HX64111997 RA982.N48 N481 1909 By-laws and rules of tyqt fctaamlt if usptial BY-LAWS AND RULES AMENDED OCTOBER, 1909 K*{?8Z./v'¥8 ~M?8/ Columbia $totoer*itj> College of ipfjpgtcianfii ano burgeon* Hturarp BY-LAWS AND RULES OF The Roosevelt Hospital Including the Rules of THE TRAINING SCHOOL FOR NURSES Amended October, J 909 -RA 9«. W Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/bylawsrulesofrooOOnewy The Roosevelt Hospital Occupies the block of ground between 58th and 59th Streets and 9th and 10th Avenues, and has erected thereon suitable buildings, which furnish accommodations for about two hundred and thirty- seven patients. It was opened for the treatment of medical and surgical patients November 2, 1871. The Ambulance Service, which was established in 1878, was discontinued in 1909. The Out-Patient (Dispensary) Department was added in 1881. The Gynsecological Division was separated from the Medical in 1888. The McLane Operating Room, the gift of Dr. James W. Mc- Lane, in memory of James W. McLane, Jr., for the use of the Gynsecological service, was opened in 1890. The Wm. J. Syms Memorial Operating Theatre was erected in 1892, and the Private Patients' Pavilion in 1896. The Training School for Nurses was organized in 1896. The Accident Building was erected in 1898, providing in the first story for treatment of emergency and accident cases, and in the second story a Medical Ward (opened in February, 1899), to be known as the Catherine A. Bliss Ward for Sick Children, the beds in which (12) were endowed by Miss Catherine A. Bliss. The power plant was erected and equipped in 1903 by Mrs. George Theodore Bliss in memory of her husband. A new up-to-date laundry and kitchen, a new executive office, a recreation room for the staff, a new carpenter shop and extensive fresh air balconies have since been constructed and equipped by friends of the Hospital. The Pathological Service was reorganized in 1909 and a new build- ing, fully equipped, was provided for its accommodation. To erect, furnish and maintain the buildings, according to the plans adopted, will require additional money beyond the funds provided by Mr. Roosevelt's Will; and the Trustees solicit con- tributions for this purpose, and for the endowment of free beds. A donation of five thousand dollars entitles the donor to nominate patients to a free bed in perpetuity; and a donation of three thousand dollars entitles the donor to nominate patients to a free bed for the life of the donor. CHARTER AN ACT to incorporate "The Roosevelt Hospital," in the City of New York. Passed February 2d, 1864, three-fifths being present. The people of the State of New York, represented in Senate and Assembly, do enact as follows : Section i. It being represented to this Legislature, that James H. Roosevelt, late of the city of New York, departed this life, in the month of November, eighteen hundred and sixty-three (never having married), possessed of a large real and personal estate, the bulk of which by his will he devoted to the establishment of a Hospital in said city, naming for that purpose certain trustees to manage and conduct the same, and directing them promptly to apply to the Legislature of this State for proper acts to incor- porate, secure and perpetuate said Hospital, and such application having been made accordingly: Be it, therefore, enacted, That the trustees named in said will, to wit, George T. Trimble, Presi- dent of the Managing Board of "The Society of the New York Hospital," Edward Delafield, President of the Managing Board of "The College of Physicians and Surgeons in the City of New York," Thomas House Taylor, President of the Managing Board of "The New York Eye and Ear Infirmary," Frederick E. Mather, President of the Managing Board of "The Demilt Dis- pensary," Augustus Schell, President of the Managing Board of "The New York Institute for the Blind," and their several suc- cessors in their respective offices as such Presidents, and James I. Roosevelt, Edwin Clark, John M. Knox, and Adrian H. Muller, all of the city of New York, and their successors, are hereby in- corporated and declared to be a body politic and corporate by the name of "The Roosevelt Hospital." Sec. 2. The object of the said corporation shall be the estab- lishment in the city of New York of a Hospital for the reception and relief of sick and diseased persons, and its permanent endow- ment pursuant to the directions of the last will and testament of its founder as aforesaid. Sec. 3. The direction and management of the affairs of said Corporation, and the control and disposition of its property and funds shall be vested in said trustees and their successors. In case of any vacancy from death, resignation or otherwise, of any of the four individual trustees herein designated by name, and not by title of office, or their successors, then and in every such case the vacancy so occurring shall be supplied by the surviving or remaining trustees from male, native born citizens, then resi- dent in the city of New York. The property, real and personal, of said Corporation shall be exempt from taxation, and shall be entitled to the benefit of the provisions of law relative to charitable institutions. Sec 4. The Trustees of said Corporation shall elect one of their number President, who shall hold his office during their pleasure, and they may also elect or appoint, and at any time re- move, a secretary and a treasurer, and such other officers as, in their judgment, the management of its affairs may require. Sec. 5. The said Corporation shall be, and is hereby em- powered — 1. To demand and receive from the executrix of the last will and testament of the said James H. Roosevelt, as proven on the sixteenth day of December, eighteen hundred and sixty-three, and recorded in the office of the Surrogate of the county of New York, and from the residuary legatees named in said will, all personal property and real estate, and the proceeds of all per- sonal property and real estate in any manner devised or be- queathed by the said will for the establishment in the city of New York of a Hospital as aforesaid, for the reception and relief 6 of sick and diseased persons, and for its permanent endowment. 2. To purchase and hold real estate in the city of New York, and erect and maintain thereon suitable buildings for the use of said Hospital. 3. Upon the sale of the real estate of the said James H. Roose- velt, as provided in said will, to purchase and hold the whole or any part thereof as the Corporation may determine. 4. To invest all funds of this Corporation not otherwise specifi- cally appropriated, whether derived from the estate of said James H. Roosevelt, or otherwise, either on bond, secured by mortgage on unincumbered improved real estate in fee, in the city of New York, or in public stocks of the City or State of New York, or of the United States of America. Sec. 5. The said Corporation may take and hold any additional donations, grants, devises and bequests which may be made in further support of, or addition to said Hospital — so far forth as the same is in accordance with the general laws of the State, and not otherwise. Sec. 6. The said Corporation shall possess the power, and be subject to the provisions, liabilities, and restrictions contained in the third title of the eighteenth chapter of the first part of the Revised Statutes, except as is otherwise provided in this Act. Sec. 7. This Act shall take effect immediately. State of New York, Office of the Secretary of State. I have compared the preceding with the original law on file in this office, and do hereby certify that the same is a correct tran- script therefrom, and of the whole of said original law. Given under my hand and seal of office, at the city [l. s.] of Albany, this 4th day of February, in the year one thousand eight hundred and sixty-four. Chauncey M. Depew, Secretary of State. 7 CHAPTER 375. AN ACT to amend Chapter four of the laws of eighteen hun- dred and sixty-four, entitled "An act to incorporate The Roose- velt Hospital in the city of New York," in relation to the election of additional trustees and the filling of vacancies. Accepted by the City. Became a law, May 5, 1905, with the approval of the Governor. Passed, three-fifths being present. THE PEOPLE OF THE STATE OF NEW YORK, REP- RESENTED IN SENATE AND ASSEMBLY, DO EN- ACT AS FOLLOWS : Section i. Chapter four of the laws of eighteen hundred and sixty-four, entitled "An act to incorporate The Roosevelt Hospital in the city of New York," is hereby amended by inserting there- in a new section to be section i-a thereof and to read as follows : i-a. The present trustees of The Roosevelt Hospital or a majority of them, shall forthwith elect two male, native born citizens, resident in the city of New York, as trustees, in addi- tion to the nine named in the first section of this act, and the eleven trustees and their successors shall be the body corporate by the name of and known as "The Roosevelt Hospital." 2. Section three of such chapter is hereby amended to read as follows : 3. The direction and management of the affairs of said Cor- poration, and the control and disposal of its property and funds, shall be vested in said trustees and their successors. In case of any vacancy from death, resignation, or otherwise of any of the six individual trustees, or their successors, then and in every such case, the vacancy so occurring shall be supplied by the surviving or remaining trustees, from male native born citizens 8 then resident in the city of New York. The property, real and personal, of said Corporation, shall be exempt from taxation, and shall be entitled to the benefit of the provisions of law relat- ing to charitable institutions. 4. This act shall take effect immediately. The Roosevelt Hospital by-laws OF THE BOARD OF TRUSTEES OFFICERS. i. There shall be a President, Vice-President, Secretary and Treasurer, who shall respectively discharge the usual duties of such officers. ELECTION OF OFFICERS. 2. The officers shall be elected by ballot at the stated meeting of the Board, in the month of February, in each year; and shall hold office until their successors shall be ap- pointed, unless sooner removed by the Board. Any vacancy shall be filled by the Board. SECRETARY. 3. The Secretary shall have the custody of the seal of the Corporation, and shall affix it to such documents only as the Board of Trustees may direct. He shall also execute on behalf of the Hospital all satisfactions of mortgages belonging to the Hospital. TREASURER. 4. The Treasurer shall have the care of all money, bonds, title-deeds and other papers relating to the prop- erty of the Corporation. He shall also have charge of all the real estate of the Corporation, except the Hospital buildings, but 10 with no authority to let or lease any portion of the same without direction of the Finance Committee or President of the Board. He shall keep an account in one or more of the banks or trust companies of this city, approved by the Board, in the name of this Corporation, and deposit therein all money re- ceived by him. He shall not pay any money without direction of the Board of Trustees, or of a committee duly authorized by them to draw on him. He shall cause the necessary books and ac- counts to be kept as directed by the Board or Finance Committee. COMMITTEES. finance e;. The Finance Committee shall consist of three members of the Board, and shall be elected at the annual meeting. They shall have charge and man- agement of the property of the institution, in conformity with the direction of the Board of Trustees. A majority of the Finance Committee shall have authority to direct the Treasurer of the Roosevelt Hospital to sell, assign, and transfer any of the securi- ties of the Hospital registered in the name of the Hospital. building 5 # a Committee on Buildings to consist of COMMITTEE. ,«,,,-, three members shall be elected when any additional buildings on the Hospital Grounds are about to be undertaken. visiting j % At the meeting of the Board in February of COMMITTEE. . each year, or at the next succeeding meeting, the President shall appoint two members of the Board to serve on the Visiting Committee for each month of the ensuing year, and he shall fill any vacancies on the Committee that may occur. They shall give such orders and establish 11 such regulations as they shall think proper to carry into effect the objects of the Institution in accordance with the regulations of the Board of Trustees. They shall receive or reject applicants for admission in accordance with the regulations upon that subject, and shall determine whether the applicant shall be received as a free or pay-patient, and in the latter case they shall fix the rate of payment. to visit One °^ them snau< yls ^ tne Hospital at least weekly. once in each week; but in the interval between visits and when the circumstances of the case shall require it, the Superintendent may act as their representative in the admission of patients, reporting his action in each case to the Committee at the next visit. If only one member of the Committee be present, he shall have all the authority and powers of the Committee. They shall see that no patient is allowed to re- main in the Hospital when in a condition to be discharged; and that all patients whose diseases may be incurable are removed. They may, at their discretion, discharge any pa- tient or hospital attendant for disorderly conduct. to main- ■"" n case ^ e Assistant Superintendent, Super- tain disci- intendent of Nurses, House Physician, House Surgeon, House Gynaecologist, or any of their assistants, or the Matron, Clerk, Apothecary or Engineer shall neglect any of the duties prescribed for them, or refuse to comply with any reasonable request of the Visiting Committee or Super- intendent, the Visiting Committee may suspend the offender and report the case to the next meeting of the Board of Trustees, and TO _ |LL the vacancy in the meantime shall be supplied temporary by such person as the Committee may appoint. They are also authorized to fill vacancies on the House Staff occurring during a recess of the Board. 12 The Visiting Committee shall have general charge of all property within the precincts of the Hospital and authorize such purchases, repairs and disbursements as may from time to time be necessary ; expenditure for any one item exceeding $100, not for current expenses or emergency repairs, shall be reported to the Board at its next meeting. They shall examine as to whether economy is observed in the several departments of the Hospital; as to the cleanliness and order of all parts of the house and grounds ; as to the quantity and quality of the food given the patients, and into the conduct of the several officers of the House. training At the meeting of the Board in February of school eac j 1 year or at the nex t succeeding meeting, COMMITTEE. the President shall appoint two members of the Board to serve as a Committee of the Training School for Nurses, who shall have general supervision of the school. They shall nominate to the Board, for diplomas, nurses who shall have passed the required examinations and have served their term in the School to the satisfaction of the Committee and of the Superin- tendent of Nursers. They shall have full control of the Training School and may alter or amend the "Rules for the Government of the Training School," subject to the confirmation of the Board. They shall have regular reports of the condition and needs of the Training School submitted to the Board at its regular meetings by the Superintendent of Nurses. MEETINGS. 8. The regular meetings of the Board shall be held monthly, on the last Tuesday of each month ; but special meetings may be called by direction of the President, or of any two of the Trustees. Notices of every meeting shall be issued 13 by the Secretary, not less than twenty-four hours before the time of holding such meeting. 9. A Clerk shall be appointed by the Board to assist its officers and keep their books and records. 10. It shall be a fundamental rule of this Board that no continuous debt for current expenses shall be contracted, nor shall the principal of the permanent fund be im- paired for that purpose. 11. No member of the Board of Trustees shall receive compensation in any form for duties performed as Trustee or officer of the Board. 12. Five members of the Board, including either the President or Vice-President, will constitute a quorum for the transaction of business. AMENDMENTS. 13. No amendment or addition to these By- Laws shall be made except at a stated meeting, and after the amendment or addition shall have been presented to the Board, in writing, at a previous stated meeting. ORDER OF BUSINESS. 14. Until further direction of the Board the order oi business shall be as follows : Reading the minutes of the last meeting. Communications and action thereon. Reports of Committees and action thereon. Special order, if any. Unfinished business. Motions and resolutions. Adjournment. 14 The Roosevelt Hospital RULES FOR THE HOSPITAL I. medical I# The Hospital shall be divided into two surgi- DEPARTMENTS. , ,. . . ,. , , . cal divisions, one medical and one gynaecologi- cal division and an out-patient department. II.— OF THE CONSULTING STAFF. i. There may be two or more Consulting Physi- cians, three or more Consulting Surgeons, two or more Consult- ing Gynaecologists, one Consulting Neurologist, one Consulting Laryngologist, one Consulting Otologist, one Consulting Der- matologist, one Consulting Opthalmologist and one Consulting Orthopedist. 2. They may be consulted in cases of unusual difficulty, and invited to attend all capital operations. III.— OF THE ATTENDING STAFF. appoint- j All Physicians, Surgeons and Gynaecologists annual s ^ a ^ k e annually appointed by the Board of Trustees at the stated meeting of this Board in the month of December, the appointment to take effect January age limit ist in each year, and no one shall be eligible for appointment who has reached the age of sixty-five years. 2. There shall be two Surgeons, two Junior Surgeons, two First Assistant Surgeons, two Second Assistant Surgeons, three or more Physicians, one Junior Physician, one or more Gynaecologist, one Junior Gynaecologist and one Patholo- gist. 15 3. Each Surgeon, Physician, and Gynaecologist on duty shall visit his division daily. 4. The Attending Physicians, Surgeons and Gynaecologists shall have the entire direction of the treatment of patients in their respective wards. They shall also exercise a supervision of the condition of the wards, the behavior of the nurses and orderlies, and the character of the food of the patients, and report whatever they may deem wrong. clinics. They may give clinical instruction, illustrated by the patients in their respective divisions (but clinics may be held in the wards only between the hours of 2 and 4 P. M.). 5. Patients who are admitted by the Super- intendent to private rooms without special recommendation from a member of the Medical Board, shall be assigned to the care of the attending Physician, Surgeon or Gynaecologist on duty ac- cording to the nature of their complaints. private Patients who are recommended by a member of consulting the Consulting Staff or by the Attending Phy- staff. sician, Surgeon or Gynaecologist to the Out- Patient Department for admission to a private room, may be placed under the care of the individual who recom- mends them, provided that the treatment of such patients shall be so arranged with the Superintendent and the Attending on duty, as not to conflict with the conduct of the usual hospital service. The private patients of each Surgeon, Junior Surgeon or Assistant Surgeons shall be assigned to the care of the House Surgeon of the division to which the Surgeon belongs. private Privilege to use the private rooms may be privileges granted during the pleasure of the Board to Physicians and Surgeons, not members of the Attending Staff, subject to the conditions governing their use by the Consulting Staff. 16 Subject to the direction of the Visiting Com- mittee, the rooms on the first floor of the Private Patients' Pa- vilion shall be used for surgical patients, and those upon the second floor for medical and gynaecological patients. capital 5 # All capital surgical operations shall be per- OPERATIONS. formed by the Surgeons, Junior Surgeons or the Assistant Surgeons, and all capital gynaecological operations by the Gynaecologist or the Junior Gynaecologist. In cases of great emergency such operations may be performed by one of the House Surgeons or by the House Gynaecologist, provided the Surgeon, Junior Surgeon or Assistant Surgeon, or the Gynae- cologist or Junior Gynaecologist cannot attend. laboratory 7 # Any member of the Medical Board shall have the privilege of using the laboratory of the Hospital for the purpose of carrying on special investigations, provided such investigations are undertaken by himself in person. No member of the Board, however, shall have the privilege of introducing any assistants into the laboratory save with the consent of the Pathologist of the Hospital. 8. The members of the Attending Staff give their professional services to the Hospital without salary under the following terms and conditions: when prof. ( a ) They will not receive professional fees services ' . shall be under any circumstances from any patient oc- rendered cupying a bed in the wards of the Hospital, without neither will they expect or receive such fees CHARGE. from any patient applying directly to and re- ceived into the Hospital for accommodation in a private room, provided that, in the opinion of the Superin- tendent, ability does not exist on the part of such patient to pay 17 for the professional attention given besides paying first the hos- pital charges for board and nursing. (b) It is expected and required that the mem- ber of the Attending Staff who recommends a patient for admis- sion to a private room shall make definite arrangements regarding his professional fee before such patient enters the Hospital. The design of the foregoing rules is to protect the Hospital authorities and Attending Staff from any misuse of their charitable services. IV.— OF THE PATHOLOGIST AND HIS ASSISTANTS, i. The Pathologist and one or more assistants shall be appointed by the Board of Trustees on the nomination of the Medical Board. autopsies. 2 . The Pathologist shall make, or cause to be made by an assistant, all post-mortem examinations on persons dying in the Hospital, for which consent has been obtained by the Superintendent. 3. It shall be the duty of the Pathologist or his assistant, when making an autopsy, to cause it to be recorded by a member of the House Staff in a book kept for that purpose, and himself to sign the record. 4. When a post-mortem examination is de- sired by a member of the Attending Staff, that fact shall be reported to the Superintendent, who will decide upon the advi- sability of it. *>. The Pathologist shall have charge of all logical specimens from post-mortem examinations, and specimens. f a \\ guch as are removed by operation in the Hospital. 6. The Pathologist may give instructions in pathological anatomy in the autopsy room. 18 J. The necessary instruments for use in the autopsy room, shall be in charge of the Pathologist, who will be held responsible for them. V.— OF THE MEDICAL BOARD. HOW i. The Consulting Physicians, Surgeons, CONSTITUTED. _ , . , _ , , . , ™ . . Gynaecologists and Pathologist ; the Physicians, Surgeons, Gynaecologists and Pathologist, the Junior Physician, Surgeons and Gynaecologist shall constitute the Medical Board. meetings and 2 . The Medical Board shall meet monthly on ELECTIONS. the Wednesday preceding the last Tuesday of the month. At its first regular meeting in each year it shall elect by ballot a President, Vice-President and Secretary, who shall perform the duties of those offices respectively. Three shall con- stitute a quorum of the Medical Board. 3. Special meetings of the Medical Board may be called by the Board of Trustees or by the President of the Medical Board. committees. 4 Said Board shall also each year designate two of its number as a Committee of Inspection, and five as a Committee of Examination to consist of two Physicians, two Sur- geons and one Gynaecologist. 5. The Medical Board shall advise the Board of Trustees in all matters pertaining to the health and physical well-being of the patients and shall regulate the diet of the pa- tients. It shall regulate the manner and time of giving clinical instruction subject to the rules of the Hospital. absences. 6_ A n y physician, Surgeon or Gynaecologist, who has to be absent for more than a day during his term of duty will arrange to have his service attended to by the Junior of his 19 Department, and notify the Visiting Committee through the Su- perintendent of such expected absence, its duration, and who will attend in his place. The Juniors are on duty and subject to call only during the absence of the Physician, Surgeons and Gynae- cologists. TO FILL 7- In case of vacancy in the Medical Board, VACANCIES. • , 11 it shall nominate to the Board of Trustees suit- able persons for appointment. It shall also nominate to the Board of Trustees suitable persons for appointment as Attendings to the Out-Patient Department, Assistant Pathologists and the House Staff. 8. The Committee of Inspection shall per- sonally inspect, at least once a week, all the Hospital buildings; shall examine into the condition of the wards, water-closets and bathing-rooms, the quality of food and medicines furnished to patients, and into the conduct of the nurses and orderlies, and shall see that all the regulations of the Hospital affecting patients are properly enforced ; it shall examine at least once a month into the consumption of liquors for Hospital purposes. examinations 9# The Committee on Examinations shall ex- FOR . house staff. amine all applicants, except as hereinafter pro- vided, for appointment on the House Staff. An examination shall be held in the spring of each year, at such date as may be fixed by the Committee, when candidates who shall prove competent and who shall pass the best examinations shall be designated to fill all vacancies on the medical and surgical division for the ensuing year. Should satisfactory candidates fail to appear, other examinations shall be held at such times as may be designated by the Committee. Successful candidates shall be recommended to the Trustees for appointment upon dates speci- fied in the recommendation. They shall nominate at their dis- 20 cretion ex-members of the House Staff for reappointment on other Divisions without competitive examinations. VI.— OF THE SUPERINTENDENT. i. The Superintendent is appoi: Board of Trustees. He is the executive officer trustees— I# The Superintendent is appointed bv the EXECUTIVE OFFICER. of the Board, and responsible to them for the good order of the house. He is to see that their regulations and directions are promptly and efficiently carried out, and for that purpose shall have general charge of the Hospital and its belong- ings. 2. He shall have the power to hire and dis- miss all hospital employees subject to the orders of the Trustees or Visiting Committee; and it shall be his duty to dismiss any employee who shall be guilty of profanity, drunkenness or other gross misconduct, reporting his action and his reason therefor to the Visiting Committee. admission g. He shall admit patients who have passed AND r , IO „ 1 _, Ar ,^_ examinations as provided for in Article XIV., DISCHARGE. * of patients. Sections 2, 3 and 4, excepting such as he may deem improper for other than medical reasons. He shall also, at his discretion, admit patients presenting a re- quest from one of the Chiefs of Clinic of the Vanderbilt Clinic, or from an assistant authorized to sign his name, and such other patients as he may deem advisable, such patients to be taken directly to their bed in the ward without waiting for examination. He shall discharge all patients in accordance with the regulations provided on that subject. 4. He shall purchase, under the direction of the Visiting Committee, furniture, provisions, and all other sup- plies required for the Hospital, and shall be responsible for the proper issue of the same. 21 5. He shall keep in a book provided for that purpose a regular and accurate account of all moneys received or disbursed by him on behalf of the Hospital, and a record of all such contracts as he may be authorized to make, which book, with the vouchers, shall be laid before the Visiting Committee. 6. He shall deposit all hospital moneys coming into his hands with the Treasurer, and shall obtain a draft from the Visiting Committee upon the Treasurer for such sums as may from time to time be required for the use of the house. 7. He shall submit to the Visiting Committee, monthly, a roll of all persons employed upon the premises, show- ing how they are employed and their rate of compensation. 8. He or his assistant shall visit every ward at least once a day, and shall make weekly a "general inspection" of all parts of the Hospital. He shall see that no smoking is per- mitted in any of the wards, corridors or the Out-Patient Depart- ment of the Hospital. 9. He shall see that the attendants are prop- erly instructed in regard to their respective duties in case of an alarm of fire. 10. When a patient is dangerously ill, he shall notify (if possible) the friend previously designated by the pa- tient. If a patient desires to converse with a clergyman or re- ligious person, he shall request the person desired to attend. 11. On the decease of a patient, the Super- intendent shall cause the body to be removed to the dead-house, and there safely kept till delivered to the friends of the deceased, or those responsible for its interment. 12. When any articles of value or other effects are left by a deceased patient, the Superintendent shall cause them to be labeled with the patient's name and the date of his decease, and hold them for delivery to the person authorized to receive them. 22 13. When a patient is discharged or dies, the Superintendent shall cause the fact to be recorded in the register, mentioning the patient's condition (whether cured, relieved, etc.), along with any circumstance attending his departure, if dis- charged, which might influence his future admission. 14. If any of the Officers, members of the Staff or Employees violate the regulations, or be guilty of any misconduct, it shall be the duty of the Superintendent to report the facts to the Visiting Committee. 15. The Board of Trustees may appoint an Assistant Superintendent who shall perform such duties as may be assigned to him by the Trustees or Superintendent. In the absence or disability of the Superintendent his duties shall be per- formed by the Assistant. VII.— OF THE HOUSE STAFF. how Im The House Staff shall be appointed by the Board of Trustees upon the recommendation of the Medical Board, but no candidate who is not legally licensed to practice medicine in the City of New York and registered with the Board of Health shall be eligible for duty. how 2. The House Staff shall consist of a Phy- CONSTITUTED. . . . . sician, two Surgeons and a Gynaecologist, a first and a second Senior Assistant Physician, a Junior Assistant Physician, two first and two second Senior Assistant Surgeons, two Junior Assistant Surgeons, an Assistant Gynaecologist, a Se- nior and a Junior Pathologist, all of whom shall reside in the Hospital. TO S,GN 3. Members of the House Staff before enter- AGREEMENT. . , . , . , „ • ing upon their duties shall sign an agreement to conform with all the rules of the Hospital and to remain in 23 the service to which they are assigned for the full term of their appointment as follows : The positions to be filled are those desig- nated " Junior" in the following diagram, which shows the order of promotion in each successive six months' term of the two years' service. 24 4. Failure to conform with the rules or to satisfactorily perform his duties shall subject the offending mem- ber of the House Staff to removal by the Board of Trustees. not respon- ^_ Xhe government and discipline of the Hos- SIBLE FOR .... government P lta ls in no degree intrusted to the House of hospital. Staff, but they shall report immediately to the Superintendent of the Hospital any serious breach of discipline, any accident occurring on the Hospital prem- ises, or anything coming under their notice that would be likely to involve the Hospital in legal action or that would reflect on the good name of the Institution. leaves of 5 Leave of absence may be granted to a mem- ABSENCE. ber of the House Staff who has completed six month's service, not to exceed ten days during the first six months, and twenty-one days during the second six months of the calendar year; but leave will not be allowed to accumulate, nor will two periods of leave be granted in conjunction. applica- ~ Application for leave of absence shall be TIONS FOR leaves of made upon the blank form provided, signed by absence. the applicant and approved by the Physician, Surgeon or Gynaecologist in attendance upon applicants division, addressed to the Visiting Committee of the Board of Trustees and presented to the Superintendent one week before beginning of desired leave. The applicant shall remain upon active duty until notified by the Superintendent of the ap- proval of his request by the Visiting Committee, and until his accepted substitute shall have reported for duty. He shall not over-stay his leave and shall report his return in person to the Superintendent. 25 substitutes. g # The applicant shall provide a substitute during his absence who shall be either a graduate in medicine or a fourth year student of medicine, approved by the Attending Physician, Surgeon or Gynaecologist. 9. No substitute not legally licensed to prac- tice medicine in this city shall perform any of the following duties : (a) Administration of anaesthetics. (b) Ambulance duty of any kind, including transfers. (c) Prescribing for patients, treating or assisting in the treat- ment of cases in the Emergency Department. time off 10. When the service will permit, members of the House Staff may be absent on alternate week days from 6 P. M. to 1 A. M. and alternate Sundays from 1 P. M. to 1 A. M. They shall not be absent at other times with- out the consent of the Superintendent. (a) Absences exceeding twelve hours must be provided for by formal application. (b) One of the House Surgeons shall always be in the Hospital and there shall always be on duty two members of the Medical Division, two members of each Surgical Division and two members of the Pathological-Gynaecological Division. posting ( c ) n member of the House Staff may leave absence. the Hospital without "posting" his absence on the roster at the main entrance. His return shall be noted by the same means. diplomas. Tl At f-fog expiration of their terms of service, diplomas will be granted, upon the recommendation of the Medi- cal Board, to retiring members of the House Staff, if their ser- vices have been acceptable to the Board of Trustees. 26 "rounds" by I2 . The House Physician, House Surgeon and "HOUSE." House Gynaecologist shall visit each patient in their respective wards at least every morning and evening, and be prepared to report the condition of the patients to the attending Physician, attending Surgeon, or attending Gynaecologist. They shall record and sign all prescriptions and all orders for the treat- ment of patients in books provided for that purpose in each ward, and see that these orders are properly carried out. Prescription books and liquor books shall be sent to the apothecary's depart- ment before n A. M. and 6 P. M. each day. There shall also be an "Extra Diet" book in each ward, in which shall be recorded all orders for extra articles of diet. This book must be sent to the kitchen before n A. M. diet. 13. All patients shall be furnished with the regular house diet unless otherwise specially directed by the attending Physician, attending Surgeon or attending Gynaecol- ogist. "attending" j^ j n an y case f emergency the House Phy- called in sician, Surgeon or Gynaecologist shall request emergency. the immediate attendance of the Physician, Surgeon or Gynaecologist on duty, or if he cannot promptly come, one of the first Assistants. 15. The "House" shall promptly notify the Su- perintendent whenever the condition of a patient is deemed serious. consents r 6_ The "House" shall see that no patient is FOR , .... operations sent to operating room for operation until legal consent has been obtained, unless author- ized to do so by the Superintendent. 27 ly. The House Physician, Surgeon or Gynae- cologist shall in no case substitute his assistant in the performance of any duty specially incumbent on himself, excepting by permis- sion of the Physician, Surgeon or Gynaecologist, or in case of sudden illness or other emergency, when the Superintendent shall first be notified. transfer or !g # The House Physician, Surgeon or Gynae- DISCHARGE , . , „ . OF PATIENTS cologist shall not remove patients from one ward to another without the approval of the Superintendent, nor shall he discharge patients. He shall upon the directions of the "Attending" recommend to the Superin- tendent for removal those patients ready for discharge with a report as to their condition as follows : Cured, Improved, Un- improved or Undesirable. For all but the cured cases the reason for the recommendation for discharge shall be given. 19. When a patient dies, the House Physician, Surgeon or Gynaecologist shall without delay write the cause of death in the book supplied for that purpose by the Board of Health, which record shall be copied by the clerk. autopsies. 20. Post-mortem examinations shall only be made with the permission of the Superintendent, and only by the Pathologist or his Assistant, or in his absence by some one desig- nated by the Superintendent. examination 2I> The House Physician, Surgeon or Gynae- admission cologist, or a Senior Assistant, shall promptly of patients. examine applicants for admission, and shall re- port the result of such examination to the Su- perintendent, who will decide upon the disposition of the case. They shall visit applicants for admission to the Hospital at their dwellings when so directed by the Superintendent, and report to him in regard thereto. 28 22. It shall be the duty of the House Phy- sician, Surgeon and Gynaecologist to visit private patients as soon as possible after their admission and to report their condition to the "Attending." 23. They shall visit each private patient on their reception at least twice a day and shall when possible per- sonally attend to all examinations, dressings, catheterizations and treatment ordered by the "Attending." 24. In the event of both House Surgeons being detained by Hospital duties, private patients will be attended by the Senior Assistant of the division to which they are assigned ; and in the event of his inability to respond to call, the Senior Assistant on the other surgical division shall be summoned. 25. Unless otherwise ordered only the "House" shall accompany the "Attending" in his visits to private patients. gratuities 26. No member of the House Staff shall re- PROHIBITED. . ,. .,, , , : . ceive any compensation or gift from any patient unless authorized to do so by the Visiting Committee. This does not affect the right of a member of the House Staff to receive a fee, not exceeding five dollars for signing a certificate in the case of a life insurance claim, provided, however, that no such fee shall be accepted without the knowledge and approval of the Super- intendent of the Hospital, who will fix the amount to be paid. request 27. Members of the House Staff shall sign no „.__„ ,. certificates other than the death certificates of GATES TO be referred. the Board of Health and the insurance certifi- cates above described. Requests for documents relating to the condition of patients, or for records of patients, or other official Hospital business, for use outside of the Institution, shall be referred to the Superintendent. 29 28. The Assistants shall attend the House Physician, Surgeon and Gynaecologist in their morning visits to the ward patients, and shall also be present at the regular visits of the Physician, Surgeon and Gynaecologist, and at such other times as may be required. histories. 29. The Senior Assistant Physicians and Sur- geons and the Assistant Gynaecologist shall, under the direction of the Physician, Surgeon and Gynaecologist, keep a record of all cases which occur in their respective divisions. In this record shall be entered the name and occupation of each patient, the probable cause and history of the disease, the remedies used upon and after admission, the name of the Attending Physician, Sur- geon or Gynaecologist, his daily reports of the case, the termina- tion either in recovery, relief or death, and such other particulars as may tend to illustrate the case and the nature of the disease, and in the surgical records shall be entered also an account of all operations performed in the Hospital, with the name of the oper- ating Surgeon. 30. The histories are to be arranged and filed in accordance with the rules promulgated by the "History Com- mittee" posted in the History Room. histories 3L The histories of cases of patients in the NOT TO BE DIVULGED. Hospital are under the seal of professional secrecy. They shall remain in the custody of the Superintendent and shall not be communicated to any one except by his order. emergency 32. The Emergency Department shall be in DEPARTMENT. . „ , charge of the second Assistant Surgeon on the "Attending" Staff of the division admitting. 30 minor cases. ^ Minor cases will ordinarily be treated by the second Senior Surgeons, who will hold themselves in readiness to respond promptly to calls. During the absence of both on Hospital duty, the first Senior Surgeon, on emergency duty, shall be called to attend unfinished or new cases. No case shall be allowed to wait for any particular Surgeon. serious 24. All serious cases shall be seen promptly cases. by the House or first Senior Surgeon. A sec- ond Senior Surgeon may be relieved for his "time off" only by a member of the House Staff of equal or higher rank. 35. No Junior shall assist in the Emergency Department, except in case of great emergency, and when any member of the House Staff may be so directed by the Attending Surgeon or Superintendent. 36. The doctor on duty in the Emergency Department shall see every patient and shall sign his name in the proper place after the name and record of the patient. His duty in this Department shall be considered paramount. No patient shall return to this department for further treatment. transfers. ^j . No patient is to be transferred after having been brought to this Hospital, except upon the approval of the Superintendent, to whom a report of the case shall be made, giving the reason for the transfer. Application is not to be made for the transfer of patients who are not expected to sur- vive more than a few days, unless such patients are suffering from a contagious disease, or their presence would be a menace to other patients here. 38. No patient shall be transferred from the wards to Bellevue Hospital between the hours of 8 P. M. and 8 A. M., except for the reasons mentioned above. All patients sent 31 to Bellevue Hospital shall be accompanied by a brief history of the case, on blanks supplied for that purpose, which shall have the signed approval of the Superintendent. S0CIAL 39. Members of the House Staff shall treat RELATIONS with nurses tne nurses with courtesy, but their relations forbidden. with them shall be confined strictly to profes- sional duties, and there shall be no social relations whatever. They shall not prescribe for or treat nurses except upon request of the Superintendent of Nurses. 40. Minor operations such as paracentetis or thoracentesis are not to be performed on in-door patients except upon the order of the "Attending." 41. Cases suspected to be suffering from a contagious disease shall be immediately isolated and reported to the Superintendent. exposure 42, Members of the House Staff shall not OF PATIENTS. , , . , . . . , make any gynaecological examination of the patient except in the presence of a female nurse. Unnecessary exposure of both male and female patients is to be avoided. patients'^meals 43. All surgical dressings and other treatment of patients in the wards shall be suspended while patients' meals are being served, except in urgent cases. 44. Convalescent ward patients, without ex- ception, must render such help in the general work of their wards as their condition will warrant, in response to the demands of the nurses. 45. Discharged patients shall not return to the wards for dressings except upon written direction of the "Attending" for individual cases. 46. Members of the House Staff shall not 32 engage in any other business than that of the Hospital, nor shall they practice outside. hours for 47 . The breakfast hour for the House Staff BREAKFAST. shall be 8 A. M. No breakfast shall be served after 8 130 A. M., except by special order of the Superintendent. 48. Smoking in the corridors or any part of the Hospital used by patients is prohibited. 49. No instruments, apparatus or supplies, medical or surgical, or Hospital property of any kind shall be fur- nished or allowed to be taken outside the Hospital for private use. The Visiting Committee or the Superintendent only may in par- ticular cases make exception to this rule. signals. ^o. It is important that members of the House Staff should promptly respond to the bell signals and telephone calls, and when on duty word must be left at the Bureau of Infor- mation if going out of range of the signal. VIII.— OF THE APOTHECARY. 1. The Apothecary shall compound and make up all medicines prescribed agreeably to the formulas from time to time directed by the physicians and surgeons. He shall deliver no medicine or other articles which are not entered upon the pre- scription or record book. He shall put up the medicines for each ward separately, and shall annex to them suitable labels, with printed or written directions for taking them. He shall keep splints, bandages and muslin of such sizes and in such quantities as may be required, and shall issue the same upon proper requisi- tion. 2. He shall regularly attend the shop, and not be absent from the premises without the Superintendent's permis- sion. He shall keep the shop and its belongings clean and in good 33 order, and it shall remain open from 8 o'clock A. M. till 6 o'clock P. M. He shall observe careful economy in everything relating to his department. 3. It shall be his duty, when directed by the Superintendent, to assist in the supervision of the male employees and to perform such other services as will not, in the opinion of the Superintendent, interfere with his routine duties as Apothe- cary. IX.— OF THE HOUSEKEEPER. 1. The Housekeeper shall perform such duties as may be assigned to her by the Superintendent, including the careful supervision of the work of the female employees engaged in the care of apartments and corridors, and shall maintain clean- liness throughout the house. She shall have an oversight of the linen, bedding, household goods, furniture, etc., and shall report to the Superintendent any abuse or extravagant use of the same. X.— OF THE CLERK AT THE HOSPITAL. I. The Clerk shall keep the Hospital records and accounts. He shall be under the direction of the Superintend- ent. XL— OF THE ENGINEER. I. The Engineer shall have charge of and per- sonally see to the operation of all machinery and apparatus hav- ing to do with power, lighting, heating and ventilating, and shall maintain cleanliness and order in the rooms in which they are in- stalled. He will also be responsible for the good order of the water and plumbing fixtures and electrical equipment. He shall be accountable for the economical use of coal and steam, and it shall be his special duty to see that the temperature desired be maintained in all the wards during the winter, and visit them night and day as often as may be necessary to secure this object. 34 2. The Engineer and his assistants shall at all times be subject to the direction and control of the Superintend- ent, to whom the Engineer shall report at once any misconduct or neglect of any assistant in his department. XII.— OF HOSPITAL ATTENDANTS. i. Hospital employees shall be hired by the Superintendent with the approval of the Visiting Committee, in such number as the service of the Hospital may require. 2. They shall be under the control of the Su- perintendent and of the heads of the several departments in which they may be employed. 3. As far as practicable they shall have as- signed to them their regular duties, but will be expected to yield willing obedience to any reasonable requirement of the Superin- tendent. 4. They shall not leave the Hospital without the permission of the Superintendent, who shall assign them their regular hours of duty and recreation. 5. No nurse or other employee shall receive any compensation, gift, or bequest from any patient unless author- ized to do so by the Visiting Committee. 6. All employees are hired only during the pleasure of the Board. XIII.— OF PATIENTS, i". The Admission of Patients. 1. Patients suffering from severe accidents or serious illness shall be admitted to the Hospital at any hour of the day or night. 2. Other patients shall be admitted between 9 o'clock A. M. and 5 o'clock P. M. They must apply in person at the office of the Hospital, when they will be examined and recom- 35 mended for admission or rejection by the House Physician, Sur- geons or Gynaecologist, or their Senior Assistants, on duty. If unable to apply in person, they shall be visited at their homes by the House Physician, Surgeon or Gynaecologist on duty, or one of their Assistants. 3. Any member of the Medical Board may send to the wards of the Hospital such patients as he sees fit, giv- ing them a special order for admission, subject to the regulations of the Hospital. contagious 4. No patient suffering under any contagious disease shall be admitted, except such cases of emergency as require immediate attention; and such cases so ad- mitted shall be placed in the isolating room only. 5. There shall be posted in the office daily the number of occupied beds in each ward. out-of-town 5 Application for the admission of patients PATIENTS. ,. . . , , « , ,, living out of the city must be addressed to the Superintendent of the Hospital and accompanied by a certificate of some respectable physician, stating the nature and probable du- ration of the disease. payment j jf ? j n the opinion of the Superintendent, OF BOARD. ability to pay exists, such charge as he deems advisable up to $1.50 per day may be made for the ward patients' board. II. Rules for Patients. 1. Patients admitted to the Hospital are for- bidden to use profane or indecent language; to express immoral or infidel sentiments ; to play at any game for money ; to smoke tobacco in the house, or to procure for themselves or others any intoxicating liquors. 36 2. No patient shall be allowed to have any book, pamphlet or newspaper of an immoral or indecent nature. 3. No male patient shall go into any of the women's wards, nor any female patient into any of the men's wards. 4. No patient shall enter the dead-house, en- gine-room, kitchen, theatre, or any of the attendants' rooms, ex- cept by order of the Superintendent or other officer of the house. 5. No patient shall leave the house without permission of the Superintendent. When desiring to go beyond the Hospital bounds, patients must obtain a card from the House Physician, Surgeon or Gynaecologist, at his morning round, stat- ing that he has no objections, which card, when countersigned by the Superintendent, will serve them as a pass, and will be valid for the day upon which it is given, but must be surrendered to the doorkeeper when the patient goes out. valuables. g # Patients admitted to the Hospital must leave with the Superintendent for safe keeping, and for which a receipt will be given, any money or other valuables they may have, and in case of their failure to do so the Hospital will not be re- sponsible for any loss which may occur. The clothing of patients will, if desired, be cared for, but no responsibility assumed for loss or damage. All clothing infested with vermin, or for any other reason deemed unfit to be kept here, will be destroyed on the ad- mission of the wearer unless removed immediately by his or her relatives. 7. No patient may purchase, or procure any attendant to purchase for him, any articles whatever without per- mission of the Superintendent. 8. Patients are admitted only upon condition that they and their visitors comply with the rules, and failure to do so may necessitate their removal. 37 XIV.— OF VISITORS. i. The regular visiting days at this Hospital will be Sundays, Wednesdays and Fridays, and the hour from i to 2 o'clock in the afternoon. Not more than two persons will be allowed to visit a patient on the same day. notice of In cases of alarming illness, of which due no- tice will always, if practicable, be given to the immediate relatives or friends of a patient, vis- its will not be restricted to the regular days or hours. Visitors must not remain with patients longer than the prescribed visiting hours, and must not converse with any patient who is not a relative or friend. The nurses and orderlies will see that these rules, which are adopted for the good of the patients, are closely observed. They apply alike to visitors to both men and women patients. 2. All visitors are required to leave when the bell rings, at the expiration of the visiting hour. packages 3, Visitors are prohibited from taking any- „ „.,„, thing to eat or drink into the wards. All such PATIENTS. & must be left with a nurse at the entrance to the ward, marked with the name of the patient for whom they are in- tended. After the visiting hour they will be examined by a med- ical officer, and if found unobjectionable will be sent to the pa- tients as directed. XV.— OF THE OUT-PATIENT DEPARTMENT. /. Divisions and Physicians, etc. 1. The Out-Patient Department shall have three divisions corresponding to those of the Hospital, viz. : a Medical, Surgical and Gynaecological. "atten dings." 2 . Each division shall be in charge of an at- tending Physician, Surgeon or Gynaecologist, who shall be ap- pointed by the Board of Trustees on the recommendation of the Medical Board, and shall have the general direction and super- intendence of his division, subject to the authority and supervision of the Medical Board and the Trustees. They may be called upon to act in the capacity of assistants to the Attending Physicians, Surgeons and Gynaecologist of the Hospital, in the event of one or more members of the Attending Staff being unavoidably absent from the City. deputy It shall be the duty of the Attending Physician, "ATTENDINGS." c , . , . , Surgeon or Gynaecologist to designate one of his assistants, upon whom the responsibility for the work of his division shall rest whenever the Attending may be absent, and whose authority for the time being shall be the same as that of the principal. It shall be the further duty of the Attending to notify the Superintendent of the Hospital whom he has designed for that duty. assistants. As many Assistant Physicians, Surgeons and Gynaecologists as may be from time to time required shall be appointed by the Board of Trustees, on the nom- ination of the Attending Physician, Surgeon or Gynaecologist of the division, who shall also report to the Board of Trustees the resignation or neglect of duty of any assistant. The Visiting Committee, if occasion requires may assign a Physician, Surgeon or Gynaecologist to temporary duty at the request of the Attending Physician, Surgeon or Gyn- aecologist. 3. The Attending Physician, Surgeon and Gynaecologist of each division may direct out-patients to be re- ceived into the wards of the Hospital. 39 charge for ^ A uniform charge of 10 cents will be re- PRESCRIP- tions and quired of all patients prescribed for, and for all dressings. local treatments applied and all surgical sup- plies furnished (expensive dressings may be charged for in proportion to the cost) except when the Superin- tendent, or person designated by him, shall mark same free. The money received from these sources shall be paid to the Super- intendent, who shall keep an account of same and pay the money over to the Treasurer. clinics. 2. The Attending Physician, Surgeon and Gynaecologist may hold clinics at the Hospital, and may permit a limited number of students in the class room to witness the treatment of patients, when the latter do not object. No patient shall be taken elsewhere for clinical purposes, nor be exhibited without his or her consent. II. Rules for Patients. i. Patients able to pay for medical attendance are not entitled to treatment in the Out-Patient Department. 2. Surgical cases will be received between the hours of 10 A. M. and 12 noon, and medical and gynaecological cases between the hours of 2 and 3 P. M. 3. Profane or indecent language and disor- derly conduct or intoxication will not be tolerated. 4. The name, age and address of each patient will be entered by a clerk in the registry book and a card will be issued by him to every patient, to be presented to the Physician, Surgecn or Gynaecologist. 777. Rules for Physician, Surgeons and Gynaecologists. 1. Every prescription must be given or oper- ation performed by a duly appointed Physician, Surgeon or Gyn- necologist. 40 2. In order to save time and facilitate dispens- ing, the formulaae in the out-patient dose-book will, as far as pos- sible, be used instead of extemporaneous prescriptions. quantity of g. JSTot more than four days' supply of medi- limited c * ne w ^ ^ e ordered in one prescription. When no more than two or three doses are needed, only that amount must be ordered. The quantity prescribed may be doubled with the consent of the physician, in which case the charge will also be doubled. directions 4 # Distinct directions for use must accom- FOR TAKING , . . _ , medicine pany each prescription, lhe order As direct- ed" must not be used. The word "Poison" must be put on any prescription which may require it. To reduce the chances of error, poisonous substances must be largely diluted and ordered only in quantities of eight doses or less. No medi- cines prescribed will be ordered to be taken in drops. Medicines must be ordered in as cheap a form as possible. IV. Rules for Dispensing Medicines. i. The apothecary will only fill prescriptions signed by the Attending or Assisting Physicians, Surgeons or Gynaecologists, and on the Hospital blanks. 2. The name and number of the patient and the dose and time of administration of the medicine must be marked on each bottle. No bottle may be marked "As directed." 3. Poisonous mixtures and those designated for external use shall be plainly marked "Poison," or "For ex- ternal use," or both, as may be necessary. 4. The apothecary may, in his discretion, re- fuse to dispense medicine in bottles, presented by patients, which are dirty or otherwise unfit for use. 41 Rules FOR THE GOVERNMENT OF THE TRAINING SCHOOL 1. The training of nurses shall be an integral part of the work of the Hospital. 2. A Superintendent of Nurses shall be ap- pointed by the Board of Trustees on the nomination of the Super- intendent. 3. The Superintendent of Nurses, under the Supervision of the Superintendent of the Hospital and the Com- mittee of the Training School, have charge of the nursing in the Hospital and arrange the course of lectures and instruction for the training school. 4. She shall have supervision of all the nurses in the Hospital and see that the directions given by the profes- sional staff, for the nursing and care of all patients, are efficiently carried out. 5. She shall have careful oversight of the pub- lic and private wards and operating rooms, and herself or her as- sistant visit them with as much frequency daily as is necessary to that end. She shall notice whether the food is suitably prepared and served to the patients, and report to the Superintendent any failure in that regard. 6. She shall also report at once to the Super- intendent any serious neglect of duty by a nurse or orderly or violation of rules by a patient. 42 Nurses' Hours and Duties HOURS OF DUTY. 1. The hours of duty for nurses by day shall be from 7 o'clock A. M. to 7 P. M., by night from 7 o'clock P. M. to 7 A. M., and they must report for duty promptly at the ap- pointed hours. 2. All nurses are subject to emergency call, day or night. 3. Each nurse shall have a half day in each week, from 1 130 P. M. for recreation, and on other days will have one or two hours (as hospital duties may permit) for out-of-door exercise or diversion. On Sunday at least time for one church service will be allowed. 4. Nurses must be in their rooms at 10 P. M., and lights extinguished at 10:30 P. M. 5. Permission to be out later may be had not oftener than twice a month and must be obtained from the Super- intendent of the Training School before 7 P. M. 6. This pass expires at 12 midnight. If un- avoidably detained explanation must be made on the following morning before 9 o'clock. 7. All nurses coming in after 10 P. M. must sign the register in the Bureau of Information, and note thereon the hour of return. 8. Nurses must be punctual in going to classes and lectures. If ill, special permission to absent themselves must be obtained from the Superintendent of Training School. 43 HOURS FOR MEALS. i. Breakfast from 6:30 to 7:30 A. M., dinner from 12 to 1 : 15 P. M., Supper from 5 to 6 P. M. 2. Night nurses' breakfast from 7:30 to 8 A. M., dinner at 6:15 P. M. 3. Meals must be promptly attended by the nurses in turn, one nurse always remaining in the ward. GENERAL RULES. 1. No ward property of any description may be taken to nurses' rooms. 2. Visiting from ward to ward is prohibited except upon hospital business, and, when off duty, nurses must not return to their wards without special permission. 3. While on duty, the entire time of the nurse belongs to her patients and to the Hospital. Unnecessary con- versation or other waste of time must be avoided. 4. Nurses are forbidden to have any social re- lations with the Staff, patients or visitors to the Hospital. All intercourse with them must be of a strictly professional character. 5. Nurses must at all times preserve a quiet demeanor in corridors, stairways and elevators. No loud talking or laughing will be permitted in wards or corridors. 6. The affairs and conditions of all patients are to be considered as strictly private. No legal papers shall be executed by them without the knowledge and approval of the Superintendent of the Hospital. 7. Nurses, upon the entrance of an officer or stranger into the ward, shall at once rise, if seated, and give all visitors prompt attention. 8. Screens must be used to avoid the exposure of any patient. 44 9. All appliances and appurtenances for gen- eral use must be returned to the Drug Room when no longer re- quired. 10. All splints, cradles, etc., to be kept in Ward V. storeroom when not in use. n. Empty bottles and medicines not in use to be returned to the Apothecary. 12. All instruments belonging to the wards, operating rooms, dispensary or emergency department, needing repairs, are to be left in the Drug Room before g A. M. on Tues- days together with a list of the same. HEAD NURSES. i. The head nurse of each ward shall, under the supervision of the Superintendent of the Training School, have entire charge and responsibility in her ward. She shall see that all patients are kindly and attentively cared for, that strict cleanli- ness is enforced in the case of each patient and in the ward itself ; that each patient is thoroughly bathed or sponged as soon after entering the ward as the condition of the patient will permit, and is thereafter regularly bathed or sponged once in each week or oftener if required; that the head and feet of each patient are cleansed at least twice in each week, and the faces and hands of all patients are washed and their hair combed each morning, and as much oftener as is necessary. All patients, who, in the opinion of the physicians and surgeons, are able, shall take their baths in the bathroom. 2. Patients suffering from shock or severe in- juries must be placed between blankets and bathed only by special order. 3. The head nurse of each ward shall, when possible, supervise the serving of meals to patients, and shall see that such meals are properly served without unnecessary waste. 45 Dishes not belonging to the ward and all surplus food must be promptly returned to the Kitchen or Diet Kitchen. 4. Diet requisitions for following day must be left in the office of the Superintendent of Training School, not later than 5:10 P. M. 5. A head nurse, when taking and giving up charge of a ward, is to take an inventory of the ward furnishings, informing the Superintendent of the Training School of any short- age ; otherwise she will be held responsible. 6. A weekly requisition for all necessary ward housekeeping supplies shall be made by the head nurse and the books left in the office of the Superintendent of Training School on Saturday morning. 7. Borrowing supplies is prohibited. 8. When coming on duty each morning, the Head Nurse is to read, to her assistants, all orders given during the night, inquire into the condition of patients, and make rounds in the wards, lavatories, linen room and pantry, seeing that every- thing is in order before the dismissal of the Night Nurse. 9. Before going off duty, the Head Nurse or nurse in charge must know the condition of each patient, and make rounds through the wards, lavatories, linen room and pantry, to see that everything is in order for the Night Nurse. 10. New patients' clothes are to be listed, mortuary-box left completely equipped, etc. The Night Nurse is to do the same before going off duty. 11. New diet lists are to be made out each day and necessary changes made in medication and lavatory lists. 12. New orders during the day must be added promptly. 13. The Head Nurse is to assign to each As- sistant Nurse her regular duties, and hold her responsible for the same. 46 14- The assistant nurses must regard them- selves as subordinate to the Head Nurse and obey her orders. 15. The Nurse in Charge will be held respons- ible for the whereabouts of her patients. 16. If absolutely necessary for the Head Nurse to leave her ward, she must inform the nurse left in charge as to her destination. 17. Whenever it is possible, she should send an assistant nurse in preference. 18. Refrigerators, fruit boxes or cupboards and clothing closets must always be kept locked and keys left on Head Nurse's table. 19. Mistakes in medicines, the presence of Vermin and of Bed-sores must be reported at once to the Super- intendent of Training School. 20. The nurse is responsible for preparation for catheterization, and of all solutions and dressings required for orderly cases. She is to supervise the work of the orderlies in the wards, and to report any neglect or insubordination. 21. She must also know that patients are prop- erly prepared for operation, instructing orderly as to methods and dressings required. 22. The nurse must not allow orderly to take linen from the linen closet. 23. The nurse who takes a patient to the Op- erating Room, is to remain with her until dismissed by the Oper- ating Room Nurse. 24. A note of any articles borrowed, must be signed by the borrower and placed on file in the ward until the articles are returned. 25. The badge must always be worn by the nurse in charge at the time. 26. It is the duty of the Head Nurse to report 47 promptly in writing to the Superintendent or his assistant, any- thing requiring attention, and to report before 5 P. M. any fail- ure of the supply of milk, ice, etc. 27. Each Head Nurse will be held responsible for the condition of her ward, including the pantry, closets and lavatory, and for the clean and serviceable condition of all uten- sils. She is entirely responsible for the condition of the floors, and the work of the maid in general. 28. Dust on the floors should be brushed up promptly. 29. If the maid is negligent or in any way in- subordinate, the matter should be immediately reported. 30. The Head Nurse will hold the nurse in charge of diets responsible for the setting of the trays, heating of dishes, serving of meals, and the comfort of the patients while partaking of them. 31. No food is to be left in the ward. Nour- ishment glasses and dishes used between meals must be removed from the ward and washed by the nurse. 7,2. Isolated dishes and trays must be marked with adhesive plaster and kept separate. The Diet Nurse is to wash these, after the others are put away. 33. Dishes will be counted every Friday, when those broken during the week will be exchanged. A record must be kept of such dishes ; also a piece of each broken or worn article for exchange. 34. An accurate account must be kept of the condition and stock of the linen of the ward. Articles, to be mended or exchanged, are to be at once placed in a bag for the purpose and sent to the sewing room each Friday, a list being entered in the Linen Room Book and marked "For Exchange." 35. Hot water bags, ice caps, rings, tubes, ca- 48 theters, thermometers and hypodermic syringes must be counted once a week, and noted in inventory. 36. Economy is exacted in every department. ADMISSION OF PATIENTS. 1. When a patient is admitted, pulse, respira- tion and temperature must be taken and reported to the senior house officer of that service. A complete list of his or her clothing and effects must be made and recorded in a clothing book pro- vided for the purpose (together with the number of the box where deposited), and the entry signed by the receiving nurse. 2. The nurse in charge at the time, must de- posit all money and valuables in the Bookkeeper's office, and take a receipt for the same in the book supplied each ward for that purpose. 3. If on listing clothing there be any vermin found, the clothes must be well wrapped in newspaper, tagged and sent to the box provided for this purpose; notice should at same time be left in office of the Superintendent of Training School, as well as in office of the Superintendent of the Hospital or his assistant. 4. If a patient reaches a ward during the day without a card, the fact must be reported at once in writing, at the entry clerk's office; if during the night, it must be reported the following morning before 9 A. M. DISCHARGE OR DEATH OF PATIENTS. 1. When a patient is discharged, he or she must be properly dressed, and the bedside card, taken by the nurse, accompanied by the patient, to the office where any money or valuables previously left for safe keeping will be surrendered upon return of receipt. 2. When a patient dies, the card, after being 49 signed by the senior house officer of the division, must be taken to the office by a nurse. When the remains are ready for removal, the fact must be reported at the entry clerk's office. Before re- moval the body must be inspected and rings or other valuables found thereon deposited in the Bookeeper's office. 3. The body must ordinarily be ready for removal from the ward within one hour. 4. The clothing of the deceased must be care- fully collected and taken to the entry clerk's office and his receipt obtained therefor. 5. The receipt for valuables must be returned to the bookkeeper's office. 6. When a patient is discharged, transferred, or dies, the admission card must, if possible, be signed at once by the Doctor and sent to the entry clerk's office. If the signature of the Doctor cannot be promptly procured, the card must be sent without the requisite signature. NIGHT NURSES. 1. Night nurses are to remain in bed from 10 a. m. to 5 p. m. They are not to leave the Hospital for the day without special permission. They may attend one church service on Sunday with the knowledge and approval of the Superintend- ent of the Training School. 2. When on duty they are to remain strictly on the ward assigned them, unless sent elsewhere by the Super- vising Night Nurse. 3. In any case of doubt, they should report to the Supervising Night Nurse, before calling the doctor. ORDERS AND ROUNDS. 1. All orders given by a member of the house staff shall be written in the order book and signed by him. The nurse must note the time the order is given. 59 2. The nurses shall accompany the attend- ing on his rounds and render such assistance or give such informa- tion as they can when called for. They shall note the temperature and pulse of each patient as ordered. They shall apply minor dressings and, when required, assist the house staff in the per- formance of their duties on the ward. 3. Any unfavorable change in the condition of a patient shall at once be reported to the senior member of the service on duty. VACATION. 1. All nurses are granted three weeks' vaca- tion in each year. For other time lost, deduction may be made from their moneyed allowance. ORDERLIES. 1. Orderlies shall be subject to the direction of the nurse in charge of the ward, and shall respect her authority. 2. Any question of authority or neglect of duty must be reported at once to the Superintendent of Training School or the Superintendent of the Hospital. 51 DATE DUE j t DEMCO 38-296 tthe COLUMBIA UNIVERSITY LIBRARIES 0041071972 RA982.K48 N431 1909 New York (City) Roosevelt hospital l i