NUR 513 Topic 2 DQ 1: Identify at least three regulatory bodies or industry regulations that specify certification, licensure requirements, or scope of practice for your specialty

Week 2 Lecture:

Nursing in the 1970s

You would feel lost and confused if you were transported back in time to a hospital ward in the 1970s when the nurses who are now at the end of their careers were students. You would likely be out of your depth as a nurse from that era who suddenly found herself on duty in the present day.

Nursing students were part of the nursing staff allocation.

In 1975, I was accepted as a student nurse in an LPN program at a local hospital. We were given unlimited free meals, three student uniforms (green pin striped) a couple of matching caps, textbooks, and $100 a month as a nursing student. No tuition was charged. The program was a vocation program offered through Sumner county.

As students, we spent 8 hours a day Mon-Fri in class and after 3 months we spent 10 months working 8 hours a day Mon-Fri on the floors with our instructor rotating and we each had a preceptor on every floor that we worked and we also rotated through surgery.

IT WAS PROPER ETIQUETTE TO ALLOW SUPERIORS TO GO THROUGH A DOOR FIRST, AND YOU COULD OFTEN FIND A GROUP OF NURSING STUDENTS FORMING A “GUARD OF HONOR” AT A DOORWAY!

We were absolutely not allowed to use the elevators. We had to use the stairs and our classroom was on the 5th floor. It was a part of our discipline as nursing students. I did sneak a few times and used an elevator as I am sure every one of the students did as well. I was the only single student and got married the week after graduation.

The neatness of the nurse herself, as well as great respect towards licensed nurses was demanded.

We had visiting hours between 2 pm and 5 pm. No children and only two visitors at a time. Before visiting hours all the bed linens had to be straightened, with perfect hospital corners, the overbed tables had to be in a straight line at the bottom of the beds with all the wheels pointing in the same direction. Fortunately, most patients were understanding and endured the trussed-up state until the doors were opened for the visitors.

Our uniforms were the double-breasted type, cinched at the waist with a belt. We also had to learn how to fold and pin the caps into what looked like upside-down ice cream tubs and how to fasten them to our hair with clips so that they remained firmly perched in place all day.

The “mini” was in fashion then, and of course, we all tried to get away with wearing our dresses as short as possible without getting into trouble but the instructor would make sure that our dress was no shorter than the tip of our fingers when we held our arms down at our sides. We were allowed to wear a wedding ring, no engagement ring  and only simple post earrings such as gold, silver, or pearl balls and they had to be tiny. No necklaces. No tattoos or be thrown out. White granny panties, and yes, they checked! White hose, no socks, and white clinic shoes with white shoe laces and they better be polished.

Nursing duties were allocated according to tasks rather than an assignment to particular patients. As the program progressed, the student could do more advanced procedures and tasks.

The food was not portioned packed, except for special diets. It was delivered in a large cart and the nurse in charge dished up for each patient. Other nurses would collect the plates, hand it out to the patients, and then assist those who needed feeding.

Similarly, the patient’s medicines were not dispensed individually by the pharmacy. There was a cart with the full range of medications and from here, using a card system to which the individual patient’s prescriptions had been ordered, a senior nurse would hand out the medicines. Considering this system, it was surprising that very few medication errors occurred.

There were no computers and no electronic records. Everything was written by hand. The patient’s file was kept at the bedside. It contained the admission records, doctor’s notes, prescriptions, and diagnostic reports. There was also a vital signs chart on which the nurse responsible for taking the vital signs of all the patients had to chart them in graph format. Recoding vital signs required the use of a three-colored pen to reflect the three different shifts and was kept on the front of the chart for all to see.

The nursing care plans were introduced towards the late 1980s although this does not mean that there was no planning of nursing care. There was a metal flip folder, with a card for each patient from which the report was handed over to the next shift. Throughout the day any abnormal observations, changes in the patient’s condition, and treatment orders would be entered on this card. The nurse in charge would enter specific nursing instructions and handed over the card to the next charge nurse and individual nurses did not give report on their patients. The charge nurses planning of care was also reflected in the allocation of duties at the start of each shift.

Everything was written in pencil so it could be erased and updated as needed.

A major shift in hospital care has been the reduction in the length of patient stays due to advances in medicine and technology as well as the increased cost of hospital care. Patients remained in the hospital for at least one night even after very minimally invasive surgery. After surgery such as a hysterectomy, patients were on strict bed rest for at least two days and remained in the hospital for five days or, most often, until the sutures were removed. There were no pins and plates for treating fractures and a patient with a fractured femur was placed in traction and remained in the hospital for up to three months. (Consider the mix of the type of patients who most frequently end up with fractured femurs, their immobility while not being ill and young student nurses – made for some interesting times.)

“Beds and backs,” a routine done three times a day, fell into disuse mainly because of early mobilization and shorter patient stays. Usually, in teams of two, nurses went to each patient, in turn, seeing to patient comfort, making general observations, and taking action to prevent pressure sores. Bedridden patient’s backs, hips, heels, and elbows were rubbed and creases and crumbs removed from the linen. Pillows were plumped up, water jugs filled, and the general surrounding tidied.

Bedsores were frequently big enough to put your fist in and the bone was exposed. Pressure sores were treated with Maalox mixed with white sugar which was applied to the entire pressure sore inside and out and a heat lamp was shined on the pressure ulcer for 30 minutes 3-4 times a day. Patients with this level of pressure sores came in with them from nursing homes or occasionally from a patient’s home. If the pressure ulcer was on the patient coccyx, you could see the coccyx bone, just as you could see the hip bones, but when on the coccyx we had to tape one of the buttocks to the side rail for 30 minutes while the heat lamp was shining on the pressure ulcer in order to fully expose the coccyx area. There was no staging of pressure ulcers. Red areas or barely open areas were rubbed down and further than that there were huge pressure ulcers that were treated with the Maalox, sugar, and heat lamp.

Patient requests would be attended to, and anything unusual in the patient’s condition would be reported to the nurse in charge. There was less focus on infection control then, and you didn’t wash your hands between each patient! We had to clean patients stool and urine off of them with our bare hands. If we wore gloves, which weren’t around anyway except sterile gloves, the medical communities train of thought was that if we wore gloves the patients would think that we thought that they were dirty so we had anti-rooms in the halls about every four rooms apart and we went there to scrub up after cleaning up a patient and it was just soap and water. We did not know any different so it wasn’t a big deal to us. Now…..yuck!

Very little technology was in place to assist in monitoring patients. The temperature was taken with a mercury thermometer, you wore a pin watch for counting the patient’s pulse and respirations, and BP was measured with an aneroid sphygmomanometer. On general floors, most beds did not have an oxygen supply – you wheeled in a portable oxygen cylinder when a patient needed oxygen, there were no pulse oximeters.

IV fluids came in glass bottles and if you needed to control the speed of administration you either counted the drops per minute, or you stuck on a length of tape on which you marked the minutes or hours. There were no IV pumps or IV medications. The top of the IV bottle was flat and the patient would go to the restroom and put the IV bottle on the floor upside down on the flat end. By the time they got back to the bed a lot of their blood was in the IV bottle but it was just rehung and the blood was run back in with the fluids

The IV lines had just the roller clamps and very often patient with dementia or just bored would play with the roller clamp. It was not unheard of to go back to check on a patient IV and within 30 minutes 1000 ml had infused and the patient was having difficulty breathing. We just stopped the IV infusion for a while.

When starting an IV the needle remained in the patient’s arm. Every patient with an IV, which was just for hydration because there were no IV meds, had to have an arm board taped to their arm to keep the needle from bending or coming back out through the patient skin and blood pouring out all over.

Very few intensive care beds were available in the hospital. Most of the ICU’s were converted side rooms of specialist units, on each floor, with two to four beds. A cardiac monitor and a central venous pressure line were the only advanced equipment used in these units. The venous pressure line was inserted via the median basilic vein and very rarely anywhere else such as the intrajugular vein as is the most commonly used today. There were no ports of any kind.

Dialysis was available but was very complicated and lasted for 12 hours and there were no dialysis machines. The dialysis was peritoneal and therefore there were no dialysis shunts or ports. Patient died of septic infections due to lack of sterility with peritoneal dialysis although at that time no one knew what sepsis was. Mechanical dialysis was available by the late 70’s in big hospitals and by the early to mid-80’s in smaller hospitals.

There were no intermediate-high care units. Critically ill patients were mostly treated inside rooms on the floor where a form of patient allocation was used when one of the nurses on the staff complement of the unit was allocated to special one on one care.

The first big nursing strike was in 1972 when 97,000+ nurses went on strike due to pay. The second nursing strike due to pay occurred in 1974. After 1974 the average pay for a nurse went up by 30%.

Other interesting tidbits:

·        Nurses lived and died by the Kardex, a folded card-stock roadmap to all things for the patient, completed in pencil and continuously crossed out or erased and updated during every shift

·        MAR’s were hand-written every day on the night shift and would last for 24 hours. The nurse initialed when a med was given. Black Ink 7 am-3 pm, Green Ink for 3 pm-11 pm and Red Ink for 11 pm- 7 am. Military time was not used.

·        Universal precautions didn’t exist.

·        HIV, C-diff, VRE, and MRSA did not exist.

·        Electrophysiology studies were done at the bedside to discover and treat arrhythmias.

·        A patient suffering an MI stayed in the hospital for a minimum of 2 weeks and was not allowed to do anything including taking a shower or drinking anything either cold or hot.

·        All patients were given a backrub at bedtime by their nurse.

·        There were no outpatient surgeries. Most surgical patients stayed as an inpatient for 7-10 days.

·        GI bleeds were managed by inserting tubes with balloons (attached to football helmets) to tamponade varices.

·        Warm-water-heated metal bedpans were used for patient comfort.

·        Central venous pressure was measured with water manometers.

·        Nurses used the second hand of a wristwatch to calculate I.V. drip rates.

·        White oxford lace-up shoes were the norm for nurses.

·        Only operating-room (OR) staff and physicians wore scrubs.

·        Nurses wore all white, cap, either pantsuit or dress and must wear white granny panties. Colored underwear or bikini underwear would show through the white uniform and you would be sent home!

·        . One pair of post earrings, one wedding band, no stones, and no tattoos

·        Hair longer than shoulder length had to be up and under the nursing cap.

·        Vital signs recording required a three-colored pen to reflect the three different shifts.

·        Nurses mixed antibiotics without pharmacist assistance and were not available until the late 1970s.

·        Nurses became proficient in I.V. sticks by practicing on one another.

·        Patients were weighed manually.

·        Requisitions were completed on typewriters.

·        Public health meant well-baby check-ups at the new mother’s home.

·        Grandma died at home.

·        Patients heading for the OR had their body hair shaved with hand razors.

·        Most surgery patients were admitted to the hospital the night before.

·        Nursing caps were still mandatory.

·        The nurse carried the doctor’s charts and walked behind the doctor as he made rounds.

·        Dr’s. did not have beepers or cell phones. Nurses were scared of doctors and drew straws when one had to be called.

·        There were no ultrasound, CT, or MRI machines. Most surgeries were listed as exploratory because the surgeon had no idea what was going on inside the patient.

·        No pulse oximetry

·        No accucheck machines, urine had to be tested for sugar QID and insulin was given according to which of four colors the urine changed to after a clinitest tablet was added to the urine.

·        No fetal monitors existed; the baby was deemed ok when it was born alive

·        No dinemapps

·        No ventilators

·        The Physician’s Desk Reference and the U.S. Pharmacopeia were chained to the desk, were the common drug references.

·        Nurses carried trays with cups of pills and med cards.

·        Cancer was a definite death sentence.

·        Staff and patients smoked in the hospitals

·        Nurses and doctors smoked at the nurse’s station

·        There was no HIPAA. Nurses knew everyone’s business and many did tell friends and even just acquaintances their patients’ private medical information.

Nursing yesterday, today and tomorrow

Nursing has changed dramatically over the past 4-5 decades and will probably change as much or more over the next forty-five years, and this is why continuing education has become so important. While developments in society, medicine, and technology will change the landscape, it could never replace the essence of nursing – caring for other human beings at a time of need.

BTW- After graduation my rate of pay was $3.25 an hour and that was a good wage. Minimum wage was .90 an hour. My brand-new car was $2,999.99. Advertised as still being under $3,000. However, for me it was free. My parents promised me a brand-new car, of my choice, if I finished LPN school. I did not realize until the second day of class that I was in nursing school. I thought I was in school to be a CNA. Obviously at that time I had no interest in education! Oh, how times changed! (For the better)!

I hope things are going well during our first few weeks of class! I would like you to take a minute and think about the goals you have for this class. When we have specific and targeted goals, we are better able to determine when and how meet our objectives. Please respond to this topic with:

• A prioritized list of 3 to 5 goals for your personal learning for this course.
• Include a brief description of how you see yourself accomplishing your goals.
• Let me know what I can do to help you achieve your outlined goals.

While this is not a graded or required activity, I find that it is helpful to outline what you want to personally gain from a course. Also, your responses will count towards your participation, as long as they are substantive in nature (at least 100 words long).

Thanks

I have many goals for this course and graduate school in general. My biggest goal is to fully engage and to absorb as much information as possible. I have limited knowledge on the information in this class, but I am hoping that I will have a great understanding by the end of this class. To keep myself accountable, I want to be actively working on schoolwork at least 5 days per week, whether this is doing assigned reading, discussion posts, or other assignments. There is a lot of information to learn in this class, and I want to get the absolute most out of it.

My next biggest goal is to take the time to read my classmates discussion posts, even if I am not replying to them. Everyone within this class has a unique background within nursing, and it is always great to learn from a different perspective. My fellow classmates have a very diverse background of knowledge and expertise, and I am very excited to learn from their work experiences.

My final goal is to try my absolute hardest to get straight A’s. I am aware that getting an A in every class is not the most important thing, but I am easily motivated by grades. I have always been a student who is disappointed to get anything less than an A, but this is obviously a much harder program, and I am working 50+ hours per week, so it could definitely be a challenge. I am excited and nervous to see what the remainder of this class and program will bring.

My goals for this class are as follows:

Make a consorted effort to respond to the weekly DQ and other weekly assignment whether its a graded or non graded responses with in the specific time allotted. For I know if I were to submit a late assignment I would probably loose points, every points are important to me.

Learn as much as possible from this and subsequent classes so when I finish with school and become a nurse leader with a higher degree I can be effective and bring about change on the unit where I work and the patient population I serve.

Pass all my classes with decent grades for me grade is very important it is reflective of application dedication to the course of study.

Read all my classmates posts for iI know I will definitely come away with some new information which iI can incorporate in my daily practice.

I can achieve my goals by a few simple alteration in my time. I am prepared to cut back on the over time I generally work, focus on reading the outlined chapters and other material that might be helpful, spending less time on my phone looking at nothing of importance and lastly probable taking less road trips

One of my goals in this class is to make a good effort to make discussion posts weekly and respond to my classmate’s posts. I will try to be active in the online environment.

My second goal, though this is my first time doing online schooling, I will do my best to grasp every knowledge I can so that I can be successful in my field. Since I started in the ICU, I have been telling myself no matter how long I work in this unit, I will be like a “sponge” where I gather and understand everything I needed to learn.

Lastly, my goal is to get good grades in this subject. I will do my best to read, write and learn what I can.