Foolish Mistakes/Mishaps

In a diploma nursing program, it always seemed like you were on the threshold of being thrown out  or in the school's vernacular "unfit for professional nursing." Any type of minor mistake could get you tossed-missing clinical, too many demerits, or any grade lower than a "C." One mistake on the drug dosage calculating was all it took to get your walking papers. I was always worried about making an error of some sort.  Nevertheless I need to get these mistakes off my chest:

We were in a hurry to get going because there were a lot of "to follow cases." I quickly had everything ready to go, the patient was anesthetized and lo and behold one of my Asepto irrigation syringes was only about 2/3 full. Being in a hurry to fill it up, I overzealously squeezed the bulb hard enough to not only expel the air, but launch a stream of water up into the surgical lights. Irrigation fluid then dripped down onto the field contaminating everything.  We had to redrape and start all over. I felt terrible about it, but the only thing the surgeon said was that we were lucky the hot lights did not explode.

I don't  know what the current technolgy is for blood pumps, but ours were unwieldy (at least for me) hand cranked affairs. I was in a hurry (a recurring word with problems) and actually broke the crank off the machine. I felt like such a fool standing there with the crank in one hand and the blood and pump in the other. Other SNAFUS with pumped blood involved tubing connections that failed under pressure spraying blood where it did not belong. We knew nothing of any blood bourne illness.

I have also had experience with breaking glass IV fluid bottles, and if it was D5W you had the added element of stickiness to deal with. Typically this mishap ocurred if you were labeling the bottle or adding a time strip (no controllers) and the IV bottle rolled off an inclined surface during an inattentive moment. The metal hanger for the bottle could also slip out of your grip when you were reaching up too far to hang it. The aural stimulation of the breaking glass and the subsequent mess to clean up was very memorable.

This is the most foolish, dumb thing I have ever done as a nurse. My only defense is that I was called in at  3AM and was sleep deprived. The situation was a trauma case that died on the table. I had a huge mess to clean up and my first step was to get the body as expediciously possible to the morgue. I quickly filled out the toe tag and shroud label and hustled down to the morgue with the body. Later that morning one of the pathology residents called the nursing supervisor and asked her what went on in the OR last night and that they had the body of one of the nurses in the morgue. My reptillian brain had put my own name:. "OldfoolRN"  on the toe tag and shroud ID. Luckily, my usually cranky supervisor was mildly amused and understanding. The only thing she said to me was "go home and get some sleep" My coworkers never forgot this and were always kidding that I had risen from the dead.. 

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The lesson I learned here is to slow down, especially when tired. If you try and push past your limits mistakes happen. One meticulous surgeon always said "Do it the slow, fast way." I tried to remeber that, especially when tired.

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Paying for Pins

Nursing pins represented the ultimate reward for us. The payment for 3 years of unpleasantness and occasional suffering. Pins were not a commodity to be bought and sold. Their value was symbolic and firmly rooted in nursing history as something almost spiritual in nature. Certainly not something to be sold like an earring or trinket of jewelry.

This is why I was saddened to hear that whippersnapperRN's  have been asked to pay for their pins. How can something so sacred be reduced to a financial transaction. Nursing used to be considered a calling, a profession , certainly not an industry like some people frame it today.  We are not building machinery. We are caring for the sick. We are descendants of people like  Florence Nightingale not Henry Clay Frick.

Somehow, out of respect for nursing's history, the cost of that sacred pin should be factored into the tuition. When I make my first million, I'm setting up OldfoolRN's  pin trust and not one WhippersnapperRN will ever pay for her pin. That's just how things should be.

The pin should be awarded by some highly credentialed big shots not your spouse or boyfriend. Its an  acknowledgement of your accomplishment and a cherished badge of honor.  When the going gets tough and it will, you can look down at your pin and remember that Mr. Hospital Director and Dr. Chief of Staff  said you were fit to be a nurse. Moreover, this was witnessed by a slew of other important people
     
We were pinned at our graduation ceremony by the Director of Nursing with the Medical chief of Staff  and Hospital Director looking on. The pin was actually physically pinned to your white uniform  with all these bigshots looking on. There are no alumni organizations for my hospital school, but that pin symbolizes a lifetime bond to a place where you shed a lot of tears and sweat.

My pin was worn whenever on duty. We used to try and pull a fast one and "forget" to wear them in the OR, but a reprimand would be forthcoming from a cranky supervisor. I think the pin had even more significance than the cap. They couldn't enforce that "you must wear cap rule" in the OR, but you had to have that pin on no matter what.

I still have my original pin. It's been through the wash many times and I've also had to root through linen hampers and some really unsavory locations to retrieve it. My name and date of graduation is engraved on the back of it. That pin really has to been to hell and back, and I hope to be buried with it so I can follow it back to the promised land if I wind up in a very hot place

Fool's Gold - It's Payday

Libertarians say, "Well if people work harder they can make more money."   My mother is a nurse and I am a venture capitalist. I think no matter how great a nurse she is, she wouldn't earn a thousandth, if that, of what I can make.

 

                                                                                                Ben Horowitz

 

Here is a collection of pay stubs from OldfoolRN's  hey days as a nurse, which indeed would seem to bear out Ben's assertion regarding a nurse's income being less than a venture capitalist.

 

That Illinois stub reflects a pay level after I had been in the Operating Room for awhile. I also had some credibility in that I was a card carrying  AORN member. My starting salary was $4.24 per hour and now I was making big money at $5.35 an hour. This was really a generous salary for an RN in 1973  because suburban hospitals were only paying about $4.00 per hour.

 

The next pay stub is about 5 years later and I was only making $5.65 an hour working like a dog in Neuro ICU. When the shift ended I felt like an insomniac marathon runner with iron poor blood. It was a really tough job. You can readily see one of the problems here is a lack of wage progression. With more experience, the pay only increased a little bit. I hope you WhippersnapperRN'S receive better raises than I did. You have a very difficult, stressful job and deserve more progressive increases in your salary.

 

That last stub is from moonlighting with an agency on an oncology unit in the mid 1980's. I received the princely sum of $10.50  an hour and took home about $69.00.  Enough to pay for parking, a tank of gas, a meal, and a visit to the veterinarian for my best friend. Not bad for a day's work.

 

The one thing you will notice missing here is deductions for a stock option plan or a 401K retirement program. Administration perpetuated the image of nurses as angels in white and angels did not need material things like a retirement plan

 

The one really nice thing about a nursing income was that it was something you could count on. I was never laid off or fired. There was always work available. The Chicago Tribune had pages of help wanted ads for nurses in the Sunday paper. It was reassuring that someone wanted your services.

 

There were some perks to the job. If you had the misfortune of getting sick, doctors would see you as a professional courtesy and would have never thought to charge. A number of Hospitals that had a school of nursing also had  an "Alumni Room" in the hospital. This was an inpatient room reserved for the use of a graduate of their school of nursing. It was a nice room on one of the more quiet wards. It was nice to feel like someone cared for you.

 

 

 

I redacted some of the information from the pay stubs with a trusty #11 blade. I bet you thought scrub nurses lacked surgical skills!

 

 



Nurse's Cap Folding - An Ancient Tutorial

You are in for a heap of demerits if this nursing cap  winds up off center or not parallel to your face. Do not get caught wearing this outside of the hospital. It is to be removed on the ward after your shift and carried in that especially designed cap case. I still have my cap carrier today and use it to tote around my Yorkie. You whippersnapperRN's aren't the only ones that know how to repurpose an item.

Before getting to the folding stage, the cap had to be cleaned and starched. The traditional method to launder caps at our school was to fill a bathtub about 1/2 full with water add 1 cup Borax detergent and agitate with a toilet plunger that was dedicated solely to this purpose. A rinse cycle and another toilet plunger agitation and the caps were ready for starching. Cups were starched with the Niagra brand  in a hospital bath basin and plastered to our metal headboards to dry. About 20 caps could be processed at a time using this method. I am not sure how this practice originated, but maybe it evolved out of necessity. The school laundered our uniforms, but we were responsible for our own caps.

Caps were really something special in that they were a tangible symbol of  your accomplishment. Patients could readily identify a nurse by the cap and it seemed to generate a special sort of respect. Every nurse seemed to stand taller with her cap. They really were a unique symbol in nursing history and I don't think there has been a meaningful replacement.

That black band which had to be exactly 5/8 inch across was added at a banding ceremony after completion of our junior year. It was a big deal because it meant you were almost a nurse. The bands were known to be measured at uniform inspections to insure size compliance. I have heard that the black band was added to nurses cap as a remembrance and way to mourn Florence Nightingale.

This is a scan of a mimeograph, made by an old fashioned duplicating method that used a stencil created on a ribbon-less typewriter. The stencil was rotated on a hand cranked drum to create the copy.  Careless mimeograph operators could be readily identified by their blue fingers. I didn't realize that mimeographs had archival qualities - this one is nearly 50 years old and looks like it just rolled off the machine. 

The following little ditty nicely summarizes the meaning of a nurse's cap.


        The Cap
We are the "Probies"
Our piece must be said
Of our envy for the nurse
With the cap on her head.

Like an angel in heaven,
With a halo 'bout her head.
Her cap symbolizes mercy
For all sick abed.

Her duties are many,
Of  knowledge well learned
That cap upon her head?...
Yes, it's been well earned.

"Big Sisters," we're so proud
Of  your cap of white.
May we be as worthy
When we've earned that right.
                         -Dorothy Benner 

Tools of the Trade - A Retrospective

This view of a modern operating room is totally unfamiliar to someone of my  generation. It looks like one of those movie scenes where aliens are deconstructing a humanoid.  There are no familiar landmarks here. Where is the Mayo stand?  Why do they have their backs to the field? None of this makes any sense to me. There should be 2 discrete work areas,  a mayo stand with just the instruments in use and a back table for all the rest of the junk larger and surplus instruments.

Having all these instruments piled willy-nilly on one table is asking for trouble. It's no wonder radio frequency tags are now needed on sponges to prevent foreign body mishaps. There is so much clutter and paraphernalia on that table that it's impossible to keep track of everything This just  makes my head spin. I don't know how you young whippersnapperRNs do it. My hat is off to you.

And speaking of hats, what about that fancy head gear on the nurse and surgeon? This is
definitely non- regulation. The O.R. is not supposed to be a place for self- expression. I bet they don't have their grounded foot gear on and are about ready to ignite the anesthetist's tank of cyclopropane with a jolt of static electricity.  Did anyone measure their fingernails to make sure they did not exceed 1mm. We had strict rules that were aggressively enforced by ill tempered supervisors that were drunk with authority from years of inhaling anesthesia fumes.

You need a two work area mandate here. A mayo stand that the scrub nurse knows the position of every instrument without looking and  brings instruments like clamps and needle holders up from the back table in pairs. That way if their is an odd number of things, you know the surgeon better look behind that liver for your clamp.

I also cannot believe the number of instrument trays in play here. They are stacked up on right side of the table like some sort of high rise apartment building. I never handled more than two   trays  at a time. Even for big cases like an AP resection, two trays were plenty. Internists  have an old saying that "When there are multiple treatments for a problem, none of them are effective."  Is this the surgical corollary?  When you have several instruments for the same purpose, are none of them effective?
            
Back in the day our instruments were bright chrome just like the bumpers on our oversized cars.  I know those nice foreign made grey matte instruments don't reflect the light, but somehow, they just don't look right.

Finally, who gets to clean this mess up at the end of the case. From all the disposables here, there must be a dumpster outside in the hall for all those paper gowns and drapes. How can you restore order to an instrument table like this. We would have never let an instrument table get so cluttered. When you're done with something, move it to the back table.  Oops, I mean what back table.

Congratulations to the youngsters that can manage an instrument set up like this!

Assembly Line Blues

Cars are such a huge element in American culture and it never ceases to amaze me the resources people invest in them. I once worked in an area where the highlight of the morning radio broadcast was the instruction to assembly line workers of when and where to report to work. Everything revolved around the industry, even the streets had car names.  I  used to think it was strange driving a VW on Buick Drive.  Those pesky little insignificant "foreign" cars were not welcome here.

Those assembly lines must have been really nasty places to work. One day we got a victim in from the "Blazer Line" at the local plant. His name was Felix Dunkfeather and he had been working above a huge, swimming pool sized tank where the truck bodies were cooled off after a welding operation. The mix of water,welding flux, and who knows what else was heated to 200+ degrees.

Felix had the unfortunate experience of falling into this boiling hot tank after tripping over a torque wrench.  He fell in feet first and was essentially parboiled from about the waist down. He was conscious upon arrival and luckily for him, the hospital had a decent burn unit.

I was a relative novice at this institution, but was really surprised at the nonchalant response from the docs and nurses. It was a pretty spectacular, horrible injury (it still gives me the creeps) but apparently nothing new here.  I listened to all kinds of assembly line injury horror stories that made me want to buy a bike just so as to not contribute to the mayhem.

One day Felix came up to the OR for a one of his many debridements. For anesthesia training purposes, one of the rooms had a jury rigged, non-rebreathing system made up of a ridiculous hodge-podge of components. This collection of drinking straws, garden hose, and who knows what else was ultimately vented directly out  a window in the OR.

When the wind was blowing just right (or wrong in this case)  the odor of halogenated anesthesia could be strong and we would all get sleepy. This mingled with the smell of necrotic tissue and Elastoplast dressing supplies. The surgeon started in on the anesthesia personnel about the terrible smell and how he was never using this room again. He looked at me and I readily concurred. A good scrub nurse always sides with the surgeon, especially in disputes with anesthesia.

The anesthetist calmly surveyed the human wreckage from the Blazer assembly line before us and said." Don't worry,  That scent is just that new car smell."

Felix did eventually recover, but had an unusual shuffling gait. I never looked at cars the same, especially new ones with that characteristic smell.

Your Cap is Off-Center, You Just Earned a Demerit!

Excerpts from my Diploma School handbook.

Rules  within this handbook are enforced and supported by the issuing of demerits.  Members of the faculty and the student health nurse issue demerits.

If one demerit is received, the student will serve two, four hour work periods to be served on two consecutive weeknights within one week of the issue of the demerit.  Work shall be performed on a ward as needed.

If three (3) or more demerits are issued or accumulated punishment shall be determined by the judiciary committee. One punishment was to lay in bed for an extended time without turning or moving to experience the hazards of immobility first hand. Another was being assigned to a cleaning detail. (this could be really bad. There lots of unpleasant things to clean)

                                                               ATTIRE
Uniform should always be worn in hospital public areas, faculty  areas and the library. No slacks, shorts, or hair curlers are allowed in public areas. In the student rooms care should be taken in keeping the shades drawn when dressing and undressing.

                                                                MEALS
Students receive free meals in the hospital cafeteria by presenting their meal tickets. After eating the table is to be cleared, and the dishes, silver, and glasses carried to the dishwashing room. No food may be removed  from the cafeteria. No food may be kept in the dorm.

                                                               LINEN
At the beginning of each September students will receive  2 bath towels, 2 washcloths, 2 hand towels and one pillow and blanket. The student is responsible for the care of these items.
                                                                    
                                                              TELEPHONE
No telephone calls received  after 10:00PM.  Outgoing calls are limited to 15 minutes.  (There was 1 pay phone on each dorm floor and  about 30 girls lived on each floor)  This caused much name calling and hair pulling

                                                        VALUBLES/MONEY
Students are advised not to keep valuables or money.  There is no need to keep sums of money in the dorm. The school supplies all needs.

                                                          SEWING MACHINES
Sewing machine are available from the house mother. A deposit of 15 cents, which is returned is required for bobbins and needles.  (I thought we were not allowed to possess money)

                                                         RESTICTED AREAS
Men's residence quarters are out of bounds for female students. Doctors lounge and dining room are also out of bounds. Please refrain from using public bathrooms in the hospital lobby.

                                                              SMOKING
Smoking is permitted in the auditorium and classrooms as per the instructors discretion. Neatness in smoking is the responsibility of the individual. Disposal of the ashes and cigarettes in a safe and hygienic manner is expected. Ashtrays are provided

The remainder of the handbook is devoted to wearing and maintain of the uniform right down to the color of underwear that must be worn     Uniform regulations were  aggressively enforced at weekly uniform inspections and the most common reason for demerits. When there were few effective treatments for illness, Instructors tried to gain a sense of control  by enforcing rigid authoritarian rules that governed every minutiae of daily life.
                                                           

THE NIGHNTINGALE PLEDGE

To pass my life in purity and to practice my profession faithfully.

I will abstain from whatever  is deleterious and mischievous, and will not knowingly administer any harmful drug.

I will do all in my power to elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping, and all family affairs coming to my knowledge in the practice of my profession.

With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.



We recited this pledge at ceremonies such as capping (end of freshman year), banding (end of junior year) and graduation.  This pledge was also displayed in the auditorium where we held class. When we said the pledge, we held a Nightingale lamp illuminated with a candle. There was even a strict protocol on how to hold the lamp; 2 hands, waist high, extended 5 inches out.

Our class was the first to be issued cheap gold plastic lamps. Perhaps this was a harbinger of the decline of diploma nursing schools. Previous classes had nice ceramic lamps embossed with school initials. Diploma schools supplied us with everything: books, housing, food, uniforms, and even laundry service. It's no wonder they went under. When the profession was seen as a business rather than a calling, the schools were done for.

When we recited the pledge we were lined up in rows and packed together like sardines. Our tormentors instructors were always conveniently positioned in the first row and on occasion hot wax could be inadvertently dripped on the back of their neck just below that coveted cap. In this case, the pledge would be recited as "Pass my life in purity"   hot wax drip  "Ouch, you clumsy little witch!"

That line about aiding the physician in his work was an integral part of our education training. If an MD showed up at the nurses station you jumped up and offered him your chair and offered coffee beverage service. Doctors were really at the top of the food chain. They told the insurance companies how long the patient would stay in the hospital (if the patient even had insurance), Sadly there were virtually zero women in medicine. Women and nurses were cherished and sweet talked in exchange for male domination.  I am ecstatic to have lived to see this change.

This place smells funny

Old hospitals had characteristic smells so that you knew where you were located even without visual cues. I guess new hospitals must have advanced HVAC systems in place, because to my old wrinkled up nose they don't really smell or perhaps inhaling years of olfactory toxins has destroyed my senses. Anyhow, hospitals don't smell like they used to.

You could always sniff out the X-ray department by the smell of photographic fixer everywhere.  Difficult to describe, but you know it when you smell it. The medical detox wards had the over powering scent (if you could call it that) of paraldehyde, sweat, and vomit. If you were in a high end institution there were green Airwick thingees on the window sill.  Is that where they go the term window dressing?

Our cafeteria  was really a cafeteria of smells. Think bacon, fryer grease, and an industrial strength cleaning solution used in the dishwasher. The cafeteria was in the basement and the elevators functioned as giant pistons driving all the hospital smells into the eating area. What a great way to loose weight.

The hospital laundry was a weird hodge podge of smells too. Think steam and soap mixed with every smell a human body could produce. Seeing how hard the laundry workers had it was a great incentive when the sledding got tough in nursing school. I don't know how they did it.

The OR had a mix of alcohol prep solutions and bovie smoke smell. Sorta like an ultra-clean smokehouse.

Well, all this smell malarkey is making me hungry.  It's time for a lunch break. Oh and have a festive and happy Valentines Day

Foolish Memories

I have been perusing the many nursing blogs and they all seem to be posted by youngsters who are very bright but perhaps may lack perspective.  Geriatric nurses, and I am referring to the nurses, not patients have not been communicating well with the younger generation of nurses. Heck, where I live there are hardly any youngsters.  Most of my colleagues have went on to their great reward and I am not far behind them. So I am going to start this off with some foolish memories from yesteryear. I have experience in OR, med-surg nursing, and neuro ICU with a brief stint in forensic psych when it used to be called getting beat up by assaultive psychopaths.  Anyhow, on with the recollections

The aroma of a metal bedpan being steam "cleaned" in a hopper. When you opened that hopper door with your clinic shoes a big brown cloud materialized right before your watering eyes. Impressive.

Using methylene blue to dye white silk sutures so the surgeon could see it and. when you thread that suture needle make sure to pull enough through the eye. If the suture falls out when you pass it to the surgeon you're going to hear a roar like a mountain lion in heat!

Wearing beanies during nursing school hell week (initiation) and being sent to Central Supply to pick up a set of Fallopian tubes.  Your big sister (preceptor in present times) threatened to practice nursing procedures on you and had an array of latex tubing and vessels of water to back up these threats.

Bovies in the OR that looked like Maytags and made that reassuring deep HUMM noises to verify they worked properly. No beeping, clicking, flashing lights and the ground looked like a cookie sheet with camel spit smeared all over it. This was ceremoniously placed under the patients rump just prior to induction.  What a great memory before recieving anesthesia. "Oooh that sure is cold"

Setting the sigh setting on mechanical ventilators. PEEP was a yellow Easter candy.

Collecting saliva to test for Digoxin toxicity based on the notion that more potassium would be in their saliva if they were toxic. This could be confusing to some and graphic descriptions of the difference between spit and sputum were common.  Yechh

Being taught how to insert a Foley with 3 sterile finger cots.

Being yelled at, belittled, and accused of trying to bring financial ruin to the hospital if you wore gloves while cleaning up a "Code Brown"  I learned that last term from the youngster nurses-very clever we used to have to call it poop.

Well, it's getting past my bedtime but there is much more foolishness to follow.