Nursing now vs. then

xtxrn, ASN, RN · Aug 22, 2011

This is just my opinion based on seeing students at clinical in the hospital when I've been a patient AND my own nursing experience- I'm an ADN (and never regretted spending another dime on nursing- did think about other degrees to go along w/nursing, but got over that :)). I'm all for more education, if someone knows what they want to do with it- not just for the sake of having it- and now, more places are demanding BSNs (which isn't all bad- but for floor nursing, I don't see the purpose when so much of nursing comes from practical and applied experience- not letters after a name). Those hospitals need not complain about any "shortage" (especially w/so many here who are looking for work) when they've decided to throw nurses away. (the whole ADN/diploma vs BSN thing is eons old...). I graduated in 1985.

From what I can tell, the clinicals are much less inclusive, so students leave school still needing to learn a lot of the direct care functions. It's horribly unfair to the students. When I got out of school, and had to do a checklist of skills, I was expected to have already done them- and had. Now, it sounds like students aren't getting the chance to do things in school, and end up even more overwhelmed because of what they weren't taught. It's not the student's fault (or new nurse).

The work still got done ages ago, without the internet (we had books- LOL:D), BP machines, accuchecks, mechanical lifts, most of the IV pumps (only used those on kids, central lines, and those at risk for severe fluid overload- not "normal' patients in for surgery, or acute and temporary illness), no fitted sheets- or CNAs/PCTs to help with them, and the staffing was VERY commonly 1:7 on days, 1:8 on evenings, 1: 10 on nights (or higher), and in LTC, 1:30 was a good day; 1:60 was a typical night :).

We hand wrote all charting- no checklists unless for neuromuscular assessment after angiograms, all orders were done by hand and processed through the ward clerk- then rechecked and signed off. No hospitalists. Versed was used at the bedside for procedures- not sent off the floor for another department to do. Advances in medicine have made things easier in many ways- newer meds help with post-op nausea (Zofran was a huge help), better insulins, cholesterol meds prevent some of the damage to vessels, better treatment for HTN, COPD, etc. Careplans were done by hand (with an actual pen or pencil- depended on the facility). NANDA still made our lives miserable :).

Patients do not get sicker now (they just die slower)-and they end up on different floors sooner. ICU is not used as a holding tank for someone who is relatively stable, but needs a lot of care. The higher care patients end up on regular floors- they're not always sicker than the walkie talkie in the next room- they just have more hoses. There's a difference :) There used to be patients in ICU for ages- doing nothing (and weren't going to get well). Now there are LTACs, LTC, and rehabs. LTC used to be more of a warehouse- now people get well and go home. LTCs often have patients who used to be on the med-surg floors in acute care.

Doctors did primary care for most of their patient's problems- specialists weren't used nearly as much (fewer docs meant fewer medication problems since nobody looked at what the other guy wrote). And most docs went to several hospitals- not worked for that hospital's system.

Some of what I've noticed :)

Ruby Vee, BSN · Aug 22, 2011

there are still patients languishing in the icu for months and months on end . . . because ltc won't accept them or they aren't appropriate for a skilled nursing facility or there just aren't any beds elsewhere. that part hasn't changed.

thirty some years ago, there were only four or five docs to be paged, but we had to have the numbers for their home, their office, their golf club and the icus and cath labs in every other hospital in town. no one had cell phones, so we called around the city until we found them. or until we found someone who admitted to being on call for them.

thirty years ago, i had 15 patients on the day shift and 30 on the night shift with one aide to help me. depending upon the aide, the day went swell or awful. i worked with aides that were wonderful and aides that spent the entire shift in the linen closet smoking pot with the housekeepers. we were floated everywhere in the hospital and had to be competent wherever we went. i was routinely floated to another floor to do charge. staffing sucked everywhere.

when i went into icu, we ran vasoactive drips without pumps because there weren't enough pumps to go around. we'd drop an hour's worth of med into a buretrol and count drops. blood pressure goes down, turn up the dopamine or turn down the nipride. cardiac outputs were done without a handy dandy computer program that calculates your hemodynamics for you. you shot three outputs and averaged them by long division -- usually on a paper towel. svrs and pvrs were even more difficult. we had sliders to calculate bsa -- and it was a rough calculation. calculators weren't widely available until the 80s sometime. you checked blood sugars by having the lab come up and draw them and waiting a few hours for the result. sliding scale insulin was based on dipping a stick in urine and comparing the color to a little box on the bottle.

many nurses went to a diploma school and actually learned how to function as nurses before they graduated. i went to a bsn program and i didn't. i floundered and nearly failed . . . for about two years. but i never even considered quitting because i had a family to support. the idea of "looking out for number one" or having to love your work hadn't gained widespread acceptance.

i had to know all about my patients' diseases and their meds and the procedures for foleys and ng tubes and blood transfusions -- only there were no computers and no way to look them up except track down the enormous, heavy procedure manual and look them up. it takes a long time to look something up in a procedure manual that consists of procedures stuck into a notebook in random order as they're approved. my med cart had my med/surg nursing text, the physician's desk reference and (if i could find it) the procedure manual stacked on it. the apothecary system was still in use, so you had to know aspirin doses in grains as well as milligrams.

families visited at all hours, stayed as long as they want and sometimes never went home. unlike today, however, most of them had some semblance of manners and a modicum of respect for the nurse.

the biggest hurdle that i see new nurses facing now as opposed to then is that nurses then expected to work without positive feedback, and we expected to work nights, weekends, holidays. we weren't given trophies just for showing up, didn't graduate from kindergarten and our parents didn't smooth things over for us if we had a disagreement with a teacher. too many new graduates these days didn't believe they'd really have to work nights or weekends, and sometimes their parents call our manager to threaten her if she doesn't put their little darling on straight days, no weekends or holidays. if they don't like the job right away, they quit. or go back to school to be crnas. if they don't get along with their co-workers they assume it's because their preceptor is a nasty old hag who is eating her young and ought to retire or that everyone hates them because they're beautiful. thirty years ago, if you didn't like your job you worked anyway, and if your coworkers didn't like you, you assumed you were doing something wrong and you worked to fix that. no one complained about "nurses eating their young." we respected the senior nurses and learned everything we could from them.

if there was a (rare) slow night, we sat around and told ghost stories or discussed the meaning of life . . . nowadays everyone is bent over their smart phone or their bedside computer on facebook. we had potlocks for holidays and picnics in summer. we young nurses were friends with the "old hags' in their fifties. they took us under their wings and gave us advice. nowadays, too many young people seem to believe they know everything, and an older nurse who tries to give them advice is viewed with suspicion.

i love my laptop and my smartphone and my prius. i wouldn't want to go back to the old days. but i miss some things about them!

xtxrn, ASN, RN · Aug 22, 2011

Amen :) :yeah: :yeah:

TheDDrug · Aug 22, 2011

I am right there with Ruby. I graduated in 1977 and the only person who had a pump was in ICU. We ran Dopamine on the floors with a dial a flow. I had an entire med surg floor of 30 patients to myself with 2 LPNs and one CNA who passed out ice water and linens. Doing VS was considered an LPN function. We gave up our chair for the doctor to write orders and then we would stand there so he could read them to us. We placed an ashtray on the chart rack in the mornings for the doctor to smoke while he rounded. We all smoked at the nurses station and nobody complained. Families were not rude, they didn't demand things at all. When it was time for grandma to go to heaven, nobody demanded they put them on a vent. We were scheduled for shifts, we didn't do our own schedules. We could request a full weekend off usually every other month. Sometimes we would get more than that but it wasn't a given. If the night shift nurse was off, one of us would have to cover. There was no agency or float team or per diem nurses. We had to wear white with caps. We all wore our nursing school pins. I'm still bald in one spot from pinning my cap on top of my head!

As a new nurse then, I respected the seasoned nurses. Now days, the younger nurses seem to have attitude towards us older nurses, almost like we're not sharp enough or quick enough for them. What they don't realize is that we've seen a lot more than they have and realize calmness and organization to your day without drama is what makes the shift much easier. There isn't much that rattles me anymore and seeing a younger nurse running around, freaking out about something that if they had just asked we could tell them what would be the most helpful answer. However, for some reason they seem to think we're wrong. I often wonder if they think we're just ignoring important things? Nope, it's just that we manage whatever it is and without fanfare.

We used to do all of our drip calculations on paper. There are formulas we memorized for just about every drug. I remember all those formulas and use them to this day. During a code I will whip out my calculator and hang a drip in seconds while a group of newer nurses pull out a book and consult each other. I wonder if they think I'm wrong with my calcs? They don't seem to be motivated to learn these things.

This is just my take on newer nurses. I could be wrong.

Oh, the biggest thing I hear is that they worry they could lose their license. Say what? The only nurses I know of who have lost their licenses are those who took drugs and then lied about it. Stop worrying about losing your license!!

Whew, that was quite a rant. These days I usually just go to work and do my job. I try to be professional and helpful and set a good example.

xtxrn, ASN, RN · Aug 22, 2011

This is just my take on newer nurses. I could be wrong.
Oh, the biggest thing I hear is that they worry they could lose their license. Say what? The only nurses I know of who have lost their licenses are those who took drugs and then lied about it. Stop worrying about losing your license!!
Whew, that was quite a rant. These days I usually just go to work and do my job. I try to be professional and helpful and set a good example.

YES !!! You have to WORK at losing your license!! It's not the be-all end-all "punishment" that is so widely 'threatened' (or perceived?) in these threads.

I'm also dumbfounded that it's possible for a nurse to pass boards with 75 questions right.... to me, that is outrageous.

IdrilRN, BSN, RN · Aug 22, 2011

I remember the token 100 yo person in LTC. When I started 20 years ago most were 70 somthing widows. Now most are in their late 80's early 90's and sicker then ever. Only just a few years ago they would have been in the hospital still.

I loved the comment about the ash try on the chart rack. I remember my mom coming home sometime in the 80's in an uproar about no more smoking in the hospital. She ended up quiting shortly there after.

One of my favorite stories is from a lady who told me back in the 40's after she had her baby she wasn't even allowed to dangle for a week. She had been int he hospital for 12 days. She was so weak by the time she got home with the baby her husband had to carry her up the stairs to their apt, where her mother was waiting to help her. Something more may have been wrong she didn't say.

Oh and back in the day, when people listened and respected their acutal doctors and/or nurses and didn't rely on Dr. Google.

SlightlyMental_RN · Aug 22, 2011

I totally don't get the lack of respect of the "older nurses." I absolutely LOVE the well-seasoned :lol2: RN on our unit. She knows the history of all the unit policies, is unflappable, and will rescue you when you're drowning and don't know what to do. :yeah:

Something that I remember (and miss) is having an actual charge nurse that has been there for years and knows what she's doing. Putting new grads and other newer-hires as charge is nuts. I hate how hospitals are chasing out the older nurses for the cheaper newer grads.

GM2RN · Aug 22, 2011

Although I'm 53, nursing is a second career for me and I've only been a nurse for 4 years. Even though I wasn't a nurse 30 years ago, I can still relate to some of the concepts, like respect for those with experience or authority, accepting constructive criticism as just that without whining about someone being mean to me, and learning to be content with a job that I may not be in love with because I have a family relying on me.

I don't know if the OP is getting the answers that she wanted, but I'm enjoying the stories.

Medic/Nurse, BSN, RN · Aug 22, 2011

xtxrn - wow, just wow. I am humbled by you - seriously, irrevocably humbled and amazed. Kudos is not even close to what you deserve for endurance alone. I add you to my prayers. :angel:

Ruby Vee - amazing as always - anyone for a RV fan club??? I might not be "wanted" because ... anyone ... anyone ... Bueller ... oh wait, I am too pretty right??? You rock RV. :bowingpur

and now -

TheDDrug - great post.

Folks - there is more you can learn from these collective AN'ers than you ever LEARNED in SCHOOL.

Read up and search out the past posts - really. No one hates you and you are not that beautiful or blessed. No one is jealous or feels threatened. Knowledge is POWER!

Practice SAFE!

xtxrn, ASN, RN · Aug 22, 2011

xtxrn - wow, just wow. I am humbled by you - seriously, irrevocably humbled and amazed. Kudos is not even close to what you deserve for endurance alone. I add you to my prayers. :angel:
Ruby Vee - amazing as always - anyone for a RV fan club??? I might not be "wanted" because ... anyone ... anyone ... Bueller ... oh wait, I am too pretty right??? You rock RV. :bowingpur
and now -
TheDDrug - great post.
Folks - there is more you can learn from these collective AN'ers than you ever LEARNED in SCHOOL.
Read up and search out the past posts - really. No one hates you and you are not that beautiful or blessed. No one is jealous or feels threatened. Knowledge is POWER!
Practice SAFE!

Off topic- that movie was a hoot

sistasoul · Aug 22, 2011

I talked to a nurse who graduated in 1985. She said she only had to chart a paragraph or 2 on her patients at the most and that there were no nursing assistants. The RN actually had time for bedside care. Imagine a bedside nurse actually having time with her patients? Nursing would be my dream job if I had more hands on nursing care time like this nurse had. This nurse is now a supervisor.