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‘Keep going and always, always think about the patient’

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Betty Smithson trained in the NHS at its inception. She shares her memories with Christine Fernando, highlighting how nursing has evolved and its unchanging core principle

'Keep going and always, always think of the patient'

‘Keep going and always, always think of the patient’

Betty Smithson

Betty Smithson, a former assistant director of nursing education and a member of the NHS Retirement Fellowship, was training to be a nurse when the NHS was created 70 years ago. As it took its first breath on 5 July 1948, Ms Smithson was stepping into the room of her new nurse’s home in Leeds, which she shared with three others and from which they all walked a mile to their hospital each day for ward training.

“I remember being excited, meeting people and looking forward to what was to come,” she recalls. “We didn’t quite know what to expect or how it would all work. But good nurses always take everything in their stride.”

Ms Smithson says she remembers a time when patients would leave two shillings on the table for doctors to slip into their pockets before leaving a house visit. But with the NHS, those days were gone. Healthcare would be free and Ms Smithson says people were shocked.

Along with that shock, however, was an appreciation for the NHS – something she says is lacking among UK citizens today. But, she notes, initially some patients were greedy, with people grabbing heaps of cotton balls for no reason other than the fact that they were free.

“Initially, I think people were expecting too much,” she says. “They wanted everything for nothing.” Now she highlights the increased regulations that keep people from taking more than they need because the NHS can no longer afford to spend rashly.

Before her official training began, Ms Smithson’s love of nursing was sparked when she was 10 years old and contracted diphtheria. During her recovery, she realised she liked hospitals and nurses.

“I just decided that this was what I’d like to do,” she says.

She left school at 16 and began children’s orthopaedic nursing before starting her official training in Leeds. “I loved looking after children,” she says. “It was always wonderful to get them better and see how thankful their parents were. When the children got better, everyone felt better.”

After training and three months on a children’s ward, she worked in children’s surgical nursing for eight years, eventually switching to part-time nursing after getting married at age 24. Women at the time were not allowed to be married during training or to be a qualified staff member if married.

She left nursing for four months to have a child and then worked as a night sister for 12 years, before going into teaching and serving as assistant director of nurse education at Seacroft Hospital in Leeds until she retired aged 60 in 1990.

“The students were all wonderful – apart from one or two,” she says with a laugh. “I just enjoyed passing information on, and doing the best I could to make them good nurses.”

Since her retirement, her volunteer work with Healthwatch has allowed her to inspect nursing homes and hospitals, advocate for patients and even meet Prince Charles – which was her proudest moment in her decades-long career. She also spends Wednesday mornings serving tea at Seacroft.

Nursing at the start of both the NHS and her career looked wildly different from nursing today, Ms Smithson says. At her nurse’s home, no men – and certainly no boyfriends – were allowed. In addition to food and lodging, nurses were paid just over £2 a month (the equivalent to just over £50 today when adjusted for inflation).

She says nurses also had little entertainment. “We had to make our own fun,” she says. That is, until payday. “Our main extravagance was going to a local cafe to have a cup of coffee and a cream cake. That was our highlight of the month.”

The role of nurses has evolved, she notes, with staff today having to learn about more technology and keep more-extensive records. And even the clothes have changed. 

Ms Smithson recalls that uniforms were stricter: dresses had to be exactly eight inches from the floor, and nurses wore thick black stockings, black lace-up shoes and starched collars that cut their necks. “But I must say, we always looked delightful. Now, it often looks like nurses are just wearing pyjamas,” she says in relation to the growing popularity of scrubs.

With stricter uniforms, she says there was also a stronger sense of discipline, from which she wishes modern nurses would learn. Even as an educator, she says she was stricter than nurses are today. “They always used to say I was extremely strict but very fair,” she says. “I couldn’t ask for more than that. Even now, people say they used to be frightened of me.”

She says she has also noticed less respect for nurses today, because people expect more and more from them. “The public aren’t as grateful as they could be,” she says, despite everyone doing “the best that they can”.

For all nurses and for the NHS, Ms Smithson has just one piece of advice that reflects what she considers to be the core mission of nursing: “Just keep going and always, always think about the patient,” she says. “They must always come first – your aim is to get the patient healthy as soon as possible.”

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