Surgical RN: Early 1980's Nursing

I revamped one of my postings of my First job as an RN & some of the Changes in Nursing in the last 30 years since I started nursing.

I know nurses that have worked in the same job for 30 years and are afraid to make any moves elsewhere - even within their own specialty.

It is definitely more difficult nowadays to switch areas. I know that specialization restricts lateral moves between units and you have to question the safety factor - floating an RN to a unit where they are basically a fish out of water - yet it is still done all the time.


My first job as an RN was on a Surgical Unit that had approximately 45 - 50 patients. There were 4 RNs to look after 12 or 14 patients each (much improved over the 20 patients on Medical 5 years previous). Nowadays that sounds like a lot of patients (that was during the day.....at night perhaps you had 16 to 20 patients) but that was the norm back then, "back then" being 30 years ago. Nowadays the nurse to patient ratio has improved but the actual "acuity" level has gone up so I am not sure that it is any better.

I think the fact that we kept patients a lot longer back then made the load a little easier....you had more patients that actually could care for themselves, mobilize independently, and had less machinery attached to them. Lack of pumps/machinery = more space and less monitoring although what you were watching definitely needed to be followed carefully.

For Heparin drips we used volutrols and TPN would sail in "sans pump" – free flow – try calibrating by eyeball lipids at weird calculations - 35 mls/hr and the regular solution at 68 mls per hour. By this time IV bags as rather than bottles were being used (the lipids came seperate in a glass bottle).

Not one post op patient had an O2 Sat done or even were initially on oxygen when first brought out to the floor. I have suspicions that there were many patients that probably could have used O2 – if we had only known what their sat level was. Now oxymeters are pretty well routine as part of the post op assessments.

Funny, the things that were deemed "important" back then. They all DID get their complete post op bed bath and nightly back rub by the shift's end - and in this way I am glad things have changed.

There were no needle disposal systems for each room (only one huge container at the nursing station - no lid). After using a syringe you would recap and pocket it, and at some later time during the shift when you had time, dispose of it in the big open bucket at the nurses' station....unless of course, the cap fell off the needle while in your pocket.

Most new nurses listen in horror when I tell them I have no idea how many needle sticks I got in my hip from used syringes that serendipitously uncapped themselves while I was working. None of these stab wounds were ever followed up or treated. It was just: “oh well...another poke!”.

There were no gloves at our disposal...only the "sterile" ones that would be used only by MDs for procedures and NEVER by nurses or anyone else doing direct patient care no matter how messy a job you were taking care of and what bodily fluid you were dealing with. I can remember sneaking a pair of sterile gloves for a particularily messy cleanup.

It was never thought that you really had to protect yourself from anything...and heaven forbid you should make a colostomy patient "feel dirty" (yes, we were told that by our instructor!) by using gloves while changing their appliance!

Whispers of HIV were just emerging – but no one really knew anything about it. No such thing as “universal precautions”. There are now boxes (plural) of gloves of several different colors and composition in every room....and you certainly wouldn’t care for a patient without a pair of gloves. And yes, we did wash our hands religiously.

Thank goodness for running water and soap!

Medications came in big bottles from pharmacy - Valium, Serax - any number of drugs we later "counted" sat on the shelves for the "taking". It wasn't unusual, I noticed at the time, to have to restock those bottles more often than should be necessary.

I knew of at least one RN when I was first starting out on Surgical who was found with several assorted bottles at home when picked up by the ambulance and admitted for overdose.

Now in most hospitals even the tylenol is doled out by mechanical dispensing systems....with every pill or injection accounted for...attached by a numerical system to each patient.

There was a little recipe box with cards for each surgeon – their “preferences” – whether or not you could just give a sleeping pill without calling him during the night or what they did or didn’t like for their patient.

No “standing orders” ever written down. I know that some RNs didn’t even chart some of these prns given– they were just doled out as needed and requested.  Occasionally an RN would get a "cover" order the next day, but if not - oh well.

Nurses and MDs smoked at the Nurses' station while charting. Patients could smoke in their rooms but weren't allowed to smoke when oxygen was in use in their rooms.  Every once in a while at night on "rounds" you could once identify a hardcore smoker, in bed, by the soft blue glow from their nasal cannulas....the oxygen on fire when they took a puff. No smoking is the rule in all hospitals nowadays, so you really notice a whiff of cigarette smoke wafting off anyone who is a smoker.

The MDs might bring in Bailey's Irish Cream at Christmas for the nurses and we would sip on our "medicated" morning coffee with delight! Often, "the girls" would go out dancing the night before and come straight to work.....smell of smoke and alcohol permeating- still half intoxicated or at least a pretty bad hangover......and no thought given that they shouldn't be doing this....


Things certainly have changed.

Working in hospitals nowadays....I won't have even a glass of wine 24 hours before a shift.

I can remember recently the comments made to me after eating several Christmas chocolate brandy beans that some patient left for the nurses at the desk...whereas - back in the 80s - it  wouldn't be questioned.

I can remember in California it was routine to advise Laboring moms over the phone to drink “a glass of wine or a shooter of any alcohol of your choice” when in the prodromal stage of labor - and that was only 20 years ago.

It wasn’t too many years previous  that MDs would order IV alcohol infusions for preterm labor patients to stop labor. Now - Nurses will note ETOH on a patient’s chart when even a small whiff of alcohol is smelled anywhere on a patient.

Another thing I noticed has changed throughout the years is the camaraderie. It just isn't the same anymore.

Maybe it is just that I am older and it is the younger ones that take the time to do things in the evening together. Maybe I just don't have the energy. Maybe because I am not single anymore. Maybe because I am fairly new in the communities where I worked (I have moved so many times!) ....and we aren't "newbies" just starting out together like my first job. Maybe it is the style of management nowadays, or maybe it is that we are so busy we don't have the time for fun anymore.

I just can't put my finger on it....but things have changed in the camaraderie department.

That's ok though - as I ponder upon nursing past.

Things have to change. Change is good. I love change. I even embrace it.

And I think I like the detachment at work...... having it not so personal. It has been "too personal" all my life and this calm existence away from the personal and political drama at work is feeling good.

Besides, I have my husband now, after the single life for the first 50 years........and less drama is good.

*SIGH*