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!

[canoehead, BSN, RN]

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.

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Yes we never used to have gloves on the floor.

[Chris81]

Gloves for everyone(post AIDS),moist wound healing,handoff checklists,positioning devices when on gurney awaiting x-ray(PU prevention),opening closed systems every shift(indwelling foleys, IV lines),Posey vest/waist restraints in LTC, pre-pouring meds in med room(and those tiny color-coded cards), speaking of color coding-CHARTING IN BLUE/BLACK FOR DAYS/GREEN-EVES/RED-NOCS!

[scoochy]

Check out the thread "You know you're old school when.." It is under the general nursing discussion from earlier this year. There are 24 pages of posts that are great (speaking from one who has been out of school 30 yrs...).

[questionsforall]

The nurses I worked with that were around in the 70's and 80's said that they remember when HIV/AIDS didn't have a name and that these patients would come in the hospital with the diagnosis: Fever of unknown origin.

Also, many antiobiotics were given IM.

[rotteluvr31, ADN, RN]

These always throw a grain question in there and I have never, ever, ever in my entire career seen something written in grains.

There is one doc in our area who still orders tylenol in grains.

[bunsterj]

I noticed a big change in acuity with the implementation of DRG's. We used to have cataract and other simple surgical patients stay the night before and the night after surgery, then they switched to early AM admit(admitted to the floor at about 4:30 AM) then they switched to day surgery. Lost all those fairly easy patients and they were replaced with much more complex patients, but our staffing did not change.

[talaxandra]

Things I specifically remember learning about having changed through continuing education:

- a reduction in manual handling, and the evolving process of legal lifts, as something I was taught to use (eg slats) instead of a now-forbidden lift (eg shoulder, top and tail) became illegal itself;

- CPR compression rates and ventilation/compression ratios;

- a 180 on donut cushions and rings for pressure care;

- the removal of betadine as a standard prep and dressing solution for almost everything;

- multiple new medications, including whole classes of drugs; and

- the life saving introduction on Parvolex for paracetamol overdoses: seeing patients who would have developed liver failure and died now chucking wobblies because they had to stay in hospital for a couple of days was amazing!

The nurses I worked with that were around in the 70's and 80's said that they remember when HIV/AIDS didn't have a name and that these patients would come in the hospital with the diagnosis: Fever of unknown origin.

As other members have posted, this massively changed infection control measures. I started nursing in 1989 - HIV/AIDS had a name, and though people were still freaked, modes of transmission were well known. But my hospital had just introduced sharps education ("Sharp attack!") and universal precautions, then known as BABS (blood and body substances).

It was also when hepatitis came as A, B or non-A-non-B, MRSA was the scariest resistant bug around, and when my hospital introduced integrated notes, instead of separate notes for nurses, doctors and allied health.

[scoochy]

HIV was formerly known as HTLV3.......

[dscrn]

Gloves for everyone(post AIDS),moist wound healing,handoff checklists,positioning devices when on gurney awaiting x-ray(PU prevention),opening closed systems every shift(indwelling foleys, IV lines),Posey vest/waist restraints in LTC, pre-pouring meds in med room(and those tiny color-coded cards), speaking of color coding-CHARTING IN BLUE/BLACK FOR DAYS/GREEN-EVES/RED-NOCS!

oh yes, I was the green shift=then they figured that they didn't copy-red and green whenphotocopying

[vtgirl]

Fantastic!! Thanks everybody, I'll insert a few of these into my presentation on why it pays to stay current in practice!

[LPN2000]

In peds we used to do a quick TB tine test and have the parent check off a box on a postcard what the reaction if any looked like and mail it back. Now the under the skin TB mantoux test is done and the patient has to come back to have it read in 48-72 hrs. And the new digital weight scales are a lot easier to keep a patient on than the old weighted manual ones were.