Specializes in Med Surg, ICU, Infection, Home Health, and LTC.
Nurses not being able to chart or say anything that could be seen as a medical diagnoses. So you used words like "seems" or "appears" as in "pt seems to have ceased respiration..." meaning death, but since only doctors could declare a demise you had to wait for him or her to make that determination first.â€
DoGoodThenGo, your entry reminds me of a conversation I had with a doctor in one of my early years of nursing. I had to call a rather difficult doctor who had little regard for nurses and didn't respect women in general I don't think. The patient had died and I called to let him know so he could come pronounce the patient and speak with the family.
He popped off at me asking Will are you sure they're dead? I don't want to drive all the way over there and then find them just taking a nap.†He hit me in a rare blunt mouthed mood and I said Well they have no pulse, no blood pressure, and they aren't breathing and that looks pretty dead to me unless you know something I don't.†He slammed the phone down hanging up on me which is how he usually ended any phone calls we nurses made.
I love this thread and with so much grump in the news it is a breath of fresh air.
An atmosphere of pride and satisfaction in care given; daily morning bed baths using soap, water, and washcloths, and bed linen changes
***First, no offense is offered or intended to any RN here, past, present or future. I love nurses, no matter their titles. Second, this is exactly what happened and when.
I have a combination of spinal conditions, among them being spondylolisthesis, spinal stenosis, chronic sciatica, facet disease at four levels bilaterally, DDD, constant production of bone spurs and scar tissue, all between L3,4,5 & S1. The second and last surgical procedure I had for this in 1999 involved further removal of scar tissue and bone spurs, five years following the first surgery which was an extensive laminectomy and foraminotomy to free up several nerves to treat sciatic pain all the way down into both feet, foot drop on the right, and numb toes on both feet; and additional work involving harvest of bone from my illiac crest, a fusion of L-4,5,-S1 with that bone, and rods and screws. It took place at my local County Hospital, which is a high quality institution, running "neck and neck" quality wise with the largest hospitals in the nearest city, and ahead in several categories. My surgeon agreed to do it there, because he does other procedures there, and is familiar with staff, and likewise they with him. I wanted it done there because it's 10 minutes from home, next door to his group practice office location, and isn't 45+ minutes away, like all the other hospitals in the next largest city.
I was in the hospital for five full days following surgery, and was in a large, beautiful private room. The absolute best nursing care I ever had, before then or since, was from the LPN assigned to my care. Nobody was doing 12 hour shifts then, everyone still did eights. So, continuity of care was better. I could count on every morning immediately after breakfast, Nancy came in the room carrying several clean bath towels, washcloths, and went in the bathroom to get my bath basin, warm water, soap, lotion, toothbrush and toothpaste, and the clean TED hose that were dry from being handwashed the previous morning. I got a complete, warm water and soap bed bath, top to toes, which I did as much as possible, which was damn little at first. I got my legs lotioned, clean TEDs on, the ones that were removed got washed in the bathroom sink and hung to dry before the next day's bath. My teeth brushed, hair brushed, dressing checked, and my bed got changed right after that, made up nice and tight, just like I like it. And each day, I was encouraged to do more and more. She had a way about her that was both nurturing and calming, as well as encouraging, and never made you feel like she was being bothered by anything you requested. She made sure I had everything I needed before she left each morning to attend her other patients, and every day throughout her shift, I got looked in on, even between my q4h "turn and baste." She kept my ice water pitcher full of crushed ice and cold water, which I crave for some reason while stuck in a hospital bed, and it was probably the best care I ever got anywhere at anytime, for anything! I offered to bring her home with me the day I went home, but I knew I could never meet her salary!
My husband ran into her in the grocery store several times, and she always remembered us, and asked about me by name. I saw her myself several times, months later, and she always knew me. I never got bad care from anyone there, but Nancy was the one who stuck with me. Even 17 years later.
Physical Therapy followed right after I got my morning pain meds, right after my bath. Doc said he didn't like pain pumps because he said having to call for pain meds "encouraged" the nurses to look in on you more often. I didn't happen to agree with that, having been involved in health care for a long time , but I wasn't given any options in the matter. Plus, one of his orders was that I be "turned and basted" (my term here, not his) q4h. So, that was my pain med schedule too. I got my shot, got turned and repositioned by at least three or four staff members. Physical Therapy was excellent, and I left with a walker after five days. The diet I can't comment on because when you're stuck on a "strained liquid" diet, it's hard to judge! There's nothing about strained cream of celery soup, Jell-O, and the like that deserves comment! I don't even know why I got stuck on it, unless it was to keep me out of the bathroom and in the bed the whole time, because that's what happened! I had a catheter too, so that was another one of the nursing duties. I kept it full, and they kept it emptied!
*** NOT coding patients who were terminally ill, families were not consulted about this***
***Saw many instances just from my years working in Surgery, not even from any experience with direct floor nursing, where changing that policy, other than perhaps from an informational/educational standpoint, was not in the patient's best interest. Just because a technology exists, does not make it the best option for every single patient. "Cookie cutter medicine" is not thoughtful, or appropriate care for anyone.
My husband and I, and our two grown children are aware of our wishes in that respect.
***First, no offense is offered or intended to any RN here, past, present or future. I love nurses, no matter their titles. Second, this is exactly what happened and when.
I have a combination of spinal conditions, among them being spondylolisthesis, spinal stenosis, chronic sciatica, facet disease at four levels bilaterally, DDD, constant production of bone spurs and scar tissue, all between L3,4,5 & S1. The second and last surgical procedure I had for this in 1999 involved further removal of scar tissue and bone spurs, five years following the first surgery which was an extensive laminectomy and foraminotomy to free up several nerves to treat sciatic pain all the way down into both feet, foot drop on the right, and numb toes on both feet; and additional work involving harvest of bone from my illiac crest, a fusion of L-4,5,-S1 with that bone, and rods and screws. It took place at my local County Hospital, which is a high quality institution, running "neck and neck" quality wise with the largest hospitals in the nearest city, and ahead in several categories. My surgeon agreed to do it there, because he does other procedures there, and is familiar with staff, and likewise they with him. I wanted it done there because it's 10 minutes from home, next door to his group practice office location, and isn't 45+ minutes away, like all the other hospitals in the next largest city.
I was in the hospital for five full days following surgery, and was in a large, beautiful private room. The absolute best nursing care I ever had, before then or since, was from the LPN assigned to my care. Nobody was doing 12 hour shifts then, everyone still did eights. So, continuity of care was better. I could count on every morning immediately after breakfast, Nancy came in the room carrying several clean bath towels, washcloths, and went in the bathroom to get my bath basin, warm water, soap, lotion, toothbrush and toothpaste, and the clean TED hose that were dry from being handwashed the previous morning. I got a complete, warm water and soap bed bath, top to toes, which I did as much as possible, which was damn little at first. I got my legs lotioned, clean TEDs on, the ones that were removed got washed in the bathroom sink and hung to dry before the next day's bath. My teeth brushed, hair brushed, dressing checked, and my bed got changed right after that, made up nice and tight, just like I like it. And each day, I was encouraged to do more and more. She had a way about her that was both nurturing and calming, as well as encouraging, and never made you feel like she was being bothered by anything you requested. She made sure I had everything I needed before she left each morning to attend her other patients, and every day throughout her shift, I got looked in on, even between my q4h "turn and baste." She kept my ice water pitcher full of crushed ice and cold water, which I crave for some reason while stuck in a hospital bed, and it was probably the best care I ever got anywhere at anytime, for anything! I offered to bring her home with me the day I went home, but I knew I could never meet her salary!
My husband ran into her in the grocery store several times, and she always remembered us, and asked about me by name. I saw her myself several times, months later, and she always knew me. I never got bad care from anyone there, but Nancy was the one who stuck with me. Even 17 years later.
Physical Therapy followed right after I got my morning pain meds, right after my bath. Doc said he didn't like pain pumps because he said having to call for pain meds "encouraged" the nurses to look in on you more often. I didn't happen to agree with that, having been involved in health care for a long time , but I wasn't given any options in the matter. Plus, one of his orders was that I be "turned and basted" (my term here, not his) q4h. So, that was my pain med schedule too. I got my shot, got turned and repositioned by at least three or four staff members. Physical Therapy was excellent, and I left with a walker after five days. The diet I can't comment on because when you're stuck on a "strained liquid" diet, it's hard to judge! There's nothing about strained cream of celery soup, Jell-O, and the like that deserves comment! I don't even know why I got stuck on it, unless it was to keep me out of the bathroom and in the bed the whole time, because that's what happened! I had a catheter too, so that was another one of the nursing duties. I kept it full, and they kept it emptied!
Yep! Those were the "old" days. Now, patients are much more acutely I'll, on several very important medications, the Charting is VERY detailed and many more steps involved with pain and other types ofmedication administration.
I miss the days when able to spend more time comforting, reassuring, and simply caring for patient's ordinary needs.
I love this thread. We had big, thick paper charts at my hospital up until last month! I was sad to see them go, I was the go-to girl on my unit for reading awful handwriting.
Where I work, we do still give beer to alcoholic patients to keep DTs at bay. Lukewarm Milwaukee's Best, hand delivered by the pharmacy techs. Blech.
Aside from the apothecary system and conversions (which also has largely gone by the wayside), probably one of the biggest mine fields for nursing students in past was volume/time IV drop rates. Saw grown women break down into tears after getting back test results with an "F" that meant failure of the course (ours was a half semester "Pass or Fail"). This of course meant your nursing education came to a halt as you couldn't go into Med/Surg II without passing med dose calc.
You can do it in either one or two steps but either way it requires no more math skills than low level algebra and probably is the most difficult as things get for "nursing math".
Math education in the USA has been declining for decades and that may be the sticking post (as Carmine Lupertazzi, Jr. would say). Everything one needs to know is written in the med order, the rest is simply setting things up and plugging in the numbers. You'd think with the advent and acceptance of calculators (my COB program forbade them, but that was decades ago)
You've got an order for 1000mL to be infused over 8 hours, the IV set is 15gtts/mL. Pick your method, set it up and go.
Things get (just) slightly more complicated when dealing with continuous infusion rates where you are infusing something that comes as mg or mcg in a solution measured in cubic centimeters.
This brings up another point; recall reading several years ago that the federal government (IIRC) did a study regarding nurses and the preparation of reconstituted meds. Several hospitals were included in the study and a large number if not majority of nurses made substantial if not serious errors in their calculations. Upshot was the recommendation that such meds be prepared by the pharmacy... Now that is just sad.
It took the work of Florence Nightingale and others to get nurses preparing the medications they would administer. Indeed the old school model taught that a professional nurse should never administer anything she (or he) did not prepare themselves.
Unit dosage, Pyxis and the rest are wonderful inventions and so forth; but one must never lose sight of the fact responsibility for medication administered still rests mostly on the one who gives. Computers, calculators, phones and the lot are all useful tools, but they can only give answers based upon what is input; garbage in still will get you garbage out. Worse over reliance upon devices can result in nurses losing (or not even developing) the knowledge/skills that comes from being intimately familiar with nursing math.
Am sure many remember the rash of infant deaths/adverse reactions not that long ago due to med errors involving heparin.
I'm a newer nurse (second career - started late) and I had to learn drip rates -we also had a very high standard for our med calc exams - you had to score 100% to move on.
I always stressed out (even though I have fairly strong math skills) and figured I wouldn't use it much. Oh how wrong I was.
I have frequently had to mix my own medications in emergent situations - setting up a stat amiodarone drip comes to mind, also a lidocaine drip on several occasions. The pharmacy can take a LONG time when the surgeon is breathing down your neck and the patient is tanking.
I felt I did my part to help pass on these skills when I showed a brand new nurse how to hang albumin to gravity and calculate a drip rate. Her school had never covered that at all. (Couldn't just run it in on this particular patient).
I've really, really enjoyed this thread! Thanks to everyone who has shared. My mother was a recovery room/PACU nurse in the 70s. I remember her bringing me to work with her on occasion and me playing in the ward. I remember seeing her change the dressing on a fresh BKA and the smell of formaldehyde- which is now somewhat nostalgic for me (carcinogenic though it is!)
I remember all the surgeons coming to talk to me about my horses while I did homework, and then taking me on "rounds". :)
This old bat graduated from a Diploma school in, hold on now, 1967!! I love all these posts and it's been a walk down memory lane!
Back in the day if a spouse said "Don't tell my wife/husband she has cancer because it will upset her" we didn't tell!
But I loved nursing then and I love it now. I'm still working and while I've survived all the changes over these almost 50 years the one I don't like most is the computer charting because all the info is "out there" in cyberspace whereas on paper it was right in front of me and it was easier to spot trends. Also it takes 15 mins to chart on 5 mins of care!
But thanks for the memories to all the other old bats out there! I hope you young' in's get to be old bats one day!
I'm still working and while I've survived all the changes over these almost 50 years the one I don't like most is the computer charting because all the info is "out there" in cyberspace whereas on paper it was right in front of me and it was easier to spot trends. Also it takes 15 mins to chart on 5 mins of care!
I'm right there with you on the computer charting issues.
Second, this is exactly what happened and when. 
having been involved in health care for a long time 
, but I wasn't given any options in the matter. Plus, one of his orders was that I be "turned and basted" (my term here, not his) q4h. So, that was my pain med schedule too. I got my shot, got turned and repositioned by at least three or four staff members. Physical Therapy was excellent, and I left with a walker after five days. The diet I can't comment on because when you're stuck on a "strained liquid" diet, it's hard to judge! There's nothing about strained cream of celery soup, Jell-O, and the like that deserves comment! I don't even know why I got stuck on it, unless it was to keep me out of the bathroom and in the bed the whole time, because that's what happened! I had a catheter too, so that was another one of the nursing duties. I kept it full, and they kept it emptied!
Cheyenne RN,BSHS
285 Posts
Nurses not being able to chart or say anything that could be seen as a medical diagnoses. So you used words like "seems" or "appears" as in "pt seems to have ceased respiration..." meaning death, but since only doctors could declare a demise you had to wait for him or her to make that determination first.â€
DoGoodThenGo, your entry reminds me of a conversation I had with a doctor in one of my early years of nursing. I had to call a rather difficult doctor who had little regard for nurses and didn't respect women in general I don't think. The patient had died and I called to let him know so he could come pronounce the patient and speak with the family.
He popped off at me asking Will are you sure they're dead? I don't want to drive all the way over there and then find them just taking a nap.†He hit me in a rare blunt mouthed mood and I said Well they have no pulse, no blood pressure, and they aren't breathing and that looks pretty dead to me unless you know something I don't.†He slammed the phone down hanging up on me which is how he usually ended any phone calls we nurses made.
I love this thread and with so much grump in the news it is a breath of fresh air.