Wednesday, December 2, 2015

Old school rules for patient care

Never ever give ice water to a cardiac patient. This triggers a vagal response resulting in life threatening arrhythmias.

Never allow a patient on Coumadin to use a standard razor. An electric shaver must be used to prevent exsanguination.

The open end of all pillow cases must face away from the entry door to the room. On wards, the open end of pillow cases must face away from the window.

A patient could not get out of bed (OOB) to use the bathroom without a BRP (Bathroom privilege order.) This one really bothered me. Since when is going to the bathroom a privilege?

If the patient vomited on a dietary tray, nursing service must clean it up. This rule was especially unfair since it was probably the food that triggered the emesis.

Our neuro OR had  big notice on the door: "NO TALKING OR LAUGHING  NEUROSURGERY IN PROGRESS."  I guess I will have to stroll down to the heart room before busting a gut.

Patients with abcesses or infections were in a special classification - Contaminated Case which had all sorts of special rules such as being scheduled at night after all other cases were done, everything that exited  the room except the patient double bagged, and scrubbing the tile walls upon conclusion of the case with some sort of toxic witches brew of disinfectant.

After finishing a case in the OR all instruments must be returned to Central Supply unratcheted. If you really wanted to get a rise out of the old geezers in Central Supply, return a knife handle with the blade attached. Witnessing an old battle hardened nurse moving toward you at the speed of light with a knife in her hand is very frightening.

The grounding plate for the Bovie must be placed exactly in the center of a patient's buttocks. This rule caused much animated discussion and and arguing about gluteal anatomy. The grounding plate was the size of a cookie sheet and the best strategy was to place it on the table prior to the patient's transfer from the Gurney. I always thought this must be a really bad pre-induction experience for the patient. Imagine being frightened by the strange environment complete with scary, sharp metal objects and then being plopped onto a cold metal plate all gooey with conducting gel. YIKES and OOW that's cold.

The circulating nurse must be at the patient's side during induction even if there is nothing for her to do.

Use only a glass syringe to administer that Paraldehyde and make sure the  number on the syringe barrel matches the number on the syringe because  old syringes were not interchangeable. Don't you just love that Paraldehyde-Paregoric-coffee ground emesis smell on the alcohol detox ward. It was a great deterrent  when the urge to imbibe struck. "I think I'd just like a Coke tonight. That  Paraldehyde smell is imbedded in my nostrils."

I am certain there are many more, but I seem to be having one of my brain freezes. Don't forget to hold that cold water when caring for a cardiac patient!


  1. Oh!! How well I remember the "No ice water for cardiacs" rule! And that we would let them brush their teeth, but we didn't let them brush their false teeth... And that they didn't get out of bed for about 3-5 days after an MI... And that they were ALL on Lidocaine drips!

    Fun, fun, fun!

  2. They were also all gorked on Valium and had to use bed pans. I think gaining BRP was the highlight of their MI hospitalization!

  3. I graduated from RN school in 2012 and it seems that we were told in one of our intro classes about the keeping the open end of pillow cases turned away from the
    door. How do you manage a patient in a private room with an open door and open window.
    The scrubbing down of rooms s/p a contagious case doesn't seem like such
    a bad idea. My mom was in an isolation room in a NYC hospital. The walls, which were streaked and stained room could have used a seriously good scrub down I try not to think of what is breeding in the privacy curtains in hospital rooms.

    I have been meaning to say that I think that I think the clinical experience earned in the diploma programs prepared nurses far better then they are today. I graduated from RN school with a laughingly little clinical experience. Never inserted a Foley, drew blood,
    or started an IV. This was not uncommon for my class. We were told that we'd be taught all this once we landed a hospital job. Ironically most new grads have a hard time getting hospital jobs without experience. I agree that a bachelors degree should be the entry degree for nursing as it is for other professions, but new nurses need to have a good grasp of the skills used in practice. Wacky as some of the rules and regulations you were taught. I wish I'd had more hours working with patients rather than learning "nursing theories" and cultural competency.

  4. You bring up some interesting points. Diploma nursing school was all about training as opposed to education. The rigidity of training was probably not a good thing. I really had a difficult time with change. Gloves were being worn more frequently toward the end of my career and I just never was comfortable using them. I guess one other point is that you can always learn to do a procedure, but the principles and education behind it can more difficult to come by. I think young nurses have a much more comprehensive view of the big picture regarding wellness than I did. We were lacking in real treatments that were effective.

    I once worked with a surgeon that argued the only thing we can treat is trauma and after working in the OR, I could begin to see his point. It was very rewarding to see a trauma patient walk out of the hospital.

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