So what WAS nursing like in the "good old days"?
0Jan 25, '04 by findingmywayRNEver 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 more back then during their shift than she did (coffee pouring/making/drinking/, chatting with passers by, nurses in all areas with a 1:1 nurse to patinet ratio, etc.).
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? Or, have things always been pretty much as they are now? As a new nurse to the area it makes me sad to hear that nurses leave because how much has it changed. I'm very interested to hear any stories of the old days of nursing.
0Jan 25, '04 by nursemaaI'm only relating my experiences here, others may differ. When I was a new grad in 1980, here was my typical shift:
I would be the team leader for a 15 patient team. I would take 2 or 3 patients to give complete care to (bath, bed change, dressings, feeding, turning, etc), and I would divide up the remaining patients between the LPN and nursing assistant according to the skill level required for the patients' needs. The LPN charted on her patients, plus 1/2 of the NA's patients, I would chart on the rest. I would pass meds on the entire team, and be responsible for IV maintenence/restart, signing off and implementing or delegating tasks, calling physicians for orders or to report lab results/test results, updating the Kardex, etc. LPN's would do limited assessments on their patients, I would do assessments of lungs, heart, etc on the more complex patients. It seems the nursing staff worked more like a team then: we often made rounds together and turned, cleaned, changed beds, did dressing changes, etc.
We didn't have flowsheets or computers for charting so everything was written in narrative form. No IV pumps, so you had to stand there and count drops per minute every hour to ensure flow rate was correct. No electronic thermometers or vital sign monitors either- I remember going down the line, putting glass thermometers in the patients' mouths, then going back around and taking them out and reading them. Some patients were admitted for "tests" and were pretty easy to care for, others were much sicker. Paperwork was the RN's responsibility, and since there were no computers there was alot of it. No PCA pumps, had to give alot of IM/IV narcs as I worked an ortho floor. No computers for order entry, the clerical tech made out paper reqs, then put them in the chart for the nurse to double-check and sign off on. When I worked 11-7, it was our job to re-copy the MAR's by hand (no computer generated ones).
I don't think in our hospital the physician/nurse relationship was much different then- they still acted pompous and irritating! I remember some docs throwing things at nurses, yelling at them, threatening to report them to administration....sound familiar? We just blew them off and made fun of them when they left.
So I don't know that it was so much better then, just different.
3Jan 25, '04 by lindaleeNursing was so different you would not recognize it. I graduated with a diploma of nursing in 1964. I have worked my entire life in hospitals. My first job was at a county hospital. I was the only RN on two nursing wards. I went between them, being responsible for maintaining the IV's, calling the intern if the IV was infiltrated--indeed we did not start them. We did however do hypodermaclysis where fluids were allowed to infuse into the SQ tissue. A Y type tubing was used, wydase was given into the area to help with absorption and a liter of fluid was given SQ. Sort of similar to what vets do for animals these days. (By the way, it saved many a life) An LVN headed my staff on each unit, she gave all the po meds, and I had to give the IM or SQ meds. We did not give IV meds. The units were staffed with two orderlies on the male floor, and two aides on the female floor. If I remember correctly, each unit had thirty patients. The aides and LVN did all basic care. I assisted when required. Meds were given on time. Patients were not as ill as they are today--The patients on the floors today would not have survived in this environment.
My first critical care job would have been in 1965. We had one monitor that was taken from patient to patient. Nurses did not read rhythms. We did quickly learn to recognize NSR and PVC's but we had to call the intern when we thought there was a problem.
Renal failure---well it was pretty much a death sentence. Dialysis was in its infancy. You had to be approved by a committee to be allowed to have dialysis--and forget it if you were over 45. You simply died. Renal frost was not at all an uncommon thing to see in those days. We did not ventilate patients--if I remember the first ventilator I used was an old bird machine and maybe in 1966. Most patients did not receive ventilator support even for a brief time.
If you had a hernia repair or an appy, you were in the hospital for four or five days. Our MI's were kept on bedrest for 14 days and frequently died on bedpans. No one had multi-organ system failure--if one system failed, you died. I could go on for hours, but believe me, nursing has changed. The legal issues were not even thought of back then. People seemed to be grateful for the care they received and no one though we could keep people alive forever. I have been an RN in hospital nursing for nearly forty years now. Certainly the responsibilities of nursing have changed and increased. The technology has gone so far forward in forty years that nurses working in the 60's would be totally lost trying to work now. I still very much like nursing but miss the ability to know my patients and their families. There was a time when you could educate your patients and really talk to them. These days everyone runs so fast that I feel this is not done. That is a great loss as we have much to teach. I think the little things that we were once able to do (hair wash, take a patient outside in a wheel chair, that type of thing) are gone forever. Somehow those little things I remember making such a difference to patients. We have moved very far forward with our responsibility and technology but the things that made us caring nurses seem to have been lost. Does this make sense? Our patient survive these days where they did not forty years ago, but the personal touch is gone and has been for a long time now. So much has changed and so quickly. Remember that once there was no AIDS, no universal precautions, no critical care areas in most hospitals. There was no air critical care transport, no fetal monitoring, and no computers. Nurses did not always do physical assessments. Our ability to do invasive procedures was very limited. Although our responsibilities and accountability have greatly increased, our respect has not. This is sad because the public still sees nurses as physician handmaidens and that is far from the truth. It has been an amazing field. I am sorry this is so long.
0Jan 25, '04 by zambeziIt is interesting to read these posts in addition to all of that in books etc. Being a new generation nurse, I look at these descriptions and *think* that I would prefer todays nursing (of course, I don't really have much to compare it too). I love the technology that I have to work with, being able to combine that technology with assessment and patient presentation...writing long narratives for charting--no thanks. Counting my drips--i prefer pumps (and yes, I have counted my drips). That whole physicians handmaiden thing--not for me. The public perception may be that are still that way but in my unit and with the docs that I work with I don't get that feeling at all. Working in critical care is different from the floor, so I usually do have time to do one on one care, baths, etc as we don't have aides on nights. I can still do teaching and interact with the family (if I were on the floor more I would want more time/less patients so I could do these things too so certainly these concerns would be priority). But I do enjoy hearing how things used to be...since I don't know any better and I grew up with all of the technology and learned nursing technlolgy etc it is what I am comfortable with--the old way, well seems old! I should probalby print this out and read it in forty years....
1Jan 25, '04 by Sis123I was in school in the 70s and I remember:
Surgical patients were admitted the night before the day of their surgery, and were given a pre-op before the gurney came for them in the morning.
Stays were generally much lengthier. New moms stayed in 4 days or so, babies went to the nursery so that the moms could sleep when they wanted to.
The only thing that was really locked up were narcotics.
If a nurse was assigned a particular patient, that nurse would usually remain that patient's nurse on that shift till the patient was discharged. This helped both to get to know each other and feel more comfortable with each other.
We used to actually give backrubs to people to help them feel better.
1Jan 25, '04 by AudreyfayI graduated in 1976. My first job was working with a modified primary or primary care system. In primary care, the RN had a maximum of 5 patients, and sometimes had to cover IV medications for 1 LPN. The patient and nurse formed a good relationship by the time the patient went home. A cholecystectomy was in bed for 24 hours before getting up.
A new mom usually stayed in the hospital for 3 days with a vaginal delivery, 5-7 days for a c-section. The nursery kept the baby, except for feedings. If mothers wanted to keep their baby in their room, they had to sign a release form, so the mom was responsible for the baby while in the room. If the mom fell asleep, the baby was brought back to the nursery.
While the nurse was always careful with supplies, there was no need to worry about a hospital bill not being paid by the insurance company. Hospital bills were always paid. There were no prospective payment systems. Patient were not sent home until they were well. No foleys, IVs, or drains EVER went home. The sutures were usually taken out in the hospital. No staples. They hadn't been invented yet. (Actually, I circulated on the first intestinal surgery using staples in an large Operating Room, in 1978.)
The most technological equipment the nurse had was an IV pump. Even chest tubes were just water-sealed drainage systems, taped to the floor. If a patient needed anything more than O2, an IV, and a foley, they were sent to ICU.
Out of 5 patients, three of them were self-care, "walkers and talkers." Mercury thermometers were used. Automatic b/p cuffs had not yet been developed.
No such thing as disposable. Basins were silver, and re-sterilized between patient use. Medications were passed out on a tray, using little med cards and a souffle' cup for each patient's medications.
1Jan 25, '04 by santhony44Interesting!
I started nursing in the early 80's. People did come in the hospital less sick, including coming in for testing, and stayed longer. No one went home with tubes. Everyone having surgery, and most tests, came in the night before and stayed afterward- outpatient surgery really had not caught on. I also remember open cholecystectomies- turn, cough, deep breathe, NG tubes! I was deeply thankful a few years ago to have a lap chole. I remember when those were still "experimental." I remember testing trauma patients' NG drainage for pH and giving Maalox/Mylanta, and then having Tagamet come on the scene. I've seen CVP's done with a water manometer. OB's coming in for delivery got the shave, the enema, etc. And, I remember seeing "twilight sleep" still used when I was a student (barbaric!). I also remember (pre-AIDS and pre-universal precautions) being taught not to wear gloves unless you were cleaning up BM.
Wash basins, emesis basins, and bedpans were all disposable, though. I've talked with many nurses and aides who recall sterilizing and reusing them. Also with nurses who remember sharpening and sterilizing needles and cooking morphine tablets in a spoon over a burner to make injectable morphine!
I will soon have been a nurse for 21 years. At least, I'm not alone in being "old;" my dh is one of the few folks who can still use a slide rule!