Tuesday, August 10, 2010

Graduate Nurse, 1973

Thinking back...

There was no shortage of graduate nurse positions when I graduated. I was hired without fanfare to work in the rehabilitation unit at a large teaching hospital at the munificent rate of $4.11/hr. Orientation, such as it was, lasted two weeks and centered around hospital issues such as how to charge a patient for use of equipment. The white nurse's cap with its black-velvet ribbon declared you an RN to one and all. Add to this a crisp white uniform and a four-color ballpoint pen, and you were ready for duty.

All nurses wore dress uniforms (no pantsuits allowed) with white hose and shoes; if we weren't clean and tidy, we heard about it immediately from the supervisor. One thing every nurse had in her work locker was hairpins; no nurse could go onto the floor to work without her cap pinned snugly in place. I was taught to pin a folded kleenex to the top of my head with crossed bobby pins to anchor the heavy cap, which was then also pinned behind.

Graduate nurses wore caps with a school-designated ribbon (not black), and were required to sign themselves Jane Doe, GN, and were supervised by an RN until they passed state boards. We spoke in a hush about what might happen to one who failed state boards, but as I recall all my cohort passed on the first try. The board exam prep we got must have been good; I ranked in the 99th percentile on the boards and still use their test-taking techniques today.

After passing the state board I dribbled a narrow bead of KY jelly along the back of my new black velvet band and affixed it to my nurse's cap with cap-tacks. I think my pay went to $4.23/hr. Eventually I transferred to a medical-surgical floor. The work was difficult, repetitive, and there was little nurse autonomy. We did team nursing, with the RN as med-passer and overseer for LPN's and Aides who gave care to a group of 8-12 patients. In practice it was a difficult juggling act to pass meds on time, keep the IV's running on time, check patients for critical changes, call doctors for orders, and take care of smaller details. Sometimes patients waited for hours for a meal tray or equipment.

IV fluids came in glass bottles with a straw inside to vent; venous access was made via metal needle with two wings called a butterfly. More often than not the patient's movements spoiled the site by puncturing the vein or producing a localized phlebitis. There were several kinds of IV tubing, with three different drop rates, which we calculated by hands. The Buretrol, a rigid plastic chamber which one could use to infuse a controlled dose of meds/fluids, slowly moved from pediatrics to the med-surg floors where it was considered high tech. IV's were regulated by roller clamp and counting drops timed with your wristwatch. Not a shift went by when all the IV's infused according to Dr's orders.

All medical equipment came from Central Supply. Most of it was reusable stainless steel, thus the reputation for cold bedpans. A bedpan thrown to the floor had served as an emergency signal for help in the era immediately preceding mine. Those high, bulky, bedpans were hard to get onto and off of, and the very devil if your patient was helpless or had back/hip pain. They could be emptied in the patient's toilet but had to be taken down the hall to be cleaned in the bedpan washer; thus the necessity for a small linen bedpan cover. A lower, scoop-shaped fracture pan was standard issue only on the orthopedic ward. Like everything else, you could requisition one via pneumatic tube to Central Supply and after a time it would be sent up on the dumb-waiter.

Most pliable medical equipment was made of rubber; gloves (sterile only), suction catheters, and tubing (except IV). Kits for procedures, such as lumbar puncture and chest tube insertion, were made of durable equipment wrapped, sterilized, and sent to us from CS. The only things we didn't return to be re-sterilized were needles, which were all disposable. No sharps boxes in patient rooms, though. No Hazardous Waste bags, either; anything especially nasty was double-bagged and went with the usual trash.

Kardexes were done by hand in pencil, and changed as orders or patient needs changed. A long-term patient could be identified by his grey-smudged Kardex. There was no such thing as "nursing orders" so literally anything you wanted to do for the patient, for whatever reason, required a Dr's order. Standing orders were few; we called the docs for just about everything.

Narcotics were counted...endlessly counted...dozens of sleeping pills, pain pills, and injectables had to be counted at the start and finish of every shift. The outgoing nurse couldn't go home until the count was right, or the discrepancy reported and written up. We carried the keys to the narcotics cabinet (another sign of a full RN) and occasionally were called back to work for having carried them home in a pocket.

Each and every medication had its own 2"x3" med card, listing patient name, start/stop date, drug name, dose, and time of administration. Usually they were legible. We were required to check med cards against the Kardex at the start of every shift for accuracy and order changes, which meant we began every shift behind time. Nurses with strong visual perceptual skills were deemed "good" nurses because they were quick to identify transcription errors and they worked fast. Fast was good.

Meds were supplied as patient bulk, floor stock, and emergency types. It was a rare shift when all the med cards were accurate and the patient's meds were in his box; calls to docs to clarify orders, and to pharmacy for missing meds were frequent. There was no med administration record, and much was left to hopeful memory. With all the "holes" in this system, med errors were all too frequent.

Patient charts were all paper, bulky, and the purview of doctors, except for the Nurses' Notes section. We were expected to note all the features of a patient's day in ink, without spelling error or time discrepancy. Day shift wrote in blue ink, 3-11 in green, nights in red. If an error was made, we lined through it just once and wrote above it "error" and a signature. About this time, lawyers popularized a way to impeach the testimony of a nurse under litigation, out of which was born the phrase, "If you didn't chart it, you didn't do it." We did our work under terrible constraints of time and staffing...and prayed. After a year on the job, I developed a case of irritable bowel syndrome that still flares up occasionally today. After six years in nursing, I was downright grateful to stay at home with my firstborn, and I never really wanted to go back to it after that.


  1. Now this reminds me of one of my very favorite books series, Sue Barton. I own several of the series. They are now freaking expensive and I can't afford them. In Sue Barton, Staff Nurse they discussed the black band around the hat. There are 6 or 7 books in the series and I read them over and over again when I was 10-12 years of age(borrowed from the library because they were older books even then).

    I really adore your stories!!

  2. Wow. All sounds familiar. I remember so well... *sigh* :)