A Look At Hospital Nursing During the 1970's

Drop a modern nurse into a 1970s ward and they would feel lost. Drop a nurse from that era into a ward today and they would be far more lost still. Knowledge and technology have grown faster than almost anything else over the past few decades, and life outside the hospital has grown less formal and more equal along with it. All of that reshaped patient care. Here is what the work actually looked like, from someone who trained in it.

Students were part of the staffing

In 1970 I was accepted as a student nurse into the only degree program of its kind at the time. We were university students, but we were paid through government bursaries, a small monthly salary, which made us answerable to the hospital. The day after we reported, we went to work in our assigned ward for two weeks before lectures even started. You learned on the go, and fast.

First year students worked five hours a week during term and a full 45 hours during university holidays, with 30 days of leave a year. Term-time hours rose to 20 a week in second and third year, mostly weekends, and to 40 hours in fourth year, all while attending lectures and studying for exams. Registration required a set number of night shift hours, so much of our holiday time went to night duty.

Discipline

We lived in the nurses' residence during first year. Signin was 19:00 on weekdays, 23:00 on weekends, unless the matron granted a special exception. You reported at least 15 minutes early for handover and were expected to know the names and conditions of all 30 or more patients on the unit.

Seniors were revered: the sister-in-charge, the doctors, and above all the matrons. Etiquette meant letting superiors through a door first, so you would often find a cluster of students forming a "guard of honor" at a doorway while the matron was still 20 paces away.

Neatness mattered as much as anything. Before visiting hours, every bed was straightened with perfect hospital corners, and the overbed tables lined up at the foot of the beds with all the wheels pointing the same way. Most patients tolerated the trussedup state until the doors opened.

Uniforms

We collected our uniforms on induction day: the first of seven starched white blocks issued weekly, plus a cap in its flat state and a short and long cape. The final year students taught us how to iron each block into a wearable double-breasted dress, cinched at the waist, and how to fold and pin the caps into what looked like upside-down ice cream tubs so they stayed put all day. A policy change in our second year gave us a uniform allowance to buy washandwear versions instead. The mini was in fashion, so we all wore our hems as short as we could get away with.

Work was task-based, not patient-based

Duties were assigned by task rather than by patient. Junior students did "beds and backs" or took every patient's vital signs. As you advanced, you took on more complex procedures, and a final year student could run a unit when no registered nurse was on duty.

Food was not portioned, except for special diets. It came up on a large trolley, and the nurse in charge dished up for each patient. Medicines were not dispensed individually by pharmacy either. A senior nurse worked from a trolley holding the full range of tablets, using a card system that transcribed each patient's prescriptions. Given that setup, it is surprising how few medication errors occurred.

Records were all on paper

There were no computers. Everything was handwritten. The patient's file lived in a room beyond the ward office, not at the bedside, and held the admission records, doctor's notes, prescriptions, and diagnostic reports. The vital signs chart was kept in graph format, and recording it required a three-colored pen, one color per shift.

The nursing process and formal nursing care plans were not widely introduced until the late 1980s, which did not mean care went unplanned. A metal flip folder held a card for each patient, and the report was handed over from it. Abnormal observations, changes in condition, and treatment orders were entered there through the day, along with the nurse in charge's specific instructions. Her planning showed up in how she allocated duties at the start of each shift.

Long stays

The biggest shift in hospital care has been how short stays became, driven by advances in medicine and the rising cost of a bed. Back then, patients stayed at least one night even after minimally invasive surgery. After a hysterectomy, a patient was on strict bedrest for at least two days and stayed about five days, often until the sutures came out. There were no pins and plates for fractures, so a fractured femur meant traction and up to three months in the hospital. (Picture the mix: the kind of patients who break a femur, immobile but not sick, and young student nurses. It made for interesting times.)

"Beds and backs," a routine done three times a day, faded out as early mobilization and shorter stays took hold. Working in pairs, nurses went patient to patient seeing to comfort, watching for problems, and preventing pressure sores. Backs, hips, heels, and elbows were rubbed, crumbs and creases cleared from the linen, pillows plumped, water jugs filled. Anything unusual went straight to the nurse in charge. Infection control was an afterthought then, and you did not wash your hands between patients.

Almost no monitoring technology

Very little equipment helped you watch a patient. Temperature came off a mercury thermometer, you counted pulse and respiration against a pin watch, and you measured blood pressure with an aneroid sphygmomanometer. General ward beds had no piped oxygen, so you wheeled in a portable cylinder when a patient needed it. IV fluids came in glass bottles, and to control the rate you either counted drops per minute or taped a strip to the bottle marked off in minutes or hours.

Intensive care beds were scarce. Most ICUs were converted side rooms inside specialist units, holding two to four beds. The nephrology unit, for instance, had a two-bed ICU section for kidney transplant patients. A cardiac monitor, a respirator, and a central venous pressure line were usually the only advanced equipment in use. There were no intermediate high-care units. The most critical patients were often "specialed" right on the ward, with one nurse assigned to just one or two of them.

Nurse leader Pamela Cipriano has catalogued more of the era's everyday realities:

• Nurses lived and died by the Kardex, a folded cardstock roadmap to everything about the patient, written in pencil and constantly erased and updated.
• Universal precautions did not exist.
• Electrophysiology studies were done at the bedside to find and treat arrhythmias.
• GI bleeds were managed by inserting balloon-tipped tubes (attached to football helmets) to tamponade varices.
• Warm-water-heated metal bedpans were used for patient comfort.
• Central venous pressure was measured with water manometers.
• Nurses used the second hand of a wristwatch to calculate IV drip rates.
• White oxford lace-up shoes were the norm.
• Only operating-room staff and physicians wore scrubs.
• Nurses mixed antibiotics without pharmacist assistance.
• Nurses got good at IV sticks by practicing on each other.
• Patients were weighed manually and requisitions typed on typewriters.
• Public health meant well-baby checkups at the new mother's home.
• Patients heading to the OR were shaved with hand razors, and most were admitted the night before.
• The Physician's Desk Reference and the U.S. Pharmacopeia, chained to the desk, were the common drug references.
• Cancer was a death sentence, and staff and patients alike smoked in the hospital.

Then, now, and next

Nursing changed enormously in a few decades and will change as much again in the next forty years, which is exactly why continuing education matters so much. Society, medicine, and technology keep redrawing the landscape. None of it replaces the essence of the work: caring for another person at a time of need.