I remember my days as a young nurse, days all in white, head to toe, with white dress and stockings and freshly polished white shoes. There were bandage scissors in my pocket, and a watch with a second hand on my wrist. I was an oddity in the small community hospital–an RN with a four year college degree in nursing, stethoscope hung round my neck, daring to listen to heart and lung and bowel sounds as I made rounds to assess the thirty patients on the medical ward where I was charge nurse. The LPN, displaced from the charge nurse position by my arrival on the scene, was somewhat dubious of this upstart young nurse who thought nurses’ notes ought to say more than “a good day” or “slept well” or “up in chair” and “ate well”.
I remember the excitement I felt the first time I recognized the signs of congestive heart failure in the patient before the doctor had diagnosed it. And the satisfaction of receiving a call from the OR with the surgeon’s message, “Tell Ms. Parish the appendix was hot.” It was oh, so satisfying, since I had called so many times to convey my concern for the patient that she was finally taken to the OR. The memories that fill my mind, the stories I could tell, the love that I have had for this profession sometimes overwhelm me. Often I have said, “I came up in the glory days of nursing.” No IV pumps–we counted drops to control the flow of IV fluid. I can shake down a mercury thermometer and take temperatures without the aid of a machine. I can use manometer and stethoscope to check a blood pressure–no Datascope needed here. I wrote legible, meaningful notes and enjoyed the confidence placed in me by both my coworkers and the physicians with whom I worked.
It’s all changing now, you know. Some things are so much better. It is nice to have an IV pump to control the flow of intravenous fluids and blood and medications. And it’s nice to have patients on continuous cardiac monitors that detect changes real time. Temporal scan thermometers are cool. Heart attacks can be stopped by a trip to the cardiac catheterization lab and an angiogram and balloon angioplasty with stent. Slow heart rates can be corrected with pacemakers. Sudden death can be aborted by implantable defibrillators. There are now a multitude of medications to treat hypertension and diabetes and high cholesterol that were not on the market when I started.
Some changes, though, leave me with a sense of sadness. The paper chart that used to be the story of the patient’s hospitalization, to be safeguarded and reviewed and valued as a communication tool is becoming obsolete. Electronic medical records are the future, and the future is now. Please understand that I’m not bemoaning the advent of electronic records in their totality. They’ve made my life easier in so many ways. And, to the extent that they contribute to a seamless delivery of care to the patient in a high quality manner, they are a gift to both patient and practitioner. But, in some of their incarnations they serve only to tie nurses to computers and turn physicians into clerical workers, and those iterations bother me. Are we losing some of the humanity of healthcare? Is the relationship of caregiver to patient being disrupted by the presence of mere machines?
But, there’s no going back. So the white cap is on a closet shelf, and I wear scrubs instead of white. And I struggle to adapt to the changes while still cultivating the patient and family relationships that make this profession so rewarding. I remind myself that life itself is a series of changes, as is the profession I have chosen and enjoyed for so many years, and I try to develop a sense of anticipation that better things will come from this struggle.