training of the individual nurse and also the ratio of nursing per-
sonnel to hospital beds. A general hospital with a minimum of 50
beds may be sanctioned as an authorized school of training for
nurses with permission to grant to the successful candidate a certifi-
cate of proficiency. It is well known that the standard of hospital
training of a nurse varies widely in different hospitals, depending
very largely on the requirements of the individual matron. In some
hospitals the standard required of the nurse is very high; it may be
even too high, calling for the comment from competent judges that a
nurse's training should be restricted to nursing matters and not
trespass into the domain of the medical man ; while in other hospitals
the standard of training is very much lower. Both sets of nurses
" qualify " and issue from their respective training schools into the
service of the public, each possessing her certificate of proficiency.
The public have no means of judging as to the quality of the train-
ing of the nurses they seek to employ beyond the general label that
" she is a certificated nurse."
The probationer nurses receive technical lectures from the matron and her senior assistants and from members of the junior medical staff of the hospital. Unfortunately there are too many hospitals to-day where the same individuals who give the tuition constitute the examining body, whereas in the larger hospitals one or more " external " examiners are appointed to share in the examination of the candidates. It is surely obvious that in such an important profession as nursing there might have been evolved ere this some definite minimum standard of proficiency applicable to all training schools. Again, it is not suggested that hospitals be asked to conform to some rigid mould of training, but in the interest of nurses them- selves, and especially of the general public, some minimum standard should be fixed below which no hospital should fall.
A parallel illustration might be quoted in the final examination of the medical student, for it was only after the General Medical Council instituted a system of inspection of the various " final " examinations held throughout the country that something approach- ing a minimum standard of proficiency was adopted. Further, in regard to the ratio of nurses to beds, hospitals show a considerable range of difference, even after making due allowance for the variety in architectural structure of the buildings. The absence of any standard in this connexion makes it very difficult to institute a com- parison .between similar hospitals and renders of little value the figure quoted by hospitals as being the " cost per bed," for it is obvious that if one hospital employs more staff than its neighbours, the cost of provisions consumed by them but attributed to the patients will be higher, and so also with salaries and wages.
In conclusion, it may be stated that there is practically no depart- ment in a general hospital where some basis could not be arrived at for instituting standards of efficiency. Such standards would be of considerable value to the hospitals themselves and also to the general public, both in regard to economical administration and in the general service to the community; but owing to the want of knowl- edge of each other, hospitals at present lack the information that would be of so great value in the establishment of standards. This knowledge would readily be forthcoming under a system of hospital coordination, and the institution of some such system seems the most essential step towards a solution of the present-day hospital problem. (N. B.)
UNITED STATES
The hospitals of the United States in the years 1910-21 grew in number and made progress in the acquirement of national characteristics and fixed economic and social importance. In 1921 there were in the United States 7,667 hospitals maintaining 695,698 beds; in addition 24,394 beds were used for hospitai purposes in homes for aged and in similar institutions. Table I. presents an analysis of these hospitals.
TABLE I. U.S. Hospitals.
Public: supported by taxation.
Private: supported by earnings, endowments and contributions.
Federal, State, County, Municipal.
Proprietary, for profit.
Voluntary Corpora- tions not for profit.
Small hos- pitals for patients of one pro- prietor a physician or surgeon.
L a r ger i n stitu- tions for patients of a group of owners.
Church
Non-Sec-
tarian.
(Covering
the larger
endowed
general
hospitals,
including
those con-
n e c t ed
with uni-
versities.)
Hospitals for special groups maintained by
Fraternal Large Orders. Industrial Plants.
The proprietary hospitals show a much larger proportion of the total number of hospitals than of the total number of hospital beds, as most proprietary institutions have less than thirty beds. Larger proprietary institutions are divided into two classes. Some are jointly owned by two or more physicians or surgeons who combine to gain the increased facilities and efficiency ob- tained by pooling the volume of their professional business. Others are controlled by specialists corresponding to the depart- ments of a general hospital including X-ray and all forms of laboratory work. This was a recent development and the number of such hospitals was in 1921 few, but they showed great effi- ciency. The numbers will increase and in 1921 there was evi- dence that the basic idea commonly called "group practice" was bettering the professional service in other hospitals.
The hospitals in 1921 were classified by capacity as follows:
Bed Capacity Hospitals Percentage
Under 25 3, no
 | A table should appear at this position in the text. See Help:Table for formatting instructions. |
25 to 49 50 to 99 100 to 199 . 200 to 499 . 500 to 999 . i ,000 and over
i,859 1,263
781
45 116
133 7,667
40-56 24-24 16-47 10-19 5-28 1-52 1-74
In discussing the number of active hospital beds (exclusive of convalescent and allied institutions and hospitals for nervous or mental diseases) needed by a given population, the figures for
TABLE II. Hospitals and Active Hospital Beds by States, and Ratio of Beds to Population.
States
Hos- pitals
Beds
Ratio of Beds to Pop.
Alabama
84
4,214
to 557
Arkansas
58
3,147
to 556
Arizona .
66
2,285
to 146
California
409
27-384
to 125
Colorado
109
8,629
to 1 08
Connecticut
71
6,466
to 213
Delaware
16
1,005
tO 221
District of Columbia
28
5,160
to 84
Florida
61
2,436
to 397
Georgia
88
4- 26 3
to 679
Idaho
57
1,738
to 238
Illinois
304
29,215
tO 222
14.8
8,902
to ^2Q
T-^
IQt
8 T.2I
iw O*V
to 289
Kansas
- yo
122
u .o
4-95
to 357
Kentucky
87
5,134
to 471
Louisiana
53
5,553
to 324
Maine
56
2,477
to 310
Maryland
70
9,319
to 156
Massachusetts
298
23,3H
to 165
Michigan
206
16,384
to 224
Minnesota
212
1 i ,903
to 2OO
Mississippi Missouri
50 149
2,017 12,476
to 887 to 273
Montana
99
4,238
to 129
Nebraska
IOO
4,894
to 265
Nevada
27
734
to 105
New Hampshire . .
52
1,994
tO 222
New Jersey New Mexico
127
54
12,121
3,939
to 260 to 91
New York .'....
537
66,274
to 157
North Carolina ....
112
5,641
to 453
North Dakota
67
2,476
to 261
Ohio
280
19.059
to 302
Oklahoma
99
3.292
to6i6
Oregon
98
4,127
to 190
Pennsylvania
378
38,962
to 224
Rhode Island
32
3.291
to 184
South Carolina ....
57
3,640
10463
South Dakota
70
2,892
to 220
Tennessee
86
7,452
to 314
Texas
225
12,300
to 379
Utah
46
1.965
to 229
Vermont
- !
1,083
to 325
o * 1 06
7 SS'*
to "*o^
Washington
162
/ .000
8,384
vv ^ J *J
to 162
West Virginia
74
3,636
to 402
Wisconsin
95
11,106
to 237
Wyoming
4 2
2,520
to 77
Outlying Possessions
131
13.902
to 758
