Nursing: Then and Now

The nursing profession, as a whole, as well as the role of the nurse have evolved dramatically over the past several decades. I personally have witnessed the changing face of nursing during my 30+ years in the profession. Gone are the days when nurses were thought of as little more than helpers or assistants for physicians. Today's nurses are healthcare professionals in their own right, playing an important and vital role in providing excellent healthcare. Nurses General Nursing Article

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Looking back to when I was in nursing school, and then starting my nursing career, I remember many things that are no longer in use, or things that have transformed over the years. Gone are the days of paper chart, replaced with electronic medical records. Gone are the nursing caps that distinguished the nurse from the rest of the healthcare team.

Here is a partial list of things I remember from days gone by.

Back in the day...

  • Team nursing
  • Primary care nursing
  • Longer patient stays (Patients were actually able to recuperate in the hospital rather than being sent home too soon. There was no such thing as same-day surgery.)
  • Nurses wore uniforms which consisted of white dresses, white hose, white lace-up oxford shoes, and, of course ... white nursing caps!
  • Only OR staff and physicians wore scrubs.
  • The Kardex, a large folded card, was used as an important document of all patient activities, meds, etc. And it was hand-written in pencil so it could be erased and updated as needed. Talk about document tampering!
  • Requisitions were composed on a typewriter.
  • Patients were called Mr. or Mrs.
  • Gloves were used for sterile procedures only. Universal precautions did not exist.
  • The only lifting machines we had were male aides ... and of course ourselves.
  • Nurses bent and broke off needles from used syringes
  • IV pumps were used only in Peds and ICU. Nurses had to calculate the drip rate using the second hand on their watch and a roller clamp to regulate the flow.
  • Heavy glass IV bottles were still in use
  • The charge nurse made rounds with the doctors ... and carried the heavy metal charts.
  • When a doctor arrived at the nurses' station, it was expected that a nurse would stand up and offer her seat....and the doctor never refused
  • Male nurses were very rare
  • Cold metal bedpans were offered to patients.
  • All patients were offered a daily bath and back rub
  • There were no fitted sheets. Remember hospital corners??
  • Glass thermometers were still in use.
  • Nurses notes and vital signs were recorded using a pen with 4 colors of ink as different colors of ink were used on different shifts. Actually, only 3 were used since there were 3 shifts.
  • Surgery patients were admitted the night before surgery so their preps could be started that evening.
  • Nurses smoked in the nurses' lounge.
  • Cancer was almost always a death sentence
  • Medicine was dispensed by the med nurse carrying a tray with small paper cups of pills and different colored med cards.
  • Four-year BSN programs were not as plentiful. Most nurses graduated from hospital-based Diploma or ASN programs.
  • State boards were 2 grueling days of exams that were completed with number 2 pencils. No computerized tests in those days.

Feel free to add items that you remember from the past, even if that past does not seem that long ago. Changes are occurring at an even faster pace in the digital and electronic age of today. What do you think of some of the changes???

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.
Kind of sad-face that the several other threads in this vein (some dating back 10-plus years) weren't linked.

Feel free to copy any of those posts here. I'm sure our members would enjoy reading some of the older posts. However, many of those older threads are now closed and no longer open for comments.

Staff is trying to continuously start new threads and articles.

Specializes in ER, progressive care.
I just thought of another one. Years ago, nurses were not allowed to check a patient's cervix lady partslly do to the risk of infection, nurses could only check rectally. I have spoken with an older nurse who said you really could tell when they got complete, but I seriously doubt I could distinguish 2cm from 3cm that way.

you can check labor progress rectally? :eek: would have never guessed...but I'm not an L&D nurse...

Use of the word "appears".

Nurses couldn't come out and state an event occured and or pronouce a patient's illness or condition, that was considered medical diagnosis and reserved strictly for physicans. You could get your head handed to you on plate by any MD from an intern to attending if they didn't like what they overheard or read in nurse's notes regarding their patient. At best a physican would complain to supervisors and have you taken off caring for his patient, at worse it was the dreaded FTV (Float,Transfer, Vacation) until the offended MD relented and could stand the sight of you again.

So nurses simply wrote "appears" in front of their observations when charting and or conversations. Instead of saying someone was dead, it went "pt appears to have ceased respiratory activity".

Thing is that often nurses knew what they were speaking about and noticed early signs of disease or conditions that if treated could nip things in the bud. Scores if not hundreds of patients probably had adverse reactions and or simply died because physicans either refused to read nurse's notes and or took offense that a *mere* nurse was observing and by extension diagnosis.

Specializes in retired LTC.

"Appears sleeping" is my first favorite, then "appears to cease breathing"is my second fav. How stupid.....

Like others, I am careful with dropping diagnoses, and that IS a throw-back to the old days. I will qualilfy any diagnoses with my observational S&S. Physicians ARE NOT interested in our fancy, schmancy nsg diagnoses when I call on 11-7. So I have progressed to using medical diagnoses - DVT is more to the point than 'alteration in...'

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Here is a great post from Penguin67, who posted this in a similar thread in 2009.

Hmmm, let's see, alot has changed...

We used to manually sign our own timecards, not punch a time clock. Still wish for those days, as nurses should not have to punch in and out.

Chest tubes drained into glass jugs that you taped to the floor, not a pleuravac.

Charts were on paper, not on the computer. Those were the days!

Same thing with labs. You ordered tests on a carbon set of papers, and sent it with the specimen.

There were no Pyxis machines. You had one narcotics box, and the charge nurse kept the keys. If you went home with the keys, you returned soon after with the keys.

All unit supplies had a charge sticker, that usually ended up on your nametag or on the floor. Omnicells took care of that.

There were no nurse zone phones. There were call lights.

MRSA and VRE weren't as big of a thing. Probably around, but we didn't know much about it.

Nothing was on the computer. There was a care kardex, used for report, and a med kardex used to record all meds given. You hand wrote on these.

Most IVs were on gravity drips. And you had to calculate them. Pumps were rare.

You could take all of the styrofoam water pitchers from all the patient rooms and put them on a cart to refill the ice water from the ice machine. Now, due to infection control, you never take the pitcher back in to the ice machine, you only take plastic bags of ice ot the patient.

Heat lamps were used pospartally to assist with healing of the perineum. You set up the heat lamp on the bed, then placed a cradle -like cage around it and covered it with the blanket, to provide for privacy. What a fire hazard!

NCLEX was a two day ordeal. Paper and pencil. Most state had one site, and larger states had more than one site. Given twice a year only. New grads got temporary licenses until results were known. NCLEX was for 12 hours, two 3-hour sessions each day. Then, you waited about 8 weeks to get your results in the mail.

Twelve hour shifts pretty much weren't anywhere utilized as they are now. It was standard to work 7-3, 3-11 or 11-7. Some straight shifts, and some got rotating schedules. And I honestly didn't see the level of burnout and call-ins that we see today on 12 hour shifts.

Specializes in Surgical/MedSurg/Oncology/Hospice.

It seems like today's tube feed formulas (Glucerna, Osmolite, etc) always cause diarrhea...did the 'old' way of using thinned blenderized real food do the same? It seems like those patients always end up with diarrhea and skin breakdown, maybe the other way was better...

Specializes in ER, progressive care.

We still have charge stickers, but only for certain things like dressing supplies (Aquacel, etc) or a foley cath...and they end up on my badge

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Metal syringe pumps that you programmed using the "syringe factor"...no digital read out or even ml/hr dial. Mixing our own IV fluids in the NICU! It was night shift's job. We just laid a towel on the work counter by the sink and pulled out the "recipe" book. This included fluids with potassium in them....for preemies! :eek:

IV pumps were used only in Peds and ICU. Nurses had to calculate the drip rate using the second hand on their watch and a roller clamp to regulate the flow.
Just last week I had to count drips instead of using a pump. I work in the ED, and pumps are few and far between. They're only used for peds patients, geriatric patients and for medications that MUST be put on a pump, such as Heparin. This was the first time I did this.
Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.
Just last week I had to count drips instead of using a pump. I work in the ED and pumps are few and far between. They're only used for peds patients, geriatric patients and for medications that MUST be put on a pump, such as Heparin. This was the first time I did this.[/quote']

I'm glad you were capable of doing this. This is definitely a nursing skill that must taught.

We have gotten to the technological age where we tend to rely too heavily on machines to do our thinking. Then when we have a malfunction, we are not mentally capable of doing things manually.

Another example....... many nurses rely totally on blood pressure monitors and have not developed the ability to take a BP manually. Back in the day, all we had were manual BP cuffs.

I'm glad you were capable of doing this. This is definitely a nursing skill that must taught.

We have gotten to the technological age where we tend to rely too heavily on machines to do our thinking. Then when we have a malfunction, we are not mentally capable of doing things manually.

Another example....... many nurses rely totally on blood pressure monitors and have not developed the ability to take a BP manually. Back in the day, all we had were manual BP cuffs.

Two words: Hurricane Sandy. Ok, need to add a few more: NYU-Langone Hospital evacuation.

Those nurses had to care for then move >200 pts in the dark and without pumps and the other machinery/computers that have become part and parcel of modern nursing/hospital care.

Posted a link elsewhere to an interview ABC news did with the NICU nurses and the one question the woman had for the nurses was "how did you know what to do?" especially in relation to venting and otherwise keeping those very ill newborns alive not only on unit without power, every moment until the transfer was complete and they were at a new NYC hospital.

What did the nurses answer? To a one "you just know..."

To a lay person that may sound like an easy answer but to any seasoned nurse it comes down to knowing one's stuff and basically it all comes flooding back and one simply gets on.

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Most excellent point, DoGood!!!

Just think of all those nurses had to cope with. Most of all that modern technology does rely on electricity.

Nurses at all times need to rely on their brains and basic, but very important nursing skills. Skills that do not require electricity but are important for monitoring the lives of their patients. These are the same skills we learned and practiced "back in the day".