A Long Shift in Nursing Perception and Practice

From The Floor

A Long Shift in Nursing Perception and Practice

The most important change in nursing over the past decades is the shift in the status of the profession

By Genevieve M. Clavreul, RN, Ph.D.
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Do you remember cleaning and polishing your white nurse’s shoes with Hollywood Sani-White? Was a starched white nursing cap part of your daily uniform? Were the “apps” you used to calculate dosage or convert measurements stored not in your smartphone, but in your head? If so, then you’ve had the privilege of being a nurse long enough to see nursing evolve from the “doctor’s handmaiden” stage into a highly-respected and well-paying career. Nursing is a profession that has refused to remain static and continues to evolve, grow and adapt to the challenges and demands of today’s healthcare environment.


When I began my career oh so many years ago, you’d find me reporting to work in my starched white nurse’s dress with matching white stockings, polished white leather shoes and matching white nurse’s cap. I was expected to keep my uniform crisp, clean and free of stains — failure to do so could easily incur the wrath of my head nurse or director of nursing and earn me a trip home to change. It wasn’t uncommon for me to have to clean and shine my shoes each night while our family watched “The Ed Sullivan Show” or some other TV program.  

You can imagine my relief when nurses were allowed the option to wear white slacks and later scrubs. I saw this evolution in attire as a benefit, since many nursing duties, like reaching across a bed to turn a patient, are not conducive to wearing a dress. And an all-white uniform quickly shows wear and tear, even if you’re the most fastidious of people. White is also a most unforgiving color. I’ve never forgotten the day I had to send one of my staff nurses home to change because her red-heart-festooned panties shown like a neon light through her white nurse’s uniform.


Back then, bachelor-prepared nurses were nearly as rare as diploma-prepared nurses are today. In fact, back in the day, most RNs were either associate-prepared or diploma nurses. It was not uncommon for some hospitals to run their own nursing programs, in essence educating and training their own nurses — talk about a homegrown solution.

Nurses were basically generalists and were expected to work in pretty much any unit that needed them. Intensive care and specialty units were nearly unheard of, with the exception of the emergency room, labor and delivery and, of course, pediatrics. The ‘60s and ‘70s saw the emergence of specialty units, many of which still exist today. Pediatrics would later split off into pediatrics and pediatric intensive care, which was then further subdivided into pediatric and neonatal intensive care.


At the nurse’s station back in the day, we’d gather around the Kardex to review the printed cards for each of our assigned patients. We’d take blood pressures with the manual sphygmomanometer and temp with our handy-dandy mercury thermometer. We dealt with glass syringes and needles that often caused our patients to cringe with fear. You haven’t lived until you had to hang a glass — yes, glass — IV “bag.”         

Let’s not forget those wonderful hospital beds that required real muscle to manually raise or lower the bed to make our patients more comfortable or comply with the doctor’s orders.

Today, electronic sphygmomanometers allow nurses to get an accurate read on their patients’ blood pressure, pulse and oxygenation far more easily than with the manual method. The mercury thermometer is almost extinct, replaced by such wonders as the temporal scan thermometer, which provides an instant and accurate body core temperature with a simple swipe of the patient’s forehead.

Our patients now rest comfortably in beds that a nurse can adjust with the push of a pedal and that patients can adjust themselves with controls at their bedside. Of course, these advances can open the door to dangerous or even deadly errors due to equipment malfunction or improper calibration, but the benefits are undeniable.

Back in the day, we seldom thought of gloving up — oh, how times have changed. It wasn’t that we didn’t care about cross-contamination or transmissible infections; gloves just weren’t part of our practice. Of course, we’d scrub thoroughly, having been well-versed on hygienic theories and the research done by health luminaries like Semmelweis, Pasteur and Lister, but gloves were generally considered the realm of the surgical nurse.


While mathematics remains an important skill for today’s nurse, it used to be even more integral to nursing practice. Back then, nurses were expected to be able to calculate IV fluids down to the drop per minute and had to carry a watch with a second hand to time manual titrations. In those days, calculators were an expensive purchase, often costing hundreds of dollars. My children still joke about how we nearly had to take a loan out to buy the first Texas Instrument calculator I used for nursing school.

Today, calculators are cheap and nurses can usually fall back on their smartphones and tablets to assist with complicated conversions and calculations. Most modern hospitals also have smart pumps and other automated equipment that allows nurses to do with the touch of a button what it took their predecessors untold amounts of manual calculation to accomplish.


All these reminiscences doesn’t mean that I wish to return to the “good old days,” because that would mean giving up decades of advancement in nursing practice. However, it is helpful to remember how far we’ve come.

We may still be decades away from treating our patients as they lie on a bio-bed with their medical status displayed on a biofunction monitor or delivering medication via a hypospray, à la “Star Trek.” However, today, we do have beds that allow us to weigh our patients while they’re still on that bed. X-rays, which once had to be developed on specialized film before being read, can now be displayed almost instantaneously on a computer screen and then emailed to physicians, radiologists, diagnosticians or even the patients themselves.

Telemedicine now allows physicians, nurses and other healthcare professionals to seek advice from experts across the country and around the world without anyone even leaving their hospital.

Thanks to our smartphones (weighing about 5 ounces) and tablets (weighing about 1 pound), that 10-ton behemoth, the printed Physicians’ Desk Reference, may soon disappear. And of course we no longer spend our evenings cleaning and shining our shoes and ironing and starching our white uniforms since Crocs and scrubs have become the standard.

Technological advances aside, perhaps the most significant change in our profession has been the advancement in our status. Where once we were supposed to dutifully and unquestioningly follow doctor’s orders, like children meant to be seen but not heard, today we have nurses serving on hospital councils, sitting on nursing boards and even holding political office at all levels of government.

Nurses today not only provide care at the bedside, but also write influential blogs, host radio programs, author important research, and advocate for significant legislation that impacts both our profession and patients. What changes will science and technology bring to our profession in the upcoming years? As technology marches forward, can the sophisticated sick bays of science fiction be far behind?

Geneviève M. Clavreul RN, Ph.D., is a healthcare management consultant who has experience as a DON and as a lecturer on hospital and nursing management. She can be reached at www.outsidethebox.net.

This article is from workingnurse.com.

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