[1] In 1929 Smith was appointed as Lady Superintendent and Matron at The Middlesex Hospital, in Mortimer Street, London.

[2] From the beginning she made reforms including amending the patients breakfast time from 05:00 to 07:00, and increased the nursing sisters off duty.

[7] During the Second World War the Middlesex Hospital, which was in central London, was hit by bombs and Smith remained on duty day and night.

[1] The hospital was badly damaged during the war, but she developed a good working relationship with the Mr W. D. Doherty the medical superintendent and they soon improved the conditions.

[1] Smith was appointed Officer of the Order of the British Empire (OBE) in the 1943 New Year Honours in recognition of her work as matron of Middlesex Hospital and a member of the Princess Mary's Royal Air Force Nursing Service Advisory Board.

[11] She was promoted to Commander of the Order of the British Empire (CBE) in the 1953 Coronation Honours in recognition of her work as chairman of the General Nursing Council for England and Wales, and matron of Guy's Hospital.