Nursing, along with the rest of the medical field, is constantly evolving to ensure better patient outcomes.
Nursing skills, in particular, have changed quite a bit over the last several decades. Some skills have even been discarded completely for the sake of safety or efficiency. Here are 10 interesting examples of old-school nursing skills that have either drastically changed or are no longer practiced:
- Reusing syringes and urinary catheters
Believe it or not, new nurses, many of today’s disposable medical items, like urinary catheters and syringes, were made to be reused in the not-too-distant past. These items were sterilised between uses, a process that was eventually deemed too costly as disposable items became more common.
- Charting patient care on paper
While it’s still possible to find smaller trusts that utilise paper charting, a proportion of health-care facilities these days chart electronically; eObs, ePrescribing, eDocumentation. In addition to providing all members of the health-care team with easier access to patients’ charts, electronic charting is typically more efficient and more accurate.
- Using urine dipsticks with sliding-scale insulin
Sliding-scale insulin has been in use longer than glucose meters. Before these meters were used to determine how much, if any, insulin to administer to a diabetic patient, nurses had to rely on urine dipsticks. Urine-dipstick results aren’t as accurate as those provided by glucose meters, so it’s no surprise that they aren’t used in this manner anymore.
- Regulating IV fluids manually
Before infusion pumps were invented, it was necessary to manually regulate IV fluids. To do this, nurses had to count drops and calculate drip rates for each and every patient receiving IV fluids. Now, thanks to infusion pumps, administering IV fluids is easier, more accurate, and much faster.
- Palpating for blood pressure
The vast majority of health-care facilities take patients’ blood-pressure measurements automatically, but this wasn’t always the case. Nurses used to rely on palpation to obtain blood-pressure measurements. To obtain a patient’s blood pressure in this manner, nurses would inflate and deflate a compression cuff while feeling for the disappearance and reemergence of the radial pulse.
- Shaving patients prior to surgery
Up until fairly recently, hairy patients had their incision sites shaved prior to surgery. New evidence suggests that this leads to an increased risk of infection, and many hospitals have eliminated this practice. Now, instead of using a razor, nurses use clippers to cut away excessive hair as a part of their preoperative preparations.
- Shaking mercury thermometers
Now that digital thermometers are used to obtain patients’ temperatures, the sight of a nurse shaking a mercury thermometer is extremely rare. In the past, however, nurses could be seen shaking mercury thermometers in hospitals on a daily basis. The reason that these old-school thermometers were shaken is that the mercury would often cling to the inner sides of the thermometer. Prior to taking a new temperature reading, bringing the majority of the mercury back down into the bulb by shaking the thermometer was the best way to ensure accuracy.
- Cutting urinary catheters during removal
While cutting urinary catheters during removal is not recommended, some nurses and doctors still utilize this practice. It’s considered unsafe for two reasons primarily. Firstly, traction on the catheter could cause it to retract into the bladder if it’s cut. Secondly, the balloon might not deflate, which turns a simple catheter removal into something much more difficult and costly.
- Irrigating NG tubes with Coca-Cola
Many old-school nurses swear by Coca-Cola for NG tube flushing. In theory, this is due to the coke’s acidity. Regardless of the reason behind this method’s supposed effectiveness, it’s not recommended as it can affect the plastic tubing. Before using coke, juice, or something similar to flush an NG tube, refer to your facility’s guidelines. More likely than not, using water when flushing an NG tube will be the preferred method.
- Treating congestive heart failure (CHF) with rotating tourniquets
CHF patients used to be treated with rotating tourniquets. Essentially, these tourniquets were applied to the lower limbs to diminish venous return. These days, however, we have a wide variety of effective diuretics that can be used to help decrease the strain that excess fluid volume puts on the heart. Not only is this treatment more comfortable for patients than applying tourniquets, it’s much more effective.
Are there any old-school nurses working with you on your unit? If so, do they still practice a few of the skills mentioned in this article? Leave a comment below and let us know!
Adam Kay’s Letter to the Secretary of State for Health
Adam Kay, a former Doctor, publishes an open letter to the Secretary of State for Health calling for him to walk a mile in the shoes of a junior doctor.
In his new book, ‘This is Going to Hurt: Secret Diaries of a Junior Doctor,’ the former obstetrics and gynaecology doctor writes candidly about his experiences as a junior doctor and the effect working in medicine has on both his personal and professional life.
In the open letter to The Secretary of State for Health, he said;
“Roger Fisher was a professor of law at Harvard University, who suggested back in 1981 that they should implant the American nuclear codes in the heart of a volunteer. If the President wanted to press the big red button and kill hundreds of thousands of innocent people, then first he’d have to take a butcher’s knife and dig it out of the volunteer’s chest himself; so that he realizes what death actually means first-hand, and understands the implications of his actions. Because the President would never press the button if he had to do that.
“Similarly, you and your successor and their successors for ever more should have to work some shifts alongside junior doctors. Not the thing you already do, where a chief executive shows you round a brand-new ward that’s gleaming like a space station. No: palliate a cancer patient; watch a trauma victim have their leg amputated; deliver a dead baby. Because I defy any human being, even you, to know what the job really entails and question a single doctor’s motivation. If you knew, you would be applauding them, you’d be proud of them, you’d be humbled by them, and you’d be eternally grateful for everything they do.
“The way you treat junior doctors demonstrably doesn’t work. I strongly suggest you seek a second opinion.
The Junior Doctors Survival Guide written by Nurses
Well done. Congratulations. You’ve survived medical school and made it ‘on to the shop floor’, this is where the real test begins.
Your first few weeks as a Junior Doctor are going to be difficult and jam-packed; a new hospital, new colleagues, new patients, and a new hospital system to figure out.
Here are ten tips that will stand you in good stead for your first day, week, month, year and beyond. This is your Junior Doctors Survival Guide as written by Nurses;
- Respect the nurses. You can come to us for advice and guidance – we will have you back – but please don’t take us for granted. We have an abundance of knowledge about our patients, the hospital and how to make stuff happen.
- Each member of the team is important. Doctors, nurses, porters, physiotherapists, domestics, estates, plumbers – the hospital simply couldn’t function without them.
- Don’t be a smart arse. We know and understand you have worked hard through medical school and congratulations on becoming a Doctor, but now it’s time to get to work.
- Have a sense of humor. Make sure your able to have a laugh and a joke but be careful not to cross the line.
- Master cannulation. I don’t just mean know how to put a cannula in – develop the skill and master it – it will stand you in good stead for the future.
- Eat and drink. The list of jobs is, and always will be, almost endless. Make sure you take your breaks; eat, drink and chat to your fellow colleagues.
- Show emotion. I’m not going to lie to you, it’s going to be hard – medical school hasn’t prepared you for the first few months of life as a Doctor. If you’re having an especially tough day talk to someone about it. Don’t beat yourself up for having a little cry – it happens to the best of us.
- Don’t just look at the numbers. We spend 12 hours a day with our patient, we will come to you when “something just isn’t right”, we don’t know what, we can’t put our finger on it. But, we know our patients.
- Your first death is hard. Expected or not, nothing can prepare you for the death of your first patient. We have all been through this. See- show emotion and How to Deal with the Death of a patient.
- Tidy up after yourself. Nothing and I mean nothing, annoys the ward staff more than a Doctor who thinks the staff are there to clean up after them. Tidy away your sharps, notes and coffee cup.
- Ask for help. Your seniors are there to support you – it’s literally their job. Don’t be afraid to escalate patients or situations to them and never put yourself in a situation where you have no backup.
- Admit when you simply don’t know. Making up an answer to a question can have serious consequences. If you don’t know. Say, but find out.
- Try to go home on time. Look through your list – find out what can wait until tomorrow. Your downtime and social life are important too (check out our list of NHS Discounts for downtime ideas). You work to live not live to work.
- The hospital at night is scary. There are fewer doctors, nurses and seniors around to support you. Call for help early and escalate appropriately.
Remember, you are part of our team. Our job is to work together in the interests of patient care. We will try to look after you, make you tea when you’re sad and, rest assured, we will tell you when you’re being an idiot.
Workforce4 days ago
MP insists nurses are already well paid compared to hairdressers, plumbers or carpenters
Nursing Associates2 days ago
Nursing associates could be the answer to the NHS staffing crisis
Workforce3 days ago
Patients are being mislead by unregistered staff using the “Nurse” title
Workforce6 days ago
Two junior doctors left to care for 436 patients on a night shift