Nurses, We've Come a Long Way!

From The Floor

Nurses, We've Come a Long Way!

The RN of today would scarcely recognize nurses from the past

By Genevieve M. Clavreul, RN, PhD
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The highly-educated professional RN of today would scarcely recognize nurses from the past. Welcome to the wonderful world of the 19th century nurse. In addition to caring for 50 patients, each nurse was expected to adhere to the following regulations:

1. Daily sweep and mop the floors of your ward, dust the patient's furniture and window sills.

2. Maintain an even temperature in your ward by bringing in a scuttle of coal for the day’s business.

3. Light is important to observe the patient’s condition. Therefore, each day fill kerosene lamps, clean chimneys and trim wicks. Wash the windows once a week.

4. The nurse's notes are important in aiding the physician's work. Make your pens carefully; you may whittle nibs to your individual taste.

5. Each nurse on day duty will report every day at 7 a.m. and leave at 8 p.m., except on the Sabbath, on which day you will be off from 12 noon to 2 p.m.

6. Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes or two evenings a week if you go regularly to church.

7. Each nurse should lay aside from each payday a goodly sum of her earnings for her benefits during her declining years so that she will not become a burden. For example, if you earn $30 a month, you should set aside $15.

8. Any nurse who smokes, uses liquor in any form, gets her hair done at a beauty shop, or frequents dance halls will give the director of nurses good reason to suspect her worth, intentions and integrity.

9. The nurse who performs her labors and serves her patients and doctors without fault for five years will be given an increase of five cents a day, providing there are no hospital debts outstanding.

One look at this list should give any nurse reason to celebrate that we no longer work under such conditions. It’s easy to become so focused on our work that we fail to recognize the great strides in the definition and expansion of nursing roles and responsibilities since the posting of the above job description (circa 1887). Though I never worked under such regulations, I have been in nursing long enough to experience many significant changes. My early years were spent learning how to carefully inject patients, using glass syringes capped with needles so rigid that we often warned our patient not to tense their muscles, for fear that the needles might snap mid-injection.

Mixing Dosages and Hand-Cranking Beds

Thanks to modern technology, today’s nurses can rely on sophisticated computers to calculate medication dosage. Previously, doses were calculated by hand, while IV meds were painstakingly counted by each individual drip to ensure the prescribed amount was administered. It was tedious and demanding work with the constant reminder that, if we erred in calculation or calibration, the results could be disastrous for our patients. Also, most drugs and compounds that were usually mixed at the bedside are now, more often than not, mixed and prepared by

Unlike today, glass was the material that ruled the world of nursing. Many of the beakers, containers, bottles (including baby bottles), and other such equipment were made of glass that nurses were required to sterilize. Of course, we had to exercise caution when sterilizing many of these pieces of equipment, since too much heat could expand, distort, or shatter them. Cuts from breakage and handling were part of nearly every nurse’s daily experience. Not to mention porcelain-coated bedpans and emesis basins that also had to be sterilized on a routine basis, versus the disposable variety of today.

Of course, no trip down memory lane would be complete without a mention of the could-not-live-without reference book, such as Mosley or the Physicians Desk Reference (PDR). Today, they have nearly gone the way of the dinosaur thanks to such technological advances as the computer and PDAs. Where do you keep your handy dandy PDR? I keep mine on my Treo. Also available on these platforms are a multitude of nursing resources that we once committed to memory, or at the very least, knew where to locate a reliable source for information. In the past, that source was often the dreaded nursing staff “house mother” that nearly every hospital seemed to have.

Today, the hand-cranked bed has been relegated to the junk heap, while hydraulic and other mechanical assistance devices can be found in all but the most archaic hospitals. Nurses are now able to rely on hydraulic lifts to assist them in lifting and moving patients, which helps minimize the lift-related injuries that are still one of the leading causes of injury in our profession. However, work still needs to be done in making lift-teams and other safe-lifting rules more de rigeur.

Career Opportunities

Although basic nursing has changed significantly, the greatest amount of change is in the myriad of nursing career paths available today. Nursing is no longer the bastion of women, but now includes men. Nurses no longer have just a bedside nursing or nursing school professor position to aspire to, but rather, a plethora of choices including, but not limited to, nurse researcher, advance practice nursing, case management nursing, certified registered nurse anesthetist, legal nurse consultant, pain management nursing, and nurse practitioner, among many, many others.

Nurses’ week should be about more than just acknowledging and thanking nurses for the role they play in society. It should be an opportunity for nurses to remember where we’ve been, how our profession has grown and the new ground we have forged for the prospective nurses that will come after us. As a profession, it is still far from perfect, and much work can be done to improve working conditions, how we are treated by other healthcare professionals (including other nurses), and how our role is defined.

Yet when you take a look back at the job description that many of our predecessors were expected to adhere to, you can see that we have truly come a long way—the key now is to maintain our ground while keeping our eyes firmly fixed on the future.


Geneviève M. Clavreul RN, PhD, is a healthcare management consultant who has experience as a director of nursing and as a teacher of nursing management.

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