Ruby Vee

I've been wearing clogs since I was a teen — Bastad wooden clogs until 1997, then Danskos. At one point, I had 30-some pairs of Danskos (I lived hear the Dansko outlet.) I'm 70 now, retired for the second time, and I've noticed that after all these years, my ankles are rolling in Danskos. My PT recommended I ditch them. That's breaking my heart! If I cannot wear Danskos, what's an old-lady safe alternative that is equally cute and comfortable? HELP!

Yeah, me too. It's not the same place anymore. I'm glad to see it's veering away from the "all the older nurses are bullies who just hate me because I'm young and beautiful" malarky though.

Ya know what? Young'uns don't get to decide whether or not I can call myself a COB. I'm a Crusty Old Bat!

And there are some who cannot take any feedback that isn't a glowing endorsement of their wonderfulness.

Yes, and the new young nurses were thought they were being bullied believed it was because the older nurses were jealous of their youth and beauty. (That was a hilarious thread.) Then there was the thread from the new nurse who was sure she was being bullied because the preceptor didn't invite her to lunch. Or walk her out to her car. Or, my personal favorite, greet her first on her way in from the garage. As it turns out, the Crusty Old Bat who failed to say hello first had a habit of driving to work wearing her glasses, leaving them in the car and putting in her contacts when she got to the unit. She didn't recognize the newbie and the newbie didn't say hello to her, which might have alerted her to look a little closer and say hello back. There was the nurse who started out in the Cardiac Surgery Intensive Care Unit and six months in, couldn't identify the "yellow thing sticking out of his neck.” (Something that should have been learned by the end of her first shift with a patient.) She was sure she was being bullied when she was put back on probation and placed with a 1:1 preceptor again. (The preceptors all thought she should have been fired, especially when, another month in, she still didn't understand the "yellow thing sticking out of his neck.”) I like the "seagulled" thing.

Crusty Old Bat here: I'm the only person in my unit who has ever worked with paper charts except for that one time there was an IT Oops and Epic was down for most of our shift. The newer folks were utterly lost. Even though I worked with paper charts for decades, I wouldn't want to go back. Short of an apocalypse, I don't know why anyone would want to go back. 1. When new notes, orders are added to a chart, how were you made aware? New orders were "flagged" by folding the page over. Nurses weren't "expected to" read physician notes, so they weren't flagged. The house staff who had rounded with the attendings knew what the attendings were thinking, planning or wanted done and the nurses were expected to find out when the house staff wrote orders (or, in the ICU, informed them face to face). I preferred to read them for myself, so I looked every time I spotted attendings on the unit, had new orders or had a chance to look. 2. were RN orders ( or RN tasks) placed on the blank Dr order sheet or was there another location for RN orders such as vitals, wound care etc? All orders were placed on the same order sheet, and sometimes you'd have six lines of pharmacy or RT orders, one RN order another six lines of something else. So you had to pay attention. Orders are orders. 3. How were active meds kept track of? In the paper MAR? The ones Ives seen only have 3 days worth of dat, so did that have to be transcribed again and again? Paper MARS — one day's worth for the ICU, and the night shift was responsible for copying the active orders onto a new MAR. Stepdown had three days worth of meds, and again, night shift copied the new orders over. The floor had 7 days, and rhab had 30 days. Some rehab units started a 30 day sheet on the first of the month, so that you had all of January 1977 on one sheet, February on the next, etc. 4 when a Dr placed orders, how were you alerted to review or check the chart? ESP. Seriously, if you saw an attending on the unit, you checked your orders. Or the unit clerk would page you to the desk for new orders. If you were expecting new orders, you swung by the desk to check again and again until you found them. Or ESP. 5. If an order was for an ancillary dept, who's job was it to let them know? The Unit Clerk/secretary would schedule it, if you had a good unit clerk. If you didn't have a one or they weren't a good one, it fell to the RN. In truth, everything fell to the RN. If something fell through the cracks, it was always the RN's fault. I've seen RNs fired for "failure to supervise.” Back in the day, you picked up the phone and called the ancillary department — a LOT. When you changed jobs, you carried a little notebook or card in your pocket with the most frequently called numbers for that unit. I knew the Blood Bank, pharmacy, radiology, the OR and the three cardiology practices by heart, and could call the operator and ask to be transferred to any place I didn't know the number for. As much as I dreaded Epic — to the point of changing jobs and moving cross country two weeks before they were scheduled to go live in my ICU — I would not want to go back to paper charts. In a teaching hospital, the house staff would hog the charts and then be upset because the q 15 min vital signs weren't charted after they'd taken the chart off the unit for an hour. I've seen attendings come to actual blows because one service had the paper chart when the other service was rounding. (Usually cardiac surgery was one of the combatants. Anesthesia was a frequent offender, and pulmonology was another. Cardiology would just ask me whatever they wanted to know if another service had the chart, including things like "What does renal want to do?” and "did they (primary service) write for a neuro consult?" Someone transcribed the MAR incorrectly and the patient got three days of the wrong medication/dose/route/whatever. Someone's handwriting was illegible or they used the wrong abbreviation and the nurse or unit clerk who transcribed the order transcribed what they actually wrote rather than what they meant. I could go on forever, but I doubt anyone wants to read that.

What happened to COB? (Crusty old Bat?). I prefer Crusty Old Bat — I *chose* that.

What's an "OG Nurse?"

For your first nursing job, choose a manager, not a specialty. Take the job where the manager is is interested in and supportive of new grads, where the orientation program is structured with a consistent preceptor or pair of preceptors, where there are plenty of learning opportunities, and where you will learn good habits and be socialized into the job. After your first year or two, you will learn how much structure you like in your day, what patient population you most enjoy working with or what organ system fascinates you and you can choose a specialty from there. My advice — MedSurg is a great place to learn, and a flexible foundation that you can take anywhere.

My advice would be to pick the one with the best manager, the best orientation program and the most support for new nurses. You'll want to get a good foundation in the basics. You'll *need* to get a good foundation in the basics, to be socialized to the nursing world, to learn to do a fast, focused assessment and to learn those "skills" we all talk about in a timely and efficient manner. Much as I want to say to choose ICU (because I've loved ICU since 1983), I don't think it's as important which specialty you choose as it is to choose a supportive place to work where you'll learn good habits, have coworkers who you can trust to have your back and the most learning opportunities.

In my 40+ years of nursing, I've been threatened with guns, knives, a machete, scissors, a "police dog," and one guy threatened to "cut off your tits" with a plastic knife. I've been spat on, deliberately barfed on and pooped on, punched, slapped, kicked and tackled. One HIV+ patient (back in the day when no one wanted to take care of HIV+ patients) chewed a hole in his art line tubing and stood at the nurses station, aiming the spurting blood at everyone. (The physician said, "Don't approach him, but order up a few units of blood. When he passes out, we'll transfuse him.") Back when Hickmans were a new thing, an addict with a Hickman for prolonged antibiotic therapy got the bright idea to go home with the Hickman in place. When I followed him onto the elevator, trying to explain why that was a bad idea, he grabbed me by the upper arms, lifted me a few feet and slammed me into the side of the elevator. "You gonna stop me?" he demanded. Two armed agents of a federal alphabet agency (whom I mistook for drug dealers based on their obvious weapons stuffed in their pants, dress and demeanor) threatened to "mess up" the nurse practitioner, and if I didn't produce her immediately, they'd mess me up. When the police became involved, they produced their law enforcement identification. It didn't end there, and it didn't end pretty. An inmate of a federal penitentiary became a long term patient with multi-system organ failure. We wanted to withdraw care, but the penitentiary objected on the basis that we'd be "shortening his life sentence." But they would allow his son to visit. The son was also an inmate with a life sentence and came with his own escort of corrections officers. I had my back to the door trying to unclog the patient's feeding tube when without any warning, one of the corrections officers tackled me. As I lay face down on the floor with the corrections officer on top of me, I saw a machete lying on the floor where I'd been an instant before. It seems the son had no qualms about shortening Dad's life sentence. While the greatest danger comes from patients, family members and rival gang members (I lived and worked in large, inner city teaching hospitals) there was that respiratory therapist who got angry and sat outside the hospital taking potshots with his 9mm at colleagues leaving the parking garage. There was the custodian who stalked and harassed me. There were physicians who got handsy with me, including the one who tugged so hard on my skirt that he pulled it right off me. At the nurse's station, in full view of patients, visitors, and everyone else. There were physicians punching physicians and other nurses, and one memorable chap who was swinging a metal patient chart at another physician who accidentally hit a nurse on the backswing. (He said, "I wasn't trying to hit you, I was trying to hit HIM." As if that excused it.) I once saw a surgeon (who disagreed with the anesthesiologist's method of shooting a cardiac output) burst out of the OR I was passing with his hands around the anesthesiologist's throat, and when I was on orientation in my second job, a neurologist chased me and my preceptor down the hall drying to throw a (full) bedpan at us. Fortunately, he wasn't as young or agile as we were. He was evidently a "world famous neurologist," and was upset because I didn't know who he was. It used to be that physicians were the biggest hazard to our safety, but they've been required to attend anger management classes in the last few decades. Now the danger is from patients and visitors. They've gotten much worse.

Scrubs I don't know about -- my employers have mandated where we must order our scrubs from, what style and color we can wear, etc. Good luck if you have an employer like that . . . they are never the most flattering or comfortable. As far as shoes, buy whatever is most comfortable on *your* feet, your legs and your back. I wore Danskos for years -- there is something to be said for stainless steel arch supports. In my old age, however, bunions and hammer toes have made the Danskos less comfortable. I went to a running store and had my feet X-rayed and analyzed and followed the store's recommendations for shoes. My Brooks Ghost shoes are very comfortable, and I don't have leg or back pain when I wear them. My best friend has a different brand, and she loves hers, too. I have colleagues that wear nothing but Birkenstocks, but they don't have enough cushioning for the concrete floors of the hospital -- not for me anyway. As far as shoes go, be prepared to spend some real money for shoes, because it's worth it. And when you buy shoes, get two pair and rotate them. It takes more than 24 hours for the innards of the shoe to recover from you walking around in them all day, so if you rotate, both pairs last longer.

Do you come off as an unreliable employee? Probably. One of the beauties of nursing is that you can schedule your movers to come on a weekday (it's cheaper!), request a day off weeks in advance, or trade shifts with a colleague. Plan your move ahead of time. If you're good about returning favors, you'll almost find someone willing to trade.

And I would think they'd be less sensitized to it than us crusty old bats who fought for the ERA . . . remember that? Newer nurses today will often preface a statement by saying, "I'm not a feminist." If you're not a feminist, maybe you just aren't seeing all those bright red patriarchal flags. And now this thread will be about Full Glass and her disrespect rather than about sexism in health care. That's too bad, because it might have been an interesting discussion. I am a feminist and so is my former colleague, Mathew who is an NP (one of those worthier souls who was an excellent nurse before he went on to his NP Program). It was Mathew who pointed out to my NP colleagues that when the attending came around to round on our patients with him, they sat down with him and chatted for a moment or a few and THEN got up and walked around the unit. They *listened* to him, and to the bedside nurse because Mathew made a point of introducing the bedside nurse by name and asking a question about the patient's status. When the attending came to round with the female NPs, they were expected to stand up the moment they noticed his presence, and if they didn't immediately do so, he'd say something like, "Come walk with me." Bedside nurses weren't supposed to speak unless spoken to.

I think we understood exactly what you meant. "Be quiet; you're just a nurse. And an old one at that."

I distinctly felt that vibe. Thanks for saying it.

I have never been an NP, but I've been an RN since the late 70s. I have experienced a LOT of sexism in nursing. One would think it would have gotten better over the decades, and it has, to some extent. (No one has grabbed my boobs, yanked my skirt off, or come up behind me and put his hands on me -- and that was just the MDs -- in this century, allthough that might also be because I'm older now, and not young and cute.) There was the assumption that the nurses (female nurses) would babysit the male physicians' children when they brought their kids in on the weekends. Like I had nothing better to do than prevent your kid from damaging equipment or themselves. Swinging on the Hoyer Lift was always a thing. There was the talking down to us, the assumption that we didn't know what was going on with our patients or in our own lives, and the assumption that any male in the room -- including the student we were precepting -- knew more about anything than we did. There was the expectation that we offer our chairs when the MD showed up, and fetch coffee and an ash tray. And then there was the wage gap -- and don't try to tell me it's because "men work more overtime" or "men take more challenging jobs." I was married to two male RNs, and I saw the pay stubs. In union hospitals, too. My friend the nurse manager says, "there's always a way to find a little extra pay for someone if you want to," and she admits she was encouraged by administration to find a little extra for every nurse with a penis. I could go on and on, but I've put off getting a new phone for so long that this one holds a charge for an hour, so I'm off to the store.

At my last job, management (our nurse manager) made rounds in the morning at 10am with her boss and her boss's boss. The patient was scrutinized for things like central line dressing integrity, date, time and initials on every dressing, every IV line, every IV bag or tube feeding bag, neatness of the room . . . just about everything. If you had forgotten to change a dressing, or forgotten to change your IV tubing (every 8 hours on some drips) or hadn't dated, timed or initialed it properly, a incident report had to be filled out immediately and turned in before the manager left the floor. Some of our patients had 12 drips, two or three central lines, arterial lines, surgical sites, etc. A LOT of incident reports were initiated on those management rounds. My point is, the day shift nurses may not have a lot of choice about when to "report" something. One night I had a patient with a dozen drips, two arterial lines and two central lines and a few surgical site dressings. Because it was my birthday after midnight, when I made up all my date/time stickers before I even started changing the lines, I dated everything with my birth date (month, date and year of my birth in the last century) rather than the actual date. The month and day were right, but the year was WAY off. I got written up for that. My manager said, "I know you changed all your lines and dressings, and everything looked pristine. But my boss was horrified at the date, so I had to write it up."

I disagree. I think it was a nice thing to do -- she had to report the infiltration. It was nice to give the coworker a head's up rather than letting management blindside her.

Years ago, when I was a floor nurse in a famous New England teaching hospital, I was asked to float to CCU to do charge. I was told there were some "really good travelers and floats" on shift, but they needed a nurse who was permanent staff from the facility to do charge. I was a relatively new nurse -- two years of experience in a different state, and recently referred to an oncologist for biopsies, so I was scared to death of losing my job and my health insurance. I said I wasn't qualified to work CCU, and I wouldn't do it. The supervisor told me refusing and assignment was grounds for being placed on unpaid administrative leave or being fired. "I'd rather lose my job than my license," I said. And stood there quaking, awaiting her response. She wrote me up, but didn't put me on unpaid leave or fire me. Doing the right thing sometimes has negative consequences. It is still the right thing.

At least it wasn't an infusion of chemotherapy. I did that once, back in 1980 when working on a heme/oncology floor before I went into ICU. I did get talked to by management, written up and got some extra education by the IV therapy team. (That was a good thing -- it really improved my IV skills. If they want to "punish" you that way, let them.) The IV infiltrated, there were consequences for the patient. He asked to see me the next day and I was scared to death -- he was a lawyer, I thought he would sue me. Turns out that what he actually said was nurses are human, and humans make mistakes. It could have been worse, and he hoped I would be able to stop beating myself up and forgive myself. I have (mostly). The thing is, we all make mistakes. I've made some big ones. I've caught a few big ones, too. I've had a lot of orientees over four decades, and they've ALL made mistakes. They've also learned from those mistakes, as I'm sure you have too. Somewhere on this site is a thread about the worst mistakes we've ever made, and I've contributed a few. What matters the most is what you do AFTER you make the mistake. (I've written an article about that on this site, too. Please excuse my Boomer Brain for not knowing how to post the link, and lacking sufficient interest to try to figure it out. I have a dog to walk right now.

I've never been regarded as the nicest nurse on staff, but as a Crusty Old Bat with over 40 years of critical care experience, my advice is this: People who fire you generally are just angry and trying to flex. I've been fired many times, and it is nearly always something for which to be grateful. Angry people more concerned about their "rights" than their health are not pleasant to take care of -- you dodged that bullet. Frequently fliers are not generally pleasant to take care of (although I've had some frequent fliers I enjoy taking care of and believe it or not, some of them ask for me on admission). You dodged that bullet, too. It may have/probably has nothing to do with you. I've been fired for being fat, for being white, for being blonde, for being young, for being old, for being the float nurse, and because I wouldn't give out my phone number. (That was in 1980-something. I don't get asked for my phone number any more.) The nurse who *doesn't* get fired is probably not doing their job safely. People will fire you just because they don't like the word "no." "No" is a valid response to a patient request/demand -- but make sure you explain the rationale. As suggested before, plan how you're going to toilet the patient before you give the furosemide. Get them to agree. If they won't agree, a conversation with a male usually helps -- male nurse, male doctor, male respiratory therapist. One time a male secretary got the patient to agree to stop asking for water while she was NPO. I dunno why that works -- probably patriarchy. If you're going to get the patient up to the commode against policy, having a doctor's order for it will probably save your butt. It's usually worked for me, but your milage may vary. Talk to you manager about it at your first opportunity. Heck, text her and let her know. Either way, get the doctor to talk to the patient. (Or the male medical student.) Don't ever tell the patient. you've talked to the doctor when you haven't. All you need is for that doctor to drop in unexpectedly and look puzzled when she demands to know why he won't let her get up. And again, so you hear this. Getting fired is a milestone, a badge of honor and usually a boon. Patients who fire staff aren't easy or pleasant to take care of.

I was responding to the post I quoted. The person implied that caring for two critically ill ICU patients was less work or less stressful or less something than caring for 6 floor patients. I don't think she has an idea what kind of patients we routinely take care of in ICU. I don't think I'm the only one who has ever taken care of critically ill patients, but I am probably one of the few who has done so for over 40 years. I have also taken care of floor patients -- 1:5 ratio, 1:10 or 1:15 and everything in between. I get it. I get the difference between caring for 1-2 ICU patients and 5-6 floor patients, and I get that they require very different priorities, skill sets and planning/organization. My point was that the poster said we ICU nurses shouldn't judge floor nurses and assume that they've missed something. Floor nurses shouldn't judge ICU nurses and assume that because of our ratios, we should never miss something clinically either. We should not be judging each other; we all work together. Evidently I didn't make that point very well.

I am a proud founding member of the "Crusty Old Bat" Society that was once (and may still be) active on Allnurses.com. It may have originally been a derogatory term, but it is now a badge of honor and pride.

"Quick to judge" anyone? Have you ever *tried* taking care of two critically ill ICU patients? Honestly, I had more downtime taking care of 15 floor patients. As an ICU nurse, when a sick patient is transferred into the unit, my first and biggest concern is the patient. I try to be as kind as possible to the transferring nurse, but the patient comes first and if you're meandering through a lengthy "report" about how much he ate for breakfast last week rather than a short, focused report about what's happening now, I may be abrupt. Even if your report is perfectly adequate and the patient suddenly coughs out his ET tube, goes into V-tach or V-fib or begins to flail around like a hooked trout, I may turn away from you to deal with the patient. We can all learn from one another, support one another and put the patient first.