From core measures to bedside manners, the standards of care in nursing have evolved dramatically since I was in nursing school. Back then, I recall Sister Mary instructing us not to wear gloves. It offended the patient and implied the patient was “dirty.” Textbooks instructed nurses to administer aspirin to children with fever. That was the nursing practice of 1985.
The tremendous change in care throughout the years has led me to wonder about the nurses who have come before me and those who will come after me. What evolution will they witness? To truly appreciate where we are going, it is important to know where we have been. With that in mind, I met two colleagues to reflect on the changing standards of care in nursing.
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Our Background
Anna Mae received her diploma in 1950 from Saint John’s Riverside Hospital’s Cochran School of Nursing with in Yonkers, New York. Two of her sisters are also diploma nurses.
Carol received her diploma from Shadyside Hospital in Pittsburg, Pennsylvania in 1962. She later also became a nurse anesthetist.
I received my Associate Degree from Columbus College in Columbus, Georgia in 1985, the only degree offered at the time. It was only in my senior year that a Bachelor’s program was introduced. With no bridge programs, however, I would have been forced to start over from scratch if I changed programs.
Nursing Standards Then
In the past, nursing, secretarial work, and teaching were largely the career choices for women. Hospitals and schools were the work settings for nurses at the time. Nurses were well-respected.
The equipment they used included iron lungs, oxygen cribs, and rocking beds (used to rehabilitate the patient after the iron lung). CPR had not been introduced. Doctors started IVs and cut downs were common. The nurse dissolved tablets over a Bunsen burner to prepare an injection. Neither colleague remembers a single patient developing an abscess from such injections.
Anna Mae and Carol both lived in the hospital dorms. A strict house mother enforced the rules. One of the rules forbade the student to marry. My aunt was in such a program and chose to marry—she was never certified as a nurse.
Technological Developments
Anna Mae cites pharmaceutical advances as revolutionizing nursing. She witnessed the introduction of antibiotics and vaccines. Prior to this, she saw patients die from pneumonia and treated patients with polio and whooping cough. A patient with fever required much care as treatment did not include medication. Sponge baths and enemas were instead used to lower the body temperature.
I bear witness to these changes both personally and professionally. I was among the first group of children not to be vaccinated against smallpox. In my nursing practice, I saw the introduction of flu and hepatitis vaccines for healthcare workers.
Carol cites disposable equipment as a major change. She remembers sterilizing the reusable glass syringes and checking the needles carefully after sharpening for burrs. She also notes that disposable equipment, designed to be used once, were of lower quality than reusable ones and attributes it to the rising cost of healthcare.
I remember having to recap needles for disposal in the sharps container located at the nurses’ station. Both Anna Mae and Carol noted that increases in technology have not translated into less work and more free time. The introduction of various scopes impresses me.
I recall patients dying during open lung biopsies on the OR table as the physician attempted to confirm pneumocystic pneumonia, the only way to confirm HTLV III (AIDS). We had no blood tests and no bronchoscopes to confirm the diagnosis.
Different Times, Different Manners
Back then, we were not allowed on the physician side of the nurse’s station and had to rise to give any physician on the nurse’s side our chair. We received reports on the entire unit in person and made rounds with the physician. We handled the chart, looking up any information and writing the orders.
Today, we do not see nurses making rounds with physicians and we struggle to keep informed about the patients assigned to us. That’s one of the striking differences regarding the standards of care in nursing then and now.
When I graduated, I could keep abreast of advances in health care by reading a nursing journal. Now, I struggle to keep pace with advances in my particular practice setting. I serve a well-informed patient population who surf the internet for up-to-date information.
The education debate has raged our entire careers. Perhaps we should learn from pharmacy schools. We made the Doctorate Degree the entry level in 2000 and closed all other schools.
There is little compensation for experience or advance nursing degrees. Anna Mae and Carol graduated before I was born, yet our salaries were comparable. Pay improved in the 1980’s and 90’s but has stagnated since. All RNs, except APRNs, take the same NCLEX regardless of degree obtained. Most share the same job description.
Nurses Today
Nurses today are more educated and certified in their nursing specialties. Yet we continued to be pulled unit to unit and expected to meet the competency for that unit. Few seek bedside positions as the work load and stress increase while pay and respect decrease. We find new graduates ill-prepared.
Carol was fortunate to be hired upon graduation in 1962. Despite the shortages, the hospital did not have positions for the entire graduating class. The shortage has continued for my entire career.
Nursing is one of the most trusted professions, but there is a lack of respect for nurses even among our own ranks. Our roles are changing daily in a myriad of settings. Nurses are not even aware of what colleagues are doing. They are overwhelmed and not supportive of each other.
The public is ill informed of what our jobs entail. The media too often portrays nurses in a degrading manner. The idea that nursing is merely a “calling” and not a profession has hurt us. We must stay abreast of the changes, become involved to shape those changes, and serve as a model of modern nurses.
The Future of Nursing and Beyond
This is what drew me to legal nurse consulting. I revel in a chance to define the standard of care, rather than have it dictated to me from non-nursing sources. We applaud California’s mandated nurse/patient ratios. I suggested my hospital track nurse/patient rations occurring on incident reports.
Although we do not have unions locally, Carol saw improved conditions as a result of union efforts when she held temporary positions elsewhere. She also faced hostility when she declined joining, as a result of her transient position.
Our predictions for the future of nursing include highly trained non-licensed personnel, providing care traditionally provided by the RN.
It has been an interesting journey for each of us in nursing. Our long paths have been marked with tears, smiles, failures, and triumphs. I am honored to have been a small part of it and to have shared it with such fine colleagues. It is with great privilege that I have been involved as the standards of care in nursing evolved and charted its own history.