Nurses then and now
Our daughter, Laurel, came down for the Tuba Christmas in the mall and other Victorian Christmas Events, and she started telling me about her last twelve hour shift. She works three shifts a week. About the same time, I met Sam Vodola at the Y and he shared a short article, “All in a Day’s Work”, a job description given to floor nurses by a hospital in 1887, published by the Sauder Farm and Craft Village. Our readers might be interested in the contrast between the attitudes toward nursing and the tasks they performed then and now.
THEN, a nurse’s daily tasks were to sweep and mop the floor of the ward, dust the patient’s furniture and windowsills. She shall maintain an even temperature in the ward by bringing in a scuttle of coal for the day’s business. . Each day she is to fill kerosene lamps, clean their chimneys, and trim wicks. Wash the windows once a week.
NOW, Laurel Twardzik arrives at St. Vincent’s Vascular Care Unit at 7 AM. She checks the Card Ex with reports from the night shifts. She starts new report sheets, writing down the doctors on the case, diet activity, dressing changes, labs that are to be drawn that morning and takes the results off the computer and makes sure they are on the chart for the doctor. She checks vital signs and listens to the pulses in patient’s feet.
Dialysis patients are readied for their trip to the floor below. Their medications are placed in a locked box to accompany them along with their charts, and Laurel summons three or five other nurses and aides to help lift her patient from the bed to the gurney for the trip.
Strips are pulled from the heart monitors of all patients, are read for irregularities, and charted. Laurel then checks all I-V drips to see if they are the ones prescribed, if they are open and flowing at the correct rate. She checks to see which patients are on glucometers, pokes their fingers, and gives insulin if necessary. All of this happens before breakfast trays are brought in.
THEN Nurses notes are important in aiding the physician’s work. She should make her pens carefully; she may whittle nibs to her individual taste. Each nurse on day duty will report every day at 7 a.m. and leave at 8 p.m. except on the Sabbath, on which day she will be off from 12 noon to 2 p.m. Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes, or two evenings a week if she goes regularly to church
NOW. Call buttons ding constantly throughout the ward of twenty-four patients. These come into the unit coordinator’s desk. She then calls out the nurse’s name. “Laurel, the patient in 213 needs water.” or help with bathroom visits, or a bed change.
Now as then, nurses bathe patients or wash their backs if they are able to bathe themselves. Many patients need to be transferred from their beds to a gurney or a wheel chair for physical therapy, or X-ray, CAT scans, MRI’s or vascular work. Every bed is changed.
All during the day Laurel is teaching patients: what to do to avoid pneumonia; what they do in a cardiac cauterization procedure; what tests are ordered and why; and diet instruction. She may show a new amputee how to get out of bed.
Around 11 a.m., doctors visit their patients accompanied by the nurse in charge. She then transcribes the doctor’s medication orders onto Card Exes and medicine sheets and carries out the doctor’s orders. Then residents come on the floor and ask about the patients and ask nurses to call up their labs on the computer.
THEN Each nurse should lay aside from each payday a godly sum of her earnings for her benefits during her declining years so that she will not become a burden. For example, if she earns $30 a month, she should set aside $15.
Any nurse who smokes, uses liquor in any form, gets her hair done at a beauty shop, or frequents dance halls will give the director of nurses good reason to suspect her worth, intentions, and integrity.
NOW Before lunch is served, nurses must poke the patient’s finger and administer insulin if needed. Patients are now coming back from therapy and tests and must be pulled over again from the gurney or wheel chair into bed with the aid of other nurses. While the patients eat, Laurel is watching and feeding her patients and one additional one so other nurses can take a lunch break. Then it will be her turn to take a 45-minute break. If her patient is critical, she doesn’t take a lunch break until the condition is reversed. If that is not possible, she gathers their belongings and they are transferred to ICU.
Some patients require immediate priority attention. If their respiration is 40 breaths per minute instead of the normal 15, if they have chest pain or their blood pressure is too high or too low, nurses have to ignore all other calls and call the doctor to do the necessary treatment to stabilize her patient and get him or her out of the danger zone.
If her patient is discharged, Laurel does the discharge teaching, reviews prescriptions, home treatments, answers questions, takes out the I-V ‘s, and, if they are going to a nursing home, talks to social workers, therapists, and doctors and sends along accompanying paper work.
By afternoon I-V bags have emptied, and new veins may have to be found for the needle as the sites wear out. Laurel tries to get as much charting done as she can before the round of checking blood sugar and giving insulin begins again before dinner at 5 p.m.
THEN. The nurse who performs her labors and serves her patients and doctors without fault for five years will be given an increase of five cents a day, providing there are no hospital debts outstanding.
NOW The night shift arrives at 7 p.m. and day nurses provide a history for them and finish charting. On really busy days, Laurel doesn’t leave the hospital until 8:30 or 9 p.m. She says to herself, “Thank God I’ve made it through another day and my patients are still alive.”
An after note. The Christian Science Monitor reports the results of a survey which shows that our population places the greatest trust in Nurses, followed by pharmacists, doctors and teachers.
– Mary