of the assignment. In the first instances where it happened, the Ward Sister sent her for diagnostic testing for infection, for allergies, for any medical cause for the symptoms. There was no obvious cause ever found, but the symptoms rendered Trish useless for the first week of each new discipline. She couldn’t talk to the patients or the other staff, and she couldn’t answer the phone. Each new ward assignment began with her cleaning linen cupboards, trolleys, bedpans, cleaning everything until her voice returned. She was not aware of being particularly anxious about new placements, rather; she was curious about each new ward, but the laryngitis symptoms occurred each time. It didn’t take long for her to become known for it. “We are getting Lewis, at least we will get clean cupboards”, the Ward Sisters quipped, and they made sure Trish was busy cleaning during the first week of each placement. No one could say she wasn’t useful, even if she was inexplicably silent for the first week of each rotation.
Maintaining cleanliness was a top priority for everyone at the hospital, and student nurses played a key role in keeping patients, wards, and medical equipment clean. Early in their training, they learnt by heart the procedures for sterilizing and managing medical instruments. It was a fundamental part of their work, and it had to be done in precisely the same way it had been done for years.
On each shift staff nurses or student nurses boiled all instruments that had already been used or might be needed later on the ward. After boiling the instruments for the required amount of time to disinfect them, the student nurse arranged the tools for a single procedure—for a dressing change, for example—on a sterile towel on a trolley. They then covered the trolley with another sterile towel. The process felt slow and labour-intensive. To be prepared, nurses planned ahead and set up everything they might need for the shift in advance, as disinfecting an instrument on the spot would take too long. A separate trolley was prepared for each expected procedure.
Trish watched the experienced staff nurses use the prepared dressing trolleys. The nurses worked in pairs, a ‘clean’ nurse and a “dirty” nurse, one on each side of the trolley at a patient’s bedside. The ‘dirty’ nurse removed the old dressing, swabbed and cleaned the wound, then the ‘clean’ nurse stepped in to redress the wound. It was smooth and fast, like a well-rehearsed dance. The two nurses moved from patient to patient in this manner, washing their hands between each dressing change.
Hospital staff did not wear gloves for day-to-day care, only staff in the operating theatres wore gloves. Instead, staff on the wards washed their hands multiple times a day using antiseptic soap. The soap of the day was Carbolic soap, and staff and students alike had very red, sore hands as they worked. There was always a tin of Lanolin on the ward and most staff applied it liberally to their hands as soon as their shift ended so they had a bit of relief before the next shift.
Staff and students had access to cotton three-layered masks to use when infection was a concern. The masks had two sets of ties, one set to tie behind the head above ear-level, and the second to tie behind the neck. The masks only came in one size, so they only seemed to fit properly on some staff. Trish wondered how effective they really were, as it was common to see the masks pulled down and hanging around the necks of staff between procedures. Staff reused their masks throughout the shift.
After the initial study block, Trish started on her first ward rotation with a three-month assignment to the ENT ward. She spent the first week on day shifts, cleaning and observing, due to her laryngitis. During the days, patients were admitted to the ward, and many were awaiting surgeries. As soon as a new patient arrived, they needed to be checked for nits, or head lice. Checking for nits was the lowliest of jobs on the ward, and it usually fell to the most junior student nurse. When it was Trish’s responsibility, she would end the morning with white, wrinkly hands as the metal nit combs were carried from patient to patient in a solution of carbolic to keep them disinfected. The kids called the students who checked for nits “Nitty Nora, the Bug Explorer”. The name had been passed down from one patient to the next for years! Trish noticed that little jokes like that helped lighten the mood on the ward for the patients, particularly during the day.
The night shifts were a different matter. On her first night shift Trish realized the ward was a completely different world at night. On dayshifts she had been the most junior person on the shifts, doing as she was told, and looking after the most menial of jobs. There were other staff responsible for the patients and the operation of the ward. On the night shift, Trish was alone on the ward with one nurses’ aid.
She arrived on the ENT ward at 8:00pm for her shift. She was met by the Day Sister who quickly read her a report for each patient on the ward. The Sister went through the reports mechanically, not pausing to see if Trish understood or had questions. She had to know Trish wouldn’t be able to absorb or remember the information. There was too much, and it was too unfamiliar. Trish stood in a fog, her mind racing and her heart pounding. When the Sister finished the report, she turned to leave. Trish moved to the door and held it open for her superior, as she had been trained to do.
“Goodnight Sister.” And there she was, ‘in charge’ of 30 sick kids.
Trish was 18 years old. She was only a few months into her training, standing in a dimly lit hospital ward, realizing she was in a completely alien world. During the day the ward was busy, patients were being admitted or discharged, and the porters coming for others to take them for their surgeries. Some patients were returned from their surgeries, still groggy from sedation. Younger patients played and were rowdy, and parents visited. It was lively.
At night, there was tension, and not just for Trish as she felt the weight of the situation. She looked around the ward. The patients who had their surgeries that day were uncomfortable. Younger patients were afraid and lonely, many were crying. The younger patients who had not yet had their surgeries were watching the ones who had, and they were afraid and crying too. They were all missing home, and their parents. It wasn’t such an interesting adventure once the sun had set.
There was a Night Sister on duty who oversaw several wards. Trish knew she would come by the ENT Ward two hours into the shift to do rounds. She could be called in the case of an emergency. Trish wasn’t sure if she really knew what constituted an emergency, everything seemed like a crisis in that moment.
Trish squared her shoulders, and she and the aide began checking on the most distressed patients. As she approached each one, she tried to learn, then remember, their name and diagnosis. Many of the patients needed help with bedpans, or to be helped to the toilet. Those who had their surgeries that day needed to be checked every half hour for signs of bleeding. Temperature, pulse and respiration, referred to as ‘TPR’, needed to be checked for every patient, then recorded in the ‘TPR book’ in the Sister’s Office. TPR needed to be recorded every four hours, Trish remembered she should check the TPR book to see when the last set had been recorded. When she had a moment later in the shift, she was to use a ruler to draw new columns into the TPR book for the next shift.
She and the aide assisted patient after patient, while trying to keep up with the scheduled tasks as well. Trish’s mind was in chaos. How on earth would she manage all this?
As they were at a bedside, Trish noticed the doors to the ward swing open, and a man walked into the ward. It was well past visiting hours; parents should no longer be on the ward. Finally, here was a problem Trish could capably manage. She approached the man, firmly told him visiting hours had ended, and sent him on his way. To her relief, he looked surprised but left without complaint.
A few hours into the shift, when she felt she was able, she retreated to the dining hall to get a quick coffee, leaving the aide to watch the ward for a few minutes. When she returned to the ward, her eyes fell on the Night Sister, who was standing at the foot of one of the beds. Beside her was the man Trish had removed from the ward not long before. Trish froze, he wasn’t a parent; he was the ENT Consultant. He was coming to check on the patients he had operated on that day. The bottom fell out of Trish’s world. Why had he left the ward, rather than giving her a good dressing down - he had the right to - and then carrying on with his work?
The Night Sister glared at her, and Trish felt the angry gaze burn into her. Heart pounding in her chest, Trish approached the Sister and the Consultant to learn her fate.
“Now Sister, don’t be cross,” the Consultant said as Trish stepped into earshot, “she was only doing her job. My wife is always telling me I look like the gardener!”.
Relief and gratitude left Trish feeling quite weak at the knees. She could see the Night Sister was still not happy but had to smile at the Consultant’s joke. She sent Trish on her way to carry on with her tasks.
The rest of the night passed with Trish feeling like she was swinging between one calamity to the next. Mercifully, most of the patients slept for at least some of the time. By the end of the shift, Trish grimly thought the only benefit of a night shift was that she had not been called “Nitty Nora” even once.
The ENT rotation continued. As the most junior student nurse on the ward, during day shifts Trish handled a lot of cleaning duties, helping the younger children to the toilet, helping them with meals, and joining other staff on rounds. She began to really enjoy working with the patients, as they were usually lively and often amusing. She also appreciated the sense of camaraderie with the staff on the ward, even as a First Year student. The wards had no designated staff area, except for the Sister's office, which was too small for breaks. To get around this, on some wards, the Sister allowed staff to take ‘two by two’ secret coffee breaks in the linen room. The routine started by brewing a pot of strong coffee in the ward kitchen and heating a large jug of milk by placing it in the boiling instrument sterilizer. Both were then carefully carried to the linen room and hidden behind a stack of bedsheets. The first pair to sneak in for coffee was the Sister and the staff nurse, followed by the student nurses and aides. Each pair had ten minutes to enjoy their coffee, rest, and chat before returning to work.
Night shifts became less terrifying. Trish became more confident that she could learn the kids’ names and diagnoses quickly, and she better understood what was expected for rounds. The ward slowly became more familiar at night.
The weeks and months flew by, even though the work was hard, and the days were long. The first year of studies passed in a fog of exhaustion. At times, Trish and her classmates felt like slaves. They were the ones to mop the floors every morning; they were the ones called to clean up vomit. The work was menial much of the time, but it wasn’t repetitive and tedious in the same way punching cards at AT&E had been. Trish could see how even the worst jobs were important, as she also worked with the patients those tasks were benefitting. The menial tasks weeded out some students, the ones that felt that kind of work was beneath their dignity. Those who persisted, like Trish, were tired all the time. Despite the exhaustion, she never entertained the thought of quitting. To say she enjoyed it was a stretch, but she was managing and could keep up with the pace of the work and the studies.
Not all her classmates could say the same. Some girls had little difficulty with the theory components of the training but lacked the practical abilities to think on their feet. One girl who, when told to sterilize the thermometers on a ward, boiled them. It took only moments to end up with a layer of mercury and broken glass at the bottom of the pot, and the ward was suddenly without thermometers. The girl was very bright academically, she just struggled to apply the knowledge to practical tasks. Girls like her were subject to pranks by the Ward Sisters.
When a Ward Sister wanted a break from one of the more scattered students, she would send her to the Porter’s Lodge for a long stand. The student would go out to the gatehouse and ask the porter on duty for a long stand. The porter would tell her to wait, and he would go back about his work. At some point, the student would find him again, and insist that the sister was waiting.
“Excuse me, but Sister is going to be annoyed, she sent me for a long stand.”
“And you’ve just had it,” the porter replied. After considering what had just happened, the confused girl went back to the ward to be assigned some other undesirable or mundane task.
Some Ward Sisters would send hapless students to a ward at the far end of the long hallway with a stainless-steel pail, instructing them to ‘fetch a bucket of steam’. When the student arrived, the Sister in charge of that ward responded, feigning annoyance, "But you didn’t bring the lid," and sent the unlucky student all the way back down the hallway.
Trish was a quick thinker and approached even the most menial of tasks with practical thinking. She rarely drew attention for creating more work for anyone and she never got caught up in the pranks. She was, however, the cause of a few legendary one-liner ‘rules to live by’ at Alder Hey.
On her Ophthalmology ward rotation, Trish was working her second night shift of the rotation. On her walk around the ward to check on the sleeping patients after lights out, there was an empty bed. She checked the toilets, but the child wasn’t there. She then asked the nurses’ aide who was on the ward with her to help her look for the child. They searched the dayroom, sluice, kitchen, side-wards, everywhere, and saw no sign of the child. She decided there was no choice but to call the Night Sister. The Ophthalmology ward was on the ground floor, and Trish feared the child had been disoriented in the dark and could have left the ward completely, or worse, left the building.
The Night Sister arrived and decided to check the beds herself. She returned to the rather rattled Trish and the aide, with a grim expression. Trish’s heart sank. The Sister gestured for the girls follow her, and they walked down the row of beds, stopping when they came to a bed with two small figures in it, instead of one. It turned out the child had gone to the toilet in the night and returned to the wrong bed. The Sister said little as she left the ward, except, "Count heads, not beds, Nurse Lewis." The phrase stuck and was repeated often in the days and months that followed, as it was both catchy and important advice.
Another memorable aspect of the Ophthalmology ward for new nursing students was the ghost story. During the war, some wards at Alder Hey, including the Ophthalmology ward, had housed soldiers. The door to the ward had a fan light with a half-finished painting on the glass. On their first night shift, student nurses were regaled with the tale of the ghost of a soldier-painter who returned at night to finish his painting!
When Trish was on rotations on the wards, she sometimes had split shifts. On those days, she worked from 7:30 am to 9:15 am, then had the rest of the morning off before returning to work from 1:00 pm to 8:00 pm. During her break, Trish sometimes visited her mum. She placed a call to their neighbour, Mrs. Lamont, who would happily go over to tell Florence that Trish was coming. Florence then rushed to the bakery to buy potato cakes and two chocolate eclairs—Trish’s favourites. They enjoyed the treats together with a cup of tea. With her dad at work and her brothers at school, Trish and her mum had a nice time chatting before Trish returned to Alder Hey for her afternoon shift.
As the year progressed, students alternated between ward rotations and blocks of theory. At the end of each theory block, there were examinations. Sometimes the subjects being examined lined up nicely with the wards students had already seen, and they had a deeper understanding of not just the theory, but also the application of the knowledge. Other times they were evaluated on areas of practice they had not yet been exposed to. In those cases, the exams required rote memory of the content they had read, making them a bit more difficult. For example, being examined on the surgical care segment of the schooling, without yet having been on the Surgical Ward was challenging. The practical evaluations included setting up trolleys for general nursing activities such as, dressing changes, bed bathes and hair washing, and enema and suppository administration.
All the different layouts for the various trolley sets were in diagrams in her textbook, and Trish studied them to make sure they became second nature before being examined on them. She passed all the evaluations and continued progressing through the program.
At the end of the first year, there was larger, final evaluation, and again a brief break while the Sisters graded the examinations, and set the second year classes. Trish felt confident of her standing at the end of First Year and welcomed the break in her studies.
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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.
The Journey is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
I'm exhausted just reading about that training. You have created a real feeling of being there.