Nursing now vs. then

xtxrn, ASN, RN · 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.

My first hospital job was on an acute neuro/neurosurg unit...28 beds...night shift....2 nurses. No CNA/PCT. No unit clerk. 14 patients each- most needed some turning. If peds came in w/neuro issues, we got the kids. LOTS of total care,trachs, g-tubes (we used Foleys back then- very convenient to change :)). RotoRest beds for some (a C1-2 rotary sublux that had been in an MVA, thought she was ok, and walked around with an unstable spine for a couple of weeks:eek:.....

Guillan Barre, progressive supra nuclear palsy, Jacob Creuzfeldt Disease, coccydiomycosis, herpes encephalitis, s/p GSW to head, quads, paras , CVAs, craniectomies for CA, and the tamer laminectomies, cervical lams, seizures, ALS, etc..... a lot of heavy care. Sometimes I wouldn't see the other nurse until 2-3 am, when we'd finished first rounds, meds, and getting folks settled. We PRAYED for the "flip, flop, fold, feed, and fluff" patients - they didn't use the call light If bedside care had to be given, there were 2 of us to get it done :) And, we did. It is what was expected- so we did it. I'd come from 6 months of LTC, so 14 patients was a holiday:D.... We helped each other when we could (I worked with a really good nurse- learned a lot from her). But it was pretty much a blur from the end of report until leaving in the morning. :twocents:

aznurse1 · Aug 22, 2011

Hey there! Love the thread. Back in the 80's the patients and family didn't argue with the treatments the doctor recommended. The family didn't stand at the bedside and write down everything that was being done for the pt and stare at you with daggers... It was just different, you were a trusted authority on what would be best to help the patient. Now the patient and family advocate for the patient and end up with care that is not as good (because of their ignorance) and end up alienating their caregiver.

nursemichelle80, BSN, RN · Aug 22, 2011

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

I wish it would have been that easy for me 5 years ago:( I got all 265 questions. Walked out of there wanting to jump from the 6th story window. Still not sure how I passed...but oh so thankful I did!!! :yeah:

gettingbsn2msn, MSN, RN · 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.

I am in your world. Second degree, older student, med surg and enjoying the stories. We are the same age and I am starting a masters program! I am loving all of this!:heartbeat

llg, PhD, RN · Aug 22, 2011

The OP might find it interesting to do a literature search on the concept of "complexity compression." There is a research team in Minnesota working on this phenomenon.

Back in the olden days when I graduated (1977) NCLEX was still 2 full days of tests. Five separate exams -- each one a couple hundred questions. And it was only offered twice per year: so, if you failed one of the tests, you had to wait 6 months to try again.

In our NICU (where there patients were quite sick, believe me) -- Respiratory Therapy came around once or twice per shift to check the ventilators. In between, the nurses set them up and made changes as needed.

xtxrn, ASN, RN · Aug 22, 2011

The OP might find it interesting to do a literature search on the concept of "complexity compression." There is a research team in Minnesota working on this phenomenon.
Back in the olden days when I graduated (1977) NCLEX was still 2 full days of tests. Five separate exams -- each one a couple hundred questions. And it was only offered twice per year: so, if you failed one of the tests, you had to wait 6 months to try again.
In our NICU (where there patients were quite sick, believe me) -- Respiratory Therapy came around once or twice per shift to check the ventilators. In between, the nurses set them up and made changes as needed.

Yep- same in 1985...morning and afternoon sections on both days....no leaving the exam room without an escort (even to the bathroom), and you had to get at least 60% (I think that's right) correct- so several hundred questions RIGHT- but had to answer all of them and wait for a couple of months to get the results. There were 1500 people in a conference room at a hotel at the end of one of the runways at O'Hare Airport (back when it was the busiest in the world)....every few minutes, some huge jet would scream overhead ..... as if nerves weren't already whacked:eek: And we used .....gasp.....#2 pencils

One poor girl was in a hospital bed (broken leg, I think) at the front of the room, so she didn't have to wait the 6 months to take it

TrafalgarRN · Aug 22, 2011

Ruby, Xtrn and the rest of the nurses who have been doing this for a long time congrats and keep up the good work. I have been doing this for 10 years and enjoying every moment of it. When i started i was oriented by a nurse who will be retiring this December after 45 years of nursing care. She has worked in every unit in the hospital; from the clinincs, Peds, ICU and i owe her everything for the training and education. She taught me everything there is to nursing and 10 years later, we still work on the same shift and she will always throw in a word of advise every week.

The problem with nursing starts with money and statistics. Damn those computers that track every click we make. Care is also based on reimbursement where Medicare and every organization under the moon will come up with numbers that they need to reimburse or certify a hospital. If those numbers fail then the nurses are to blame and the management gets into our case. We rely on budgets and for the last 10 years i am always told we are over the budget yet i work for a non-profit that makes billions in profits. We sometimes end up working 2 nurses short in a shift because the so called trends are showing that our census is low at a particular time and we are staffed to core. And what does that translate to? Patients waiting for care in the ED, getting grouchy and irritated plus complaining to the management who think we are misusing resources. And yet the management never sits down to hear about out complaints but just want to tell us how we should run the department.

My second issue is the idea that some of the new nurses went to school with the idea that nursing is a money mine. It kills me when every day of the week i will see some nurses sitting on the computer planning those Hawaii vacations, that new car or that new set of furniture. And to make matters worse they will have the guts to complain that they are broke. When i talk to some about savings, retirement accounts i get that look of "who cares". I'm 30 so probably i am the wrong person to talk to talk to them about money but i have seen many things in my life and don't mind sharing whats on my mind. I hate to see people living from pay check to pay check when they have a choice to make better decisions. I love it when that new grad starts working and in less than a month has that $ 50,000 BMW and has to work every day to make payments and complains when they can't get an extra shift. One new grad even bought a $117,000 car...yes..no typo...he is 32 and lives at home with dad and mom and the car payments are over $ 1500. With such financial responsibilities nursing is just a paycheck not a career. Or the cheeky ones who tell me "they don't care" and are in for the money; luckily i haven't slapped anyone.

My motto is treat everyone as you would like to be treated or how you would like your family to be treated. There will be bad days since some people are difficult and need extra time to understand or just ungrateful. My other pet peeve is that we have let computers take over. Its obvious that you should always look at the patient first before the machine but some people have already forgotten that. Yes it looks like Vtach but can you please look at the lead placement. Yes the BP just dropped but can you check your cuff and see if its the right size. Iphones and those smartphones....I hate...I hate. Can you please leave them in your locker or car. Unless you are expecting a call from your child' day care or there is something important like a sick child or family member then i don't expect to see that phone in the patient care area. When i charge i have no qualms about telling people that i don't expect to see you chatting at 0300 in the morning. If its slow then good...help the EDTech by cleaning up rooms. Don't ask a tech for an EKG when they see you are on the computer shopping online. I have no problems with computer use as long as patient care is not neglected.

Older nurses? They may be old in their years but they have tons of experience. Someone mentioned about drip calculations. Some people already have it to an art where they can calculate it on paper. But we have come to the era where everything is on the computer and even in emergencies you will see people pulling out calculators and though this is a safe way it beats me that this is not the first time you have given the medication. There are what we call High Alert Medications that need double checks and independent checks by 2 licensed providers. What i have noticed is that the older nurses have had a hard time with the computers but that should not be a reason to look upon them. I work with this nurse who will assume care of patients and 3 hours after has not charted any vital signs or even made any narratives; woe to you if you have to give him a break since you have no clue what he has been doing for the last 3-4 hrs. We have talked to him plus my mentor with 45 years has talked to him but he just blows us and management won't do nothing since his mom is senior management plus we are union. It just beats the purpose and guess they will wait for harm to occur for them to act.

I work with ratios but have worked in the Midwest with no ratios where I had 6-8 patients in an ER. Tell that to some nurses and they think you are telling tales. When they have 4 patients its the end of the world and that's when you tell them its all about priorities. You don't have to bother about an ear pain when you have a chest pain. I was once new and was there but as i realized it was all about priorities then life was easy. Or when i assume care of a patient in the department who has RLQ pain and getting ready for CT to R/O Appy; they are tachy but for the last 7 hrs no on has bothered to check a temp and when i do its 103. What kind of nurse are you when you can't correlate symptoms and disease process....and to make matters worse that was your only patient for the last 3 hours; its not like you were swamped.

This is more of a vent and should not be taken as a posting against new grads. There are good and bad fruits but we need to show compassion and care. And for those who have been doing this longer always push the younger by instilling your knowledge. Sometimes its not "eating your young" rather its training someone who will take care of you tommorow and you will know you are in perfect hands

DPSGraduateNurse · Aug 22, 2011

Personally as a nursing student, I think new graduate nurses still have some false expectation about the whole nursing career. It is hard work and dedication required. Fortunately, I have held many positions in my life where if I was 1 min late to work I was documented and if it happened more than 3 times a year, I would be out of a job, no excuses!

Some are in for a rude awakening. More experienced nurses need to set better expectations and not every job is M-F!

GM2RN · Aug 22, 2011

I am in your world. Second degree, older student, med surg and enjoying the stories. We are the same age and I am starting a masters program! I am loving all of this!:heartbeat

I'm hoping to start a masters program in January. They only accept 12 per year and I won't know until if I'm accepted until after October 1. Good luck!

GM2RN · Aug 22, 2011

Ruby, Xtrn and the rest of the nurses who have been doing this for a long time congrats and keep up the good work. I have been doing this for 10 years and enjoying every moment of it. When i started i was oriented by a nurse who will be retiring this December after 45 years of nursing care. She has worked in every unit in the hospital; from the clinincs, Peds, ICU and i owe her everything for the training and education. She taught me everything there is to nursing and 10 years later, we still work on the same shift and she will always throw in a word of advise every week.
The problem with nursing starts with money and statistics. Damn those computers that track every click we make. Care is also based on reimbursement where Medicare and every organization under the moon will come up with numbers that they need to reimburse or certify a hospital. If those numbers fail then the nurses are to blame and the management gets into our case. We rely on budgets and for the last 10 years i am always told we are over the budget yet i work for a non-profit that makes billions in profits. We sometimes end up working 2 nurses short in a shift because the so called trends are showing that our census is low at a particular time and we are staffed to core. And what does that translate to? Patients waiting for care in the ED, getting grouchy and irritated plus complaining to the management who think we are misusing resources. And yet the management never sits down to hear about out complaints but just want to tell us how we should run the department.
My second issue is the idea that some of the new nurses went to school with the idea that nursing is a money mine. It kills me when every day of the week i will see some nurses sitting on the computer planning those Hawaii vacations, that new car or that new set of furniture. And to make matters worse they will have the guts to complain that they are broke. When i talk to some about savings, retirement accounts i get that look of "who cares". I'm 30 so probably i am the wrong person to talk to talk to them about money but i have seen many things in my life and don't mind sharing whats on my mind. I hate to see people living from pay check to pay check when they have a choice to make better decisions. I love it when that new grad starts working and in less than a month has that $ 50,000 BMW and has to work every day to make payments and complains when they can't get an extra shift. One new grad even bought a $117,000 car...yes..no typo...he is 32 and lives at home with dad and mom and the car payments are over $ 1500. With such financial responsibilities nursing is just a paycheck not a career. Or the cheeky ones who tell me "they don't care" and are in for the money; luckily i haven't slapped anyone.
My motto is treat everyone as you would like to be treated or how you would like your family to be treated. There will be bad days since some people are difficult and need extra time to understand or just ungrateful. My other pet peeve is that we have let computers take over. Its obvious that you should always look at the patient first before the machine but some people have already forgotten that. Yes it looks like Vtach but can you please look at the lead placement. Yes the BP just dropped but can you check your cuff and see if its the right size. Iphones and those smartphones....I hate...I hate. Can you please leave them in your locker or car. Unless you are expecting a call from your child' day care or there is something important like a sick child or family member then i don't expect to see that phone in the patient care area. When i charge i have no qualms about telling people that i don't expect to see you chatting at 0300 in the morning. If its slow then good...help the EDTech by cleaning up rooms. Don't ask a tech for an EKG when they see you are on the computer shopping online. I have no problems with computer use as long as patient care is not neglected.
Older nurses? They may be old in their years but they have tons of experience. Someone mentioned about drip calculations. Some people already have it to an art where they can calculate it on paper. But we have come to the era where everything is on the computer and even in emergencies you will see people pulling out calculators and though this is a safe way it beats me that this is not the first time you have given the medication. There are what we call High Alert Medications that need double checks and independent checks by 2 licensed providers. What i have noticed is that the older nurses have had a hard time with the computers but that should not be a reason to look upon them. I work with this nurse who will assume care of patients and 3 hours after has not charted any vital signs or even made any narratives; woe to you if you have to give him a break since you have no clue what he has been doing for the last 3-4 hrs. We have talked to him plus my mentor with 45 years has talked to him but he just blows us and management won't do nothing since his mom is senior management plus we are union. It just beats the purpose and guess they will wait for harm to occur for them to act.
I work with ratios but have worked in the Midwest with no ratios where I had 6-8 patients in an ER. Tell that to some nurses and they think you are telling tales. When they have 4 patients its the end of the world and that's when you tell them its all about priorities. You don't have to bother about an ear pain when you have a chest pain. I was once new and was there but as i realized it was all about priorities then life was easy. Or when i assume care of a patient in the department who has RLQ pain and getting ready for CT to R/O Appy; they are tachy but for the last 7 hrs no on has bothered to check a temp and when i do its 103. What kind of nurse are you when you can't correlate symptoms and disease process....and to make matters worse that was your only patient for the last 3 hours; its not like you were swamped.
This is more of a vent and should not be taken as a posting against new grads. There are good and bad fruits but we need to show compassion and care. And for those who have been doing this longer always push the younger by instilling your knowledge. Sometimes its not "eating your young" rather its training someone who will take care of you tommorow and you will know you are in perfect hands

We could be working in the same ED. I am often in charge and having the same issues with a few folks right now. Thank God I have an understanding manager that backs me up when they complain to her when I tell them that they need to address the orders that have been sitting for an hour on a patient that came in with SOB, or that they need to pick up the pace because they have 3 patients waiting to go to xray for more than 2 hours and yes, it is part of the techs job to take them but not exclusively and it's ultimately your job as the RN to see that it gets done. And yes, I do help you when I can but I have patients backed up in the lobby with a full ED, ambulances rolling through the door, and we are short 2 of our staff, so you need to get your butt off the chair and get the job done. :confused:

jmqphd · Aug 22, 2011

Well... I graduated in 1971 and up until a year ago had a job at the bedside (now I teach.) Trafalgar has touched on what I think is the biggest difference, and that is all the core-measures-national-patient-safety-goals-Joint-Commission-NDNQI-Quality-Assurance-patient-satisfaction-scores etc. etc. etc. The competing and overlapping accrediting agencies, the threats to withold remuneration if this criteria or that issue is overlooked, it is just incredible. How much of it contributes to patient safety? How much evidence based information is there for each nuisance they impose? I think that best practices that are researched then promulgated nationally and enforced by some agency or another are a good thing. The problem is that no one researches unintended consequences of each new policy.

(The latest best practice is that any med given down an enteral feeding tube has to be given individually. Each med ground up and dissolved in it's own cup, each shot down the tube individually, each followed by some volume of water. Pts with G-tubes are very sick. They usually have at least a 3 page MAR. Meaning prepping and giving meds takes a HUGE amount of time. And, during that time, I am not available to my other 5 patients. Additionally, this practice is presumed to be better because meds mixed together in solution can react with each other, thus we are technically giving some chimeric chemical rather than the active drug that was ordered. Yes... but once in the acid of the stomach, each drug has its own pK and will dissociate. The policy is stupid, unscientific, and loaded with hazard for patients as a whole.)

So, the regulators and EMR are probably the biggest changes that have happened over the last 40 years.

I don't think nurses were more respected in the "olden days". Each historical epoch has its share of a**holes. We had nice families and awful families, good doctors you could work with and rotten, self-absorbed, arrogant, idiot doctors.

I think the smoking restrictions are great because I almost couldn't get through report without an asthma attack. The atmosphere in the nurses' lounges was terrible.

There are way more resources for continuing education than there used to be, and specialty nurses organizations are more important and influential.

In the olden days, there was really very limited amount of orientation. I was charge nurse (the only "nurse" but a GN at that) on swing shift on a post-op gyn floor before I'd taken my boards. Crazy!!!

I love it when students sweat the NCLEX. Like others here, for me, it was 2 days, 5 exams, 100's of questions on each and you didn't know if you passed for about 8 weeks! Now you know instantly. In those days, some states required a minimum of 500 on each part of the NCLEX before they would grant reciprocity. (For the vast majority of states it was 350.) Thus nurses could say they had passed "the nationals" if they had 500 or above on each test. (For the record... my lowest score was 530... in psych)

We didn't have unit dose. We had big jugs of pills on shelves and we dispensed from those. We used a little push cart with rows of med-cups, and little cardboard squares that told us what had to be given to whom and when. When I started, there was team nursing. Theoretically, a charge nurse (who baby-sat the MD's and answered the phone. Notice, singular... the phone. We didn't carry our own phones.) a med nurse who gave meds to all the patients, and maybe a treatment nurse who changed dressings etc.

When I graduated, starting an IV was not a nursing function. (I am not making this up.) The junior resident had to start the IV's. Then eventually, they let nurses start IV's with scalp vein needles... but not cannulated needles... ("jelco's" we called them.)

They hadn't invented the hand-held calculator then. I and O for a patient on peritoneal dialysis meant a long column of adding and subtracting. You had to be able to do the math on every med you gave, every IV you ran.

But... you know what? Back then, it was all about the nursing process and it still is today. Can you assess your patient fully and efficiently, figure out what the patient's problems are? Can you prioritize those problems, and mentally establish goals you want to achieve by the end of your shift? Can you articulate the nursing actions that you'll use to reach those goals? And can you evaluate if they work or don't and adapt your care accordingly.

I believe if my graduating class had stepped into a time warp and exited in the year 2011, we'd do just fine. We were taught to think like professional nurses and take responsibility for our actions. Once we knew how to work the technology, we'd run circles around most nurses today. (I'm sort of biased, so take it for what its worth. :) )

CapeCodMermaid, RN · Aug 22, 2011

I graduated in 1982 ...diploma from a hospital based program. We didn't graduate until we had done EVERYTHING at least three times so when we got to the floor for our first job, we had already done it.

To the poster who complained about Gtube meds with 5 other patients, in LTC we' ve had to do that one at a time thing for years and still take care of 15 or 20 or more people.

IV pumps were just starting to be used when I was in school. The charge nurse walked around muttering "I trust eye ball NOT IVAC"

I had a nurse in a tizz once because the doc said to start the tube feeding right away but we didn't have a pump. The concept of gravity was quite foreign to her.

We will always think we work the hardest and have the most to do. Ask nurses who graduated during the second world war....at least WE don't have to scrub the floors, and sharpen the needles