Thursday, November 30, 2017

Hospital Signage - Yesterday and Today

Visits to contemporary hospitals always throw me for a loop. The hodge-podge assemblage of signage is indeed mind boggling, at least for me. Practically every vertical surface or door has a sign of one sort or another dutifully posted. Guide signs, financial responsibility notices, warning signs, nursing award plaques (none of those back in my day, that's for sure,) and mystery signs that my foolish mind simply could not decipher.
Signs were few and far between in vintage hospitals.

I found myself asking myself, how in the world did old school hospitals function without the copious ( that "c" word is one of the all time  favorite words of my generation of nurses) use of signs? The hospital building itself was without an identifying sign. It was completely unnecessary because everyone intuitively knew it was a hospital. A hospital was a hospital and everyone knew where it was. Does God sign the sky?

Walking through a modern hospital corridor with all those solid, opaque doors with confusing (at least to me) signage does cultivate a sense of mystery. When one of these  modern, occlusive, door  contraptions swing or magically whoosh open, I scramble to peak inside. I could have read the ever present, omniscient signage, but I like the feeling of being an explorer on an adventure. It's like a series of hidden little worlds where computers and electronic doo-dads seem to dominate.

Old hospitals were not like this. No signs necessary. You could sense where you were by the various olfactory, auditory, or visual  cues. The radiology department was defined by the scent of photographic fixer and all those lead aprons hanging outside the mostly open doors. No mysteries here. Morgues and central supply were always in the basement and the ORs were always on the top. I rambled on about this in a previous post.

Emergency rooms were always on the same level as the street and there was  a memorable sign nearby. Old school  emergency triage began at street level and an actual sign began the process by a stern warning: AMBULANCE CASES ONLY. There was always an assemblage of police cars at the ER and I suspect hospital emergency rooms were one of the safest places in all of Chicago.

Hospital labs were easy to navigate. Everything was out in the open. Hematology was defined by the click-clck-click of manual tabulator gizmos used by the technicians to count the various lymphocytes and eosinophils in a sample. I used to love that sound because it reminded me of crickets. A bit of nature  in the midst of an urban jungle. The microbiology department was easy to spot with banks of incubators and rows of microscopes. The chemistry lab division smelled, well chemical. You couldn't miss it. The hospital laundry was easy to find, just follow that lovely clean linen smell and as you got closer, little flecks of lint falling like snow clearly defined the locus.

Old hospitals had very few people just strolling through as outpatients because there were no outpatients. Any nurse would be all to happy to direct any lost soul moving about the halls so there was little need for signs. The loud, ubiquitous hospital paging system clearly announced visiting hours and instructions for hospital visitors. One of the greatest advances in modern hospitals is the absence of verbal loud speaker pages. They could really jangle your nerves.

Occasionally, a modern hospital sign will cause my foolish, old brain to crash in a state of persistent befuddlement. What the heck is an outpatient ICU?? I was completely  bamboozled by a sign pointing the way to "Ambulatory Surgery."  How in the world, I wondered, can you perform surgery on someone while they are walking around? I suspect it is a great way to prevent post op complications like atelectasis and clots, but do the benefits outweigh the risks of surgery in motion?

I' getting carried away here so I'll leave you with some contemporary hospital signage that got my attention and made my blood boil. The sign below serves to provide the patient with all the respect and dignity of a visit to Wal Mart. The remuneration request is for something that is an abstract concept concocted by an office sitting bean counter which  contrasts with the mission of healthcare to provide tangible care for a person in need. Money and associated big business  is what robbed both doctors and nurses of their status as caring professional care givers and relegated them to nothing more than dollar sign driven minions. It's a sin and a shame.


  1. At least Wal Mart waits until checkout to collect the money. Right on OFRN!!

  2. That sign makes me feel thankful that public hospital care is free in Australia! There are no charges to patients at all.

  3. In the U.S. far too many resources are squandered on administrative costs, advertising, and my all time favorite villain, office sitters of any variety. You cannot help anyone sitting in an office. Don't get me started on this one!

  4. We have far too many administrators here too OFRN - mostly I have no idea what they actually do. When I nursed in the 1970s and 1980s we didn't have them and everything worked fine... Matron and her deputies ran the hospital back then. The hospital had one floor devoted to her office and the senior medical staff and whatever administrative people were needed. Now they take up entire buildings.

    Still we are fortunate that if you have an accident, or need medical treatment or surgery of whatever kind, you get it free. Resources are, however, stretched to the limit. The last time I had to spend time in hospital as a patient after surgery (about 15 years ago) it was about five hours between any visit from a nurse. I was at the end room of a long hall, so no nurses walked past. I had dropped the call bell and my catheter had blocked. In severe pain (hooked up to cannulas etc) I managed to use the phone on my bedside locker to ring the reception office in the hospital foyer and ask them to phone the nurses' station on my ward to get a nurse to come in and see me. Gracious. What a long and convoluted way for a patient to have to get a nurse to attend to her!

    Personally I liked the long Nightingale wards we had when I trained 15 beds up and 15 down - less privacy for the patients perhaps but I could always see the patients and they could always see a nurse.

    I have a friend who used to be very senior in a company but was retrenched in his 50's - he considers himself fortunate to have managed to get a job as a hospital porter. He complains to me that the nurses now all spend their time sitting at computer screens or at their mobile phones. One elderly lady was left lying in her own excrement until he told the nurses to do something about the smell. This would never have happened when Matron rang the hospital! I don't know why mobile phones aren't banned while on duty. But sorry I digress from the hospital signs topic!

  5. Thanks so much, anonymous, for your fascinating comments. As a young student nurse, I cared for patients on wards too. Our wards accommodated about 10 patients and the nurse was always in the room with them-the nurses desk was front and center of each ward.

    When the wards were split up and call bells implemented, older nurses were shocked with such a foolhardy notion. The nurse should always be in sight of patients and in their vernacular, call bells were balderdash of the highest order.

    Times have certainly changed.

  6. You did of course learn to walk the length of those wards very fast whilst looking very busy, in a hopeless attempt to discourage the constant calls of "Nurse, Nurse!" But yes they were so much safer... None of us liked the change to separate rooms and call bells, I remember that well.

    It was Miss N herself who declared that the nurse should always be in sight of the patients and vice versa.

    I loved the old tuberculosis wards we worked on - no longer needed for that purpose, they had doors opening onto wide shady verandahs which looked out over the beautiful hospital gardens - no locked windows and air conditioning when I trained.

    And I discovered there are entire web sites devoted to ridiculous hospital signs OFRN - they are worth Googling!

  7. Like McDonalds, please have payment ready to prevent delays. Hospitals calling patients customers, stores calling customers guests. The world has gone crazy.

    1. As time passes the signage issue expands. On a recent hospital visit there was a notice that if you were bothered by noise, ear plugs were available. What happened to those SHHH! posters with a nurse admonishing folks to keep the noise down.