What was it like to be a nurse in the 1980s

[fatrabbit]

I'm writing a paper for one of my classes. I have to briefly discuss what the role of the nurse was in the 1970s/80s. The only sources I can find talk about events pertaining to nursing in the 1980s.

I really want to know the experience of being a nurse in the 80s. How much respect did nurses have? Where they able to question doctors? advocate for patients?

[irishicugal]

Nurse;8996349]Valium and Ativan were not counted in the drug count

Glass IV bottles were the norm.

Reyes Syndrome was new.

You actually had time to feed a patient.

Heat lamps were used on decubs

Treatment and med pass 1"X1" cards were color coded per shift so you would know what was due and when.

Shift report was given by the head nurse who read through the patient names on the kardex along with their whole life history in a nutshell.

The patients hairdresser could walk in and inquire about the patient and no one would bat an eye.

You could score a breakfast tray a lot easier if you were hungry.

The hospital provided coffee, toast, butter and jelly for the break room.

Central processing would try and resterilize anything they could get their hands on.

They would Not tell you the sex of the baby if you had an ultrasound. (Just a bunch of Killjoys)

It cost around $3000 dollars total to have a baby!!

Ireland is STILL like this, all of it except the heat lamps....

[Catcar1963]

Here's what's different between then and now: Exponentially increased documentation requirements. Patient satisfaction trumps common sense and honesty. Virtually every hospitalized patient today would have been in a critical care bed back in the 80s. Except OB. Childbirth has become a spa experience. But the biggest difference? The Quality and Safety Police have made individualized care a thing of the past.

Very well said, and very true.

[amoLucia]

Graduated 1974.

1 - Enteral feedings were done by bolus feeds via NasoGastricTubes. No pumps. No such thing as Ensure,Glucerna, etc. From Dietary, used to get big industrial size mayo jars (with individual pt name) and the individualized specifically prescribed diet (1800 cal, 1 Gm sodium diet, 2000 cal diabetic diet, bland diet, etc). Just the 24 hour diet BLENDERIZED into a puree that we poured out a certain amt and diluted with water and did the feeding q3 or 4 or 6 hours whatever. It wasn't until late 1980s that I worked with GTubes & pumps and by then, that was in LTC.

2 - Back then freq in LTC, had pts with orders for alcoholic 'nitecaps' as an HS prn. Some even had a 'may repeat X1' order for NOC shift. One place had a liquor closet that was primo stocked with top-shelf liquors provided by families. I remember that liquor closet was one to be envied! (And there was no 'declining control sheet' to count remaining volumes!)

3 - Had major abdominal surgery 1985. Staff received 'professional courtesy' as a provided benefit for any debts not covered by insurance. My surgeon and anesthesiologist also did 'professional courtesy' for staff.

[Ruby Vee, BSN]

Team nursing. This is how it looked in the mid to late 70's. We called our head nurse and supervisors, "Miss ..." So, naturally we called our doctors "Dr..." We did give up our chairs when a doc approached. They smoked at the nurses' station. I worked 3-11 and I typically worked with with one LPN (who was not allowed to give I.M. narcotics, which were all given either p.o. or I.M. back then, by the way) and we were responsible for 21 patients! Of course, the patients were nowhere near as sick as they are today. Many of today's patients who are on med-surg units, would have been in the ICU back then. I was a brand new nurse with a BSN and most of the other nurses were diploma grads, many had graduated from that hospital's school of nursing. They had no mercy on me! But by the end of the first year, I had gained their trust. Almost all rooms were semi-privates and we had two four-bed rooms, where Medicaid/Medicare patients were placed. Makes me cringe to think of that now. We tried very hard not to call any docs to clarify orders. Apparently they never made mistakes! I remember as med nurse, we would pour our meds into little paper cups that fit into a metal tray. Typically we balanced that tray on the edge of the sink in the med room because there was no counter space. Every now and then, it would tip over and and the whole tray would be lost! Good old days? No.

My first job offer came from a "VIP" unit, where rich people and celebrities went as opposed to ordinary folks with jobs and difficulty making ends meet. They were hiring for pulchritude as much as a aptitude. I refused the job because I thought everyone deserves good health care, not just the rich and famous. I don't ever remember feeling flattered to be asked, although perhaps I should have been.

I was hired into a hospital that had their own diploma program -- I was the first BSN they'd ever hired, and they didn't have any idea what to do with me. Their new grads had a semester of team leading; I averaged 8 hours of clinical a week with at most 2 med Surg patients. It was a truly miserable first year for me.

After two years, I moved to the east coast and worked for a large teaching hospital there. They had separate units for Medicare, Medicaid and "charity" patients. Those units were not well-equipped, to say the least. The ICU didn't have enough monitors to go around, and even bedpans and commodes were in short supply. Even back then, I thought it was horribly wrong.

Even now, some hospitals have a special floor for the rich and famous. I remember the man who was transferred from there to our specialty unit. He ended up in a six bed room, and was astonished at how the other half lived. It wasn't until after his surgery that he understood the transfer. "You know what you're about," he said. "Those other nurses were gorgeous, but they couldn't answer any of my questions and they didn't seem to know what was going on."

[PANYNP]

Graduated in 1983; spent 6 months working Med-Surg, then moved to rotating between a 10-bed CICU and a 10-bed General ICU in a 300-bed community teaching hospital in suburban Philadelphia.

No white caps; only the critical care nurses wore blue scrubs; a mark of prestige at the time. Gradually, other units adopted their own color for scrubs, often with start-up $$ donated by families of patients. E.g, renal unit nurses wore peach-colored scrubs, PCU wore burgundy-colored scrubs, Resp step-down wore mint-green, Maternity wore pink; ED wore navy etc

Almost all ICU patients had an art line and a PA catheter. Sometimes, an additional central line for infusions was placed as well. PICC lines started being used around 1990. PA and Art lines were zeroed and leveled every 4 hours.

PAWP readings were recorded every 4 hours, or more often, depending on drips.

We did not have IABPs, so patients in cardiogenic shock were given the equivalent of a physiologic balloon pump via the simultaneous use of IV NTG and Dobutamine drips. We titrated to written parameters. Also used amrinone and neosynephrine drips. Sometimes an isuprel drip via a syringe pump.

Very unstable patients, who required immediate cardiac intervention beyond what we were able to provide, were transported by ground ambulance to one of the many Philadelphia teaching hospitals, a 20-minute ride away. However, this was a rare occurrence. We medically managed all types of MIs, from anterior to non-Q wave.

All ICU RNs were ACLS certified, and we initiated and ran codes until the residents, fellows, or attending cardiologists arrived. Most RNs were CCRNs; the hospital reimbursed for the cost of the exam and prep courses were reimbursed as conference time. A small premium was added to salary when the CCRN was attained.

Resp Therapy managed the vents. During the 1980s we moved from MA-1 and MA-2 vents to mostly Bear vents. Settings were assist control (AC) or intermittent mandatory ventilation (IMV). PEEP was used, but rarely > 10 cm.

SPO2 started being used around 1988; SVO2 around the same time. We did cardiac outputs via CO2 carpujects, then later with iced injectate.

Marquette monitors replaced old clunky GE monitors in 1985. The Marquette monitors were so advanced and so sensitive, we said that all they needed was an arm that would come out and place bedpans, and we'd be all set.

We did peritoneal dialysis, CRRT, and CAVH.

Management of GI bleeds, in the days before widespread use of endoscopy, consisted of iced saline lavage, often with levophed added to the lavage. This could go on for hours.

Patients with bleeding esophageal varices had a Blakemore-Sengstaken tube inserted, and wore a football helmet to stabilize the tube, which was threaded through the face mask. Internal cuff pressures were checked and the cuffs released q 1 hour. Scary stuff.

General ICU patients were mostly big abdominal surgical cases, some trauma, respiratory failure, overdoses, acute liver failure, acute renal failure. We started seeing patients with AIDS in 1984.

Mostly 8-hour shifts during the 1980s, although the 12-hour Baylor or WOW (work only weekends) was instituted in 1988. Many nurses, myself included, took advantage of the WOW plan to return to school. I worked 12-hour weekend nights, retained FT benefits, and picked up one additional 8-hour night shift per week.

I spent a total of 7 years there; the hospital paid 100% tuition and books for my Nursing Master's degree at a prestigious university, with no obligation to remain on staff. At the time I graduated, there was no suitable position for my new skillset, so I moved on.

ICU nursing during the 1980s comprised the glory days of my nursing career. I was privileged to work with smart, supportive, and collegial physicians, and dedicated and empathetic nurses, as well as dedicated respiratory staff.

Thirty-three years later, still going strong.

[PANYNP]

EMT Jeremy, BSN, RN -

Your questions make me smile. The 1980s weren't quite the Stone Age!

Please see my post toward the end of this thread.

Best of luck to you!!

[Mimi56]

I began working in 1976 on an Orthopedic floor as the charge nurse on the 11 pm-7am shift. It was myself (a new graduate) and a relatively new LPN to care for 32 Orthopedic/Surgical patients. I had a medication room where I mixed all of my own IV piggybacks and dispensed my own medications. My biggest nightmare was the list of patients awaiting pain medication when I arrived and it seemed like about the time I got everybody serviced, it was time to start all over again. This was in the days of skeletal traction for femoral fractures for 6 weeks and total hips were non-weight bearing for almost a week. There were no scope cases- all knees were open knees. While I was in orientation, I wore my white dress and cap, but at night, I wore a white pantsuit and my cap. If I felt it was necessary to consult with a surgeon regarding a patient or an order, I had no problem doing so. And I learned soon enough, what was important enough to wake up a doctor for and what could wait. After about 11 months, I transferred to the SICU step down floor. I loved this experience. I worked a 3pm-11pm shift and had the opportunity to work with some really great nurses in the SICU that I really learned a lot from. During this year, I began to "forget" to put my cap on (and kept getting written up for it), developed a horrible bilateral ulcerative blepharitis as a result of taking care of trach patients, and eventually got the opportunity to transfer to the OR. This made me a very happy girl! The rest of my career has been spent in and around the OR--happy days, indeed. Times have changed a lot. And yet, nursing has gained very little in 40 years. Nurses are still overworked, floors are understaffed, and no one wants to pay you what you are worth.

[Axgrinder]

When I was my 3rd year of Nursing (1997?) I had a co-worker who had been at it for quite a while. She said one of the care plan orders on the 3p-11p shift for inpatient admits was an afternoon back rub (must have been for skin care?). I remember plenty of older patients demanding to know why they weren't getting their back rubs in my first nursing job (1994) which was on an insanely busy Med-Surg unit at a teaching hospital. Initially I thought to myself, "Are they serious? Right after I get mine!", but then a couple of years later I understood why they thought as such. Sorry amigos - the code down the hall takes precedence …

Also in my first nursing job I had a patient who was a nurse well into her 80's - she told me when she was a new grad that there was no vented IV tubing: they had to stick a large bore needle into the rubber seal of a glass bottle IV. She also said as a nursing student that she was expected to sharpen all the needles (YIKES!).

Another nurse told me in the 1960's-1970's things were way different for controlled substances. Once while working in a small hospital she had a Rx order for cocaine for a patient's eye - it was the middle of the night. She said she went to the pharmacy to get the Rx med and ended up dropping the whole thing everywhere. My eyes popped out, but she said at the time it really wasn't such a big deal.

Of course, these are all second-hand accounts, as I wasn't there, so take the validity with a grain of salt (or cocaine?).

I'm just glad I didn't have to wear nursing hats - they sound like a PIA, and a good source of vector disease transmission. I have a friend who graduated about 5 years before I did who wore nursing hats without being required to. She had a whole collection of them, and I remember the newspaper actually did a story in her. At the time I didn't know her yet, I just knew of her (we became close friends 2 years ago at my current job). I recall at the time she was scorned and ridiculed behind her back by most other nurses in our facility, but I have to admit the patient's really liked it, and so did the MD's. Now, 22 years later, she's given it up somewhere along the way (we both do telephone triage nursing). She still has the hat collection, and she has also started collecting old nursing capes too. It's actually kind of cool.

I have to admit I was shocked at how little new grads made when I graduated in December 1993. The highest pay in our city was: $12.75/hr - that was less than $25,000 annually for full time work. This was very disappointing. Even in 1994 that stunk.

[Mimi56]

Regarding the above comment about Cocaine-- when I did transfer to the OR in 1978/79, Cocaine 4% solution was on the shelf in the OR room. It was the prettiest ocean blue. After a couple of more years, it began to start disappearing and we had to start locking it up with the other narcotics.

i have just read through this whole thread. We are so lucky to have had the wonderful, wacky, experiences we have had and survived. My only hope is that this new generation of nurses will commit to care for their patients, in spite of what insurance, legislators, or administrators throw at them.

[Nursj68]

I surely believe we were respected more then by patients and their families; but I believe physicians; and physician extenders respect us more now; and take our thoughts/concerns more seriously now; there's not so much of a "fight" when we're trying to advocate for our patients.

[Nursj68]

Caps; white dresses; white hose...

patients could smoke in their rooms....

staff could smoke at nurses station and there were ashtrays at the desk....

there were med nurses who gave meds/ blood to the entire floor; and floor nurses that did everything else....

We still counted narcotics manually; and wrote them in the narc book....

we gave alcoholics beer; and Jim bean.....

there was liquid cocaine in Th narc box for our ENT patients..... (Nasal packing)

during my OR rotation; they used Everclear to preserve specimens.....

u really didn't speak to dr's unless you were the charge nurse; we would tell the CN whtever issues we were having w the patients; she would call the dr and get the orders. I went months as a floor nurse w/o speaking to a dr over the phone.....

we we would take the "dsg cart" from room to room w the surgeons for rounds and THEY changed their surgical dsgs....

pts had to PAY for their tv's to be turned on every morning.....

we we still had semi- private rooms; Ik they still exist but it was STANDARD back then; also had 2 4-bed wards on my floor. If I had a dollar for all the musical beds we played bc a white person didn't want to be in the Same room as a black person.....

patients came in for surgery and were worked up the day before.....

lap surgeries weren't common yet; everything was "open" ppl would b in hospital for days for a gallbladder or an Appe....

Glass chest tubes....

Urine dipsticks for glucose....

HIV pts on isolation.....

we mixed our potassium in our IVF....

MARS/labs/orders all handwritten and done by the secretary.....

kardexes.....

imsurance wasnt a rip off.....

ppl were not nearly as sick as a whole as they are when admitted these days....

we still gave back rubs at night as part of "hs care" and the charge nurse would literally ask the patients if they'd gotten their back rub for the night. We also passed out juice; diabetic snacks; and picked up our own trash.....

shifts were 8h; the paperwork was a FRACTION of wht it is now; and we actually had time to CARE and LEARN about our patients. It was not uncommon to have 7 or 8 pts; but the acuity was MUCH less than now; and It was RARELY overwhelming as compared to putn fires out all day with 3/4 pts.....

pts tht are now considered stepdown pts; or even just busy floor pts would've bn n ICU then.....

peds pts were put n rooms w adults if our SMALL pediatric unit was full. And yes; iv taken taken of peds/ adults same shift w one less pt as the peds pt counted as 2.....

i could go on and on but that's just off the top of my head

[Nursj68]

I started out as an LPN in '88. 1st pay was......$5.95....

at tht time I worked w a nurse who'd already bn a nurse for 20+ yrs; and her starting pay was $2 and some change....the eldest nurses who were about to retire so had bn nurses since Th 40s-50s talked about their pay in WEEKLY terms..... Same amts:nurse: