Royal Prince Alfred Hospital
Royal Prince Alfred Hospital
RPA Museum & Archives

History

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Nursing History

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Wages & other industrial matters

In the early days it was queries as to whether nurses should be paid at all, since hospitals were for the sick poor and nurses were dedicated to the care of the sick and were receiving training at the same time. Their pay was very poor for many years and early nurses speak of being 'proud' they worked for so little, as their dedication to the care of the sick and the sick poor was considered more important by both themselves and their employer. But they weren't complete martyrs. As recorded in a 1900 Matron's report to the Board of Directors, "There is an idea prevailing among the nurses that as soon as their certificates are granted they should take up work that is more remunerative than that of the Hospital. They frequently forget the trouble and expense their three years' training has been to the authorities and moreover, they lose sight of the fact that they are thoroughly trained at the end of the three years." It seems that the nurses were to consider themselves in debt to the Hospital for their training, discounting of course their very hard work and long hours. (Until the late twentieth century nurses lived on site during their training and received room and board.)

Approximate salaries per annum in 1882: Probationers £21.5; Nurses £35; Sister £58; Matron £150.

In comparison, a Resident Medical Officer earned £450, an Assistant Medical Officer £250 and the Dispenser £200 per annum. The 11 servants had a combined yearly wage of £325 (1 cook, 1 kitchen maid, 7 servants and 2 laundresses). 

In 1892 the annual leave allowance increased from 14 to 21 days, later increasing to 28. One day off each month increased to one day off each week, then to one day and a half each week. Night nurses were relieved of duty at 7.30am instead of 6.30am.

ATNA (first known as the New South Wales Trained Nurses' Association and then the Australasian Trained Nurses Association) formed in December 1899 and served as the governing body for all trained nurses. The specific objects of ATNA were:

  1. To promote the interests of trained nurses in all matters affecting their work as a class.
  2. To establish a system of registration for trained nurses.
  3. To afford opportunities for discussing subjects bearing on the work of nursing.
  4. To initiate and control schemes that will provide nurses with an allowance 'during incapacity for work caused by sickness, accident, age or other necessitous circumstances'.

RPA Matron Susan Bell McGahey was a founding member of ATNA and held the most senior nursing position in the association, that of founding honorary secretary. She was a member of its council until 1912 and founding editor of its journal, the Australasian Nurses' Journal, the first nursing journal in Australia (1903). She represented the association at the first International Council of Nurses Congress at Buffalo (USA) in 1901. RPA trainee Ellen Gould was also a founding member of ATNA, was a council member from its inception until her retirement in 1921, and served on the editorial committee of its journal.

From 1906 ATNA conducted the final nurse examinations until the establishment of the Nurses' Registration Board in different states of Australia.

The position of wardsmaid was created in the hospital in 1902. These women took over the heavy cleaning previously done by probationer nurses.

In 1911 concerns were raised that the nursing staff was being overworked because of new technologies such as X-rays and more invasive surgeries. There were also many cases of typhoid fever and several nurses got sick. This led to an investigation by a committee of Board members and doctors resulting in some improvement in working conditions, with increases in nursing staff and better time off duty.

The RPA nurses received a pay rise in 1920 making their salaries on par with Sydney Hospital. One day off per week for nurses was extended to a day and a half.

The NSW Nurses' Registration Board was formed in 1924 with the need to rationalise nurse training and examinations. It was clearly difficult to organise the lectures, many given by doctors, so that nurses had some knowledge of the specialist areas to which they were sent.  Most of the training was imparted by ward sisters and senior nurses in a strictly hierarchical ward and hospital structure. 

During the Great Depression in Australia (1929-32) there were high levels of unemployment amongst nurses. 200 beds closed at RPA and the numbers of nurses were reduced with many given extended leave without pay.

A group of Matrons formed a Nurses' Association in the early 1930s to discuss nurses' working hours.  One Matron said "Nurses would not want more time off as they would not know what to do with it".  Nevertheless this Association advocated for improvements in the working conditions of nurses, and pushed for payment for overtime worked. In the 1940s the time off was extended to 48 hours which could be taken as 2 full days if the Ward Sister was able to manage the roster suitably. Time off for special occasions was sometimes possible.

The 44 hour working week was introduced under the Industrial Arbitration (Amendment) Act of 1932 but this was not implemented at RPA until 1936. On nurse who trained in the 1930s recalled, "Resignations came thick and fast because we were so tired and miserable but a sympathetic matron encouraged us to reconsider."

Until the Nurses' Award of 1937, time-sheets did not exist. A 1930s trainee remembered, "It was a seven day week but if there was no-one to relieve us during our time off, we could work ten days or more before relieved of duty…to ask for rights and privileges was unheard of. We obeyed the rules. Uncomplaining acceptance of abrupt orders and harsh reprimands were part of our day."

Nurses were expected to view nursing as their main life interest and had very few rights. The Nurses' Home was a place in which a nurse did not introduce her friends or family except during special events.

1930s - Day duty was 6am-8.30pm with a break/pass of 3-4 hours, and 20 minutes Room Time at 9am. Night duty was 8.30pm-6am with ten nights on and two off.

In 1936 a NSW Nurses' Award was created in the Industrial Court. The award increased the wages for trainee nurses and sisters and decreased the number of hours worked. It was challenged by many hospitals including RPA who argued that it would cost an extra £11,000 per year to accommodate the conditions of the new award. Interestingly (and many nurses may disagree), the Commission found that "no evidence has been produced that any hospital has exploited these young women (trainees) by requiring them to perform arduous work under the guise of training or that any system exists of using trainees as a cheap method of getting the necessary work of the hospital done." Under the new award, the rates of pay were: between £85 and £130 for trainee nurses;

1946 - All nurses were expected to join the Health Insurance Fund.
One nurse recalled, "I believe nurses generally enjoyed good health, but should sick leave over and above a few days be necessary, the time had to be made up at the end of the four year course."

In 1947 the NSW Nurses' Association presented a successful case to the Industrial Commission for improved salary for trainee nurses. However, this decision was reversed in 1953 with the inclusion in the award of lower living standards and reduced annual leave for nurses. A salary rate for male nurses 20% above the rate for female nurses was also introduced in this award. The first male nurse was employed in 1966.

In the post-war years hospital funding continued to be an issue. Nurses were often asked to volunteer their time to collect for the Hospital Saturday Appeal and in the RPA Auxiliary Tearooms at Sydney Showground. The nurses' ongoing willingness to work long hours with low pay allowed RPA to provide a reputable and high quality service.

By the 1970s trainee nurses were earning between $1900 and $2808 per year. In their first year of service (post-training) the wage was $3627/year and after 5 years the wages were $4316/year. These numbers do not include penalty rates for weekends and nights. (The average yearly Australian wage in 1974 was around $5400).

By Dr Vanessa Witton and Dr Kathryn Hillier, RPA Museum and Archives
Sources: 'The First Fifty Years' by Dorothy Mary Armstrong (1965); 'The Second Fifty Years' by Helen Croll Wilson (2000); The Life and Times of Royal Prince Alfred Hospital, Sydney, Australia by Muriel Knox Doherty (1996); Australasian Trained Nurses' Journal; The Sydney Morning Herald; RPA Archives "Memories" collection.