Differences: Nursing then and now...

neonatal3 · Jul 21, 2008

Hello all,

I graduated nursing school in 1970. One difference back then was about writing doctor's orders. When I made rounds with a surgeon I was expected to listen to him and quickly write most of the new,long post-op orders for each patient--and doctors considered nurses less competent if they asked the doctor to repeat or clarify these verbal orders.

Another difference back then was fewer guidelines to do some medical procedures. One registered nurse on my floor was placed on probation for about two weeks from work because the doctor was running late and she removed a few sutures from a patient's incision so that he could be discharged home. At that time, the hospital guidelines included that only doctors were allowed to remove sutures.

One other example of differences back then was less availabiltiy of patient monitoring equipment. For example, there were no electric IV pumps on some of my first jobs. We were required to make IV rounds each hour to check the site, count the drip rate to make sure it matched the order, and mark how much IV fluid was remaining in the IV bag(and notice if difference in volume in bag from previous hour was consistent with rate ordered by doctor). The risks for IV problems were higher because the only "sensor" you had between IV rounds was the patient who might have been too sick to notice any change. Yes! Many things in nursing were very different "back then" !

softstorms · Jul 22, 2008

I have found that most nurses now days have no clue about making rounds with the Dr. Most think that their day to day job is to pass meds and take off orders. Most have no clue about making rounds. The interaction between nurse and Dr. has changed. Nurses think it is a interuption in thier job, but it is not. We are the link between pts. and the Dr. We depend on our CNA's to give us information about our pts. and our Drs. depend on us for the same.

Mara123RN · Jul 22, 2008

I remember when I first became a nurse.

We smoked in the nurse's station.

We had to wear caps, which were a pain because they would fall off at times.

Gloves were insulting to the patient.

You stood up and offered the doctor your seat and you brought them coffee.

We did not have IV pumps. You calculated your drips and used a roller to regulate them.

ICU patients were in ICU, not on the floor. The floor was for walkie talkies.

You never heard that's "not my patient". All patients were everyones responsibilty. It was "our" hospital and we were proud of it and the care we provided.

Doctor's writting was never legible.

We had standing orders for pain meds, sleeping pills. meds for nausea etc.

Tylenol was given as a nursing order until recent years.To name a few things

Some things are much worse than they were years ago and some things are much better. Mainly I think nurse's attitudes have gotten much worse. Alot of nurses come to the profession for the money. To me this is not a profession you do for the money, although I think we deserve the money and even more money than we make. But then who will that attract to our profession?

**canoehead, BSN, RN** · Jul 22, 2008

I remember the bedpan sterilizer that spewed out steam and hot water all over the dirty utility when it broke (often).

Central lines and IV pumps were only in ICU (late 80's)

Gloves were not available, just the sterile kind for MD's doing procedures, and using them to clean a patient would be detrimental to the patient's body image. (Not using gloves was care planned for fresh colostomies for this reason (bleah).

Women were labored in labor rooms (semi private) and moved at 10 cm to a transport stretcher, down the hall in front of God and everyone to the delivery room, which doubled as a Csection if needed. It was the scariest looking room in the hospital, with the narrowest OR table for a stretcher . During my student rotation women would need a few minutes to acclimatize to the new room before they really got going again.

No one ever did IV antibiotics as outpatients. The idea of doing preop testing as an outpatient came along after I graduated, and everyone congratulated themselves on what a great money saver that idea was.

My great aunt Berna tells about how they would go around and clean the lamps and stoke the fire in the 30's, and they had to add firewood to make the porridge in the morning. They had to be unmarried in those days, and live in residence.

There's another thread around here somewhere...

https://allnurses.com/forums/f8/let-s-play-i-remember-when-903.html

https://allnurses.com/forums/f8/does-anybody-remember-when-603.html

neonatal3 · Jul 22, 2008

Hi again all,

Enjoying all your comments about differences in nursing "back then" ! Canoehead, especially appreciated your comments about the big difference of rare use of gloves in care back then--so agree with your comment that back then the school of thought was "using gloves to clean a patient would be detrimental to the patient's body image"!--when read your accurate comment of back then " not using gloves was care planned for fresh colostomies...bleah",got memories of such messy colostomy care experiences(which always made me seriously nauseated) and got a big laugh at your "bleah"--yep!!

Best wishes to all.

softstorms · Jul 24, 2008

O.K. Way back. when I was an aide...not certified,or registered.Just a plain old off the street person who learned from the other care givers LOL.

We would have B.M. nights. Every thrid night, anyone who had not had a B.M. got a supp. Given by the aides. We had the old type of gloves ( issued just for that) All other clean-up was done with wash rags. I think that at that time we had no clue about HIV or MRSA. C-Diff was not routine to us then. I think maybe we have built up a tolerance to these germs, or we just work harder to keep from catching them?

jandkmom · Jul 28, 2008

I graduated from nursing school in 1994, and my class was the first one that didn't have to wear caps. :)

softstorms · Jul 30, 2008

The real difference between nursing now and then is pt. care.....or is that resident care.....or is it client care? That is the change. Please forgive me as I rant for a minute or two! One day we were nurses, now we are "jack-of-all-trades" We do PR, we are "maids" we have a "concerge service". Welcome to Rehab/Acute care. Nope, we can't brew coffee at 10 p.m. and yep. that was the nurse who ans. your call, the pt. was asleep. We do not keep paper plates and forks at the nurses station for your comfort. And Yes..when I am on the phone to a DR.....you are not my major concern.....Mom's constipation takes a back door to a pt crashing!!!. One last complaint ...Do you really think when you walked into a facility with over 120 pts. That we knew who you were when you said.......I want to talk to "my mom's" nurse.

paddlelady, BSN, RN · Aug 25, 2008

I trained in the late 60's. We passed food trays to the patients. We kept cataract patients a full 10 dys on bedrest and had to set up their trays with the food at clock position. We instructed a patient to where their juice was on the tray. We also collected the trays. WE did our own physical therapy. Took all the vital signs, even emptied the trash if we had too. We gave the good old hospital massage and patients love the touch.

Blood came in bottles scarey esp if you dropped one. Meds had to be calculated most of the time no unidoses.

I worked trauma for awhile and we had to do kidney dialysis using a portable bath tub this was at a county hospital. But things were fun the interns, residents and nurses did work as a team at the country but the private hospitals the nurse doctor relationship was strained and sometimes condescending. The equippment was arcaic and even the chest tubes drained into bottles. We sometimes worked all 3 shifts in one week and only had one weekend off per month and only made 3.05 an hour. Benefits were terrible. Not even sure why I went into nursing. Todays salaries are amazing in comparsion to the late 60 to even the 80's. I could go on and on about the differences. But one thing that remains the same is the quest to do the best patient care with :nurse:excellent outcomes no matter what the salary.

**canoehead, BSN, RN** · Aug 25, 2008

In the 80's we were trained in physical and respiratory therapy treatments and expected to provide both. The physical therapist saw people as outpatients, and the nurses did the treatments in hospital. We were just starting to hear about respiratory therapy, and they were confined to the ICU vents. Central lines were brand new, and also only in the ICU setting. We actually had a few pumps outside of ICU- maybe five for a 150 bed hospital, and they were used almost exclusively for chemo or children. Funny, now that I think about it I don't remember any child sick enough for continuous IVF during the month I spent in pediatrics. These days if they don't need an IV they don't need a hospital bed. We had lots of kids with vomiting and diarrhea on clears, and several boarding kids that would be in a nursing home or foster care now. Preop, and postop, I remember only IM meds and an IV until they woke enough to drink. Hmmmmmm. After I graduated I worked in an exclusively pediatric hospital, so we had lots of IV's and pumps there, but only one central line for the first year- and it clotted off on my first day of orientation. I had sooo much to learn, I was with an LPN for the first few days, and thought I'd never catch on and be as knowledgeable as she was.

Re gloves- I didn't see my first Kleenex box of gloves until 1991, for an AIDS patient. Diarrhea, and vomiting were still gloveless cleanups unless they were visibly stained with blood. I actually thought about stealing a housekeeper's elbow high rubber gloves as a new grad when I was totally grossed out by a poop blowout. BAD NURSE!

TopazLover, BSN, RN · Aug 27, 2008

I love this thread. I laughed so hard reading some of the things I remember so well.

Do you remember the clysis? I hated them when I was an aide. I was so afraid the needle would fall out.

People were hospitalized for 6 weeks following a heart attack. If that did not kill them, they went home weaker than when they had the MI.

T&As were common. Ice cream was the drug of choice after surgery. It still is my drug of choice 50+ years later. Wonder if they started my addiction for this? :jester:

Grace Oz · Aug 28, 2008

T&As were common. Ice cream was the drug of choice after surgery. It still is my drug of choice 50+ years later. Wonder if they started my addiction for this?

Haha! This just proves healthcare was/is the same across the globe! lol Here in Oz it used to be BOTH ice-cream AND jelly! :) The jelly couldn't be red of course, for obvious reasons! :)