Spinoff : What We Do, What We Used to Do

[NursingAgainstdaOdds]

The HIV thread reminded me of a thread I've wanted to start here for a while. (Apologies if it's been done!)

I love to hear accounts from experienced nurses about how nursing practice used to be, or how different practices have evolved. For example, an experienced traveller shared with me recently how patients with feeding tubes used to have what everyone else had - just pureed like crazy. (Interestingly to me, she also informed me that there was no such thing as a tube-fed patient with obligatory diarrhea. She felt this was because the patients got "real" food. I thought that was very thought-provoking.)

So, please share. Nursing history of all kinds really fascinates me. I wouldn't restrict this to practice-based issues, either - nurse/patient, nurse/doctor, nurse/nurse relationships have also evolved in fascinating ways. Let's hear it!

Edited to Add : I'm also interested if anyone has experiences which exemplify where certain procedural changes originated - i.e. our vigilance with IVs.

[Spidey's mom, ADN, BSN, RN]

ebear...we STILL mix our IV meds over the weekend..pharmacy is closed!

Pharmacy goes home at about 3:30 p.m. and there is no pharmacy on weekends here either. So, even though our pharmacist tries to have everything pre-mixed .. . there are always exceptions.

steph

[ebear, BSN, RN]

For the life of me, I cannot understand how a hospital pharmacy can just LEAVE at a certain time and not work weekends!! The patients still require meds. 24 hrs/day and do not magically get well just because it's Saturday or Sunday. Once again, it falls back on the nurse, just like everything else! :angryfire

ebear

[Spidey's mom, ADN, BSN, RN]

For the life of me, I cannot understand how a hospital pharmacy can just LEAVE at a certain time and not work weekends!! The patients still require meds. 24 hrs/day and do not magically get well just because it's Saturday or Sunday. Once again, it falls back on the nurse, just like everything else! :angryfire

ebear

I vaguely remember a thread about this in the past.

Small rural hospitals cannot ask their pharmacist to work 24/7/365. We are in a pilot program where we have access to a pharmacist at UC Davis when our pharmacist is gone for the day/weekend - we fax orders and they look them over and ok them or question them. However, we are responsible for getting the meds.

The floor is stocked with most often used drugs and we have narcotics available in a locked cabinet - the pharmacist makes sure we have a ready supply prior to leaving for the day. If we get into trouble - we can call him at home (although he works very hard and we try not to bother him) or call the DON or CEO, who both have keys to the narcs in the locked pharmacy.

The nursing sup has keys to the pharmacy - we can access it after the pharmacist goes home. As I mentioned, premixed stuff is available. But sometimes you have a run on certain things, like Rocephin, and we mix those.

steph

[Spidey's mom, ADN, BSN, RN]

I must have had my oldest children on the cusp of change . . .my first experience was the enema, complete shave, 3 days in the hospital for a normal vag delivery. 2 years later in a different hospital, no enema, no shave, barely 24 hours in the hospital.

The shave was the worst part - growing back . . oh my gosh. :trout:

We've used coffee grounds for odors . . . . not vanilla. And also bowls of vinegar.

We do narc counts every shift.

steph

[ZippyGBR, BSN, RN]

I remember the 3-11 charge telling me it hadn't been too long before I started nursing that morphine injection was mixed by the nurses. A tablet dissolved with sterile water or saline and then drawn up and injected.

i know you guys in leftpondia don't use it , but diamorphine still comes as freeze dried powder,

plenty of injectables still come as powders / freeze dried in rightpondia, most antibiotics, omperazole, ...

glucagon has to come as a paowder IIRC - which makes it THE most fiddly Emergency drug ...

[nightmare, RN]

For those of you who were nurses at a time when gloves weren't required, how was it to make that transition to use gloves? Was the idea to start using gloves reject at first or was it a relief that it was required? Thanks in advance.

I still just one gloved hand for "dirty" jobs.So I have one "clean" hand (ungloved) one "dirty" hand.Try as I may I cannot feel if anything is wet with a glove on and also the fingers of the gloves are way too big and I can't use a spray can (foam for cleaning)it just goes all over the glove! (now that's a new innovation that I do like ,the cleaning foam!) I find wearing latex gloves gives me the creeps and prefer to thoroughly wash my hands,obviously wear them for dressings etc.

[ZippyGBR, BSN, RN]

For the life of me, I cannot understand how a hospital pharmacy can just LEAVE at a certain time and not work weekends!! The patients still require meds. 24 hrs/day and do not magically get well just because it's Saturday or Sunday. Once again, it falls back on the nurse, just like everything else! :angryfire

ebear

it's called stocks on the units and in the emergency cupboard ...

we are a fairly typical hospital i nthe Uk in that pharmacy is 'open' from 0830 to 1730 M-F and Saturday morning, there's often cover ealier and later than that - often he on call pharmacists will stay on site for a few hours in the evening and they nearly always com in on sunday at some point , there's also the 'emergency cupboard' which the Site Nurse / Bed manager has the keys for and we are allowed to move meds between units ( a few exceptions such as large unit doses of morphine / diamorph and injectable potassium)

the ED has a stock of typical Emergency Dept discharge meds (mainly analgesia, antibiotics and stuff like antihistamines)

we also encourage peoel to bring their chronic meds in from home if they are admitted so can use those if in our professional judgement they are suitable to be used (in original packaing and labelled for the patient by hospitla or community pharmacy and otherwise acceptable for use)

[talaxandra]

We do narcotic counts every shift, too, Steph :)

We don't have 24/24 pharmacy service (major metropolitan tertiary hospital), though the department's open every day from 0800. There's a pharmacist on call if need be, but most meds can be sourced through other wards and departments.

I remember the double glass bottles in a wire cage for underwater seal drainage. I also remember 2L glass bottles for wound drains.

And I remember all patients on O2 via mask having 'bubblers' - we went around every morning washing out the humidifiers and refilling them with sterile water. I was told off as a student for leaving a patient on dry oxygen because I didn't get back in time after a neb. Then someone discovered any number of nasty bugs growing in the humidifier bottles and overnight - dry O2 for almost everyone!

There's a thread on rapid response codes (https://allnurses.com/forums/f8/rapid-response-team-decrease-codes-264066.html) that reminded me of the frustration of deteriorating patients before we had Medical Emergency Team calls.

My favourite thing? When my mother trained there weren't any sealed drainage systems - what few IDCs they had drained into an open container. Ew! There were a lot more UTIs.

[Medic04]

That's interesting about the sharps in the gurney thing. My second day as a new grad RN I got a needlestick because someone had defeated the safety on a needle, used it to draw blood, and then stuck it in the isolette mattress and apparently forgot to throw it out. . :uhoh21:

I am sorry to hear that, but this was before the days of safety needles even in the early to late 90s. I still got some old IV cannulas I had in a jump bag here at home.

UGH, I have been stuck bu patient pockets more then my own.

[Medic04]

I have also enjoyed this trip down Memory Lane! I had completely forgotten so much of this stuff! Especially stripping glass IV bottles! hahahaha!!!! ...and sticking sharps into mattresses!!

Do y'all remember when patients were admitted on the day before surgery?

ebear

SURE DO!:monkeydance:

[elizabells, BSN, RN]

I am sorry to hear that, but this was before the days of safety needles even in the early to late 90s. I still got some old IV cannulas I had in a jump bag here at home.

UGH, I have been stuck bu patient pockets more then my own.

Well, if the person who left the needle was the person I think it was, they were definitely nursing back before safety needles. A few people on my unit, when they're having trouble getting blood, will snap the needle off a syringe needle and insert it with a Kelly and let the blood drip back into a microtainer. Weird things happen in the NICU. Our filter needles still don't have safeties on them.

[JustMe]

You know what? I'll bet if the crap ever hits the fan and we don't have all the luxuries, an experienced nurse who could actually take care of a patient with nothing to rely on (as far as equipment) will be a valuable commodity. Years ago, a good nurse could actually tell what was going on with a patient with only observation skills and NO MONITORS!

This is EXACTLY what I try to teach my RN students! As nurses our powers of observation are phenomenal and we need to improve, expand and rely on them. I had a student come to me (an LVN who worked in a dialysis clinic) who was worried that his patient's BP was 90. I asked him what the pt was doing. The pt is sitting up in a chair eating breakfast. I asked the student "Is the pt warm, pink, dry and alert?" Of course the answer is yes. So I told him that I know you want to run in there and give the poor guy a liter of IV fluid and he said YES! I shook my head and told him to think about it. Treat the patient--not the equipment! Learn to trust your instincts. Sometimes I think pts would do better without all the intervention we put them through.