So what WAS nursing like in the "good old days"? - page 3

by findingmywayRN

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Ever since I was in nursing school a few years ago all I heard was how much nusing has changed since the 60's/70's/80's. My only frame of refrence for this time period is Dixie from EMERGENCY! (LOL) I know that nurses did a lot... Read More


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    [QUOTE]Originally posted by findingmywayRN
    [B]It is amazing to read all of your experiences! Thanks for sharing them. I can't believe how different things were - COUNTING the drips on all the IV's??? NO GLOVES???? I can't imagine life before universal precautions. Were they still strict with handwashing proceedures? I can't believe doctors got away with throwing things at the nurses. And mercury thermometers? OMG!
    To think that anyone with more than basic trappings (IV, Foley, etc.) would require intensive care is hard to imagine. And to think multisystem organ failure is a new phenomenon....Nowadays the basic medsurg floor is like an ICU.



    I worked in Boston in 1978. I had fifteen patients in a ward and one other person to help me. If I was lucky and it was day shift, that other person was an LPN rather than an aide, and if I was even luckier, that person had worked in the hospital at least one other shift. Don't laugh -- many of them were agency and hadn't. Many nights the NA spent the night sleeping in the break room, and if you woke them up and asked them to do something, they complained that you were harassing them.

    Since I worked on a heme onc floor, each patient had Ticarcillin, Tobramycin, Amphotercin, and transfusions. Because we did bone marrow transplants, some of the transfusions were for WBCs or incompatible blood. (That one was always fun -- standing in the patient's room taking VS every five minutes while the rest of your patients were on auto pilot.) We had to wash our hands for one full minute for each transplant patient, and your hands were raw and bleeding!

    We had mercury spygmos and mercury thermometers, and yes, I did play with the mercury when they broke. I remember giving paraldehyde to the ETOHers -- you had to get them to drink it fast before it disintigrated the cup it was in! Since patients really didn't want to take that stuff, you often had to chase them down and beg them to take it. In my hospital, nurses didn't write nursing notes because (and I'm quoting my manager here) "nurses don't have anything to say anyway." (Yes, I soap noted on every one of those 15 patients every shift -- and did not get paid OT to do it!)

    Doctors screamed, cursed, called you names, threw things and attempted to get you fired if they didn't like something you said or did. (I once told a surgeon I went to school in Oshkosh. That was a huge mistake because in Boston, they had this saying that "I had to go all the way to east Oshkosh to find a bedpan," or whatever. The surgeon thought I was being a smartass and tried to have me fired.) Once a neuro-surgeon chased my preceptor down the hall with a (full) bedpan, attempting to throw it at her. Another time, an OB decked a nurse and when her manager stood up for her, they were both fired. When a doctor entered the unit, you were supposed to stand up and offer him your chair, and make sure he had a clean ashtray for his cigarette.

    I remember it was a point of pride NOT to use exam gloves for anything except giving a suppository. Nursing before AIDS. (I remember sex before AIDS, too!) All in all, I'd rather work now.
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    I can remember utilizing shaving creme as an antiseptic on new incisions........and mixing betadine and sugar to cram in decub's ...I can remember when a nurse was respected and ....boy.....that was a long time ago wasn't it?
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    Boy, does that bring back memories! I graduated from a diploma program in the early 70's.
    Right before everything became disposable. We had to do a sint in central supply and learned how to wrap and sterlize all the equipment. Everything was "recycled." We had to work in all the different depts (kitchen, lab, xray, pharm etc.) in the hospital. My senior year a severe snow storm kept the reg staff from coming in. So the senior class basically staffed the hosp. We lived on the hosp grounds. A real learning experience! We were unpaid labor. If you worked the night shift you were still expected to be in class that morning! Being woke up in the middle of the night when you were on OB rotation and were on call for deliveries.
    Things have changed so much.
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    Originally posted by findingmywayRN
    But seriously, what has made nursing so different today? How sick were the patinets, what was the nurse to patinet ratios? How was documentation? Did you really have time to relate/get to know to your patients? How did nurses and doctors relate to each other?
    What a great question to ask. I graduated from nursing school in 1984 and there has been many changes within the profession of nursing and health care in general. First, and probably the most important change from my perspective has to be the changes in reminbursement for the hospital. When DRG's (Diagnostic Related Groups) came into the picture, the hospitals began to realize that the only way they were going to make any money was to discharge the patient as fast as they could.

    As patients began to discharge sooner and the advent of managed care, the hosptial became the place where really only the sickest of the sick went or patients who needed surgical intervention. This translated to big changes on the unit. I remember when patients would come to the hospital for cataract surgery and as nurses, we would care for them for 3 days before they would discharge. That is unheard of today. A gallbladder .... they were in for a week or longer.

    During this time, nurses had the opportunity to develop relationships with the patient and most times, with the family. There was not the "in" and "out" on the units that we see today. Yes, we received admissions, but most of the time, it was an organized transition. Today, it is full of chaos and dis-organization .... patients moving all around the hospital like a bunch of crazy people.

    Positive things have also happened over the years, advancing technologies have made diagnostics really impressive. Advances with cardiac and heart disease (i.e. stents, drug eluding stents, etc.). Another thing that has changed, from my view, is everything today is disposable. When I was a new nurse, we actually autoclaved many of the trays and supplies we used daily. I remember using mercury thermometers. Geeze, am I dating myself (I am really only 39, but graduated from nursing school when I was 20).

    Anyway, there have been many changes, but most have been for the positive. Physician relationships have really changed. I remember the charge nurse giving up her seat when the attending came to the floor, even though there were several chairs available. That would not happen today. Nurses have gained some ground with physicians .... I think the new docs are getting the message. The older docs still have many of the same attitiudes that I have dealth with over my 20 years in nursing.

    Anyway, sorry for the long response, but it brings back memories to think about all the changes that have taken place since I have been a nurse. I am sure older nurses could tell more tales.
    DeLanaHarvickWannabe likes this.
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    Graduate 1975 here. Let's see...mercury BP's and thermometers. Played with the mercury if either broke. Counted drops for IV's. Started a new IV site each day with a butterfly needle every morning, discontinued after 8 hours. On evening shift were expected to take the BP of every visitor in the room. Cholecystectomies, hysterectomies and the rare C-section stayed 10 days. Only exam gloves were in the treatment rooms for the docs to use. Patient's families brought us LOTS of food. First T'giving I worked, brought me full plate of turkey and dressing and all the fixin's. Fresh tomatoes out of the garden...we always asked for a loaf of bread from the kitchen each night knowing what our supper would be (can you tell I am from the south?) "Good evening" was adequate charting. Had a med tray filled from multi-dose vials...I could tell you the name of every med on the tray. Staffing...one charge nurse with no patient assignment, one LPN to do treatments, another RN to pass meds, an orderly to take care of the male patients. Charge nurse did the charting. Really sick patients died. Occasional admit to the ICU meant probable death...a floor nurse was pulled to staff it until they died or got better. Very little was disposable. Bed pans, emesis basins were sterilized and returned for further use. You could admit grandmother because you were her primary caregiver and needed a vacation. Medicare approved a specific number of days they would pay then you called and begged for more days...and they would grant it and you would get paid. You could call the pharmacist in town and he would open the store to fill a prescription. And I could go on forever...not today's world.
    DeLanaHarvickWannabe likes this.
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    RNPATL:
    Thank you for such a detailed and thoughtful reply! It seems there's no going back to the days when patients stayed long enough in hospitals to get to know them. Today's health care system and technology have probably created sicker patients - not healing properly/thoroughly before discharge, prolonging the inevitable, teaching families to provide patient care at home that should be still done by nurses, etc. But, there are obviously many lifesaving benefits to modern medical technology. Plus, I couldn't imagine counting IV drip rates or sterilizing bedbans!!
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    Originally posted by ernurse2244
    On evening shift were expected to take the BP of every visitor in the room....

    "Good evening" was adequate charting. .
    Really interesting stuff here!! But why did you have to take the BP of every visitor in the room???
    DeLanaHarvickWannabe likes this.
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    Just 'cause they asked me to...and I had the time.
    jrwest likes this.
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    I graduated in 1987. AIDS had just come to the forefront. I worked in an intensive care unit, it was supposed to be cardiac but we took regular icu overflow too. we would look like we were going to outerspace just to walk in the room for our aids patients. We had gloves, but it was very common to not use them except when you knew the patient had HIV. one of my patients was the first patient to get TPA at our hospital in 1988 or so. I went to the ER in 1990. The single biggest difference in there is the sheer volume of patients that we see. i worked 11-7. we had 8 beds. me and an lpn, unit clerk and one doc. my big job was making sure the place was restocked. we saw 2-3 patients per night. we had one hellacious night we saw 16 patients, 3 were MI's, 2 went to surgery, 2 were transferred to other hospitals. the next day the doc that was on that night quit. today, that would have been a less than average night. today, at the same hospital there are no lpns, there are 4 rn's at night, 2 docs, a er tech and a unit secretary, the 8 beds are now 14 with 6 holding beds for folks waiting to be admitted. we didnt do conscious sedation back then. if you needed that much sedation you went to the or. luckily for er nurses, most er docs are also a breed apart, i personally have never been treated like crap by an er doc. the private docs are another matter, lol.
    DeLanaHarvickWannabe likes this.
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    Originally posted by findingmywayRN
    Today's health care system and technology have probably created sicker patients - not healing properly/thoroughly before discharge, prolonging the inevitable, teaching families to provide patient care at home that should be still done by nurses, etc. But, there are obviously many lifesaving benefits to modern medical technology.
    Early discharge, back in the days when it was new, attibuted, in my opinion, to many deaths, especially for the elderly patients. However, early discharges also created a whole new speciality in that nursing homes developed and opened sub-acute care units. These units would care for the patients after they discharged from the hospital and were to sick to go home. This also changed the complexion of the nursing homes, as patients were moving in and out of the nursing home about as fast as they were moving in and out of the hospital. As a result of the increased acuity in the nursing homes, assisted living facilities became the big rave .... people who use to go to nursing homes, were now not considered "sick enough" to be there.

    I also recall my nursing instructor telling me that I only needed to wear gloves when I was doing a sterile procedure. I remember cleaning an elderly homeless man and I asked my instructor for a pair of gloves, she frowned at me and said ... "be a man!' ... can you believe that? Of course, today that would be unheard of!


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