Change, change, change

Nurses General Nursing

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reposted from another board...even if you're new to nursing, i would love to get your feedback on this issue! thank you so much for your time!

can you please answer the following questions for a nursing school assignment i'm working on? thank you in advance for your time!

what changes have you seen in nursing practice since you began your career? what trends have come, gone, and stuck around since you began your career?

Specializes in Critical Care, Cardiac Cath Lab.

Excellent responses, everyone! I'm really looking forward to sharing these with my class tomorrow afternoon. One of my favorites is smoking during report...that's wild! It's amazing how things change...I remember when I was a kid smoking was still allowed in banks and fast food restaurants. BLECH! :)

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Scrubs, computers, diminishing courtesy, extremely high demand on nurses to always smile, no matter how much work is piled on or how fast the work pace is; Many new meds, increased endoscopic surgery, better imaging, more people who don't know enough med terminology or medicine/nursing making decisions about who gets what treatment, far to much growth in the power insurers have in America, doctors brought down a peg by insurers (but only a peg); nurses expected to do way too much for too little pay, employers welching on pensions; divorce & abortion up; pendulum swinging toward normalcy in child abuse investigations; women having many more opportunities; no more giving up our chairs or the charts to doctors; lots more female doctors;

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Emilyerin-do we go to the same school? I had this very same assignment, VERBATIM! Thanks, by the way, I posted under 'nursing student forum' and got no bites

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Specializes in Critical Care.

I did some thinking about this while I was at work last night: I wrote a list. . .

(I started nursing in '93)

1. Stents are greatly improved. So much so that the ave # of open hearts have decreased from 500,000/yr to 350,000/yr. And the therapies surrounding stents: plt aggregate inhibitors, et al.

Something that came and went: brachytherapy - irradiating stents to keep them open; now, they are coated for that purpose with drugs that 'elute' long term protection of the stent.

Another thing that came and went in this dept: Ticlid - (was a new and improved 'Aspirin'; now replaced by a PO plt aggregate inhibitor: Plavix.

2. Swans: out of favor.

3. Critical Care drugs: when I started, Levophed was out of favor (Leave 'em dead); now - back in favor, everybody's on it.

Bretyllium: they killed the plant it came from by overuse; so the plant and the drug are now 'extinct' (If you watch E.T., one of the docs coding E.T. says, "Let's give him some Bretyllium.")

Natrecor: last year's big CHF drug; now, not so big.

4. Needleless systems

5. Pulse Oximeters: new technology introduced in mid-80s (slightly before my time) - Today: indispensible.

6. MRSA was a BIG BIG DEAL; not so much now (maybe it should be! - but when the community is acquiring it now, it's sort of beyond our control)

7. Open ICUs/Family Presence in Codes: both passing fads, if you ask me.

8. Before HIV ('81-'82), they gave blood transfusions just to 'perk you up'. Now, transfusions are much more conservatively considered.

9. Nurse had 'image' problems with respect and professionalism then; and now.

10. There is a HUGE increase in Type 1 DM in children: be it autoimmune triggered by something new introduced to our society or a viral 'bug': I'm amazed this isn't SO FRONT PAGE NEWS. The increase in numbers is new and dramatic and SCARY.

11. Evidence Based Practices are the coming thing and here to stay: Institute for Healthcare Initiative's 100,000 lives Campaign is the forefront (goal: save 100,000 lives/yr by instituting changed in practice governed by evidence of efficacy.) The Rapid Response Teams being initiated EVERYWHERE are an example.

12. Compact Licensure is a coming thing: about 15 States are in the Compact; more will come. (Let's nurses licensed in one state work in all the other compact states without having to get licenses for each state.)

13. California's Ratio Law. Various States backlashing against Mandatory Overtime.

14. HIV: we used to have 1/3rd of the unit filled with people dying of ARC (AIDS related complex). Now, we only get the homeless, non-compliant ones (everybody else is taking anti-retrovirals and LIVING: YEAH!!!!!!!!!!!!!!) - Can anyone say PENTAMIDINE for PCP? Used to give it like candy; now, maybe once a YEAR!

Ok, that was just off the top of my head. Maybe I'll think of more, later.

~faith,

Timothy.

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Specializes in tele, stepdown/PCU, med/surg.

Why are Swans out of favor? Forgive me, I'm not a critical care nurse.

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Specializes in Critical Care, Cardiac Cath Lab.
Emilyerin-do we go to the same school? I had this very same assignment, VERBATIM! Thanks, by the way, I posted under 'nursing student forum' and got no bites

Why, yes, Becca, we do go to school together! :cheers:

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Specializes in Family.

I've only been nurse for 3.5 years, but I've seen some changes myself. I've seen a lot of floors go from being team players to an every man for himself attitude. I've seen paperwork dramatically increase, also the number of patients per nurse has increased. There have been several meds that have come and gone, one specifically that we used to give for post-op nausea and I can't remember it's name!! Pt's and their families are much better educated about their conditions, but a lot of times this is detrimental. I have seen a return to all white for nurses and smoking bans on hospital property. The dr's still don't answer their pages and raises are still almost nonexistent.

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Specializes in Critical Care.
Why are Swans out of favor? Forgive me, I'm not a critical care nurse.

For the same reason that birth control pills are far more effective in study trials than they are in real life: misuse/inappropriate use.

Studies consistently found that Swans (which are primarily data collection devices) could greatly improve interventions. And so they were used, everywhere. And that's a true fact, if used correctly.

The problem: so few practitioners actually know how to CORRECTLY interpret and act on the data, that the risk/benefit ratio is a complete wash. And the risks are real: infection, popped lungs, arrhythmias, etc.

And since the new studies have shown that IN ACTUAL PRACTICE, there is NO real benefit to the devices, they've fallen out of favor. (To use my original analogy, when the users only take their BC pills a third of the time, how effective are they, compared to a placebo?)

In actuality, I really only see swans anymore in open hearts (and maybe a few shocks, be it septic or cardiac), and then, only in about a 1/3rd of them, and THEN, only if the doc is concerned about the cardiac output and wants to monitor THAT for 12 hrs or so (CVPs are also routinely monitored from the swan, but can be monitored without one). Try to give the doc any other data from the swan but CO/CI, and if tends to fall on deaf ears. Maybe RARELY they will ask/look at the SVR, but that's not a given.

There's nothing like asking the doc/anesthetist when recovering a pt how well a swan wedges and getting the following answer: '"I don't know, try it." (Most of the key data uses wedge pressures in their calculations; not even bothering to test it/check it is very TELLING: they only put the swan in for the CO/CI.)

And there are easier, safer and cheaper ways to get CO/CI these days; some of which are non-invasive.

So, faced with the study tested prospect that the devices are useless if you don't know how to use them; lots of docs took that as the 'national standard' to suggest/cover themselves that they aren't needed.

~faith,

Timothy.

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Specializes in Critical Care.

15. When I first started in Critical Care, we would 'shoot' Cardiac Outputs by injecting room temp dextrose into the heart and watching to see how the machine used changes in temperature gradients (between the dextrose and blood) to calculate Cardiac Outputs. Now, we have machines that continuously calculate that: Continuous Cardiac Output (CCO) monitors. I haven't 'shot' a CO in 3 yrs. For our last JCAHO inspection, they removed all our sugar 'bullets' because they were all out of date.

16. When I first started, we had a few IV pumps, but they were reserved for more 'dangerous' gtts. Routine IVF/Antibiotics/Etc were estimated by counting 'gtts/min'.

17. We were always told to NEVER use pumps for blood. The older machines 'squished' the RBCs, or so we were told. Now, the pumps are supposed to be 'OK' for blood. But, unless you have a policy against it, I bet you can ask/observe/find an older nurse who doesn't/won't use pumps for blood. . .

18. Gloves for IV starts. That's why you newbies can't EVER start IVs. . . (I've since learned a 'modified' technique where I leave my 'feel' hand ungloved with the glove on standby, and don that glove before taking the safety harness (that houses the needle) off the hub).

~faith,

Timothy.

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Specializes in Critical Care.

So, BOTH OF YOU - how did your assn go?

~faith,

Timothy.

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Specializes in Med/Surg.

Glass IV bottles, with tape marking the rate of flow,Now plastic bag IV 's with all on IV pumps to reglate the rate.

Glass syringes ,cleaned and reused (Cleaned by nurses) Also needles. Now plastic synringes and needless needle systems.

Going to work in white uniform (dress) white hose and shoes (not sneakers or cloggs). AND cap on with hair out of face and off neck.

Taking forever for a taped or vocal report and narc count at change of shifts. Now narc's in the accudose and counted by computer and a phone in voice care report on your own pt's. Shift change over in 15-20 mins.,

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