The Bad Old Days - page 2

by SharonH, RN

2,585 Unique Views | 24 Comments

I was reading nurscees's thread and some of the comments about nurse-patient ratios and I started remembering: Back in 1991, I started my nursing career at Thomason Hospital in El Paso, Tx on the pediatrics floor. We also... Read More


  1. 0
    I hear a lot about patients being less acute in the old days. I've only been a nurse for 3 years, so I don't have any basis for comparison. Does less acute mean that not everyone had IV meds and toileting help? Fewer dressing changes? Fewer tubes in every orifice? Tell me what it was like.

    As a new nurse, I worked a general surgical floor on evenings and had 5-6 patients. Nearly all would have IV meds, fluids or TPN. A couple would have AC and HS fingersticks, everyone would need pain meds, some or most might be fresh postops. At least a couple dressing changes. Usually at least one vomiting or stooling all over, requiring multiple bed changes. They were all supposed to have help with TCDB/IS and ambulation. Usually not more than one total care, but on a really bad night you might have two. Charge nurse took off orders and checked labs. Lots of NGs, ostomies, drains and t-tubes. Our floor got the gastric bypasses, so in addition to your regular obese patients, you could count on a few postop bypasses who would need to be closely monitored so they didn't drink 200 cc at once and bust their stomach sutures.

    Compared to what others describe, it doesn't sound hard. I ran my butt off. We had one aide on a good night for 40 patients and most of the aides were useless. We never had enough supplies or equipment, I was always hunting down a dynamap or glucometer. The pharmacy, lab, xray, orderlies, housekeeping and EKG techs seemed to be on perpetual supper break. God forbid someone crumped and needed stat labs, CXR and EKG. Granted I was a new grad and had some things to learn about organization, but nurses keep leaving that unit and from what I hear it just gets worse. I work in MICU now and in two years I don't think I've had to take more than 2. The various support services respond immediately. The nurses are less burnt out and more willing to support one another. It has its faults, and I'm moving on in any case, but you could not pay me enough to return to a med-surg floor.
  2. 0
    Quote from BETSRN
    I am on a floor with excellent ratios(LDRP) , but I keep wondering of the stuff JCAHO thinks up is supposed to keep us AWAY from patient care. Truly, I don't understand how one can do nursing care with all the extra crap we have to fill out, ask, etc. It's rarely vial to the patient's well-being.
    this is perhaps, the ONE thing that may drive me away from bedside care one day....I can see it. I hate the paperwork and it's getting beyond ridiculous. In just 7 years, I have seen things get MUCH worse this way. It's obscene, really.
  3. 1
    I graduated in 1977 and went to work on a 36 bed Med/Surg floor in a brand new hospital with all the latest equipment. Well, the hospital had been around since the early 1900's, but the building was built in 1976 and the equipment was new.

    I worked day shift 6:45 am - 3:15 pm, rotated to nights 10:45 pm - 7:15 am and only got 1 weekeknd off each month.

    We had team nursing where 1 RN (me), 1 LPN, and 1 Aide cared for 12 patients on days and 1 RN (me), 1 LPN, and 1 Aide cared for all 36 patients at night. This was before the days of managed care and DRGs were just coming about. If you had "good insurance", you could stay in the hospital until your MD wrote a discharge order and some patients did just that, staying weeks when they could have been at home. Needless to say our acuity (was that even a word in 1977) was very low. Patients were admitted 2 or 3 days prior to a protoscopy, upper GI, lower GI, or other GI/GB test for "prep" and stayed for days afterward to get the test results. A cardiac cath resulted in at least 7 day stay and surgery well 10 days at least!

    We had no IV Team, no Code Team, no other team - we WERE the team. We did all the AM care (most patients got bed baths) as a team and had to 'Heat Up" all meals in a microwave oven and pass to patients.

    I did all IV's, IV Meds and treatments the LPN could not do. We had no IV pumps, I counted gtts to assure the correct flow of the IV and calcualted I&O and fluid counts to give to the next shift. Most every patient had an IV. We used "butterflys"; angiocaths were just coming about and cost too much to use for everybody.

    The LPN did PO meds and treatments the Aide could not do.

    The Aide did all vital signs except BPs.(They were not allowed to take BPs) The thermometers were glass and mercury and each patient had their own (We no longer had to clean with alcohol between each patient). We took pulse with our fingers on the patient's radial artery and respirations by watching the chest rise and fall. We had the old mercury BP cuffs we had to roll from room to room.

    The LPN and I "split" the hall for documentation (black ink for days, green ink for evenings, and red ink for nights) and I gave report on our team.

    I was responsible for signing off all our orders and counting narcotics. There was no such thing as Unit Dose, Pyxis or Accudose. We gave sliding scale insulin accorrding to urine sugar tests. The LPN did the test and I gave the insulin.

    I could go on and on, but I look back on those as good days! I had time to spend with my patients and I had a great team to work with.
    MMaeLPN likes this.
  4. 0
    June55baby, your early nursing experience in the 70's could be mine...and I also look at it as the 'good old days' and look back fondly. We weren't burning out, stressing out, and we DID have time with our patients...much more quality time than I do now. I enjoyed nursing back then, not so much today.

    Our acuity was lower and I try to think hard about why that was. Were problems treated earlier before huge complications set in? Did doctors in their clinics spend more time with patients...'heading off at the pass' potential problems? Were patients allowed to come into the hospital 'for a rest' and a little TLC (I used to always have one or two housewives in with this)and did this actually prevent disease?

    I can't help but wonder how much our high stress lifestyles today plus the HUGE changes in patient care since DRG's and managed care actually lead to the high acuity and complex patients we see on today's medsurg units.
  5. 0
    Quote from mattsmom81
    Our acuity was lower and I try to think hard about why that was. Were problems treated earlier before huge complications set in? Did doctors in their clinics spend more time with patients...'heading off at the pass' potential problems? Were patients allowed to come into the hospital 'for a rest' and a little TLC (I used to always have one or two housewives in with this)and did this actually prevent disease?

    I can't help but wonder how much our high stress lifestyles today plus the HUGE changes in patient care since DRG's and managed care actually lead to the high acuity and complex patients we see on today's medsurg units.
    That's a great question--where are all these higher acuity patients on M/S floors coming from? In the "good old days," would they have been in the ICU's? I'm wondering what staffing was like in the critical care units compared to the general floors.
  6. 0
    Quote from rnmi2004
    That's a great question--where are all these higher acuity patients on M/S floors coming from? In the "good old days," would they have been in the ICU's? I'm wondering what staffing was like in the critical care units compared to the general floors.
    ICUs came into being in the late 60s, if I recall correctly. Other CCUs came along later.

    Higher acuity pts came from the fact that pts don't get into the hospital in the first place without being sicker, and go home sooner. If it can be done outpt, it can be. (I was just looking at something where they were doing an hysterectomy with a new procedure that could be done outpt!!!). If it can be done with home health care rather than the hospital, it will be.

    NurseFirst
  7. 0
    I think the newer drugs and the technology has expanded so much that personally I've seen people who would have never made it to the ER go home. I'm amazed at how long chronically ill people are surviving these days.
    One thing I've noticed in my area the past year or so, is how many older morbidly obese are surviving longer. I've seen 400 plus lbs in their 50,60, and even 70's come in. That's something I don't recall. But then again, I haven't recalled many younger ones of that weight coming in either.
    Back in the old days, even though we had more patients, it seemed to me in my area that people were much more satisfied with their care and had more trust in their nurses and docs than I see now. Alot of them wouldn't even be in the hospital or even overnight nowadays, they would have been done as an outpatient. The very ill we see now just didn't survive. I don't remember seeing as many errors as I do now. Alot more older nurses who have worked there for a long time. Much more job satisfaction. The care was in general good. It's so sad how things have become; not in terms that people are surviving longer of course, but everything else. I've been saying for a while that I personally believe these are signs the entire system is falling apart.
    Last edit by sherrimrn on Feb 14, '05
  8. 0
    My impression is that the sick floor patients would have been in the unit, and the unit patients would be dead. We can preserve life a long time these days, sometimes to no one's benefit.

    We had a really spacy house sup one evening a couple years ago. My floor was swamped and understaffed. So this gal, who hadn't been a bedside nurse in I don't know how many years, came to help us out. We expected her to take vitals or give IV meds for the LPNs. Nope, she offered to pass the drinks trolley. As a new nurse I was puzzled. What drink trolley? Someone explained it to me and I couldn't believe that a practicing nurse still thought we had time to be flight attendants!
  9. 0
    Quote from mattsmom81
    Our acuity was lower and I try to think hard about why that was. Were problems treated earlier before huge complications set in? Did doctors in their clinics spend more time with patients...'heading off at the pass' potential problems? Were patients allowed to come into the hospital 'for a rest' and a little TLC (I used to always have one or two housewives in with this)and did this actually prevent disease?

    I can't help but wonder how much our high stress lifestyles today plus the HUGE changes in patient care since DRG's and managed care actually lead to the high acuity and complex patients we see on today's medsurg units.
    These are good thoughts. If we offered more "rest" and TLC, would it be preventative? I don't know.

    I remember when my twins girls were born in 1978 I stayed in the hospital for 13 days... My OB said she was keeping me a couple of weeks because she didn't want me to be driving back and forth to visit them in ICU (about 14 miles - 1 way). That was not uncommon nor looked upon as poor management. In fact, it was good practice!

    But as others have said, we are saving patients who didn't have a chance in 1977. Technological advances have soared and many of those patients we cared for in the ICU in 1977 are now receiving care on the general units. While those we offered rest and TLC to in 1977 are at home and usually not receiving care at all. Maybe that's why sales of drugs for depression and anxiety have risen dramatically. But did we even have anything for depression and anxiety back then other than Elavil or Valium??
  10. 0
    I graduated in 1981. Nothing annoys me more than listening to "old timers" bragging to today's new grads that when they started they took 60 patients by themselves, cooked all the patients' meals, did all the laundry, walked ten miles to work uphill both ways, etc. I remember having a hall of 26 patients on evenings with myself two Lpn's and one aide. Most of the patients weren't even sick! Those were the days when people could be admitted for a barium enema, an arthrogram, a check-up, or whatever else. Patients were kept in the hospital extra days to accommodate families who didn't feel like picking up Grandma on Tuesday so could she please stay until Friday? Most if not all of the patients on the medical oncology unit where I work would have been in intensive care when I started. I hope new grads do not pay attention to this kind of nonsense. They face very difficult, very sick patients. It also amazes me the way the hospital lobby has been so successful at thwarting efforts to have nurse/patient ratios written into law. Day care centers operate under such mandates, so why not hospitals, too?


Top