The American dream

I sailed from England on the ‘Scythia’ on May 9th and landed at Quebec in the very early morning of May 19th. I travelled alone and was away from England for 13 weeks, during which time I covered approximately 23,000 miles, slept in 30 different places and visited 21 hospitals.

In a particular digitised report in the archive (MS 1721/3/2/1/1), which often reads like a personal diary, Raven details her extraordinary opportunity to embark on a three-month trip to North and South America via Canada, America, Mexico, Panama, Chile, Peru and Brazil between May and August 1953: to 26 cities in 8 countries culminating at the Quadrennial International Congress of Nurses in Rio de Janeiro. 

With the intention of what now would be described in the NHS as ‘sharing best practice’, Raven’s mission was to discover whether the nursing problems being experiencing in Britain were also confronting America, and if so what methods are being adopted to overcome them.

The neatly typed, 10 page document is a revealing insight into Raven’s astute observations on her travels; of nurse training methods, patient care systems, equipment and accommodation. Whilst the record is a formal report to the Board of Governors of the Leeds General Infirmary, excerpts of her journey also read like a descriptive novel:

Through the vast plains of Canada, over the Rocky mountains to Vancouver, to Seattle, down through California, to San Francisco, Los Angeles, across the Arizona desert to Pheonix and New Orleans.

Finally arriving in Rio after her long trip, she was one of 20 British delegates attending withi representatives from 46 countries. However unusual it might have been to dispatch a senior nurse on a lengthy research visit at the time (it may seem unthinkable today), by her own admission she describes her ‘extreme good fortune’ to be given this opportunity and expresses her gratitude to the Board several times.

All the mod cons

Beyond the training and management of nurses that Raven was particularly keen to understand, she also observed the modern design of hospitals in the USA, clearly understanding how this benefitted patients and noting the considerate efforts to the elimination of noise and non-practical tasks on the wards to improve the patients’ environment. She was most impressed by the ‘inter-departmental pneumatic tube’ (still used in hospitals today) where in Minnesota, the tube stretched two miles between hospitals, delivering patient notes and prescriptions. In one detail, she even delights at her first sight of a vending machine:

The planning of new hospitals left little to be desired. The entrance halls for patients and relatives were impressive and even magnificent, displaying gift shops and mechanical devices for obtaining coca-cola.

Summarising her many findings with exceptional detail and clarity she was unafraid to also insert her own observations: ‘In at least two of the hospitals, the Director or House Governor was a woman. It is not surprising therefore that these hospitals were well conducted!’

Interestingly however, there is no acknowledgement in the report between the UK’s then recently formed public NHS and the American care system (that incidentally doubled in cost in the 1950s) that Raven would have observed on her visit.

The voice of nursing

Over 140 documents and hand written speeches in the archive confirms why Dame Kathleen was often referred to as the ‘voice of nursing’.  At the high point of her career she delivered countless talks and speeches on Woman’s Hour, the opening of intensive care wards, nursing AGMs and a lecture at the Royal College of Nursing she gave in 1995, aged 84.

Her influence whilst Chief Nursing Officer led to key developments in nursing and medicine, systems of progressive patient care, the implementation of nurses at all levels of hospital management. Based on Raven’s observations in America, the 1960 hospital building plan also required that the hospital of the future should include the first British intensive care units.

She freed the nursing division from the medical and was particularly focussed on separating the practical from the administrative aspects of nursing to improve efficiency. Former Chief Nursing Officer, Yvonne Moores wrote of her:

Dame Kathleen was an enormous influence on the nursing, midwifery and health-visiting professionals during a crucial period for the NHS (…) she retained warmth and humanity, while operating as a consummate civil servant.

The Dame Kathleen Raven archive is publically accessible and held at Leeds University Library. Digitisation of parts of the archive was supported by the AHRC project Exploring Histories and Futures of Innovation in Advanced Wound Care at the University of Leeds.

With thanks to Louise Piffero, Archivist (Medical Collections) at Leeds University Library.

Natalie Craven, public programmes officer (who coincidentally also has golden hair, blue eyes and is slightly shorter than average)

The RCP exhibition This vexed question: 500 years of women in medicine opened on 19 September 2018 and runs until 18 January 2019.