Local Appointments
    The question of promotion of the Nursing Staff arose quite early in 1914.
    It was then recognised that many experienced Staff Nurses were performing the duties of Sisters, and in order to enable these ladies to draw the pay of the Acting Rank, on the recommendation of the Matrons and Commanding Officers; the Administrative Medical Authorities of the various Bases sanctioned these appointments which were published in their Local Routine Orders.

Appointments in Routine Orders of D.M.S. L. of C.
    The Acting Rank ceased on the transfer of a Nurse to another Unit. This caused great dissatisfaction, and gave rise to complaints which reached this Office.
    The question was then well looked into, and the advice of the Command Paymaster was asked, and early in 1915 it was decided that all questions of the promotion of any member of the Service must be referred to this Office for decision, and that all appointments approved should be published in the Routine Orders of the D.M.S., L. of C., and would appear each time a Nurse was transferred from one Unit to another, so that she would be enabled to draw the higher rate of pay continuously.

Reserves to hold Acting Rank continuously throughout the War
    War Office Letter 24/Misc/1665(F.2) of 15.12.15. was received in March 1916.
It ruled that Members of the Reserve appointed to act in a higher rank that Staff-Nurse would, in future, be regarded as holding such rank substantively during the War. This ruling obviated the necessity of all re-appointments on the transfer of a Nurse, but it caused a little difficulty with regard to the higher ranks, as there were a considerable number of Senior Members who had acted as Matrons of Hospital Ships, and who, when withdrawn from those posts, could not obviously continue to be employed as Matrons.

    A suggestion was put forward in July 1917, that this letter should be modified with regard to the Matrons of Hospital Ships, but the D.G.M.S. did not consider any action necessary. These ladies, therefore, were employed to the best advantage, and were given, either the Charge of a Casualty Clearing Station, or Assistant Matron’s duties, and they continued to draw Matron’s pay.
    Later in October 1917, A.C.I. No.1460 of September 22nd was received. This A.C.I. ruled that Sisters and Staff-Nurses, granted the Acting Rank of Matron or Assistant-Matron, were to revert to their former rank, if and when they ceased to perform the duties of the higher rank. The difficulties in connection with the former ruling were thus removed.

Establishment
    The Establishment of Nursing Staff, as laid down in War Establishment Part VII gave the number for a 520 bedded Hospital in 1914 as:-

1 Matron, 14 Sisters, 28 Staff-Nurses

that is, a proportion of 1 Sister to 2 Staff-Nurses.

    Owing to the peculiar conditions of the work, and the large number of moves, necessitated by the opening of new Units, and the staffing of Casualty Clearing Stations, etc., it was found impossible to keep a fixed Establishment in each Unit, and fortunately War Office Letter 24/Misc/1665(F.2) of December 15th, 1915, made provision for this emergency.
    With the arrival of reinforcements, of both Trained Nurses and VAD Members, it was found necessary to revise this proportion, and the following system was adopted.
    The number of Sisters given in Part VII “a” was kept fixed.
    Half the number of Staff-Nurses given in Part VII “a” were maintained as such, and
    The other half of the Staff-Nurses’ posts were filled by VAD Members, in the proportion of 3 VADs to 2 Staff-Nurses, thus:-

1 Matron, 14 Sisters, 28 Staff-Nurses
with the advent of VADs became:-
1 Matron, 14 Sisters, 14 S/Nurses and 21 VADs

    This proportion of VADs to Staff-Nurses, was quoted by the Matron-in-Chief, War Office, in a letter dated 22.3.16. At no time have VAD Members been incorporated in War Establishments Part VII “a”, and no precise information of an official character, with regard to numbers has been received.
    The basis for calculation in France was decided upon with the approval of the D.M.S. L. of C. and of the D.G.M.S., and in accordance with their instructions, a table was drawn up on this basis for Hospitals with varying numbers of beds, in a scale pro rata War Establishments for Stationary Hospitals of 400 beds, and General Hospitals of 520 and 1040 beds. (The War Office was informed by wire of the principle on which these calculations were based. Wire Q.N.1470 of 18.9.16).

    In August 1917, in order to facilitate matters, with regard to the building of Huts, for extra accommodation entailed by the expansion of Hospitals, it was considered advisable to obtain the Adjutant General’s authority for the Establishments thus drawn up. A revised table was drawn up in accordance with the most recent Establishments given in Part VII “a” No.663, which gave the following proportion for a 1040 bedded Hospital:-

1 Matron, 26 Sisters, 46 Staff Nurses

that is, a proportion of 3 Sisters to 5 Staff-Nurses, and with VADs in proportion of 3 to 2 for half the total number of Staff-Nurses:

1 Matron, 26 Sisters, 23 Staff-Nurses and 35 VADs

The Adjutant General’s approval was obtained, and the scale authorised under his No A.G.D. 4459 of 10.9.17.

    Reverting to Establishments, as directly affecting promotions; as the Nursing Staff in France was at no date up to the strength required, and it was moreover found impossible to keep to the proportion laid down in any one Unit, it was decided that the vacancies for promotion of Staff-Nurses should be calculated in the method indicated above, on the total strength actually in the B.E.F., irrespective of how the various ranks were situated at the time.

    Thus early in 1916, all Administrative Medical Officers were asked to submit the names of all who had actually been performing the duties of Sister, without drawing the pay, and who were considered in every way suitable for promotion. A Confidential Report was to accompany each recommendation. With intent, no dates of Service were specified, and no restrictions as to numbers were made. It was thought that in this way, all those showing special aptitude, and who had undertaken Sisters’ duties in the critical times of 1914 and 1915 would not be overlooked.
    The result was that in June 1916, 122 Members of the QAIMNSR were promoted to Acting Sister’s rank, with pay; and in June 56 Members of the TFNS, in July 3, and in September 1916, 32 – i.e. a total of 91 names of the TFNS were forwarded to the War Office, in order that the sanction of the Army Council to their substantive promotion might be obtained.

Length of Service
    After June 1916, in considering promotions, seniority in Army Service was always taken into account. First consideration was given to those who came to France in 1914, and subsequently to those who joined Army Service in 1914, and came out in 1915, then to those who joined in 1915 and came out in 1915, and latterly to those who joined in 1915 and came out in 1916. Up to the present, it has not been possible to consider any promotions for Members who arrived in France in 1917 and 1918, as there is still a waiting list of those who came out in 1916, for whom there are no vacancies.

T.F.N.S.
    With regard to promotion of the Members of the Territorial Force, the same method was adopted as for the Members of the Reserve, and they were given the Acting Rank with pay. At the request of the Matron-in-Chief, T.F.N.S., in March 1915, a list of 29 names of Staff-Nurses, was forwarded to the War Office, with a recommendation that they might be appointed to the permanent rank of Sister.

    After June 1916, when a complete list of all those holding the Acting Rank of Sister was similarly forwarded to the War Office, no further acting appointments to the rank of Sister were made in this Corps, but the names of those considered suitable to hold these posts were forwarded to the War Office, with a Confidential Report, as vacancies occurred, in order that the approval of the Army Council might be obtained.

    It should be added that when a Member of the Nursing Staff, whether of the T.F.N.S., or of the Reserve, was passed over as not sufficiently capable or experienced to justify her promotion, a further Confidential Report was called for, and her name considered, when later lists were compiled.

E. M. McCarthy
Matron-in-Chief, British Troops in France and Flanders
A.P.O.3
28th May, 1919.