Hospital nursing in the 1970s

Image by: Dorling Kindersley RF

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).

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Nurse Rene

Nurse Rene has been an RN since 1978; CCRN since 1989 and attained a BSN in 2010. She has worked in virtually every specialty from Neonatology to Neurosurgery and is a Member of Sigma Theta Tau International Nursing Honor Society with a particular interest in helping students and new grads develop to their full potential. She's been married for 33 years and has a keen interest in history and in current issues as nursing continues to develop as a Real Profession. When not spoiling the grandchildren, she enjoys sewing, cooking, kayaking, camping and travel. She likes all music which does not hurt her ears, watching NCIS, Leverage, Top Gear and Criminal Minds and reads books written by Clive Cussler, Miss Manners, Erma Bombeck and Tom Clancy. She enjoys collecting Quotations for use in her writings.

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6 Responses to Hospital nursing in the 1970s

  1. Ivy RN

    I’ve only been a nurse for 19 years, but all of this was just the same when I started in 1993–except by then, we’d progressed past the part where we were expected to stand up in the presence of a physician! This week, I had to calculate an IV drip rate in an emergency situation: something I haven’t done in probably 18 years. And it came right back to me. Thank you, all those nursing professors who drilled me so mercilessly!

  2. Deidra47 RN

    I graduated in 1968 and stayed at the teaching hospital I trained at. We did not stand for doctors or the DON or give up our seats to them but when I moved to VA. when my hubby was in the service, they did and I was completely floored by it. I know we didn’t have preceptors and I don’t think the private hospitals did either….but when you graduated from my school, it was always…’s your time card/when can you start. We rotated shifts…..6 weeks days/6 weeks 3-1/6 weeks nights. It was also rotaing days off….ie: Mon and Tues/Tues and Wed and so on until you got to Fri and Sat then the next week, Sat, Sun, Mon. We worked as graduate nurses until we took boards which was only given once a year and if you did not pass all the sections, you could not work as a nurse. The graduate was only till you went to boards. This was in Florida. Other states did it differently……in VA. back then, you could work as a graduate if you failed boards but only 3 times and then you had to go back for a refresher course.

  3. Smithteamracing RN

    Ahhhhh the good old days. I received my RN in 1986 & was a new grad/IP until we received board results. White uniforms, no hat or very few hats & we did not give up our seats to the MD’s. The Nursing Supervisor got our meds from pharmacy at night when they were closed. The order sheets were 4 carbonized sheet…press hard—really hard!! I’m not sure how we managed without the fax machine although we had a tube system. Not sure all of our improvements are really improvements!!

  4. Stephanie D RN

    I graduated from a diploma program in 1971–graduated one weekend, took state boards the next and got married the next, because you couldn’t get married in nursing school unless you had special permission.

    As I graduated from a Baptist School of Nursing, and worked at a Baptist Hospital when I got out, pantsuits were a no-no. Dresses, ladies, with white hose, white shoes, and of course, our little white caps (with white bobby pins to keep them on), and school pins.

    Needles and syringes were sent back to Central supply to be re-sterilized, and we soaked cotton balls in jars of alcohol. We warmed metal bedpans under running water so they wouldn’t be such a shock–but be careful not to get them TOO warm, or you’d blister your patient’s bottom.

    Not only did we give up our seats for the MDs, we also fetched coffee. I remember one MD who told me he liked his coffee the way he liked his nurses: blond and sweet. Sexual harassment? What was that?

  5. 1978RN

    Your article reminded me of those days when we actually had fun sometimes at work, we had time to talk and more importantly, listen to our patients. I now teach and I miss bedside care so clinicals are a good time to connect. Sadly, bedside care is so rushed and the pressure to care for patients with higher acuities and less staff takes a toll on new nurses. I hope they can get the satisfaction I experienced in my thirtyfour years of nursing. heres to those who have come after us!

    • Nurse Rene RN

      Thank you for remembering the ‘good old days’! I, too, recall when it was actually FUN to go to work and to have co-workers whom I could refer to as ‘friends’. Nowadays it seems as if we are constantly looking over our shoulders to see if a dagger is aimed at our backs!