Musings about Nursing

by: Willa Fields, DNSc, RN, FHIMSS, Professor, San Diego State University

I entered nursing school 50 years ago. Yes,50 years ago, in 1965. That’s the year the ANA published its first position paper on nursing education and set 1985 as the date that the BSN would be the minimum degree for entry into the practice of nursing. Oops, that didn’t happen! In 2010 the IOM published The Future of Nursing, and set a lower BSN goal for 2020 at 80 percent of nurses. Let’s hope we make it this time!

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Lots has happened in the past 50 years. I thought it would be fun to reminisce…

I went to a progressive diploma school – we had three men in my class of almost 100 and even a few married students. In 1965, most diploma schools accepted only single young women who were required to live in the school dormitory with a 10:30 PM curfew during the week and midnight on the weekends. And we could not leave the dorm in pants – we had to be properly dressed. Sure glad that has changed…

The annual new graduate nurses’ salary was $3,600! By the time I graduated in 1968 progress had been made on the salary front. New graduates now made $7,200 a year. I’m really glad our salaries have improved. Even with converting the amount to 2015 dollars, we were underpaid.

Most of you probably know that nurses wore white uniforms, stockings, and shoes (there were hardly any men in nursing then), and a cap signifying your school of nursing. No scrubs for us! But did you know nurses were expected to stand when a physician came to the unit? I was once reprimanded for sitting at the nurses’ station when a physician was there (and there were other, empty seats, he could have used). Bet you know some physicians that would get a chuckle about this outdated custom.

Most nurses were educated in hospital diploma schools. There were less than 200 BSN programs in the US. There were no Clinical Nurse Specialists or Nurse Practitioners. We did have Nurse Anesthetists. The first Nurse Practitioner program opened in 1965 at the University of Colorado. Some universities had graduate nursing programs, but there was no debate between a DNP and PhD – there wasn’t a DNP program. The educational debate focused mainly on diploma vs. associate degree vs. BSN and entry into practice.

In 1965 IVs were in glass bottles, and few, if any, had a pump. We had macro- and micro-drips to regulate the flow rate, and we hand adjusted the valve with our trustworthy watch with a second hand. Care sure is safer with computerized, smart pumps. Just think what would happen now if a nurse hung an IV with no pump!

And heart monitors. Yes, we did have them. The leads were not disposable and had no adhesive backing. We secured three leads to the patient’s chest with a one inch wide and several foot long elasticized band! There was a portable monitor at the foot of the patient’s bed – no central monitoring station or time delayed printouts! You could set the alarm on the monitor for the heart rate parameters, but that was it. If you wanted a printout, you needed to get the EKG machine. Yes, another example of how far we have come with bedside monitoring.

All of our charting was completed on paper, as were the orders, and everything else in the chart. Some areas, like billing, were in the early stages of computerization, but lab results came back on little slips of paper that often got misplaced. Wow! We’ve really come a long way with digitizing health care.

We didn’t have the term patient engagement in our vocabulary. Patients often weren’t even told their diagnosis – it might upset them too much. Can you imagine a patient having no idea why they were in the hospital – just that their doctor told them to be there, often times for diagnostic testing? And there were heated debates about should a patient know they have cancer or a terminal illness.

Other words not in our vocabulary were nursing informatics, chief nursing informatics officer, evidence-based practice, clinical decision support systems, electronic health records, personal health records, and a whole slew of others. Yes, we have come a long way.

And an uncomplicated Acute MI patient was hospitalized for three weeks – one week in the Intensive Care Unit on complete bed rest which included being fed by the nurse at meal times! After childbirth a woman and her newborn stayed in the hospital for a week. At our hospital, open heart surgery patients were admitted the day before surgery so they could get accustomed to the hospital.

We didn’t argue about the Affordable Care Act and what to do about the uninsured. We argued about the elderly without health insurance and the consequences of this new Federal program, Medicare. Some things change, but only in name.

It’s been a privilege to witness the changes in health care, and particularly nursing and nursing informatics. We, nurses and nurse informaticists, are changing the health care landscape by creating, designing, implementing, and optimizing technological tools that ARE transforming healthcare.

Congratulations to all of us on what has been accomplished over the past 50 years! I’m looking forward to an even better future in nursing and nursing informatics.

We hope you join us in celebrating National Nurses Week and honor your fellow nurses during this week.

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About Christel Anderson

Christel Anderson, is HIMSS Director, Clinical Informatics
This entry was posted in Nursing Informatics and tagged , , , , . Bookmark the permalink.

2 Responses to Musings about Nursing

  1. Gina Parker RN, MSN, PHN, CPHRM says:

    I have had the honor of being one of Dr. Fields’ students, she is the best and I am grateful for all the knowledge she afforded me. I have always appreciate her ability to interject humor in her lectures.

  2. Carina Lee says:

    Great blog! It is amazing how far we’ve come in the last 50 years. I am so proud to have been your student at SDSU!

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