Ideas from nurses who've been around awhile!

[vtgirl]

Hi all,

I'm not sure if I'm in the right forum or not. I'm giving a presentation on the benefits of using continuing education to stay current in nursing. This is not a thread looking for pros and cons of continuing ed.

I'm looking for some major changes in practice that some of you who've been practicing awhile have seen in the profession over the years. For example, I had a number of years lapse between when I completed my LPN schooling and returning for RN school, and in that time I noticed that I had been taught to clean around the newborn umbilical stump with alcohol, and nowadays, just water is recommended.

Can anyone else give me some anecdotal changes that you've noted in your practice, of little changes? or major changes?

Thanks!

[rotteluvr31, ADN, RN]

we use to use heat lamps to dry out decubitus ulcers. I recall a fancy bed with a mattress of sand that had heat air blowing through it to prevent/heal breakdown. The drier the better.

Also recall mixing all of my own IV medications - pharmacy did not send anything premixed. I'm glad that has changed.

[Penelope_Pitstop, BSN, RN]

I haven't been a nurse all that long, so most of my adjusting has been technology-related. The move to mostly computer charting is the big one for me. And the beds, IV pumps, even insulin injection systems are much fancier. (And the Chest Tubes are so lovely now!)

As far as practice, we've come a long way with protocols. For example, ETOH withdrawal patients get Ativan rather than Milwaukee's Best. Foley catheters can be removed at the nurse's discretion rather than waiting for a doctor's order. What is used in skin care is way different, and I think the advent of WOC nursing has a lot to do with this.

(Another one...at least at my facility, KVO rate for NSS was always 30 mL/hour but suddenly it's 20 mL/hr. Not a big deal but kind of weird to me).

[Bubbles]

Heparin locks have gone back and forth from using dilute heparin solution to keep site open, to using normal saline, back to heparin, to nothing at all. Don't know what the current practice is.

Decubitus ulcers once were treated with sugar. Was suppossed to promote healing. Used to massage area surrounding decubitus to stimulate blood flow.

Medications used to be in big stock bottles and meds were poured in a nice, quiet med room with a door rather than dragging a big heavy medication cart out to the hall and setting up meds in grand central station. Demerol used to be in 30 cc bottles that you drew out the dosage for your patient and at the end of shift had to determine approx. how much was left. My first experience with a RN having a drug dependence problem involved her withdrawing Demerol from one of those bottles and replacing it with normal saline.

There was a time when the thinking about post surgical wounds was to leave them open to air. Small paper cuts and little stuff like that was also thought to heal more quickly if left open to air. Then thinking changed to covering wounds and keeping them moist to promote healing.

[RNperdiem, RN]

In ICU when patients were on continuous dialysis (CVVHD), nurses added concentrated potassium or potassium to dialysis bags.

Now, the bags come premixed.

The move was a safety issue to get rid of concentrated potassium sitting around the room.

This is deadly stuff if accidently given IV.

[llg, PhD, RN]

The whole spectrum of developmental care in the neonatal ICU has made enormous strides since I started practicing in 1977. The lights were always on. There was music playing, positioning was not optimal, etc. ... too many things to list.

[cherrybreeze, ADN, RN]

we use to use heat lamps to dry out decubitus ulcers. I recall a fancy bed with a mattress of sand that had heat air blowing through it to prevent/heal breakdown. The drier the better.

Also recall mixing all of my own IV medications - pharmacy did not send anything premixed. I'm glad that has changed.

Clinitron beds. They're stlil around! Helps with the pressure, but aren't used to dry out wounds. They sure can get warm.

[canoehead, BSN, RN]

The "pain is what the patient says it is" approach was brand new when I started nursing.

They don't recommend IM shots in the gluteus maximus anymore.

Pills in stock bottles is rare now. They do unit doseing, and Pyxis machines.

We no longer pumps stomachs routinely after an OD (thank goodness).

We used to make up every IV med, now pharmacy or premixed.

We used to do back rub rounds twice a day.

[tewdles, RN]

I remember putting maalox on decubs and blowing oxygen from the wall over/on them...

[Penelope_Pitstop, BSN, RN]

Heparin locks have gone back and forth from using dilute heparin solution to keep site open, to using normal saline, back to heparin, to nothing at all. Don't know what the current practice is.

We use normal saline.

And, this isn't from my memory but just from my learning...how about the advent of universal precautions in the wake of the HIV/AIDS epidemic? And utilizing contact precautions is definitely something that continuing eds involve because the bugs change all of the time, as does infectious disease research.

As equipment used to lift/move patients is enhanced, we need to be educated on how to use it properly so as to decrease staff injury and increase compliance with the use of the lifts and such.

[rotteluvr31, ADN, RN]

Clinitron beds. They're stlil around! Helps with the pressure, but aren't used to dry out wounds. They sure can get warm.

Yes! Thanks for the name refresher. Didn't know they were still in use. They made good sense for pressure, but I can see our wound care RN wincing at the thought of making all wounds as dry as the sahara.

[fungez]

I remember cleaning surgical incisions with betadine swabs, and in a very certain way. Swab one - roll over middle of incision. Swab 2 - roll over right side of incision, swab 3, over left. IIRC this was done with sterile technique.

I worked in oncology as a tech right when zofran was coming out. Prior to that all the chemo patients barfed constantly. And before G-CSF was used the patients spiked fevers to 104 and above. I spent many an hour as a tech rotating cool wet washcloths on pulse points. And before levaquin when a neutropenic spiked a temp the doc would order the same three antibiotics - fortaz (can't remember the last time I've given that), something else, maybe imipenen, and I think vanco.

Morphine drips weren't locked up in any way while dripping - they just had a little silver tape over the port so you can tell if someone accessed it. And IV pumps were reserved for central lines. The rest were gravity dripped but even then no one figured out drip rates - we just eyeballed it.

For the life of me, I cannot figure out why math tests always focus on drip rates, since the pumps do it all. These always throw a grain question in there and I have never, ever, ever in my entire career seen something written in grains.