You think its hard now?

The history of nursing has always fascinated me. Not just the more recent history, which entailed glass IV bottles and the sharpening and re-use of needles, but also the older history of nursing.
Here is a partial listing of floor nurse duties, circa 1887 (the italics are all my comments)
(source: http://faculty.mc3.edu/rbenfiel/NUR109/NUR109NursingHistory/sld003.htm)
• Sweep, mop, dust patient’s room (what no environmental services?)
• Bring in the scuttle of coal (no facilities management?)
• Clean the chimneys, wash the windows weekly. (yikes!)
• Work everyday from 7a – 8p, with a two hour break for church on Sundays (if that’s not mandatory overtime, I don’t know what is!)
• Smoking, drinking, going to the beauty shop or to dance halls is reason for disciplinary action. (this is where I think the good moral character part of the Nurse Practice Act originated.)
• You will earn a raise of .05cents a day after five years of good service, assuming that you don’t owe the hospital any money.

Nurses were also responsible for preparing patient’s meals, a scary thought for me. Florence Nightengale, in her classic “Notes on Nursing” cautions:

“A nurse should never put before a patient milk that is sour, meat or soup that is turned, an egg that is bad, or vegetables underdone. Yet often I have seen these things brought in to the sick in a state perfectly perceptible to every nose or eye except the nurse’s. It is here that the clever nurse appears; she will not bring in the peccant article, but, not to disappoint the patient, she will whip up something else in a few minutes. Remember that sick cookery should half do the work of your poor patient’s weak digestion. But if you further impair it with your bad articles, I know not what is to become of him or of it.” (source: http://digital.library.upenn.edu/women/nightingale/nursing/nursing.html#III)
A great resource if anyone is interested in the historical aspects of nursing is The American Association of the History of Nursing. (http://www.aahn.org/) I hope in the future to explore more interesting tidbits of nursing history.

Happy Holidays!
Well here we are, at the start of another holiday season. The crisp air, the fresh snow…the holiday work schedule…….

For the third year in a row, I will be working Thanksgiving.  This is my 3rd nursing position in as many years, and as luck would have it, I’ve been scheduled for Thanksgiving each year. I am not so upset by this, as the holiday pay will go a long way towards financing the next big upcoming holiday—Christmas.

This year I do not have to work Christmas, and I AM glad of that. My first year as a nurse, I was put on the schedule for 7a – 7p Christmas day. There was an issue of seniority, and being the newbie I was given no real choice. I did, however, manage to barter down to 7a –330p, and then magically got flexed for the first 4 hours of my shift. It wasn’t all bad, but still…having worked Thanksgiving that year, and then knowing I would be required to work New Year’s as well…I did find it a little unfair.

How does the holiday schedule work for you? I am interested in hearing the different ways that hospitals manage their nursing schedule throughout the holidays. Where I work now goes by the every-other holiday rule, which I suspect is the way many places plan for holiday staffing. What about your place of employment? Are there any other creative ways to arrange the holiday schedule?

How many times does it happen—you see a patient with what first appears benign symptoms only to find out that they are much sicker than was suspected? We’ve all heard of the patient who came in for a headache and ended up having meningitis, or stomach ache that turned out to be an AAA. 

We shake our heads, wondering at the human experience as we care for our patients.
And then it happens.

What is that little twinge in my temple? Why does my throat feel scratchy? What is that strange pain in my stomach?

We try to shake it off, continuing about our tasks, reassuring our patients that we are giving them our best care all the while trying to ignore the growing sense of dread that we ourselves are actively coming down with Something Bad.
At break time we check our throat for exudate, put our chin to our chest to see if the head pain worsens. We palpate our abdomens, listen to our hearts, surreptuously check our vital signs. Just in case.

In nursing school alone, I personally diagnosed myself with lymphoma, hepatitis, several bouts of pneumonia, panic disorder, and quite possibly, early-onset dementia. My classmates had similar illnesses, thereby reaffirming our belief that we were the sickest bunch of nursing school students in the history of our school.

Of course, the real diagnosis in all cases was ‘nursing school-itis.’

The stress of nursing school, combined with learning about all sorts of disorders and diseases, led us all to assume that we had just about every one of them. (Our psych rotation was arguably the worst—at that time, we started diagnosing each other. Thank goodness it was only a 6 week rotation!)

I am sure that we all racked up many co-payments in unnecessary doctor visits in the course of those two years. I know my doctor was very tolerant. And truth be told, once or twice I really was sick…sure, not with meningitis or hepatitis, but I did have an ear infection once.

So for all you nursing students just now Googling symptoms for the rare diseases you have just learned about in school…relax. Take a deep breath and have a cup of tea. Chances are that you do not have Something Bad. See your doctor if you are concerned of course, but understand that as soon as you move on to the next unit in your studies, you will be miraculously healed of your current condition…and ready to come down with the next exotic malady.

Recently, the Governor of NYS signed legislation that bans mandatory overtime for NY nurses.
 The only times that nurses would have to work overtime are:
• Natural or other types of disasters that increase the need for nursing services,
• A federal, state or county declaration of emergency,
• A nurse engaged in an ongoing medical or surgical procedure,
• When necessary to provide safe patient care where no other alternative staffing is available; and
• A nurse voluntarily agrees to work overtime.  
(Source: http://www.state.ny.us/governor/press/press_0815082.html)
When it comes to mandatory overtime, I am not overly affected. With the exception of the mandatory 12 hours of on-call time per 6 week schedule block, mandatory overtime is not an issue in my workplace. I and some of my coworkers are hopeful that this legislation will do away with call-time all together, but I am realistic to understand that call time will most likely fall under the category of ‘no alternative staffing…available.’

I do wonder about the fallout though…will we now have higher patient ratios? I am lucky in my position that it’s generally only 5 patients at a time…I have seen others where the ratio goes up to 6 or more patients per nurse.

What do you think of this legislation? Do you live in a state where overtime is mandated? How does it affect you?