Was it easier to practice as a nurse back in the day?

[guest1143647]

All of my nurse managers are nurses that had their licenses since the 70’s and 80’s. All are in different settings. One said she is counting down her days to retirement. She stated that home care visits were  so much easier to work before the government stepped in and demanded all of this paperwork.  Another manager said similar, that it’s the paperwork driving nurses away. 

[Davey Do]

Yes.

The downhill spiral began with the advent of DRGs (Diagnostic Related Groups) back in the '80's. Once insurance companies began calling the shots, excessive paperwork and jumping through hoops became the norm.

If I understand conceptually what occurred, it began with Medicare & Medicaid. Basically, the government said, "We will pay you, the provider, only x amount for any specific medical condition, and you must prove everything by this boatload of paperwork.

Private Insurers said, "Hey! If the government can do it, so can we!" and the situation snowballed.

I worked at a township hospital for the first seven years of my career back in the 80's, and unbeknownst to me, it was bliss. Then I went to work for a state hospital and the paperwork grew exponentially. I worked HH in the early 90's and the paperwork was voluminous, but understandably so.

I think it was @SmilingBluEyes who said things hit rock bottom in the early 'aughts. I had just started at Wrongway about that time and thought it was just that facility, but it seems SBE believes it was everywhere.

Long post, but we old nurses love to reminiscence.

[Guest 1152923]

     Yes and No.  'In the day', morbid obesity wasn't commonplace, as it is today, hospital patients were generally reasonable in their expectations (and not "sue happy"), staffing wasn't at critical levels, and a hyper-regulatory atmosphere didn't exist.  That said, many physicians, especially surgeons, had full license to be complete tyrants with abusive, derogatory, sexist, hateful comments and child-like behavior, knowing full well that they faced no censure from senior management or legal repercussions.

[RNperdiem, RN]

Like lots of things it is a mixed bag.

There is a whole lot more charting. It seems like every move a nurse makes needs to be backed up by some sort of documentation. 

Some things that I like about being a nurse today compared to the old days:

1. Rapid response teams. Before those, a nurse struggled on and hoped the patient didn't code until ICU could be arranged.

2. Computerized IV pumps. Old style pumps strictly did mL/hr. The nurse had to do lots more calculating with every drug titration. Computerized pumps are great with, especially in emergency situations.

3. More relaxed dress code. No more keeping white shoes and uniforms in top shape.

4. Electronic Health records: no more handwritten MARs, no more trying to decipher doctor handwriting. All orders are compiled and up-to-date. 

5. Better wound care. In the old days our weapons of choice were gauze, saline and tape. So many new products do great things for wound healing. Wound Vacs were a big step forward.

6. 12 hour shifts. Previously, hospitals tended to work on 8 hour shifts which meant fewer days off, and you stayed late to chart most days, so 8 hours weren't actually 8, and there were never enough nurses willing to work 3-11.

 

[nursel56]

On 9/18/2021 at 11:45 PM, Runsoncoffee99 said:

All of my nurse managers are nurses that had their licenses since the 70’s and 80’s. All are in different settings. One said she is counting down her days to retirement. She stated that home care visits were  so much easier to work before the government stepped in and demanded all of this paperwork.  Another manager said similar, that it’s the paperwork driving nurses away. 

You dispelled one "new" thing I believed to be happening, because your nurse managers are actual nurses with years on the ground rather than corporate managers who will never get what we do.  I thought that type of manager was almost extinct.

I agree the OASIS is some kind of fresh hell, one online course convinced me of that. I happily avoided that by working private duty (entire shift vs home health visits)

In general though, there is less paperwork, and the papers we do use have lots of flow sheets and check-off boxes plus a little itty-bitty space for the "narrative".  Plus, we're now allowed to use cursive writing!  Unheard of in the 1970s! 

I don't think it was easier to practice as a nurse back in the day looking at the working life of a nurse as a whole, though. I've thought about it quite a bit because the question comes up pretty frequently.

On 9/19/2021 at 4:39 AM, Davey Do said:

Long post, but we old nurses love to reminiscence.

Whoo boy do we ever! (Attempting to restrain itchy typing fingers)

[jobellestarr]

For me nursing changed with the advent of HMO’s and managed care. Before then, care was provided by mostly religious organizations. Also, a previous poster mentioned how the physicians treated nurses and it really was much different in the 80’s. All of this is why I encourage nurses to work at teaching hospitals or for IHS. It’s more akin to working in the peace corp (IHS) and you are all equal. I left the private hospital world and lived on the Navajo reservation for 20 years. That’s how I kept my sanity. 

[Tweety, BSN, RN]

Well I wasn't a nurse back in the day but have been a nurse for 30 years and I can honestly say it wasn't any easier then than it is now.  Seems like all the same issues of paperwork, demanding families, short staffing and the old "nurses eat their young" have all survived and not improved.  This last year with covid and it's challenges to our staff, with them getting sick, people quitting to travel where the money is has been particularly hard for us old faithfuls. 

[BeenThere2012, ASN, RN]

I started in the 80’s.

Patients smoked in their rooms and nurses smoked at the nurse’s station.  We wrote whatever we felt like writing in our documentation.  
 
Now, we are much more professionalized.  So, from the standpoint of better, more comprehensive care, it is far easier now.  Most doctors (I say Most, not all) are more collaborative and respectful of nurses.  At least as far as the way they are expected to behave now.  For all I know, they mumble under their breath as the walk away, as do I.  Hahaha!

Documentation has and always will be difficult.  The regulatory stuff now is ridiculous and redundant.  Finding information you need is much easier. 

[brandy1017, ASN, RN]

I think it was better in the old days.  But it wasn't Xanadu.  I still had stress especially as a new grad working with older nurses who were burnt out and didn't want to precept or help us.  Also dealt with bullying and cliques, but that can happen anywhere and anytime in nursing.  Toss in the anxiety about making a mistake and worrying about everything it wasn't a picnic then, but it has become pure hell in many hospitals and nursing homes now brought about not so much by covid, but rather by deliberate under staffing, micromanagement and disrespect by corporate management.

We had better staffing ratios, plentiful float pool, weekend program nurses, choice of 8 or 12 hr shift and more support staff.  Also patients were less sick, weighed a lot less in general and foleys were standard for incontinent patients.  There were less alarms since we had actual tele techs instead of alarms everywhere and phones hooked to the tele constantly beeping.  We had sitters, not a remote camera that would blast a hellish alarm when the patient tried to get up.  Charting was quick and easy, and giving meds was so much easier.  The computer charting is onerous, repetitive and micromanaging, then add the med pass with the computer demanding you answer all sorts of questions before it lets you give the med and managers that would monitor your scan percentages and if you were late passing meds.  So much micromanagement now!  I hear some places make you wear a badge that can trace where you are, how many times you go into a patient room.  Nurses truly are treated like widgets now!

Someone mentioned the MRT team, but ironically that was not from the hospitals.  Rather Dr Don Berwick and others worked together for patient safety in hospitals.  It is their work behind many present safety rules we take for granted now.   It began with the 100,000 lives campaign and later the 5 million lives campaign with ideas to prevent medical errors and patient deaths.  Check them out at  http://www.ihi.org 

Before 3 month orientation for new grads was standard on med-surg or tele and at least 6 months in ICU.  Now stepdown unit is 6 weeks orientation and trial by fire.  Many times new grads were pulled off even earlier due to short staffing. 

The focus now is about patient satisfaction, not safety or quality care!  Bedside report is to jazz up the ratings, it is not conducive to a safe shift to shift report.  Instead of being able to sit down and listen and write all the pertinent info of the patient, you are there to be the cheerleader and end up distracted by patients needing to go to the bathroom.  You can dress it up all you like but it is not for the nurses benefit.  It is especially a disadvantage when dealing with the high acuity of patients now.  The right way would be to get report at the nurses station and then have a short meet and greet with the patient and family.  Even bedside report has devolved into scripting where you are told to upsell your replacements ability, and add in hourly rounding where you are told to say you have the time even when you don't!  The goal is to mold you into the perfect Stepford nurse! LOL 

http://nurse-ratcheds.blogspot.com/2007/03/stepford-nurses.html

https://empowerednurses.org/do-you-know-a-stepford-nurse/

[Guest 1152923]

9 hours ago, brandy1017 said:

I think it was better in the old days.  But it wasn't Xanadu.  I still had stress especially as a new grad working with older nurses who were burnt out and didn't want to precept or help us.  Also dealt with bullying and cliques, but that can happen anywhere and anytime in nursing.  Toss in the anxiety about making a mistake and worrying about everything it wasn't a picnic then, but it has become pure hell in many hospitals and nursing homes now brought about not so much by covid, but rather by deliberate under staffing, micromanagement and disrespect by corporate management.

We had better staffing ratios, plentiful float pool, weekend program nurses, choice of 8 or 12 hr shift and more support staff.  Also patients were less sick, weighed a lot less in general and foleys were standard for incontinent patients.  There were less alarms since we had actual tele techs instead of alarms everywhere and phones hooked to the tele constantly beeping.  We had sitters, not a remote camera that would blast a hellish alarm when the patient tried to get up.  Charting was quick and easy, and giving meds was so much easier.  The computer charting is onerous, repetitive and micromanaging, then add the med pass with the computer demanding you answer all sorts of questions before it lets you give the med and managers that would monitor your scan percentages and if you were late passing meds.  So much micromanagement now!  I hear some places make you wear a badge that can trace where you are, how many times you go into a patient room.  Nurses truly are treated like widgets now!

Someone mentioned the MRT team, but ironically that was not from the hospitals.  Rather Dr Don Berwick and others worked together for patient safety in hospitals.  It is their work behind many present safety rules we take for granted now.   It began with the 100,000 lives campaign and later the 5 million lives campaign with ideas to prevent medical errors and patient deaths.  Check them out at  http://www.ihi.org 

Before 3 month orientation for new grads was standard on med-surg or tele and at least 6 months in ICU.  Now stepdown unit is 6 weeks orientation and trial by fire.  Many times new grads were pulled off even earlier due to short staffing. 

The focus now is about patient satisfaction, not safety or quality care!  Bedside report is to jazz up the ratings, it is not conducive to a safe shift to shift report.  Instead of being able to sit down and listen and write all the pertinent info of the patient, you are there to be the cheerleader and end up distracted by patients needing to go to the bathroom.  You can dress it up all you like but it is not for the nurses benefit.  It is especially a disadvantage when dealing with the high acuity of patients now.  The right way would be to get report at the nurses station and then have a short meet and greet with the patient and family.  Even bedside report has devolved into scripting where you are told to upsell your replacements ability, and add in hourly rounding where you are told to say you have the time even when you don't!  The goal is to mold you into the perfect Stepford nurse! LOL 

http://nurse-ratcheds.blogspot.com/2007/03/stepford-nurses.html

https://empowerednurses.org/do-you-know-a-stepford-nurse/

Brilliant Brandy!  Spot on!  Years ago too, there weren't cellular phones and social media to distract the less ambitious employees. The one positive thing I see with Corporate Healthcare today, is that most of the MDs are employees also and generally on a shorter leash.  I remember 'back in the day', some absolute tyrant doctors who pretty much said and did whatever they wanted with no consequence.  Acute care nursing today is just upside down today, unbelievable to me sometimes, kind of like some dystopian nightmare!

[brandy1017, ASN, RN]

While I mentioned the Stepford nurse tongue in cheek as sarcasm, I have encountered some nurses, who only see things in black and white and seem to have no clinical nursing judgement.  My mom was recently hospitalized and put on a fluid restriction due to her chronic low sodium secondary to diuretics and a seizure med, but this was not even the reason for her admission.  Most of the nurses, externs and staff were wonderful and lovely. 

Unfortunately two of her nurses were not compassionate or helpful and could only see things in black and white with no nursing judgement or mercy for her.  The night nurse took away the rest of her PM water without replacing it and then told her she couldn't have any.  I called right away and she literally told me she could not give her any more water or ice chips without asking the Dr first!  Seriously what has happened to nursing judgement, compassion and mercy!  She finally gave her 10 ice chips and that was it for the night!  My mom has no teeth so I couldn't give her any gum to keep her mouth moist and with visiting restrictions there was nothing more I could do. 

Then today the day nurse proceeded to give her lasix right after I spoke to her on the phone telling her not to give it because she was dehydrated.  Not sure if it was an act of defiance or if she simply lacked clinical nursing judgement to see my mom was already dehydrated.  Also I asked her to call the Dr to discharge her as she had been told she could have left the night before, but the Dr didn't come till almost 8 PM.  If she had only called me I would have gladly taken her home and she could have avoided this situation.  Of course the nurse had no answer why she gave the lasix anyway when I confronted her and said she was too busy to call the Dr for discharge orders.  I had to call the Dr myself to get her out of there.  I honestly hope both of these nurses see this and hope they would learn something, but not sure if it is possible. 

Sadly it reminds me of another nurse, whose face and name I still remember vividly when a family member was very anemic who not only wouldn't advocate for a blood transfusion to help with her shortness of breath, but actually stood there with a self-satisfied smirk on her face when a Dr refused to give her blood! 

Some of these nurses are downright scary and possibly sociopathic!  Why wouldn't you advocate for your patient who needed a blood transfusion when they were short of breath and it would help? 

Of course, I did not let her deter me and I called one of her specialists and I made sure she did receive that blood transfusion.  Sad when fellow nurses choose to be stumbling blocks to patient care!  I will never forget her smug smirk when the first Dr denied the blood!  She was so proud of herself!  Her actions were disgusting and disgraceful in my opinion!  Thankfully I've never had to encounter her again. 

The question in my mind is where does this behavior come from?  Is it the culture of that hospital?  Is it new nurses seeing everything black and white?  Is it just a lack of compassion for patients?  I don't know.  Honestly, I never encountered this type of behavior with the nurses where I worked! 

Does anyone have any ideas or experiences similar to these?

[guest1143647]

On 9/30/2021 at 6:54 PM, brandy1017 said:

While I mentioned the Stepford nurse tongue in cheek as sarcasm, I have encountered some nurses, who only see things in black and white and seem to have no clinical nursing judgement.  My mom was recently hospitalized and put on a fluid restriction due to her chronic low sodium secondary to diuretics and a seizure med, but this was not even the reason for her admission.  Most of the nurses, externs and staff were wonderful and lovely. 

Unfortunately two of her nurses were not compassionate or helpful and could only see things in black and white with no nursing judgement or mercy for her.  The night nurse took away the rest of her PM water without replacing it and then told her she couldn't have any.  I called right away and she literally told me she could not give her any more water or ice chips without asking the Dr first!  Seriously what has happened to nursing judgement, compassion and mercy!  She finally gave her 10 ice chips and that was it for the night!  My mom has no teeth so I couldn't give her any gum to keep her mouth moist and with visiting restrictions there was nothing more I could do. 

Then today the day nurse proceeded to give her lasix right after I spoke to her on the phone telling her not to give it because she was dehydrated.  Not sure if it was an act of defiance or if she simply lacked clinical nursing judgement to see my mom was already dehydrated.  Also I asked her to call the Dr to discharge her as she had been told she could have left the night before, but the Dr didn't come till almost 8 PM.  If she had only called me I would have gladly taken her home and she could have avoided this situation.  Of course the nurse had no answer why she gave the lasix anyway when I confronted her and said she was too busy to call the Dr for discharge orders.  I had to call the Dr myself to get her out of there.  I honestly hope both of these nurses see this and hope they would learn something, but not sure if it is possible. 

Sadly it reminds me of another nurse, whose face and name I still remember vividly when a family member was very anemic who not only wouldn't advocate for a blood transfusion to help with her shortness of breath, but actually stood there with a self-satisfied smirk on her face when a Dr refused to give her blood! 

Some of these nurses are downright scary and possibly sociopathic!  Why wouldn't you advocate for your patient who needed a blood transfusion when they were short of breath and it would help? 

Of course, I did not let her deter me and I called one of her specialists and I made sure she did receive that blood transfusion.  Sad when fellow nurses choose to be stumbling blocks to patient care!  I will never forget her smug smirk when the first Dr denied the blood!  She was so proud of herself!  Her actions were disgusting and disgraceful in my opinion!  Thankfully I've never had to encounter her again. 

The question in my mind is where does this behavior come from?  Is it the culture of that hospital?  Is it new nurses seeing everything black and white?  Is it just a lack of compassion for patients?  I don't know.  Honestly, I never encountered this type of behavior with the nurses where I worked! 

Does anyone have any ideas or experiences similar to these?

I really believe it’s the fear of getting sued. 
Also, maybe the first nurse gave the diuretic because she viewed the labs and your mom wasn’t dehydrated anymore, or her BP was high, she had edema,etc?