Nurse at the Switchboard

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Ten of us from a class of 44 traveled to Cape May, New Jersey to attend our 55th nursing reunion. We first met as young Catholic teens in the late ’50s enrolled in the diploma program at Saint Peter’s School of Nursing in New Brunswick, New Jersey. Hard to believable we are now in our mid-70s.

At our luncheon at the Inn of Cape May on a glorious sunny day this past September, we laughed and reminisced about the three years we lived together, when Connie mentioned that she had to man the switchboard at night during the psych rotation at a private psychiatric facility in a Maryland suburb.

Never heard of this we said. But one of us (can’t remember exactly who that was) chimed in to say she remembered at the time how glad she was that she never had to do this. So there was validation that Connie’s memory was intact. Imagine having to work at a telephone switchboard! What does this have to do with learning about psychiatric patients?

lady at switchboard

I found a picture of a telephone switchboard for you too young to remember this contraption that connected folks to each other via telephone lines. Or you could just watch the old movie: Bells Are Ringing with Judy Holiday and Dean Martin.

 

 

 

After hearing about the switchboard, we began outdoing each other with anecdotes about our early nursing days.

I wanted to take notes to capture these unique tales but decided I would rather just enjoy the fellowship. Later, I asked my classmates if I could call them, one by one, and document what they would want to share with current nurses about life in the “olden days.” They all consented.

So now I have a new project. I had been thinking about surveying my classmates about their nursing lives for quite a while. Since our 55th celebration is over, I realize it is now or never. We are dying off. Sad to say but true. Who will remember us? Or what nursing was like years ago? Who would believe that as part of the educational program to learn to be a psych nurse you had to know how to work a telephone switchboard?

You’ll be hearing more about my classmates.

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Spotlight: Marianna Crane

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This appeared in the September 2017 Erie Family Health Center Donor Newsletter

 

Anniversary Spotlight: Marianna Crane

 

Over thirty years ago Dr. Sally Lundeen, a nurse and Erie Family Health Center’s first Executive Director, spearheaded a project that would provide care for the underserved elderly right where they lived. The Senior Clinic* opened on the 10th floor of an apartment building on 838 N. Noble, then managed by the Chicago Housing Authority specifically for low-income elderly residents. Marianna Crane was one of the first nurses to join Dr. Lundeen in this endeavor. She had recently left the VA Hospital, disappointed that, due to a lack of funding, she wasn’t able to provide the specialty care she knew that the elderly there needed.

Crane was at the forefront of a shift in health care, one of the first gerontological nurse practitioners at a time when geriatrics was barely beginning to be considered a specialty. The idea that older people required a different approach to care wasn’t yet mainstream, and many doctors weren’t interested. But Crane had grown up with older family members whom she cherished – her own grandmother lived to be 104 years old – and she believed that a change in approach to elder care was long overdue. “During school, I had two classes in geriatrics,” recalled Crane. “Chronic Disease I and Chronic Disease II. It was the older people on the job that taught me what was really important about nursing.”

At Erie, Crane, along with her collaborating physician, Dr. Olga Haring, cared for patients in the clinic while staff members visited isolated lonely seniors, monitored people’s medication, and even arranged breakfasts and luncheons for those who couldn’t afford food. Crane quickly realized that meeting the physical needs of the elderly was only one aspect of care. She witnessed older people being emotionally or physically abused by their family members, and older people with depression or other mental health issues who needed someone to talk to. When she would make home visits, she was often unsure what she would find on the other side of the apartment door. She waded her way through hoarders’ stuffed living spaces, nursed sick alcoholics, and worked closely with an ambulance service to ensure critically ill patients were delivered to the right hospital. But she felt that this was the care she needed to provide. “It was such a unique model of nursing, and the job was so different from anything I had done before,” she said. “Our community nurse would give exercise classes including swimming lessons at Eckhart Park. We brought in a podiatrist, negotiated reduced fees with a local ophthalmologist. We’d host free breakfasts every single Friday. It was just so unique.”

Crane was with Erie for five years before moving on to provide home care at the VA Hospital in Durham, North Carolina. She is now retired and is an active volunteer at a local hospital, where she serves as co-chair of the Patient Advisory Council, recommending ways to keep patient care running smoothly and efficiently.

Crane is also a writer (check out her nursing blog at nursingstories.org) and is working on her first book, a memoir about her experience at Erie Senior Clinic. The book will be published by She Writes Press at the end of August 2018, and Crane has generously pledged that a portion of the proceeds from the book go towards patient operations at Erie Family Health Center.

 

*While the Erie Senior Clinic has closed its doors, Erie remains committed to serving elderly patients and connecting them with the resources and referrals they need for a healthy, comfortable life.

 

 

 

Nurses Save Lives

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What a pleasant surprise to read that nurses save lives (italics mine) in a news article yesterday, September 21. Unfortunately, the story was not a happy one. The Raleigh, NC News & Observer detailed the memorial service for the crew of a Duke Life Flight Air Ambulance that crashed on September 8 killing all aboard: pilot, patient and two flight nurses.

“Like all medical personnel at Duke, Life Flight’s Crew ‘have a strong desire to save lives (italics mine),’” said Irene Borghese, program director. She goes on to say “what sets this group apart is their desire to do so (save lives) while putting themselves in harm’s way and without the safety net of an entire health care team . . . They simply depend on each other.”

What she is saying is that the nurses can rely on their own knowledge and expertise when they deal with difficult patient problems on a flight mission and not have to follow doctor’s orders, although there probably are protocols when needed.

The nurses who died, Crystal Sollinger and Kris Harrison, had worked together on a flight “that wound up saving the life (italics mine) of an infant . . .that baby is now 3 years old, and her family brought her to” the service.

We all know that in most instance nurses are not recognized for the intelligent, caring and competent health care providers that they are.

In a post I wrote in February 2013, Businessweek reporters gave doctors credit for caring for Hillary Clinton while she was admitted to the hospital when she had a blood clot. Nurses were never mentioned. I can’t imagine a doctor was around to do vital signs on the night shift.

Thank you to Ray Gronberg and Tammy Grubb, the authors of N & O piece, for giving credit to Crystal and Kris for doing what they really do: save lives.

 

 

 

 

 

 

 

 

Laughter: the measure of a friendship

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I believe the better the friendship the more raucous the laugher—the real belly laughs that make you think you are going to die of asphyxiation. I have a number of friends that are enjoyable to be with but I have just two or three that make me really laugh.

Donna and I worked in home care at a Chicago area VA in the late ’80s. Our caseload mostly included veterans who were elderly with chronic disease or dying of cancer. Both NP’s, we worked four-ten hour days a week, each covering for the other on the day we had off. Jane, a third NP who worked with us, had young children and requested to work a regular schedule.

Many times after work, Donna and I lingered in the large 4-bed room on a deserted patient unit that served as an office for us three NPs. Each of our desks was centered against a wall. No other furniture filled cavernous room. Donna and I would take turns rolling our chairs next to the other’s desk. We discussed our patients before we wandered off into the personal and humorous. Our laughter ricocheted off the walls. If we became raucous, we didn’t care since there was no one nearby to complain.

After my husband and I had moved to the DC area, Donna came to visit. At one of my favorite art museums—The Phillips Gallery, Donna and I burst into unrestrained laughter. I can’t remember the trigger. What could be so funny in an art gallery? The other patrons gave us wide berth while we two middle-aged women tried to control ourselves. The more we worked to settle down, the harder we laughed. That was the last time Donna and I were together.

In 2000, Donna moved to southern Illinois and I to North Carolina. We emailed and occasionally spoke on the phone. In 2013, Donna was diagnosed with lymphoma.

During one of her remissions she reviewed my manuscript checking for any inaccuracies in my descriptions of NP practice in the 80’s. I sent her a thank you bouquet of flowers.

Now as I ready my book for publication, I am composing the Acknowledgements. The realization that Donna won’t see a formal appreciation saddens me. She died on July 9th.

I will miss her laughter.

Out of the Blue (aka Mr. Foley)

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  • My story was published in Pulse: Stories from the Heart of Medicine on August 18, 2017
  • Out of the Blue
  • Friday, 18 August 2017

Marianna Crane ~

As I sit in the exam room waiting for my first patient of the afternoon, the phone rings. It rings four more times before I realize that Amanda Ringwald, our eighty-year-old receptionist, hasn’t come back from taking a rare lunch break.

I pick up the phone and say, “VA Hospital. Marianna Crane.” Oops, I’m not back at the VA anymore.“Senior Clinic,” I quickly add.

“Hello, my friend.”

The familiar voice makes my throat tighten and my eyes water. How in God’s name did he track me down at work?

“Mr. Foley. How are you?”

“Not good. My wife died. She died a month ago.” He sobs, and more tears flood my eyes.

Eddie Foley, a frail man with thinning white hair and a perpetual smile, had been one of my favorite patients when I was a nurse practitioner at the VA. I haven’t spoken with him since I started this new job, six months ago.

He’d enjoyed telling me about his wife and adult son. “They mean all the world to me,” he would say. “I don’t need no fancy vacations or new cars. I’m happy as long as I got my family.”

I reach for a tissue from the box on my desk. “Mr. Foley, I am so sorry.”

About two years ago, Mr. Foley, who’d been a butcher for more than fifty years, had suddenly developed swelling and redness in both hands.

“Acute arthritis,” my boss Dr. Leon Logan had said. Although this condition is common among butchers, who constantly handle cold meat, it’s unusual for it to surface so late in life.

“Let’s put him in the hospital so the rheumatology staff can figure out what’s going on and learn from him,” Dr. Logan had decided.

I’d worried that Mr. Foley might contract a hospital-acquired infection from a contaminated stethoscope or food tray, or from a health worker’s hands.

Many infected patients died. Especially the elderly.

I tried to convince Dr. Logan not to send Mr. Foley to the hospital. When that didn’t work, I tried to dissuade Mr. Foley from going.

“You don’t have to be admitted,” I said. “The rheumatology doctors want to see what has happened to you, but there are textbooks they can look at, you know.”

Mr. Foley shook his head. “I’ll do anything to help Dr. Logan and the other docs,” he said emphatically. “If they can learn from me, I’ll go into the hospital.”

Damn.

The battery of tests and invasive procedures that the rheumatology doctors ordered made Mr. Foley dehydrated, and he started to lose weight. After a few days, I walked into his hospital room, trying not to show my concern as I listened to his labored breathing.

He’d developed pneumonia. A plastic bag hung from a pole, dripping saline and antibiotics into his skinny arm.

I sat on the side of his bed and leaned down, my mouth close to his ear. “Mr. Foley, you’d better get well. Your wife and son want you to come home.”

He smiled weakly.

“You can do it,” I urged, feeling guilty. Was I cheering him on so I wouldn’t live the rest of my life with his death on my conscience? I’d let Mr. Foley down by allowing Dr. Logan to get his way with so little resistance.

I’ll never let him down like that again, I vowed.

Three days later, I was delighted to find Mr. Foley sitting up in bed reading the Chicago Tribune. The IV bag was gone.

“The doctors say I’m a walking miracle. I go home tomorrow.” And, to my elation, he did go home to his family. In the two years that followed, he never had another arthritis recurrence, and we haven’t spoken in the six months since I left the VA.

Now, as I clutch the receiver, Mr. Foley continues to sob over the phone while Mrs. Ringwald shuffles through the door.

“Your patient is here,” she says, laying the chart on my desk.

“Mr. Foley, I’m so sorry, I can’t talk. I have a patient waiting for me.”

Mr. Foley’s voice cracks. “Oh, Doctor Crane, I shouldn’t have bothered you.”

I never could get him to stop calling me doctor.

“I’m a nurse practitioner,” I would say.

“You are my doctor,” he would respond. “And my friend.”

“Mr. Foley, give me your address. I’ll come and visit you.” Imagining a smile breaking out on his face, I write down the address he gives me. I tuck the piece of paper into my skirt pocket, resolving to visit him soon.

Before calling the next patient into the exam room, I slip into the bathroom and splash cold water on my face, blotting it dry with a coarse paper towel.

A month later, as I am restocking our medical supplies, Mrs. Ringwald says, “A Michael Foley is on the phone asking to talk with you.”

I freeze, suddenly remembering the piece of paper with Mr. Foley’s address sitting in my top desk drawer. It turned out that he lived further away than I’d thought, so I kept putting off visiting him.

My office doubles as the exam room, and the geriatrician with whom I work is using it to see a patient. There is little privacy in the small clinic, so I take Mrs. Ringwald’s desk phone and drag it with me into the bathroom. I close the door.

“Ms. Crane, this is Mike, Eddie Foley’s son.”

He sounds just like his father.

“My father thought the world of you. So I want to let you know that he died last week. I guess he didn’t want to live without my mother.”

I slide down the wall onto the cold tile floor with the phone in my lap, unable to speak.

I never thought Mr. Foley would die before I got around to visiting him. I’ve let him down, again.

About the author:

Marianna Crane has been a nurse for more than forty years and became one of the first gerontological nurse practitioners in the early 1980s. “Although I’ve dabbled in writing throughout my life, it was only later in my career that I became passionate about telling stories to educate the public about what nurses really do.” Her work has appeared in the New York TimesThe Eno River Literary JournalExamined Life JournalHospital Drive and Stories That Need to Be Told: A Tulip Tree Anthology. Her memoir, Playing Sheriff: A Nurse Practitioner’s Story, will be published in August 2018. Her personal blog is nursingstories.org.

No Edit Too Mundane

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This is the week we spend our annual family vacation at the beach. While I have enjoyed the ocean and sand, I took some time to complete an assignment. One of my stories had been accepted by Pulse: Voices from the Heart of Medicine, a digital journal. It could be published as soon as this Friday if I could make changes suggested by the editorial staff. And I did.

While most of the edits added clarity and a deeper texture to my story, one area of discussion initially seemed mundane. However, on reflection, I came to realize how important it is to add the actual time period of a story. In this case the mid ’80s.

Desk Phone

An intern who had the lead editing assignment probably was born into the cell phone era and never experienced a “desk” phone that, in most cases, was immovable from its position unless you added an additional cord.

vintage telephone cord

For example, in order to move about room, you had to add a long extension cord from the outlet in the wall to the base phone, then hold the base with one hand and with the other clutch the receiver to one’s ear. This way you could walk away from the desk and check for a report in the near-by file cabinet. (I won’t go into the fact we had hard copies of all our documents).

If you chose to add a long line from the phone base to the receiver so you didn’t have to carry the phone base with you, you would have to scurry back to the base phone to hang up.

Coiled phone extension

Plus that cord was coiled and most often became so tangled that you had to dangle the receiver until it spun and untangled. You had to plan ahead to add the cords. If, as the young intern suggested, you added an extension cord while talking to someone, the call would be disconnected.

This is probably more than you ever cared to know about old-fashioned phones. However, I learned a lesson that sometimes we know something so intimately that we assume all others share our experiences.

 

Check this site: Pulse Friday or next Friday to see if my story made it.

 

 

 

 

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Leaving Our Legacy

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I have been thinking for a long time about the fact that we older nurses are dying off. We will take with us our memories of nursing history. I have always loved to hear from other seasoned nurses about how they size up their nursing careers as they look back. What was important at the time, what were they happy to see disappear, and how do they assess current nursing practice and the future of the profession?

So I decided I would weigh in, occasionally, by spotlighting a nurse of a certain age, i.e., sixty and older, whether this is through an article I have read or by interviewing someone, or through my own stories.

This post is prompted by an article: Diane Saulecke, “There from the Start: A Hospice Nurse Looks Back,” American Journal of Nursing, 7, July 2017, 56-57.

The article features Dianne Puzycki, an 82-year-old nurse, who began to work with the hospice movement when it first started in the early 70s. She still works “the night shift at Connecticut Hospice once a week. ‘I want to be part of it as long as I can,’ she says, ‘It’s become part of my life, my philosophy.’”

 

 

 After graduating from nursing school in 1955, she started her career at Memorial Hospital (now part of Memorial Sloan Kettering Cancer Center) in New York City. There she cared for patients with cancer, many of them young women.

“At that time, we didn’t talk about death and dying,” she says. “We weren’t allowed to talk about that. It really haunted me for years.”

I remember those restrictions well. The diagnosis of breast cancer was withheld from my beloved Aunt Lena. I was in the first year of nursing school but never visited her in the hospital. One evening, when I was talking to my mother on the phone, I asked, “How is Aunt Lena?” “Just fine,” my mother said. That’s when I knew she had died. My mother would give me the bad new when I next went home to visit.

Puzycki mentions that she heard both Cicely Saunders, a doctor who founded the first hospice, and Elisabeth Kübler-Ross, who opened up discussion on dying through her 1969 book On Death and Dying. The early 70s were heady times in health care as discussion heated up regarding the previous taboo of being honest with patients by telling them their cancer diagnosis.

Kübler-Ross’ book was the subject of a workshop for the medical staff at the time I worked for a community hospital in the early 80s. To this day I remember one of the surgeons storming out of the classroom after loudly protesting, “my patients don’t want to hear that they have cancer.”

Being present for patients and “picking up on the little things” is to Puzycki the key to hospice nursing. And she says that seeing the compassionate actions taken by her colleagues, especially the younger ones, makes her feel hopeful about the future of the profession. She recently saw, for example, a fellow nurse lean down and kiss an elderly patient on the head. “I said, ‘That’s a good hospice nurse.’”

 

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I HAD A DREAM

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Revisiting the dreams.

Marianna Crane: nursing stories

Mercury Sphygmomanometer

In preparation for moving I discover the darndest things as I unpack dusty boxes stored in the attic untouched for years. This time it’s a mercury sphygmomanometer, packed in its original carton along with a “limited warranty” card that should have been filled out within ten days of purchase. Looks like I didn’t even open the box but put the blood pressure machine away for the day I would open my independent practice.

That would have been in the early 80s after I became a gerontological NP

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after I worked in Chicago with inner city, underserved elderly

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after I became frustrated with the lack of resources and left to become an administrator of an HMO

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after I knew I didn’t want to be in administration

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after going back to work as a nurse practitioner once again

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after moving to three different states

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after finally…

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Getting on the Bus

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This post appeared in two parts on September 8 & 20, 2013.

 

The first night in a hotel room in Estoril, Portugal, my heart, flipping about in my chest, jolted me awake. Thump. Thump. Thump. Silence. Then a rush of horses’ hooves clopped on my ribs. Trying to ignore my heart’s gymnastics, I tried to go back to sleep but the Mariachi band playing under my ribs demanded my attention. Pressing my fingers into my wrist, I palpated the same irregular rhythm. Besides a touch of anxiety, I felt fine. No chest pain, no shortness of breath, no dizziness, no nausea. Then my bladder upstaged my clinical observations. Damn.

Slowly, I rose and sat on the side of the bed, careful not to disturb my husband who slept beside me. I waited to pass out. When that didn’t happen, I shuffled in the dark, feeling my way along the wall, to the tiny bathroom.

Successfully back in bed without tripping, falling, or fainting, jet lag eased me into slumber.

The next morning, I awoke to the same sensation in my chest. More alert than the night before, I diagnosed the uneven heartbeat as atrial fibrillation. A geriatric nurse practitioner until my retirement three years ago, I had treated many patients with this condition—its occurrence increases with age. A fact I couldn’t ignore.

I remembered the day before as my husband and I explored the neighborhood around the hotel we had walked past a medical clinic. Through the large glass window, I saw several people sitting in a waiting room, some reading magazines, not unlike our clinics back home. I had no desire to seek help there. I didn’t speak the language, and who knew how advanced medical practice was in Portugal? Besides, I was counting on this event ending soon.

Getting ready for the day’s adventure, my husband slipped a sweater over his head as I laced my shoes. “By the way,” I said, “I am having some a-fib. It’s nothing serious and I suspect it’ll end on its own. I just want you to know, in case I pass out, get an ambulance and tell the medical folks what’s wrong with me.” I made eye contact. “A-fib, got it?” My husband of forty years knew better than to question me, and nodded. I figured he was happy to put off a deviation in our itinerary—his controlled persona would be spared a chaotic scene.

We rode the elevator down to the lobby, queued up with our tour group and boarded the bus to Cabo de Roca. I grabbed a window seat. The vibrant, coastal city gave way to dry grasses clinging to rocky cliffs. I slipped down in my seat and put my fingers to my neck, checking my carotid pulse. The irregular rhythm ticked off around one hundred beats per minute. No too rapid to worry me—yet.

After a couple of hours, the light blue sky became cloudless as we headed into thinning air. Would the high altitude affect the rhythm of my heart? Would my pulse become so erratic that my blood stagnated, forming a clot that would migrate to my brain and spawn a stroke? My husband remained deep in his book. Or was he consciously ignoring me? The medical clinic near the hotel began to look inviting. And very far away.

The bus turned into an empty parking lot. We arrived before the Japanese tourists. My husband was the only one who headed over to the one-story building that stood at the far end of the lot where one could obtain, for five Euros, a certificate validating that one had stood at the westernmost point of continental Europe. The others headed to the bathrooms or the gift shop.

I stepped off the bus last. I felt something strange. Or, rather, I felt nothing. My heart had stopped. No, it just felt that way with the prancing finally gone.

Cabo de Roca

My chest was silent. My pulse was regular. The air smelled cool and crisp.

Released from potential calamity, I dashed off to find my husband.

When we returned to the States, my internist insisted I wear an Event Monitor: electrodes attached to my chest at one end and at the other end to a plastic box that would hang around my neck for a month. When I noted any flip-flops from my heart, I was to depress the start button and the monitor would record the “event.”

During the first week, after I wrestled with the monitor to find a comfortable position in bed, I settled into sleep. My heart, booming loudly in my ears, jarred me awake. I pressed the record button and the monitor gave off a high-pitched sound and began taping. As instructed, I lay still. When the whining stopped, I stumbled out of the bedroom to call the toll-free phone number.

The nurse talked me though the process of sending the recording across the phone lines. I hung up, relieved that she didn’t tell me to go directly to the hospital, as happened with my friend, Norm, after his first submittal. He was sent to the emergency room immediately. A pacemaker was implanted in his chest the next day.

I reassured my husband, who woke up during the taping and trailed after me, concern covering his face. We ambled back to bed—him to sleep and me to await any further malfunctioning of my heart.

Three weeks later, I mailed the monitor, wire, attachments and unused batteries back to the company. I wouldn’t miss the nightly struggle to sleep with a rigid box digging into my ribs. Or fear of the monitor beeping at inappropriate times during the day. Or most of all, the constant state of surveillance for any twitch in my chest.

The only two episodes I had during the month were not atrial fibrillation but sinus tachycardia: a regular, rapid heart rate that’s not life threatening. Wearing the monitor for a month seemed too much of an inconvenience for such a paltry yield.

No doubt there will be other assaults to my aging body, mildly annoying or life threatening. The trick is to know the difference: whether to stay back and seek medical care or take a chance and get on the bus.

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Nurses of a Certain Age

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Excepted from Off the Charts, May 31, 2017

 

AJN Facebook Readers on Influences, Public Attitudes to Nursing, Practices of Yesterday

by Betsy Todd, MPH, RN, CIC 

What do you remember from early in your career that would never be seen or done today?

We “nurses of a certain age” remember!—and we’re amazed at how far our profession has come. As one nurse commented, in response to early nursing practices that seem primitive today, “Oh my goodness, how has humanity survived?!”

There were, of course, our caps, white dresses, white hose, and white shoes. One nurse recalled that we always wore our school pins on our uniforms. These seem not much in evidence these days, but were always a source of pride and connection (and sometimes, lighthearted rivalries) back in the day.

In addition, nurses pointed out that the scope of practice has certainly changed. Nurses mixed soft soap for enemas, mixed weak solutions of Lysol (!) for vaginal douching. Wound care has, shall we say, evolved. Nurses recalled packing wounds with eusol (chlorinated lime plus boric acid—“cleaned wounds by removing patients’ flesh with it!”), Savlon (chlorhexidine combined with a chemical later used for disinfecting floors), Milton (a bleach solution), or sugar mixed with Betadine or egg whites. Some remembered “vigorously rubbing talc onto bums to relieve pressure” or “Maalox and heat lamp for sore butts.”

Are automated medication dispensing systems (for example, Pyxis machines) and bar codes part of your daily routine? Several comments described pouring meds from stock bottles on the unit or mixing chemotherapy solutions in the medication room. There were no medication carts, just medication trays with cups and handwritten cards for each patient (different colored cards for b.i.d, t.i.d., etc.).

“Point of care” lab testing didn’t include quality checks. One nurse remembered “burning urine samples in a glass tube over a Bunsen burner to check sugar levels.” DeLee suctioning of newborns—“I ended up with a mouth full of stomach contents more than once”—or pipetting blood and urine samples for the lab via mouth suction were also routine.

Many comments reminded us of tools rarely seen in today’s hospitals. There were time-taped IV bags, glass syringes and IV and chest tube bottles, mercury thermometers, crank beds and egg-crate mattresses, “gloveless everything,” and no hand sanitizer.

Routines and work practices of years ago may be hard to imagine today. Nurses recalled smoking during report, and patients smoking in bed. Patients were admitted “just for observation,” or a day or two prior to surgery. Each shift charted in a different color of ink. Nurses recalled time to talk with patients, and actual “acuity-based staffing” (“RIP,” as one nurse commented).

Another nurse summed up a certain sadness as she described some lost aspects of patient care:

“morning care before breakfast, clean sheets every day, evening care with back rubs, trash emptied, fresh water and being aware of the patient’s environment. [We] took time to assess the patient by the RN and listening. The care was impeccable because of the nurses who controlled the patient experience.”

Back Rub

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