In the hospital where I worked, in Cincinnati, Ohio, and the last time there was about 1998, we had pyxis medstations. Basically, you accessed the machine by placing your index finger on an oval screen - you were identified by your fingerprint. You also had to use a code to log in and choose the patient you wanted a drug for. The system was programmed so you could only give the patient narcotics that were on his drug screen. The machine tracked whatever was taken out, so no need for another nurse to co-sign. The machine did it all. We also got stock meds that way, and everything was in unit dose - 30 ml of Mylanta or 2 Tylenol tabs packaged together. It saved a lot of money by being able to track what we used. Our machines were in an area not accressible by patients or visitors but were not locked as the medications in the machines were quite secure. I imagine bar coding is used now for some of the steps.
Medications for the patients came up in the middle of the night. We had med carts that had two cassettes with 8 drawers in each cassette. Pharmacy techs changed the cassettes every 24 hours. All medications were unit dose - in other words, if a pt was to get Digoxin .125 once a day, you got one dose of Digoxin .125 in the drawer. If they could have up to 6 doses of Tylenol per day, you got 6 little packages of two tabs each in the drawer. Anything that didn't come in unit dose, was labeled in a little ziplock plastic bag with the pts information and the drug. We didn't have boxes and bottles of medications in a room. The medication cart went to the patient room and the nurse took the drugs from the drawer with the patient's name directly to the patient. Since the carts were meant to be mobile, and they were lockable so once locked (and if left unattended, they locked automatically) no one could get to the medications without knowing the code to the lock. (No keys - touch pads) The pharmacy was in charge of reloading the medications carts every night. The whole system was one - Orders were sent to the pharmacy and entered there and meds sent up or set up in the drawers and all that information was compiled so that MARs (Medication Administration Records) were printed by each unit at night and placed on the charts. A new med record - updated - every day. If I remember correctly, there was also a medication history that could be printed. I'm sure things have changed since I last worked there.
We also used our badges to "log in" when we arrived at work, by swiping a magnetic stripe through a reader, and when we left. So, if you worked overtime, you didn't have to write it down - it was logged for you to the minute, and payroll had all that information. (And, if you showed up chronically late, that was also noted in the system.) You also had to log in at your designated unit. So, you could not log in on one unit, then catch the elevator to where ever you worked. You had to get to the proper place to log in. Most areas had key pad locks and if you needed to be in one of those areas, you needed to have the proper code to get in. We had magnetic key cards for the garage where we parked. Again, I bet things have changed since I worked there years ago.
And, I was in Cincinnati - the place where, Mark Twain once said, he wanted to be when the end of the world happened, "because everything happens 10 years later in Cincinnati."
I worked on a Cardiothoracic Stepdown unit and it was just routine to listen to every patient's lungs every shift and do a quick head to toe assessment. We even got pretty good at listening to heart sounds and picking up rubs. Every floor had a negative pressure room. There was air conditioning and heat and we had vents under the windows we could open - which were screened, too. Each patient bed had a television and a telephone. Nurses carried cell phones. The patient could press their call light and it lit up on a screen where the unit manager sat. She would answer via the bedside call system and see what the pt required. Then she would pick up the phone and call the nurse caring for that patient and tell her what they wanted, or if the nurse had a call from the lab, it could be transferred to her so she didn't have to constantly be running back to the nurses' station for every little thing. There were charting alcoves at every other room. Our patient rooms had a sink inside the door (for the nurses and doctors) as well as one in the bathroom. Rooms had no more than 2 patients and about half the rooms were private and each room had a full bath - toilet, sink, shower. I was in one of the hospitals in our system once, and in addition to my bed, I had a table and two chairs, a small couch that could be made into a bed, a TV in an armoire, and a small refrigerator below that. It was more like a very nice hotel room. I don't think I ever came across a manually operated hospital bed until I came to New Zealand. I just found it incredible that a major hospital - let alone an orthopedics ward - would have manually operated beds, but I found that to be true here.
Of course there are hospitals in the US that are way beyond - some have electronic charting so don't worry if you left your pen at home, you don't need it.