working on the old-style wards

[RNperdiem, RN]

In so many historic nursing pictures I see the wards. They have about a dozen beds along each side of a long open room.

My uncle remembers starting on a 6-bedded ward at the VA when he graduated in the 70's. An Aunt in the UK remembers when her hospital discontinued the last traditional ward not so long ago.

I have worked in private and semi-private rooms. I worked one day in the PACU with ICU patients boarding there. I liked being able to see all my patients easily.

Has anyone worked in a setting like that? What did you think? Did it affect patient care for better or worse?

[ICRN2008, BSN, RN]

Most facilities are moving to private patient rooms for a number of reasons, including privacy, visitor and infection control concerns. There is a reason that wards are no longer commonplace, at least in wealthier countries.

[oramar]

It is 35 years since I worked on a ward. Would you believe the one I worked on had 20 beds. Things were so different then, it almost impossible to make a comparision. It was not very nice from the perspective of the patients, there was very little privacy. Back then people did not know enough to complain, today I am sure they would be pitching a fit. Infection control issues were next to impossible to deal with and it was a darn good thing that the only time we isolated was for suspected TB. There were TWO private rooms in the whole hospital where TB patients were placed. Can you imagine an influenza outbreak where the patients were placed in the same room with post op appys and gall bladders, well I dealt with that situation. During the great Hong Kong flu epidemic of late 60s and early 70s and WE DID NOT isolate. The only good thing was the fact that we did not wear out our legs running up and down halls, everyone was right in front of you.

[Vito Andolini]

We had wards up until about 1980. There was a medical ward and a surgical ward. There were about 20 beds per ward, separated by curtains, in one large room, that also held the Nurses' Station, the charts, the clerk, a med cove, a supply cart, a bedpan hopper and dirty utility room, sterile dressings' cabinet, a couple of sinks, and a kitchenette with a coffeepot, hotplate, stove, and refrigerator. The interns had their space, too, for all their books and papers, in their workstation. Their call rooms were right in that big ward, too. Easy to get them when needed.

Visiting was quite limited, privacy was out the window. It was easier on the nurses, as we didn't have to run up and down long hallways.

In a way, it was nicer, much nicer than today's hospital. We were well-staffed, we were like a family, it seemed. I still see some of the docs we helped train to be the great docs they are today.

[Selke]

I was a patient -- rather I was tortured -- as a teenager in 1971 in one of the last Scottish Rite Crippled Children's hospitals, which had those old wards with the old staffing system and horrifically poor pt care. It is a world unto itself, that has thankfully disappeared from the U.S. This particular hospital was torn down in the early 1980s and was forced to revamp its entire care system when the new one was built. There was maybe 1 or 2 RNs on the floor, LVNs and CNAs provided the care, for very sick kids. I was literally dying of several complications (massive wound infection, high temps, DIC) and did not get adequate treatment that if I was in the private hospital on the other side of town I would have been in the ICU. My family was deemed "low class" by the orthopedist which is why he funneled me into that hospital and not the private one. I have a copy of all my records and this is all documented. Documentation was abysmally poor and would not meet any current standards. I won't forget the metal bedpans, the forced enemas, the rude and rough CNAs, the awful smell of the sheets, the rock hard bed (agonizing after back surgery), the lack of PT/OT, horrible food, families only being able to visit 1 hour a day and could not bring food or treats in, the lack of adequate pain medication (I was told I would become an addict if I got enough morphine), the wound debridement in the room without anesthesia of any kind, the near death experience .... it just goes on and on. I cannot make this stuff up. I was so thin and sick my mother actually snuck in some food I liked a couple of times, and she is scared to buck authority. That was my adolescence. Those hospitals are a whole different world the rest of society knows nothing about. I'm not the only one with a horror story, either.

[Vito Andolini]

I was a patient -- rather I was tortured -- as a teenager in 1971 in one of the last Scottish Rite Crippled Children's hospitals, which had those old wards with the old staffing system and horrifically poor pt care. It is a world unto itself, that has thankfully disappeared from the U.S. This particular hospital was torn down in the early 1980s and was forced to revamp its entire care system when the new one was built. There was maybe 1 or 2 RNs on the floor, LVNs and CNAs provided the care, for very sick kids. I was literally dying of several complications (massive wound infection, high temps, DIC) and did not get adequate treatment that if I was in the private hospital on the other side of town I would have been in the ICU. My family was deemed "low class" by the orthopedist which is why he funneled me into that hospital and not the private one. I have a copy of all my records and this is all documented. Documentation was abysmally poor and would not meet any current standards. I won't forget the metal bedpans, the forced enemas, the rude and rough CNAs, the awful smell of the sheets, the rock hard bed (agonizing after back surgery), the lack of PT/OT, horrible food, families only being able to visit 1 hour a day and could not bring food or treats in, the lack of adequate pain medication (I was told I would become an addict if I got enough morphine), the wound debridement in the room without anesthesia of any kind, the near death experience .... it just goes on and on. I cannot make this stuff up. I was so thin and sick my mother actually snuck in some food I liked a couple of times, and she is scared to buck authority. That was my adolescence. Those hospitals are a whole different world the rest of society knows nothing about. I'm not the only one with a horror story, either.

I am so sorry that you were treated this way.

This type of care is, of course, probably still par for the course and readily available today. I don't think we've advanced that far, that is, I still see lots of meanness, stupidity, ridiculous rules, & unnecessary misery in abundance.

I hope you are doing ok. God bless your Mom for bucking those evil beings and sneaking you in some decent food. The experience you describe was pretty standard, unfortunately.

[XB9S, BSN, MSN, EdD, RN, APN]

The UK still has wards, where I work we have wards of 36 beds, these are then split into 2 bed 8 bedded rooms, 4 x 4 bedded rooms and the rest cubicles the bays are single sex and there are single sex bathrooms.. Another hospital I cover as big florence nightingale wards like this, these wards are single sex.

I really don't like this type of ward

There are pros and cons of the wards with smaller bays.

I like:

the fact that even when I am not in the room there are other people there who can alert me if my patient becomes sick, tries to climb out of bed, that kind of stuff

The patients have company and someone to talk to, now I thought the lack of privacy would be appalling but having not long been a patient in a ward with 6 beds I liked the fact that I could chat to the other ladies and we could compare scars and motivate each other to get up and moving. It was like having your own cheering squad, the physio came and I had 5 other ladies giving me support. Also when I was in pain post op and not quite with it enough to ask there were other ladies looking out for me a calling a nurse.

Don't like

Obviously privacy is an issue, the curtains are not sound proof and when you are giving bad news it is the last thing you want.

There are a lack of cubicles, which means that if you have dying or infected patients you have to make a decision who gets the cubicle and who goes to the main ward, usually the dying patient goes to the cube but it depends on the infection.

[Daytonite, BSN, RN]

over the years ago i worked in a number of hospitals that had 4- and 5-bed rooms. in many cases they were at the ends of the hallways and probably were set up like that to utilize the space efficiently. but, i'm no architect so i'm only guessing. the problems with them for the patients were that they only had one bathroom and unless you had someone that wanted privacy it was hard for everyone else in the room not to know what was going on with everyone else. some of the most compassionate people can be other patients and they do a good job of looking out for their roommates. that is not always a bad thing. sometimes you want patients being watched over. i always worried about something happening to patients when they weren't being monitored and i took the q1h rounds during the night shift very seriously. what was bad for the staff was that when you went to answer a light in one of these rooms you generally ended up doing things for more than just the one patient who was ringing for assistance. before leaving one of these rooms i used to stand at the door and say, "does anyone else need anything before i go?" one hospital i worked in was strict about putting females only in these wards rather than men. they insisted that the females got along better. i don't know that this was necessarily true because in the va hospital that i worked we had almost exclusively male patients in the wards and they got along just fine. the fact is that anyone who didn't get along well with everyone else in a ward got moved to a semi-private room as soon as one became available. i suppose the case for private rooms in today's world is for infection control. but i've been on qa/qi committees in just about every hospital where i've worked and can tell you that private room or not, if the staff doesn't do their part in preventing spread of microbes, a private room isn't going to help.

[towntalker]

i knew this woman who had joined the peace corp and while she was on duty in africa there was a epidemic [don't remember what it was] but she was pressed into duty as an aid

she said it was the most horrid experience that a young person from here use to privilege could go thru

there were cots lined up so close to each other than you could could hardly move between..when someone died they were wrapped in a sheet that was tied over head and feet, the bodies were removed twice a day and that the other patients would avert their eyes from the body and talking was hushed until after the pickups

her intentions before this experience was to be a nurse but when she returned home she studied economics and business

[nightmare, RN]

All the wards I trained in were Nightingale wards(yes I am that old!)They were scrupulously clean thanks to the ward maids who undertook with fierce pride the cleaning of these wards.Many the wallop on the legs and ankles with a brush I got from these maids most of whom were handicapped in some way and very proud of the fact that they had this job.

The ward Sisters ruled with a rod of iron.You just did not cross the Sister!!For all that the training was good,you started out on tasks and by the time you had finished a 30 bed ward taking Obs you were very proficient.There were more nurses on the floor as well as the students and care was good.

As previous posters have stated things like privacy and isolation were a problem but patients expected that.' You leave your dignity at the door' was often quoted by patients then.

It makes me remember that,on surgical wards,there was no cleaning done until after all the dressings were done.I wonder if they still do that today?There was no smoking(in those days patients smoked in the wards) while the doctor's round was in progress,leading to clouds of smoke as soon as they had gone!

Because we trained in the wards by the time you were 2nd year you were expected to be able to take charge of a ward,especially on nights,and we did!There were always trained nurses in the ward next door if you really needed them but of course it was a badge of honour to cope with whatever was thrown at you during the night.We had proper breaks! You left the ward and went up to the dining room for a meal.I can still remember the cheese souffle,,Mmmm.I enjoyed my training,at that time,it was an excellent training hospital.

[blueheaven]

We still have 4 bed wards on the medical floor where I work. I can remember when I was in nursing school in 1975 the surgical ICU was a large 10 bed ward with curtains separating beds. We also had 2 isolation rooms.

[queenjean]

While living in a town of about 60,000 in Germany in 1994, one of my friends was in a car wreck. When we visited him in the hospital, imagine my surprise to find 7 other beds in his room! I didn't know wards still existed until that moment.