What Is the Cause of Half the Accidents Which Happen?

Notes on Nursing

If you look into the reports of trials or accidents, and especially of suicides, or into the medical history of fatal cases, it is almost incredible how often the whole thing turns upon something which has happened because “he,” or still oftener “she,” “was not there.” But it is still more incredible how often, how almost always this is accepted as a sufficient reason, a justification; why, the very fact of the thing having happened is the proof of its not being a justification. The person in charge was quite right not to be “there“, he was called away for quite sufficient reason, or he was away for a daily recurring and unavoidable cause: yet no provision was made to supply his absence. The fault was not in his “being away,” but in there being no management to supplement his “being away.” When the sun is under a total eclipse or during his nightly absence, we light candles. But it would seem as if it did not occur to us that we must also supplement the person in charge of sick or of children, whether under an occasional eclipse or during a regular absence.

In institutions where many lives would be lost and the effect of such want of management would be terrible and patent, there is less of it than in the private house.*

But in both, let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done?

Then, when anything wrong has actually happened in consequence of her absence, which absence we will suppose to have been quite right, let her question still be (not, how can I provide against any more of such absences? which is neither possible nor desirable, but) how can I provide against any thing wrong arising out of my absence?

What It Is to Be “In Charge”

How few men, or even women, understand, either in great or in little things, what it is the being “in charge”—I mean, know how to carry out a “charge.” From the most colossal calamities, down to the most trifling accidents, results are often traced (or rather not traced) to such want of some one “in charge” or of his knowing how to be “in charge.” A short time ago the bursting of a funnel-casing on board the finest and strongest ship that ever was built, on her trial trip, destroyed several lives and put several hundreds in jeopardy—not from any undetected flaw in her new and untried works—but from a tap being closed which ought not to have been closed—from what every child knows would make its mother’s tea-kettle burst. And this simply because no one seemed to know what it is to be “in charge,” or who was in charge. Nay more, the jury at the inquest actually altogether ignored the same, and apparently considered the tap “in charge,” for they gave as a verdict “accidental death.”

This is the meaning of the word, on a large scale. On a much smaller scale, it happened, a short time ago, that an insane person burnt herself slowly and intentionally to death, while in her doctor’s charge and almost in her nurse’s presence. Yet neither was considered “at all to blame.” The very fact of the accident happening proves its own case. There is nothing more to be said. Either they did not know their business or they did not know how to perform it.

To be “in charge” is certainly not only to carry out the proper measures yourself but to see that every one else does so too; to see that no one either wilfully or ignorantly thwarts or prevents such measures. It is neither to do everything yourself nor to appoint a number of people to each duty, but to ensure that each does that duty to which he is appointed. This is the meaning which must be attached to the word by (above all) those “in charge” of sick, whether of numbers or of individuals, (and indeed I think it is with individual sick that it is least understood. One sick person is often waited on by four with less precision, and is really less cared for than ten who are waited on by one; or at least than 40 who are waited on by 4; and all for want of this one person “in charge.)”

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