Sunday, May 10, 2020

Writng on Bed Sheets

Spotless white sheets were perfect for bedside note taking

I'm a diehard aficionado of the esoteric little nuances present in hospital culture. Before  I begin writing (if you could call it that,) a Google search is usually in order. If the topic I had in mind fails to show, I have a winner. I googled nurses writing on sheets and up popped, report sheets, hand off sheets, ICU cheat sheets, and brain sheets. Ahh...perfect, nothing what so ever about nurses and doctors physically writing on hospital linen. 

Seasoned, well past their prime doctors and nurses scribbled on hospital sheets all the time in vintage hospitals. The usual weapon of choice was a ball point pen, but a fine tipped felt marker would do in a pinch. Pencils simply did not cut it for sheet writing and were usually in short supply. Some physicians are inventive and I have witnessed sheet scribbling done with a broken applicator soaked with  Zepharin  solution which added an artsy fartsy touch to their scribbling  due to it's bright reddish/pink color.

Anesthetists in the OR loved to keep track of things like units  of blood or dosages by scribbling hatch marks on the sheet near the patient's head. Procedures calling for an intraoperative position change would frequently throw a monkey wrench into linen record keeping systems. The vital hatch marks could all to easily relocate to an inaccessible position. Another SNAFU was keeping simultaneous tallies such as one for units of blood and the other for ventilator settings and then confusing one recording for the other. This could lead to strained conversations such as, "Those markings are for the units of packed cells and this one over here is for tidal volume...or is it the other way around??"

Orthopedic surgeons were frequent sheet scribblers and left notes for the proper positioning of traction equipment. Before Campbell's Operative Orthopaedics became the dominant textbook, closed reductions with traction ruled the roost. All those weights, slings, and pulleys just called out for sheet side illustration.

Pioneering total hip replacements were affectionately referred to as low friction arthroplasties and required complex post-op nursing care. Hemovac drains required constant attention to maintain patency and Pehr splints to prevent abduction generated lots of twiddling. Putting an octopus to bed would have been small potatoes compared to caring for total hips.

Arthroplasty patients were to stay flat on their backs for 7 days and could not be turned side to side to make a typical occupied bed. The arduous procedure entailed suspending the hapless patient over the bed while making the bed from top to bottom. Many students sought to avoid the linen change ordeal by carefully maintaining the condition of the bottom sheet. Miss Bruiser, my favorite instructor, was always one step ahead of her intrepid students. She would make a tiny mark on the sheet in an unobtrusive spot and then check back to see if the sheet was changed by observing for the absence of her mark. If the mark was observed after the student finished morning  care a tongue lashing and demerits were liberally issued.

An  unusual sheet writing adventure occurred in the OR just prior to an induction. One of the staples stocked in our break room was canned sardines which were opened by inserting a special key into a slot and unrolling the top of the tin. The discussion among the surgical residents was how to open a can of sardines without the key. A diagram of a sardine can was scribbled on the top sheet covering the patient and the explanation ensued. "The first step is to center a knife over the crease (in the can) and make a fist around the knife. Next strike the top of your fist until it pops open." The patient thought the good doctors were discussing operative technique and let out a shriek of horror. It took several minutes of explanation to restore order and calm the patient. You can never be too careful when patients are awake in the OR!


  1. I still do this! One of my preceptors was an ER lifer, and he always did that when triaging patients so then I did too. Not as common now since we do computer charting, but I still bust out that old skill every now and then and blow the socks off the new grads.

    1. When hospitals supplied scrub suits it was fun to scribble on those too. It's good to hear that writing on linen sheets is not a lost artform.

  2. We used to write on the back of our starched aprons - they were very useful for that!

    The older nurse is looking unimpressed.. I never did manage to achieve perfect 45 degree angle hospital corners, the Tutor Sister used to check them with a set square - she used to look rather like that nurse in the pic after checking my beds... Sue

    1. Sue, your comment about aprons brought back lots of old memories. Our school had lots of rules about the wearing of aprons. It was OK for nursing students to attend the evening meal without an apron, but not lunch. I think that was because more visitors were present during the day and the hospital wanted to make a good impression.

      The girls were responsible for starching their own aprons and caps. The preferred brand of starch was ARGO and there was a box on every window sill in the dorm.

    2. We had to take a fresh apron with us on duty so we could change into it if the one we were wearing got grubby (which they did of course). They were laundered and starched for us thank goodness. Each nurse had seven dress uniforms and fourteen aprons. Imagine the cost now! Our uniforms were sewn by a team of seamstresses employed by the hospital for that purpose and were made to measure for each of us individually. They were considered to be so important!

      We had to wear full uniform including cap and apron in the nurses' dining room unless we were off duty.

      Worst was that for the first seven weeks of PTS training we were given no aprons, only the royal blue dress, so we stood out like beacons, we were frantic to get our aprons and blend in - and then we had to wear blue belts for six months to demonstrate how ignorant we were. Our fob watches had to be kept in a pocket under the apron bib, & taken out and flipped over when you used them, as a dangling fob watch was considered untidy.

      Our caps were so difficult to pleat correctly that once we had one made up we wore it until it was absolutely filthy - they were very hot and your head used to sweat inside them in summer. Once you got the veil you had to be careful not to turn your head too close to anyone, as they'd get a face full of sharp starched fabric in their eye - as student nurses we learned to stand well back from a Sister very fast!

      I guess it was all very military but we actually loved the uniform! Sue

    3. Hospital diploma schools of nursing spared no expense when it came to uniforms. We even had fancy little labels inside our uniforms with our name followed by the coveted initials "SN."
      It was a wonderful feeling to be cared about by the hospital without money changing hands.

      Uniform inspections were held on a weekly basis and demerits awarded for the tiniest infraction. One of the most common deficit was misaligned caps. They had to be parallel to the girls face and not on top of her head. The girls thought it was totally unfair that I did not have to wear a cap. At one of our many teas I was preoccupied by scarfing down crackers loaded with liver pate' and one of the girls popped a cap on my head while an accomplice took a photo! How embarrassing.

      We were required to wear wrist watches and they were provided to us by Abbott Pharmaceuticals. They were of the Timex variety and had the big "A" Abbott logo in the center.

      The girls all carried their bandage scissors in the overlap of the apron in back. I had 2 big pockets for my pen and scissors.
      When we were seniors the big thing was to carry around a hemostat even though about the only thing we used them for was clamping off Foleys. Those were the days!

    4. Gosh yes I'd forgotten OFRN, our dresssings scissors were put on a chain which linked to our belts - this was so we didn't lend them to another nurse and then not get them back again!

      Once you were a qualified Sister you wore a wrist watch, not a fob watch - don't ask me why. A wrist watch was a sign of seniority, a fob watch not!

      Your seniority was indicated by stripes on your cap - three meant you were a third year nurse, called a Senior Nurse, and practically God already. For 3 months after getting your veil you still wore the student nurse uniform, after that you got issued a pale blue dress with white collar, sleeves and buttons - two rows down the front.

      It's hard to believe how much we coveted the Sister's veil - it was a sign of authority & demanded much respect and we also found them beautiful.

      I feel like I am practically prehistoric now.. it was all so different wasn't it. Sue

    5. All this has reminded me of the first time I saw an American nurse in uniform OFRN - she was tutoring nurses for a while, I cannot remember how or why now - anyway I still remember the first time I saw her, a very attractive brunette, probably in her early 40's, in the white dress, white stockings, white shoes and American style cap with a stripe - we had never seen this type of uniform, we all wore British style outfits - I remember thinking she looked very swish (and it probably helped she was very beautiful). One of the senior medical officers had his eyes on stalks every time she went past! She was something of a sensation at the time.

      Americans are known here for having very smart uniforms. My mother used to tell me how, during WWII, (when she was young and pretty) she disapproved of all the Australian girls who dated the American servicemen out here instead of the Australians, because the Americans wore smarter uniforms and had more money.
      Fun discussion, thanks OFRN! Sue

    6. Nurses from my mom's generation supplemented their uniforms with full length dark wool capes. On of my early childhood memories was how my mom would swing her cape around before draping it over her shoulders. It was just like that little dance Stevie Nicks from Fletwood mack does while singing Rhianaon!

    7. We had those too - royal blue or red. Very stylish! We loved them! I forgot to mention them. With epaulettes at the shoulders. I think we all did the same dance! Sue

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  6. I am so glad I found your blog! Your stories of OR nursing and the nursing culture prior to the start of my career are fascinating. When I started in 1989, my hospital was one of the last to require nursing caps.

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