Medical Unit: The Good, Bad and the Ugly

My next Job as an LPN was on a Medical floor. There were 3 arms to the unit....each arm had at least 20 patients. Each arm had ONE RN and ONE LPN. It was the RN's job to give out the meds (poor things-because on a Med floor that means MILLIONS of them- and basically, that's all they did all day!) monitor IVs (all glass bottles -no bags!) and do the treatments. It was our job as an LPN to do everything else - bathe all the patients that needed bathing (which meant most), toilet everyone, answer call bells, change sheets every other day, make beds and turn any patient that required it, take vital signs, mobilize and generally do all the direct patient care as needed.

LPNs started at 7 am and we didn't get any verbal report....just a list of patients and quickly scan the Kardex for activity, I&O's and vital signs that needed doing - and off we went - 10 minutes max - or else! The RNs came on at 8 am (I was envious of that extra hour of sleep!) and then sat through report which at that time meant ALL 3 WINGS worth. Of course by the time they got out of report an hour or two later, it was almost 10 am and most of the physical work was done by the LPNs.

It was a tough go, mostly because of sheer numbers, but generally, the patients were *fairly* stable, and even though you had 20 some odd patients to look after, the acuity level was a lot lower than a medical unit nowadays. Patients stayed in hospital a lot longer so were less sick than your average medical patient today. Charting was only one page of nurses' notes and a graph sheet and a couple lab pages - no signatory, no multiple signatures or daily MARs- just one page for meds and MD notes.

Definitely fewer machines and computers- but then the rooms were too small anyway – and I don’t recall doing even one O2 sat on the ward. I can remember only one patient for whom they brought over a Pulse Oxymeter from ICU ...and it was a HUGE box. There was only the very rare IV pump. Heparin was by volutrol drip only and TPN drips were freeflow-no pump.

Thermometers were the glass-and-mercury ones for under the tongue (it took f.o.r.e.v.e.r to do temps!) - and they sat in an antiseptic solution at each bedside. We had time on days and evenings to give out ice water (which LPNs did all together along with the vital sign taking!) and there was time to give everyone a back rub (mobile or not!) at bedtime, or get them tea or whatever they needed. It was busy, but not a harried-nothing-is-ever-getting-done-oh-crap-someone-is-going-to-die type of busy like today.

We had orderlies to help with the heavy patients and care for the male catheters if we didn't have time. They were a fun bunch of guys. We had a great time, joking around, laughing, helping each other out, and I even ended up dating one or two for a while. :P

The only time I was ever involved in a full blown CPR as an LPN was on the 3rd wing of the Medical Unit. I had finished my rounds, and came back to the first room where an elderly gentleman was waiting for discharge. He was the first on my rounds. I had taken his vital signs, chatted with him about going home and then asked when his wife was coming to pick him up. I had told him to get himself ready and I would come back after I peeked in on everyone else and help him out with getting his things together. When I walked back into the room not 20 minutes later, there he was keeled over on the bed. I called the code and then set in motion the things we were supposed to do to begin CPR.

This next part is going to gross out any new RNs. Back then (now I am starting to sound like a dinosaur if I haven't already!) there were no airways or masks in the patient's rooms to use for mouth breathing. You just did the mouth to mouth directly on the patient....no gloves, no protection, no nothing. Gloves were only the sterile kind and were never used for patient care no matter what you were doing.

No electric beds - I had to hand roll with the crank at the foot of the bed so it was flat and elevated for CPR. There was only one ambu bag and it was on the crash cart in some cubby hole down the hall. Eventually someone would haul it to the scene. My RN was first to arrive. She made the BIG mistake of asking me which end I wanted to take (head or chest) and of course I picked chest compressions......for obvious reasons. I knew exactly what was coming. Three rounds of compressions into the CPR, the patient vomits - right into the RN's mouth. Whoa. So glad I made the right choice.

Once the crash cart arrived - along with the orderly, the ICU/CCU Code team and the Charge nurse and Supervisor - I stepped back to let the crowd do their thing. No one needed this body in there and besides, I had 19 other patients to sort out still. Suffice it to say, that poor gentleman went Home - just not to the "home" he thought he would be going to. The docs said it was a blown AAA.

Speaking of which. I remember doing the "rounds" one night, doing the turns, changing the beds, answering call lights - generally making sure everyone was breathing. Routinely, we would start in the 1st wing, at the four bed rooms and work our way around to the end of the hall and back. Approximately half way through the round a bell call light came on from the first room. I walked back to find out what was the problem. Everyone had been fine 30 minutes ago. Three of the four had been asleep, and the third, a (DNR) stroke patient, we turned and propped with pillows.

The call bell was from the 3rd patient kitty corner to the stroke patient. "Yes, can I help you?" I asked. "That patient over there" he pointed to the stroke patient, "is dead." "What?" I was perplexed. It wasn’t like he could have gotten up out of bed on his own and checked.
" Yes, he is gone" the gentleman continued. " I saw an angel come and stand at the foot of his bed and he took that guy by the hand and left..." No way, I thought. I went to the stroke patient's bed. Sure enough. He was gone.

That was a story I have told over and over again. Angels - right on our unit.



Working on a Medical unit, we had lots of Cardiac patients. They were my "pet" patients.....being a young thing and all, and not realizing what men REALLY thought back then, I catered to them to no end. I would make sure they were all given fresh linens, fresh water, bedtime back rubs......I just loved taking care of them....they seemed to really appreciate (no wonder!) the attention and showed gratitude for everything done for them....compared to the elderly females who would basically complain about everything! The "elderly" men I looked after back then were approximately my age now. I can't believe I thought they were "old"!! But, back then, what did I know?



Most MDs were a real pain. I felt sorry for the RNs because the Internists would come on their rounds at any old time and leave pages and pages of orders (mostly STAT) and then walk off without telling anyone. One or two were civilized but it always seems there is at least ONE that is so totally Dr. Obnoxious.

I can remember looking after one of his patients (one of 20-some!) with an RN that didn't take any guff from anyone. His “special” patient was in one of the three private rooms. In the middle of the night we had to transfer his patient out of that room and into a ward because we needed that room for a dying (DNR) patient and her family. By morning, the dear soul had passed and after the family had said their goodbyes, we were left dealing with the body.

The custom of the unit was, if it was close to morning, rather than call the family MD from home, we were to get the first doc to show up on the unit to pronounce the patient. Unfortunately for him, but mostly for us, it was Dr. Obnoxious that first arrived on the scene that am . My RN informed this doc of the expired patient that he was to pronounce. "I will NOT" he stated emphatically "Get someone else". He grabbed his chart and headed down the wing on his way to the private room where he last saw his patient, my RN on his heels, saying nothing about moving his patient. He walked into the room and pulled back the covers of the poor departed soul.

"WHAT!"he exclaimed, shocked. "But - she's - DEAD!". The spunky RN passed him the chart for the deceased patient. "Thank you, that's all we wanted to know - now please sign these". She was definitely my hero.

Generally the medical unit back then was a good place to work. Very busy despite the lack of computerization. Sometimes chaotic. But the camaraderie and friendships more than made up for any difficulties encountered. The one thing that I really liked was the independence that work brought me. I was making $8 per hour, which I thought a lot back then. At least it was better than minimum wage which was approximately $1.75 per hour. I bought my first 2 bedroom apartment at age 21 for nothing down, $200 per month for $20K, then sold it, making $10K and with that bought a 3 bedroom townhouse right near the lake for $46K.
I always rented to friends from work and we always had a great time – at work and otherwise. Not once did I ever think that one day I would be a nurse in my mid-50s, looking back on the past, shaking my head and wondering at the life of a young nurse - taking life for granted.......

I stayed on that unit for two years, then decided enough was enough. I needed to go for my RN so I could sleep in that extra hour. No lie. That was my reasoning at the time. =^@

Like I said.....I look back and shake my head.........