Change, change, change

reposted from another board...even if you're new to nursing, i would love to get your feedback on this issue! thank you so much for your time!

can you please answer the following questions for a nursing school assignment i'm working on? thank you in advance for your time!

what changes have you seen in nursing practice since you began your career? what trends have come, gone, and stuck around since you began your career?

thankfully scrubs have come and stayed. when i started one hospital told me "we allow our nurses to wear pantsuits". of course they were white. we were just beginning to use automatic b/p cuffs, not sure that is a good thing. too much dependence on the machine to be accurate. so much has improved, diabetic education and treatment, cardiac treatments. swan ganz caths for anyone in the icu, some thought if you weren't sick enough for a swan then you didn't need to be in icu. boy were they wrong! automatic rotating cuffs, they worked for chf back then but now we have better drugs. the cycler, a horrible device for peritoneal dialysis. took up half the room and too much of the nurses time to set up. it came and went. thank god for increased iv use, more iv pain meds, antibiotics. no more demerol and phenergan im injections, fewer penicillin double whammie shots, 2.4 mil units in each butt cheek-yeowww! don't forget computers and allnurses.com!

Kat, you are a lifesaver! Thank you so much for your response! :yelclap:

Kat, you are a lifesaver! Thank you so much for your response! :yelclap:

You are welcome. By the way I graduated in 1978.

When i started nursing, patients were admitted to the hospital the night before their elective surgery for "pre-op work up". They stayed in the hospital for a good 2 weeks s/p non complicated chole. We did have pleurovacs, but some surgeons still used the bottles taped to the floor for chest tubes. We used old fashioned monometers to calculate CVP readings. Patients stayed in the hospital much longer before DRG's, hence ECF and rehab transfers were much less. HIV was just becoming known in the US, and the medical field as well as the public, was freaked out about it. Here's a BIG difference (& i'm showing my age):We used to SMOKE during report and all through are shift when we had a moment for a toke in the break room. The first hospital I worked in actually had a cigarette machine in the lobby. Charting was ALL NARRATIVE. no check lists etc. orders were sent to the various depts (lab, radiology, etc) via paper requisition. We had a rolodex with physician's HOME phone numbers (no answering services) You better hope you got it right who was on call that night.

Now technology is better, but the patients are sicker. Acuities are higher. All the patients in the hospital really need to be there, but the ratios are the same as before when half your patients didn't really need you. Nurses do more ancillary jobs (phlebo, resp RX, houskeeping).

The one thing that HASN'T changed is that nurses are still the ones held accountable for EVERYONE's screw ups (physicians, lab, RT, dietary etc). We will always be the doormat on the patients way through customer service.

I'm sure there are more examples, but i have to go to work. thanks for the post. It was a fun one.

I remember the first VRE patient, you would have thought we were going into a toxic waste zone with all the gear we used to get near that poor patient. Swan Ganz catheters are now just for a short time for Open heart patients and ICU patients now are using a CO monitor that is attached to a CVP line. Open heart patients now arrive straight from the OR, extubated. We used to keep em snowed for 24 hours then OOB on 3rd day post op after removing the chest tubes. Lots of slapping sounds from the Q2 chest PT.

Stroke patients now live and many lead a productive life, not so 15 years ago. That was a death sentence to many, no intubation until they aspirated and at that point they didn't do well due to pneumonia.

We've gotten away from long narrative notes to computer charting "by exception", meaning if it's normal you don't chart it.

Infection control has made some jumps. We now isolate nursing home patients and do a rapid MRSA screen on their nares (deep into the nares).

We tried "team nursing" but that came and went in favor of primary nursing.

In Florida we have now have mandatory continuing ed in Domestic Violence and Medication Errors.

Aaahh Yes!! Remember gowning up from head to toe in isolation for MRSA!!

And all the disposable dinnerware etc!! Or how about feeding geriatric residents PO with a 60 cc syringe!! Holy cow if I had known then (late 80's early 90's) what I know now, think of all the aspiration pneumonia deaths we could have prevented!!

po Methergine q 4 hrs. for all postpartum patients. Clinitest and acetest for checking diabetic urines. Ritodrine for preterm labour. I had to wear that dorky cap when I first graduated. SOAP notes. Primary nursing and all 12 hour shifts then, now we hire people for what they can work and are a little more flexible. Moving from the labour room to delivery room when ready to push (a great feat for a multip) then to recovery and finally to postpartum. Now we have single room care and places that don't at least have LDR. Oh and thank God, all private rooms. C.sectoins stayed for five days and they didn't eat for the first two. I hear from my friends on Peds, that croup tents are out of vogue too. Remember those clinic shoes! Now I wear plastic purple clogs. Oh, I almost forgot that we once had a dress code for visitors... No tank or tube tops, sundresses, or shorts. (I worked in a Catholic hospital in Baltimore). Our maternity unit was not locked and when we asked visitors to leave they actually did it w/o a big hassle, in most cases. I graduated in 1987.

The biggest change (ok I am only 9 years into it)---but, increased computerization of all documentation of care. Also I see doctors leaving my specialty due to increased concerns over high malpractice insurance rates-----this is relatively new to my eyes as many have done this over 30 years-----

this scares me!

I am also noticing worse and worse behavior and lack of basic manners out there, not only in patients, but family members and sadly, among professionals in the hospital. It's disheartening.

There are so many things we used to do that we don't now:

• MI patients being in hospital for weeks on bed rest
  
• Using egg white and oxygen on pressure sores
  
• Rubbing pressure areas to improve circulation
  
• Using EUSOL to pack wounds (Edinburgh University Solution Of Lime) - this was proven to be absorbed and caused some liver problems
  
• Women being admitted and staying in hospital for 7-10 days following a normal lady partsl delivery

The only constant thing in health care now is change - and that has to be a good thing for patients...

Excellent responses, everyone! I'm really looking forward to sharing these with my class tomorrow afternoon. One of my favorites is smoking during report...that's wild! It's amazing how things change...I remember when I was a kid smoking was still allowed in banks and fast food restaurants. BLECH! :)