Wednesday, October 19, 2016

Coal Shoveling Nurses

As a young foolish nurse, I was admonished by much older peers on many occasions and in retrospect, deserved it. After a lengthy tongue lashing, the senior nurse would often conclude her bitter diatribe  with the qualification, "I was shoveling coal at this hospital before you were even born." Coal shoveling was a badge of honor for these older nurses and they frequently pulled the "shoveling coal card," especially if a smart alecky young upstart nurse suggested or thought a new way of doing things was superior to the old fashioned ways.

Until the advent of scrub suits as  the  uniform attire for student nurses, coal shoveling nurse heritage dictated a proper nursing student's uniform. All the diploma school uniforms were very similar. A blue or grey colored dress covered with a pristine white apron. Of course the white apron was neatly folded and carefully stored while the nurse worked her magic with the coal shovel.

One of the develpments that really rattled older coal shoveling era  nurses to the core was the introduction of disposable equipment in the late 1960's. Glass, stainlees steel,  latex rubber, and heavy muslin cloth were the benchmark in determining the quality of hospital supplies according to these seasoned old nurses. Anything that was  made of plastic or felt lightweight was immediately suspect and deemed inferior.

One of the pioneering disposables was a clear plastic enema  bucket and tubing to replace the standard heavy duty duty steel  cans with latex tubing and hard black rubber nozzles. At least early attempts at disposable enema equipment mimicked the old one by maintaining the bucket. If the switch had been from metal cans to the bags of today, old school nurses would have been totally lost. Older nurses called the disposable enema equipment "toys" and eschewed using such unimpressive, light weight equipment.

Coal shovelers  had many bags of tricks and one of their favorites was hiding old school nursing supplies and equipment that much younger nurses had determined to be obsolete. (Just in case.)  Old nurses always had a contingency plan.

 Our intermittent Gomco suctions were often mounted on a difficult to access cabinet because the big bottle patially blocked the door. These hard to reach cabinets were often packed with old school enema cans, latex tubing, clamps, and nozzles. It made sense  because Gomcos and enemas were both used on GI cases. "I shoveled coal in this hospital so I can use any enema can I please!"  Old time nurses certainly had a sense of entitlement, though it was  well earned.

Older nurses absolutely hated disposable needles and syringes. They had invested labor intensive  resources in learning to properly assemble a glass syringe with matching the correct barrel to the correct syringe. Sharpening needles was an art form and the special needle sharpener tool and it's proper use a source of great pride. If young nurses made pejorative remarks about the foolishness of needle sharpening they were certain to get the coal shoveling lecture delivered in spades by a chorus of oldster nurses. Until the mid 1970's there was often a rotary needle sharpening tool hidden away in a special unused cabinet or ward locker. I have even witnesses old time nurses sharpening disposable needles just to keep in practice. Old habits die hard.

Old nurses were also on constant lookout for ways to reuse disposable equipment. I vividly recall one elderly nursing supervisor suggesting that used "disposable" endotracheal tubes could be repurposed for retention enemas or barium enemas. " The cuff was the perfect lumen to suitably block exit from the colon. "I bet these endo tubes are radio-opaque so the radiologist could verify proper position in the sigmoid colon. I'm bringing this up at our next procedure committee meeting, "  said one old heavily wrinkled supervisor.  Whenever one of these elderly repurposers came across the ONE TIME USE  warning on disposables it just added fuel to the fire and the conclusion was that one time use as an endotracheal tube and one time use as an enema tube was perfectly acceptable. Twice the bang for the buck.

The next occasion one of you whippersnapperns don a complete surgical glove to insert a Foley, take a moment to remember  that you are standing on the shoulders of oldfoolrns like me  that could slide that Foley in place using only 2 (two) sterile fingercots. I never shoveled coal, but I do have a lengthy repertoire of  ancient nursing skill sets.
Tuck those uncovered fingers into a fist and
now grab that Foley between your index finger
and thumb. The hard part was "rolling" into that
first finger cot without touching it.

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