What things have changed in nursing since 1997???

live4today, RN · Dec 1, 2002

You mean to tell me that NOTHING has changed since 1997???!!!

Wow!!! Now THAT'S absolutely amazing siblings!!!

Come on...somebody has SOMETHING to add to my thread about changes in nursing over the past five years, eh???

Just bringing the thread forward again trying to keep it alive until I get a response from someone! :nurse:

RNforLongTime · Dec 1, 2002

Well, I began my Nursing career in 1997. Back then, you weren't guaranteed a job (at least in MY area of the country) as the nursing shortage hadn't yet hit. I think that staffing was a little better, because Clinton's Medicare reform hadn't taken place yet. I've noticed more computerized technology in use. Such as my hospital doesn't send up hard copies of X-rays anymore. They're available on-line now. I do all of my charting on computer now as compared to when I started out and charting was pretty much still being done by hand. I hope this helps you Renee. Basic nursing, though, in my opinion hasn't changed.

VickyRN, MSN, DNP, RN · Dec 1, 2002

Well, for one thing--when I started out in '96, there was a "glut" of nurses. A lot of hospitals, units, nurse managers tended to treat the nurses (especially new grads) with low respect (the "dime a dozen" mentality). Now, due to the nursing shortage (er... I perhaps should rephrase that... the shortage of nurses WILLING to work in hospitals), I have noticed a bit more respect and flexibility. Some places are still diehard, hopelessly set in their ways. A lot of places have changed for the better. Even the doctors seem more respectful. I have also noticed that salaries are much better and opportunities for new grads in specialty units (such as ICU's and L & D) are becoming the norm, rather than the exception. One more thing--this "contract mentality"--didn't seem to be around 5 years ago. Now, new nurses are signing onto a unit for the bonus and working out their contract, and 18 months to 2 years later moving on!!! No retention!!!

jemb · Dec 1, 2002

Where I work, we are now moving into totally computerized referrals, lab and radiology orders, etc, and most results are available via computer . We now have , as required by law, needleless IV systems, and self-sheathing needles for IV starts and injections. We are now in the 3rd nursing shortage in my 20 years as a nurse. (That part seems to be cyclical.) If I think of other things later, I add... In what area of nursing are you looking?

Sleepyeyes · Dec 1, 2002

hmmm...

well, dilute your IVP phenergan-- 25 mg to 9cc NS

and give it separately from your IVP demerol--which should be diluted to a 5ml NS per 10 mg demerol

Is that the kinda stuff you wanna know? :confused:

K O'Malley · Dec 1, 2002

One change I've noticed is that the patients are so much sicker and more complex. Pts that would have been in an ICU are now on telemetry, often with a combination of multiple critical drips, fresh MI, peri-dialysis and who knows what else.

baseline · Dec 1, 2002

The technology has changed....that would be the biggest obstacle to leap after 5 years. Everything else that has been said is true.....But its still nursing... and your skills and caring heart are welocome back!!!!!!

l.rae · Dec 1, 2002

Originally posted by Sleepyeyes
hmmm...

well, dilute your IVP phenergan-- 25 mg to 9cc NS
and give it separately from your IVP demerol--which should be diluted to a 5ml NS per 10 mg demerol

Is that the kinda stuff you wanna know?

Why separate...haven't heard that...sometimes l mix both in a 50 ml bag and mini drip it in......so what's up with this separate deal...they are compatible.....spill the beans sleepy, this is new to me....thanks......LR

l.rae · Dec 1, 2002

l don't see a lot of great technological changes in past 5 yrs, also, l think it depends on the specialty, and the institutions vary too. In the ER where l work, the nurses have a lot of autonomy and a great deal is expected from us. It is not unusual for the RN to start a line, draw blood and possibly order some prelim test or tx prior to MD seeing them...we have some guide lines and standing orders of course...but l think they give us a tremendous leeway compared to my previous employer....lf l drop a line in an abd pain and it isn't used...no biggie......former employer's ER docs had a lot more ego to deal with. Expect more responsibility and higher pt loads...also where l work, the RN's are expected to do some of the things that the ancillary depts are usually responsible for at other facilities....lab draws, ekg's ortho proceedures etc...sometimes we don't even have a transporter or NA....expect to be all things to all ppl.....good luck and welcome back....AND..l still hope you change your mind and come work with me.....at SH....really nice ppl and atmosphere...even compared to the Big House.....pm me if you would like more details......LR

kmchugh · Dec 1, 2002

Renee

Staffing issues, as mentioned above. Many administrators still haven't fully comprehended the nursing shortage, think they can still assign very heavy work loads to nurses who will HAVE to put up with it. Some do, many walk. They'll learn. Be a walker if necessary.

Clinically: I've seen more evidence that suggests giving compazine with demerol is a bad idea. The compazine seems to diminish the effectiveness of the demerol, and has little impact on nausea. However, try to convince physicians of this!!

Droperidol is given far less frequently since the FDA now recommends 3 hours of EKG monitoring after a dose. Believed to be involved in prolongation of the S-T segment.

Biggest change in nausea fight is the arrival of the 5HT3 receptor antagonists. Most common are Zofran and Anzemet. Zofran is quite a bit more expensive, but seems to be more effective. Anzemet is cheaper, but has a pretty tight window of administration. (These are seen from the anesthetic standpoint).

Hows that?

Kevin McHugh

Tweety, BSN, RN · Dec 1, 2002

The biggest changes I've noticed is a focus on pain control (it is now considered the "5th" vital sign). Controlling pain is now a big issue, so document carefully. (Demerol has fallen out of favor the last few years as well)

Also restraints are a big issue. How we document restraints has changed. Getting orders for restraints is a must (within 24 hours), etc.

Those are the two biggest things I've noticed the last five years. They also were the major focus of the JACHO visit we just had.

I've noticed a big influx of contract and travel nurses in our hospital. More and more units are staffed by contracts, much to the dismay of our administration. They are now looking seriously into retention issues and nurse satisfaction. Five or more years ago when there was a glut of nurses, we had a massive layoff. Big mistake.