So what WAS nursing like in the "good old days"? - page 2
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)... Read More
Jan 25, '04canoehead: Yikes...I remember that argument about not using gloves to clean pts.
Back in the late 70's when I worked as an aide, the other aides used to take pts. dentures out barehanded...that always grossed me out. They used to make fun of me for gloving, but I didn't care.
Jan 26, '0430 year long timer here.
I remember about 5 years ago we had need of a metal bedpan for a morbidly obese lady. NO one had any idea where to get it. Finally one older doctor suggested the warehouse of a closed hospital. There they were along with the crank beds, chart carousels and dressing carts.
My med surg book was written in the early 60's. 10th graders probably know more anatomy than was included in that book. My pharmacology book was about an inch thick.
Mercury thermometers-yes...and if they broke you picked up the mercury and put it down the drain. Some played with it first. Who knew? My first hospital had an isolation ward. It had screen doors....I guess they kept some "bugs" out.....?? You disposed of trash like dressings, waste paper etc by opening a chute straight down to the incinerator....sometimes you saw the actual flames.
I remember people smiling at me when they learned I was an RN. I went home happy more times than not. I remember having to starch my cap and apron every day....Mama found one of my caps in her freezer some 20 years later......you starched, you dried then you sprinkled before ironing......sometimes you did several ahead of time and kept them in the fridge or freezer.
No MAR to document meds. First thing in your charting you made a little grid with the med, the time and as you gave them you crossed of that time. FIrst shift charted blue, 2nd red and 3rd green. No worries about not showing up on a photocopy.....no such thing. Narrative charting read like: 8am awake. No complaints ate well. 12noon resting comfortably. 245 pm has had a good day. Of course you charted on all the patients. You and the one other person--LPN or Aide were the staff on 2nd and 3rd. Secretary? You wish!
My first child was born in 68....her daddy didn't get to touch her for a week......that's how long I stayed....primarily because of the nupercaine spinal that took forever to wear off.
Second child 70 five days in the hospital. Daddy still couldn't touch him.
Those were the days my friends.
Jan 26, '04Canoehead, I can remember being chewed out by my instructor for wearing gloves while cleaning up green diarrhea. The next day the pt's stool report came back positive for shigella! That was in the late 1960's.
Even in the mid 80's our infection control nurse was telling us not to wear gloves when taking care of HIV pts. She said it was embarrasing to the pt and besides, the only way you could catch it was through homosexual sex. We were also told that we were obliged to give mouth to mouth to a HIV pt who coded if an ambu wasn't immediately available. No way we could catch it. HA!
Jan 26, '04[QUOTE]Originally posted by canoehead
[B]I can remember in nursing school getting a lecture about using gloves- if we wiped our own butts without gloves, why would we use them with our patients- just wash your hands! [QUOTE]
And we wouldn't want to offend the patient by wearing gloves! It would make them feel bad....
I remember mixing chemo drugs too without gloves...not good.
I remember my head nurse was really allowed to be an advocate for her staff and not an administrative pawn. Yes there were still jerky docs, but not as many it seemed...or maybe because we weren't as stressed it didn't bother us as much.
When census dropped, we all came to work...and deep cleaned the unit, made lists and inventories, chart packs, etc...nobody was canceled. TPTB actually gave us time and staff to DO those extras.
I kept busy as a medsurg teamleader back in the 70's, but it was not crazy 'putting out fires' busy.
People in general were less demanding... less Burger King mentality than today...that in itself made our jobs more pleasant.
Remember the moms admitted to the medsurg unit for 'a rest?'
(I coulda used one of those at several points too...:chuckle )Last edit by mattsmom81 on Jan 26, '04
Jan 26, '041980: LPN: worked under direct supervision of RN. Did po, IM, sub-q meds, monitored IV's, had pumps, did dressing changes, gave baths, C,T,DB was standard teaching for all patients, activity was ordered by DR and was strictly observed. I & O was always observed and charted. Had flow sheets, and did soap charting on essential changes, Rn would sign behind. CNA, LPN, and RN for 12 to 15 patients LOVED IT
1985: RN, moved up to all assessments of patients, IV sticks, hanging IV bags, IV meds, monitored labs, called DR for critical changes, instigated new orders, monitored wounds, usually helped with baths, assisted with feeding, walked patient after surgery first time, monitored LPN and CNA. Still had 12 to 15 patients, called team nursing and we did work as team. LPN and CNA knew their jobs, no fussing over who did what or would do what. If LPN did not know how to do something and CNA did, then CNA did it! Charted flow sheet, soap or narrative note for unusual not regular care. Still loved it!
2003: Computer charting, unit dose, universal precautions, still monitor labs and call Dr, still assess patients heart and lungs, still instigate new orders, less time for teaching, less time for giving personal care and talking with patient and family regarding home care. Case manager dumps her work load on primary RN, CNA and LPN do not know jobs, other RN's usually have under 5 years of experience so do not know how to insert and check NG tube, or chest tube, or suprapubic cath change, or stick difficult IV. Charge nurse in meetings several times a day. No help with patient going down tubes. lHN no longer advocate for staff and patients, patient is customer, thinks staff is at beck and call and does not follow Dr orders. SUE happy patients, unsupportative administrators, Dr wants to make money and DO NOT CALL AFTER 1100PM orders standard. Still love nursing, just trying to find a place where I can practice the "Art of Nursing". Patient ratio is 6 but ends up 8 or 10 because patients are sent home sicker, new admits, and helping other younger nurses.
Jan 26, '04It's not my story, I just graduated a few years ago. But my Grandmother who started nursing in 1932 has told me some doozies.
First she not only looked after her patients but also washed the windows and the floors. The operating room had a window that they kept open for the "nice breeze".
Also I have a couple of the text books and the nutrition section in one of them includes recipes. Because, of course, the nurses cooked the meals and did the dishes!!!!
Jan 26, '04Gradutated nursing school in 1984- I went to a vocational school while in high school and we were actually taught the curriculum for the AD RN program at the local community college, but being just out of high school the most we could test for was LPN. Our instructors taught us everything they knew and I am grateful. While working nights in a nursing home there was frequently no RN in house to do things an RN was 'supposed' to do, and then there were often times an RN in the house had no idea what to do.( not saying anything against RN's-- have worked with good and bad RN's, LPN's and CNA's over the past 20 years.)
Gloves were never available, we did baths, tube fdgs, iv's, wound care, laundry, snacks, took orders, checked orders, performed cpr and called 911, prepared the patient for transport and then walked them to the ambulance to make sure they got there ok...
we never had enough time, enough supplies, enough staff and always had too much to do, too many patients and too many complaints coming our way...
but we all survived and I can honestly say that some things have gotten better... but then some things have not. I now have all the gloves I could ever want, support staff available if I need them, computers to make my charting easier and a generation of MD's that are more receptive to the ideas and observations of nurses... I also now have too many things to do and not enough time to do them, computers to make life easier and charting more , 101 new generation drugs to have to learn everything about in case a patient has a reaction to one... and a computer that is supposed to make my life easier...
I am a home care nurse and the best thing that I still have that I had in any job back in the 80's is time to spend with my patients so that I can build a rapport and really get to know them as people and not just as illnesses.
Jan 26, '04[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.
Jan 26, '04I 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?
Feb 1, '04Boy, 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.
Feb 1, '04Originally 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?
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.
Feb 1, '04Graduate 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.
Feb 1, '04RNPATL:
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!!