What was nursing like in the year of 2000?

ihavealltheice · May 29, 2019

I was still in nursing school in a more rural area in 2000, but worked as a CNA during my summers in breaks in a large teaching hospital in the Chicago suburbs. We had computer based charting in the teaching hospital vs paper charting in the hospitals where I did my clinical rotations. So, I having more "hands on" experience as a CNA and learning on the computer system, I hated paper charting during clinicals.

We also had the Pyxis for all of our medications in the teaching hospital, not in the rural hospitals.

When I was hired after I graduated in 2003 (at the same teaching hospital I worked as an aide), I was able to work as a RN-P (RN Pending)...meaning I hadn't passed my NCLEX yet. I don't think you can do that anymore. Most of my preceptors either had their associates degree or were diploma nurses.

Hoosier_RN, MSN · May 29, 2019

Back then, we were more focused on actual care, as others have stated. It was already changing, but the big focus on profits really hit right after the crash of 2008. Since then, my area has been awful!

NurseSpeedy, ADN, LPN, RN · May 29, 2019

Back in 2000 we worked as nurses....fast forward to 2019 I have to remind myself the the big H on the large medical facility is not representing the Hilton yet I will be expected to act more like a hostess and kiss my patients butt, AND save it, and the dietary staff work as cooks, not certified chefs, and once upon a time patients would joke about the mystery meat-now they send it back to be redone!

In 2000 paper was my friend, now there is an ancient computer program that keeps getting longer with annoying check boxes that must be addressed every so many hours that takes forever to complete on each patient. Gotta love when the stupid thing decides to glitch and I to start all over again because it didn’t save before it crapped out...and what idiot make the save key located right next to the delete key on the keyboard? I’m assuming it wasn’t someone who just spent 15 minutes charting on someone that years ago would take less than five minutes to complete written charting.

Years ago nursing was more personalized, now the patients see us as the worker with the rolling cart with pills, 2 million questions, and a bar code scanner. One told me he felt like he died and woke up in Walmart! Everyone is scanning his barcode and most of us doing so are wearing blue (Wally worlds shirt color). Unfortunately his bill will probably look more like a store he’s never shopped at before and the return policy won’t be as flexible.

Those of us who remember nursing before now probably miss it more than ever as things keep changing, and not for the better it seems.

peacepilgrim66, ADN, RN · May 29, 2019

I was working in rural Idaho in 2000 (nursing home, hospital, ER, lab, pharmacy and clinic all rolled into one). Paper charting vs Electronic seems to be the biggest difference. The next biggest is the corporate conglomerations and hospital associated LTC facilities. I enjoyed the small LTC facilities that were more common in 2000, where the facility was an extension of the community. Now corporations bring big ideas and bean counters to run nursing, kind of like "health" insurance. The stress of short staffing was the same.

Ruby Vee, BSN · May 29, 2019

I don't remember exactly when we went from paper charting to the electronic medical record -- I suspect it was in the late 90s. I cannot believe how much easier it was! Instead of calculating SVR and PVR by algebra, the flowsheet calculated it for us! It calculated drip rates, totaled I & O and made the medical record visible to a surgeon at a conference in San Francisco as well as to the physician sitting outside another patient's room in another ICU.

Before the EMR, we totaled our I & O on a paper towel before entering it on the flowsheet. Everyone carried a calculator in their pocket for calculating drip rates, body surface area, converting pounds to kilograms and back, etc. There was only one flowsheet and often five or six people who wanted access to it at the same time. (My favorite was the doctor who grabbed the flowsheet out of your hands and then quizzed you -- "what time did you turn up the dopamine? What was the K+ at 3am? What was the pCO2 when you made that ventilator change?").

Computerized charting, computerized medication access (rather than carrying the narcotic keys around and hoping fervently NOT to be the one holding them at change of shift when count had to be done) and email were the biggest changes in the past 20 or so years. Email was a big game changer, too. Instead of those paper notices clogging up a tiny physical mailbox on the unit, all of those changes in policy, introductions to the new house staff, cautions about drug shortages and complaints about how someone was rude to the blood bank were in an electronic inbox. You could ditch the ones you didn't need and keep the ones you did, then pull them up when you needed to know the new phone number for the lab or the name of the new chief medical resident.

When hospitals started putting their policies and procedures on line, that was fabulous. You used to have the policies in "policy books" which were 20 pound binders. Things weren't always filed as they "should have been" and you might find the policy for patient elopment under "e", under "p" or under "a" for AMA. Or you might find it misfiled under "q" because whoever pulled it out last didn't put it back where it belonged. A searchable online policy and/or procedure manual was a real game changer. I could ditch my thick binder with copied policies or procedures (useful when precepting) and just show my orientee how to look things up on the intranet. Along with tons of other useful stuff, like the formula for calculating Fahrenheit temperatures from Celsius, the policy for incarcerated patients or how to use that shroud that comes in the death kit. (And we didn't need the formulas anymore with the EMR.)

What else has changed? Health care has become more of a business, more concerned with the bottom line than ever before. The "customer service" craze happened, and hospitals were sending managers to Orlando to study the Disney model. Seriously. Suddenly, making patients happy became more important than helping them get well, and complaints about not getting the third Dixie cup from a patient hospitalized with DKA and not getting a cheeseburger from an NPO patient were seriously entertained. Visitors became more concerned about their "right" to be in the patient room than with what the patient needed, or about supporting the patient, and their complaints were taken seriously. You can't just eject a disruptive visitor; and if you try, you have to explain it to management. (Even if they're carrying knives and guns, which was rare 20 years ago.)

IV pumps became smarter (and more plentiful). We had ventricular assist devices, first to bridge to transplant, and then as destination therapy. Telehealth is a thing now -- it was in its infancy 20 years ago. We have new drugs, insulin pumps, continuous blood gas sampling . . . too many wondrous inventions to name.

Devices have become smaller, and things we never dreamed could be computerized have been. Now if you want to know about changes in the past 40 years, I got stories for that.

FolksBtrippin, BSN, RN · May 30, 2019

I'm not sure, but I think Conan knows.

Goodmom2 · May 30, 2019

Enjoy working prison then.Much more freedom independent nursing with some great doctors.It all changed when it went Private;;;;;;not for the good

bluebonnetrn, BSN, RN · May 31, 2019

I graduated in 2001 but I was working in a hospital as a student nurse tech before that. Paper charting was the norm. I worked for the VA and we did have an electronic charting system and it was cutting edge. Because I was the young nurse I learned it faster and so I was unofficially elected to be the one to teach the older nurses how to use it. "Click there. No, click it twice. No, you have to click it twice real fast" That being said, there were still a lot of paper notes and orders. We still had large hard charts in chart racks. When certain doctors rounded we had to have all their charts pulled and sitting out for them because they didn't like to look for charts. At the end of the shift we did chart checks on each chart and there was a different pen color for day shift, evening shift and night shift. We had gigantic binders for our policies and procedures and the same for the MSDS book. Protonix was the latest and greatest med and only ICU patients got it. On the med-surg floor it was the norm to have 8-9 patients and one CNA to share between 2 nurses. My assessments were on a one page piece of paper that stayed on a clipboard hanging outside of the patients room. I would write orders and hand the chart to the doc and say "Hey I wrote this order. Sign it." and they did. I kinda liked trying to decipher doctor's handwriting. You would get to know the docs and their handwriting and it wasn't really that hard. We used iodine to change central line dressings. All of the patients meds were in a med cart drawer that was labeled and pharmacy filed it. Of course we still had to check meds as we gave them but we didn't have to go and gather all the meds. Everyone had their meds right there in a drawer together. We used multi dose vials for insulin and heparin. Nobody had to check my dose. An intern once accused me of administering insulin instead of heparin to a patient, which would've equaled 50 units of insulin. The way I knew I had NOT done that was because I had 3 patients on heparin and drew all 3 shots up at the same time so if I gave one insulin, I would've given them all insulin. Everyone was always looking for the narcotic keys. Who has the keys? I gave them to Jane? No Jane says she doesn't have them. And if you accidentally took them home in your pocket ooo boy you better turn right around and take them back. I once got stuck in a horrible traffic jam on my way to work. I was stuck on a highway and had no way of contacting anyone - no cell phones! I was TWO hours late to work. They had called my husband at home and he told them I had left for work at the regular time. So for 2 hours nobody knew where I was. On evening shift I "tucked" all my patients in for the night on my last rounds and for the most part they actually slept at night. We restrained patients all the time. Of course we had protocols and regular checks but we used side rails, wrist restraints, bed vests and enclosure beds. I also worked agency from 2003-2005. So I went all over to multiple units and multiple facilities. I think there was less standardization for care. I learned a lot doing that because I learned a million different ways to do everything.

Peggy Tinti · Jun 1, 2019

On 5/26/2019 at 8:43 PM, jezun said:
Hey, so I'm writing a paper for my school project and I need to know what it was like to be a nurse in the year of 2000. I looked into some websites and did not find what I was looking for. Is it any different compared to the present (2019)?
I need to know the experience of being a nurse back then. How much respect did nurses have? How is the technology different from now? Were there any specific restrictions or allowances? Thank you so much.

I was working in an LTAC in the Ca ssf e Management department. Charting, computerized, i work for the same company now, different location, paper charting! Payient focused care in 2000, now its all about the end figure. "Did we profit"..? I have been a nurse for 40 years, combined LVN/RN. Have worked in almist every field. Research was probably the most interesting, ICUs for over half my career, absolutely love it, but the bottom line is, get in on time and out on time. Being a night shift worker this is almost impossible if you want the patients csred for. I dont l er t my CNAs do all the diry work, thats not what i was taught. I still love bedsidenursing, but have come to realize thatI am not the nurse tut h as t just sits and does paperwork to get out on time. My priorityhas and always will be the patients. For the corporate people its not good enough, you have to get it done on time. My feeling is patients first and paperwork when time is available! Searching for something new but not easy for us older nurses.

GaleSRN51 · Jun 3, 2019

The biggest change is paperwork vs computer charting. Much harder to get medical records, etc. I think the newer Med School graduates respect us more. Even 20 years ago, a lot of MDs had the G-D complex. In 1999 I was working at Stanford. I felt respected, appreciated. In my current management position, I feel the same respect and appreciation. The pay is much better, but not when you compare it to the cost of living. Numbers are just numbers until you look at actual costs. Depending upon what area you worked in, there was not a lot of ancillary help, like techs or nurse aids. I think our nurse/pt ratios have improved. Also BSN just got you a slight increase in salary. Now it is a requirement in Magnet hospitals like Stanford. You cannot be a manager without at least the BSN, preferably MSN.