When I was a brand new “graduate nurse” (a temporary license designation which no longer exists in my home state) back in 1978, we were oriented as new nurses just as if we were already full-fledged RNs.
We proudly wore our hard-won caps and school pins with our white uniforms, even in the ICU. And ALL new nurses worked the “off” shifts of 3-11 pm or 11 pm-7 am after orientation with an RN preceptor was completed (i.e. after it was determined you were unlikely to kill someone!).
Day shift (7 am-3 pm) positions were highly coveted. Usually you had to “wait your turn” until a slot opened up after having proved yourself on the evening or night shift.
NOTHING came premixed or unit dosed in those days. We had to calculate, mix, draw up and administer antibiotics and other IV meds.
There were no mechanical medication dispensing systems such as Pyxis and all controlled drugs were locked in a cabinet with a key. There was no pharmacist on duty after about 10 pm. So if you needed to give a narcotic, you had to find the nurse who had the keys. It was not unusual for one to drive home with the keys in a pocket only to have to turn around and take them back so the unit could function.
Charting, in many hospitals, was color-coded. Day shift wrote in blue ink, evening shift in green and nights in red. Everyone owned one of those little four-color pens. Doctors’ orders were written in blue or black on yellow sheets of paper so as not to be overlooked. The order pages had at least two pages–one for the pharmacy and the original to be kept on the chart.
There were no fax machines, so often on day shifts couriers picked up order sheets and delivered them to the pharmacy or lab. If you needed something in a hurry or on an off shift–you guessed it–you had to run the order sheet to the pharmacy or central supply and pick it up.
The State Board Exams (now known as the NCLEX) were administered twice yearly in June and January. The test was split into five sections: Medical, Surgical, Peds, OB and Psych. If a nurse did not pass one or more sections, he or she was allowed to retake those parts again only after a course of review was completed. In the interim, the “graduate nurse” status was still in place, allowing them to continue to work and learn.
In many hospitals, protocol required nurses to stand and give up a chair when a PHYSICIAN entered the unit. Orders during MD rounds were often dictated to the nurses and then co-signed by the MD. As if their hands were paralyzed…but, in truth, for many it was the ONLY way to decipher what the orders were! Physicians’ assistants did not yet exist, although an MD might have “his” nurse who made rounds just ahead of him and who often assisted him in surgery.
The best part about “back in the day”? Staffing was done according to patient ACUITY and not simply the total census of a unit. It was more sensible and safety was the critical factor.
Nurses’ skills were also a consideration. When a new ICU opened up with six specialty beds, only four were in use initially because there were not enough qualified RNs to staff all six, no matter how much the docs lusted over the two empty rooms!
What lies behind us and what lies before us are tiny matters compared to what lies within us (Ralph Waldo Emerson).
For more Inspiration and Stories pick up the latest issue of Scrubs magazine, available at a retail store near you!