PERSPECTIVES

Although nursing can be traced back to 1 AD as an entity, it seems impossible that when I entered practice that the profession was only about 100 years old. Most of us remember Dr. Ingalls telling us that “the first nurse was the first mother!” We started our careers in the fifties and have experienced half of the time since FLORENCE NIGHTINGALE

advanced what was done by many as a nursing profession, a calling, a work to be honored. Those of us who were born in the thirties have also experienced one third of the history of this country.  Our experiences need to be recorded and I have chosen to use my anecdotes as opposed to cold hard facts, although I try to be as factual as possible.

A very significant event in my professional life was the unique opportunity to consult for several months each of several years for the health care system in the United Kingdom and to be part of their standards development. The sense of history, continuity and its importance that is present there is so important for each of us. I made some wonderful friends with some NIGHTINGALE NURSES.

Nightingale Nurses Pin

Compare this JOHNS HOPKINS pin
to the original Nightingale one. Very similar
but I do not know the connection.

As a result, I had the opportunity to go to the NIGHTINGALE MUSEUM in London

Nightingale Museum London

for a behind the scenes visit, and to the areas in ST THOMAS HOSPITAL/GUYS

St Thomas when Florence was there.

where FLORENCE NIGHTINGALE lived and worked.  In the 1990’s the nursing unit had been left pretty much like it was many years ago and was still an active patient care area when I was there. 

Looked the same to me,
take away the people.

The quarters that nurses lived now held offices but the board room that FLORENCE used was still in use and was where we ate our working lunches.  The classroom that was part of the nursing school was used for me to deliver lectures.  The nurses who were trained/educated here are a very proud bunch.  To be a NIGHTINGALE NURSE carries clout far beyond the credential itself. 

This work took me also to deliver a speech at the WESTMINSTER CHURCH HOUSE in London.  I was helping to build legislation regarding accreditation and survey process. Just before I was to go inot the round room, I was told that it was the room that once held Roosevelt, Stalin and Churchill at the end of WWII.  I was so nervous that I was taken with a bout of coughing that I could not control.  I also had a picture taken by the official photographer of Churchill and it is still one of my most prized possessions.

I was very humbled by this experience.

Many nurses up until the middle of the century remained committed to the profession due to situation, economics or in many cases religious commitment.  This supported a practice of providing a “nurse’s home.”  Most hospitals had a dormitory like accommodation or perhaps apartments on the hospital grounds that were given to nurses for very inexpensive or no rent at all.  As I look back today it seems that this kind of life was pretty sterile, cold and pretty horrible by today’s standards.  It was, in retrospect, a way to control nurses and to get workers available at a moment’s notice.  When I went to work at WESLEY LONG HOSPITAL in the late 40’s there was just such a residence across the parking lot from the hospital.  Nurses who lived there generally took all their meals at the hospital cafeteria.  The buildings varied from house-like small residences to large buildings attached to the hospital.  Later when I worked in Saudi Arabia we were provided by the company accomodations that were similar.  The other time I witnessed such an accommodation was when I taught classes in Barrow Alaska. The housing would be impossible if this was not provided in these two places.  Usually there were adequate lounging areas with things like ping pong tables, tv, and group kitchens.  Residents had much greater privacy than did the student nurse dormitories.  But in many cases there was still restrictions on time to be in at night (well into the fifties.)

Work days were generally five or six eight-hour shifts a week.  However there was much overtime that was expected, required or extracted from the permanent nursing staff who lived there. The nurses who had families and were married were give a different set of expectations.  If the hospital had a SCHOOL OF NURSING, one might live in the residence as part of their “training” and simply stay after graduation until they were married or in many cases the rest of their career.  Of course this practice gradually went away in the years after the fifties.  DUKE did not have this as a practice and I am not sure when or if they ever did.  Perhaps there is a historian out there that knows. The NIGHTENGALE NURSES actually lived on the units where they worked in the same way as nursing residences were in this country.  Many of us knew a maiden aunt or other relative that was a nurse and lived this way.  They were always thought of kindly, and invited to all family functions.

Until the mid-sixties, as a nurse you would be required to put off marriage for the years that you were in school, but that is not to say that there were lots of secrets. If you did get married you were immediately out of school. DUKE was somewhat advanced in that marriage was not smiled upon but you could get married in your senior year, but you could not be pregnant.  A number of my classmates left because of marriage, and two married in their senior year.  These two women, SUE GREENWOOD (HEAD) AND KATY KELLER (MAULTSBY) went on to have very excellent careers in Nursing as beloved teachers. Sue was required to leave and gave birth to the oldest of her four daughters, Julie, the summer of our senior year. I know I was on my elective rotation on OBSTETRICS and was the first to see her enter this world. Sue returned to school many years later and became a very important member of the faculty at the UNIVERSITY OF NORTH CAROLINA in Charlotte and a very prominent participant in nursing practice for our state. 

So, I am going to be a nurse! There were other interesting decisions that were further complicated by choices in how you wanted to get the nursing credentials.  It was easy for me as DR JOE STEVENS, my mentor, was very helpful and directive in making my decision as I have discussed earlier. Women, there were no men in nursing save those in the military, could attend a three year hospital based program and receive a DIPLOMA in nursing, you could go to only a handful of university based program and get a BACHELORS OF SCIENCE IN NURSING, you could go to school for a year and get a certificate in LICENSED PRACTICAL NURSING, or you could get on-the-job training as a NURSING ASSISTANT.  The two-year ASSOCIATE DEGREE program was not yet an option. All of these avenues would take you to specialization and upward mobility in a greater of lesser degree.

As a sophomore DUKE student, I was still waiting to do things that I had been doing for several years as a nursing assistant. At the time it seemed that my friends from high school and our classmates at Duke who were in the 3 year diploma programs, were so far ahead of me. They were already “in charge” on nights and evenings.  They were running the show on their units under the direction of a house supervisor.  We were still cooling our heels in the “chem” lab, anatomy lab, taking sociology and doing procedures on each other in the nursing arts lab. They seemed so far ahead and so much more skilled.  We were told that we not only would know what to do but the WHY and we would know in depth what we were doing.  They were right, of course, but in my teen-age mind I had one foot on the gas and didn't know the car had a brake. 

The work that we were doing was so basic, so routine to me.  It got me into a lot of trouble.  We were taught in the lab how to make a bed and after the hundreds I had made using the HILDA TAYLOR method (remember her from an earlier post?), I was able to do it rapidly and well.  The instructors would strive to find something amiss, especially LOIS KNOWLES.  They seemed happy when I faltered but now I know it was because of my arrogant attitude.  The precision required I found to be far less that than required by HILDA TAYLOR.  There was another issue, I had been taught short cuts and I unwittingly used them to finish fast. That was certainly not acceptable.  It was some years later that I appreciated the wisdom of my instructors.

LEARNING THE BASICS

I am very excited about the increase in those of you viewing this blog. As I began to write this exploration of one career, I felt that my focus was to be on NURSING PRACTICE. I want to leave a legacy, for those who were interested, that told my story. You will find that I do repeat some parts of the story for clarification, and expand the story to refresh memory, and refer to previous entries.   There have been so many changes in health care and in nursing in the over sixty years of my career.   I have found that my colleagues, role models, mentors and others who taught me important lessons are a major part of my memories and I wanted to publically acknowledge their contributions to me and to others.   I will continue to talk about these people as I talk about my journey as well as the funny and sometimes pathetic stories of my classmates, co-workers, bosses and health care leaders. Sometimes I will be very critical, negative, or judgmental.   Having developed a sincere respect for history from my Professor husband, Ralph W. Greenlaw, Jr.,I know I have earned the right to report my observations. It is more than true that WE MUST EXAMINE and ANALYZE OUR COLLECTIVE OR PERSONAL PAST in order to move forward with improvement.  This account is indeed a combination of a personal narrative and a discussion of practice and its development as I know it.

Years of uniforms...Ours are back center. The 50's

The first semester of our sophomore year was spent doing the very basics of nursing both in the laboratory in Hanes House and on our assigned patient ward.  We were finally dressed in our starched aprons and blue student uniforms. Our caps were starched and with the help of white bobby pins attached to our heads. We learned every single little detail of care. Making an unoccupied bed was done with a very specific method that emphasized two important things. You were to maximize efficiency and protect your body.  To be as fast as possible was important because in a few short weeks we would carry an assignment of 10-12 patients in a morning for bath, bed, and the treatments we knew. All before we left at 11 to get to class or eat lunch. We would not be doing medications until we had mastered pharmacology. 

My bed making with HILDA TAYLOR was such a gift.  I already knew how to do hospital corners, flip a quarter on the sheets to make sure they were tight enough and how to put a pillow case on. There were class members who had not even ever made their own bed and I felt so bad for them in their struggle.

Oh the simplicity of the
beds of the fifties!!

Some bed-making rules: 

Never go back and forth from one side of the bed to the other. You start at the side of the bed furthest from the door, strip linen to the middle of the bed, make the side you are on, go to the other side remove the dirty linen and put in the hamper, complete the bed and then put on clean pillow cases.   Make sure that the bed is tight, especially the draw sheet. 

No piece of linen is ever used if it hits the floor. It should not touch your uniform.

Pillow cases were put on with your hands only.  Never mind putting the pillow under your chin like when you were home.

The bed was always in the UP position so that you did not have to bend.

The absolutely accuracy of these rules was so important and I expect that most of us still make a bed the way we learned in 1954.

I am very appalled today when I watch nurses and nursing assistants making a bed. I was a patient not so long ago at Duke for four surgeries followed by three weeks of rehabilitation three times, which translated in close to 90 days of watching from a patient point of view.  I observed many beds being made and not one single person made it so that the really basic principles were followed. Rarely did the bed get raised from a low position to be made with ease.  I asked how they had learned to do the very basics of nursing and bed making.  I am sorry to report that they learned by watching videos, maybe reading a procedure manual but not one admitted that they had an extracting instructor like my HILDA TAYLOR OR LOIS KNOWLES to guide them and give them the gift of being able to do something very well as second nature.  As a student, I thought if I heard the criticism that I was not using good BODY MECHANICS another time I would cry.  I know that many of my problems today relate back to the use of my back and I so wished I had learned that better.

Making an occupied bed was so much more complicated but required the same exacting procedure coupled with the comfort and safety of the patient.  Bed rails were critical and you just didn’t make a bed with a patient in it without them being up.  So many safety issues were critical and I believe if we had forgotten to do what we should, we would have been quickly booted. About half the time, care givers would make my occupied bed without raising the side rail.  Of course I became a real pain to them when I corrected this practice.

We mastered the beds, the feeding of patients, and cleaning the areas, as we moved past the beginning of our clinical rotation.

As a nurse surveyor for Joint Commission, many many years later, I had a most fascinating interview  on a nursing unit. It made me understand how lost the basics have become.   In order to ascertain how a nursing unit had approached improving the quality of care, we asked that they do a presentation for us.  A wonderfully bright nurse in a California hospital was given the chore as presenter. They had state of the art EVERYTHING. She explained that they had researched the airline industry to find some direction as to how to approach improving PATIENT SATISFACTION.  They were in a bit of difficulty with their numbers from their data collection.  They found that one of the big customer satisfiers was the warm washcloth given to travelers before meals (this was when they actually did this on airlines.)  The nursing staff had decided to give warm wash cloths before each meal to their patients.  I ALMOST LOST IT!   It took all the control I had to ask the nurse for their procedure book.  I asked her to find the procedure she used to give meal care.  She began to read and I let her continue until she and her committee were totally red-faced.  They had, in essence, not even met their minimal standard of care. They had long before dropped the practice of mouth care and hand washing before meals from their procedure.  There are so many reasons that adherence to basic hygiene is critical. I often worry that if current JOINT COMISSION SURVEYORS were taught the same way how can they truly assess practice? 

As we were being groomed for professional practice, I remember DEAN ANN JACOBANSKY giving a lecture regarding our emerging roles.  She made such a valid point.  If we did not learn these basic things, if we did not learn to do them automatically through practice and understanding then we could not move to applying the complex skills that we would later learn and use as an integral part of our practice.

Being Always Tired and Sleepy

Such excitement!!! It was time to return to DUKE and my first love.  HERMAN BUNCH had already returned to campus and to August football practice at UNIVERSITY OF NORTH CAROLINA.  I was anxious and could not wait to leave Greensboro and return to my newfound life.  I do not think that I gave a thought to the fact that I was really leaving my home for the last time.  I would come back for very short periods but never to be part of the life of my grandparents in the same way.  We said our goodbyes in a typical stoic way that we had lived life.  I knew of their deep love and I am hopeful that they knew of mine.  I knew they were very proud of me and would do anything in their power for me.  They had no real understanding of my life.  They did not understand why I did not spend time with my friends from Greensboro.  Two girls, TRICIA BOOTH (FISH) and ANN HUNTER (MCLAUGHLIN) were on East Campus.  I had been friends with them from the first grade through high school.  Although early in my freshman year, I had attempted to continue our friendship, it was rejected soundly. I had ridden to school every day with them, gone to many birthday parties, done pajama parties, and in high school we had gone out to lunch in Tricia’s blue Plymouth every day, and had shared all the growing up stories we all have. I think the reason for this in relation to NURSING is because of the reputation of what NURSING WAS.  Somehow we were a class lower.  It was hard for us at one of the best universities in the country to understand.  How could be that a teacher was in a loftier profession? That rejection that I felt was shared by many girls in my dormitory.  The feelings were soon lessened when we heard the words of THELMA INGALLS and the history of those who went before us.  The boys at DUKE seemed to prefer the more direct, more real, and less husband seeking girls of HANES HOUSE. That was not our primary reason for being at the university. There was no time that dates were not abundant. One of the very anger producing reasons that came from the boys was that we understood human needs, knowing all about people.  That would be their last date.  There were significantly more dates available than time to date, and besides for me I had found my lifelong love and was not interested.  My satisfaction and pride in my profession has only grown over the years and my respect for those who practice it.  It was the ignorance of youth that caused the pain.

Dr. Edens, President of Duke

It was sadness and shock when we began this second year.  I may not be totally accurate but of the 49 of us who had arrived in the fall of 1953, there were only 34 who returned.  Some had just decided that it was not for them, some did not make it and others transferred to East Campus.  We were however joined by an equal number of transfers in.  One of the most “famous” was MARY ANN EDENS (WINGFIELD).  Her father was PRESIDENT of DUKE UNIVERSITY.  This certainly added some prestige to our school.  I can remember thinking about my high school friends when I was spending the night or going to a tea at the home of the president. We did have other wonderful classmates that joined us.  I personally had several lifelong friends from the group that joined us. More about the class later.

AND the fun began….. I wish that I could find my class schedule for that second year. We continued our classes on WEST CAMPUS. We had required courses of Sociology and Psychology. The first semester challenged us in Anatomy with DR. J.E.MARKEE, organic chemistry with DR. TAYLOR, Sociology, Physical Education and Nursing Arts with LOIS KNOWLES.  The classes in anatomy and chemistry were taken with medical students and we were required to take the same tests and meet the same schedule.  Chemistry was very difficult for me, as I look back; I think it was because in high school all the sciences were easy for me. Zoology was another of our courses that were designed to flunk our folks and I did very well in that.  This was different. It was also a course used to flunk out medical students and the same held true for us. It was painful.  We were quite diverted by the guys, as well.  Anatomy was taught in the cadaver lab. The medical students would do the dissection, to prepare them to be surgeons, as we watched.  Then we would spend hours both in class and extra hours identifying the stringy vessels, hunks of organs, and muscle mass.  On one occasion after dinner we returned to work on our male cadaver.  When we entered the lab, the old guy was covered, as was the habit, with a white sheet.  As we entered the room and turned on the light, his male member came erect.  Oh yes, our boys had set up a string above the appropriate place, were waiting for us to return to jerk the string and scare us to death.

 

Nursing Arts was very exciting.  This class was taught to us in the lab and lecture hall in HANES HOUSE.  We received our uniforms.  After the first few weeks of just class we were to start our work in the hospital and needed to be in proper attire.  We received six aprons, three blue uniforms, six collars, and two caps. We supplied the white hose (please, my spell checker tells me that hose is now not a word!) and CLINIC shoes, and underwear. No jewelry at all was worn.  We were very disappointed in one aspect.  In the past, nurses had received their caps in a ceremony.  It had been determined that that ceremony was unnecessary in a professional school.  The caps were in a chair outside the lab for us to pick up.  To my knowledge, it was the last time a class did not have a capping until much later.  We made sure that our younger “sisters” had this ritual.  The uniforms were sent to the hospital laundry and returned to the dormitory starched and ready for us to wear with pride.  The nursing arts textbook was entitled, THE ART AND SCIENCE OF NURSING. The book was blue.  I cannot find in my research the book and am hopeful one will show up for me to read again.

After the first weeks of study we were ready to go to the hospital.  We were all excited and scared at the same time.  We were alphabetically divided into groups and assigned a hospital floor that would be our home for that first semester.  I was assigned to OSLER which was white, female, and public.  At DUKE the floors were named for famous doctors, were both public and private areas, were male or female areas or whole units, and were either black or white.  The public floors were located on the back of the hospital and contained four four-bedded open areas, a sunroom of six beds, two rooms with four beds, and four private rooms for very sick patients.  There were no INTENSIVE CARE UNITS; we would wait until the sixties for these units to be common practice. The very sick patients were put into the private rooms that were clustered around the nursing station.  As you walked onto the hall of these public wards, you first came to the dietary kitchen.  The food was delivered from the main kitchen on carts, served by nursing staff or later kitchen staff, onto trays and delivered to the patient.  There were rooms on either side of the hall, a nursing station with the charts and telephones, a treatment room where patients were brought to have special things done, a utility room for cleaning things and disposing of excreta, and at the end of the hall the large room with the four four-bedded cubicles all in a large open room with very high windows and ceilings.

Our first days were spent delivering water, delivering trays, making unoccupied beds, having conferences with our instructor, cleaning and cleaning and cleaning. Every single detail had to be in order. We would help the upperclassmen and doctors doing exactly what they asked.  We would arrive on the unit at 6:45 AM after a hearty breakfast in the cafeteria on the first floor and finish around 11 AM. Then we would rush, in uniform, to our classes on West Campus and were lucky to get a lunch.  We would get back to the dorm in the afternoon for Nursing Arts lab or lecture and back to the hospital for dinner in the cafeteria.  On two days a week we would leave dinner and go to physical education next to CAMERON STADIUM in the swimming pool.  The physical activity was exhausting by today’s standards and it was hard to work in study time without falling asleep.  Dates were rare except on weekends.

Off to Work we Go

This semester was filled with learning, being constantly sleepy, and looking forward to the next date with HERMAN BUNCH.  It was wonderful that I had not yet begun to work weekends and could go to football games and enjoy the beauty of a NORTH CAROLINA fall.

THE LAST OF SUMMERS AT HOME

I remember one of my good friends and her falling in love.  I went back and forth from Duke to Greensboro on the bus.  On the way back in early 1954, I met a very handsome sailor, MELVIN GUINN. We quickly made friends, talked all the way to Durham and made plans for him to come and see me at Duke.  As life unfolded, I had the blind date with HERMAN BUNCH, got pinned and forgot about MELVIN GUINN.  As young impulsive sailors are, he showed up at the dormitory one Friday evening. Scared me to death. I was in a panic.  We had a long chat in the parlor as I explained the events of the last few months since I had seen him.  I offered to find a blind date for him and his friend.  ELINOR EMERY was a good friend and she agreed, although reluctantly, to go out and we found a friend for his friend.  The rest is a story of friendship between Elinor and I until her death in recent years.  She rode many miles on a bus to come to my wedding.  One of the very important things about Elinor was that she might well have been the best nurse among our crew.  She raised four boys, pretty much alone, and worked as a shift staff nurse at GRADY MEMORIAL HOSPITAL in Atlanta until her belated retirement.  She loved nursing and loved working at GRADY which was a huge hospital serving the poorest among us. I, as a JOINT COMMISSION SURVEYOR had the privilege of visiting GRADY MEMORIAL HOSPITAL.  I asked the Nursing Administrator about her and she told me that she was due to come on duty at 3 and she would let her know I was there.  Elinor never forgave me.  She was not accustomed to being called to the office of the NURSING EXECUTIVE.  She arrived wearing her DUKE HAT AND PIN and we had a great visit.  The most important thing was to have the nursing leadership at GRADY MEMORIAL HOSPITAL tell me of her dedication and contributions to nursing.  She spent many more hours that any one of the rest of us doing the basic nursing things that are so critical to each patient.  Here’s to you girl!  Our last visit was in Savannah GA when some of the class got together at the home of MARY ANN EDENS (WINGFIELD) shortly before her death. Mary Ann was the Director of Nursing for Delta Airlines, SUE GREENWOOD(HEAD) who became beloved as a professor, KATY KELLER(MAULTSBY) who also taught so many Nurses in Burlington….I genuinely apologize…Does anyone know who else was there?

That second semester at Duke was indeed formative and exciting for me and for each of my classmates.  Many of us found our beginning directions.  I may be wrong on the exact facts but we in so many ways set our on an exciting life and career.  I find it very difficult to separate the career from personal life – this was one of the issues of that time in life and has continued throughout my life.  We did not compartmentalize our lives into family, work, church, etc. etc.  We lived it all together.  We were all very busy trying to make sure our grades (there were no such thing as grade point averages) were good so that we could return next semester.  We were busy finding love and enjoying our new found freedoms. 

The summer came way too soon.  I had to leave HERMAN BUNCH and my life at DUKE to be home for the summer.  I returned to work at WESLEY LONG HOSPITAL after six weeks at OLD MILL CAMP as a counselor.  It was my last time to do both these things for after this summer, I would be totally immersed in NURSING.  I was welcomed back to WESLEY LONG with open arms.  I was viewed with greater respect though I do not know why.  I certainly knew very little more than I knew before I left for DUKE except about art, religion, and the other liberal arts courses.  But I loved the new assignments.  I spent a month as the director of the CENTRAL SERVICES….well, the only employee there.  I used what I had learned in my earlier orientation to all the sterilization procedures.  I have had a great lifelong respect for INFECTION CONTROL issues, mainly because of this experience.  I was given an opportunity to spend time in the delivery room, the nursery and the emergency room.  Of course these experiences were sandwiched between regular nurse aide chores but to me they were very remarkable. 

One evening they could find no one else and I was drafted to go into the delivery room.  At that time, you opened a can of ether and dropped it onto a mask.  I was asked to do just that.  The doctor simply told me to give the patient a few more drops, or give her some oxygen …from the bottom of the table.  I am sure that this practice would not happen today. We used ether, which was not locked down, for cleaning things as well as anesthesia.  We were dangerous and did not know it.  However, we were careful.  It was not until I saw the movie, CIDER HOUSE RULES that I really remembered this practice recognized the implications.

I loved being in the nursery and feeding the babies.  We did all the work so the mothers could rest for their week in the hospital, feasting on lush meals, getting red roses, and lounging. We gave them immaculate peritoneal care with heat lights that they loved.   We took the babies out to see the mothers in the mornings and the evenings when there were no visitors.  I loved setting up the babies for their families to look through the huge window.   We would hold them up and undress them a little so the dads and grandparents could see all their toes and fingers.  

One of the little ones did damage to my FRATERNITY PIN.  The baby grabbed it and broke the chain.  That means that we did not wear over garments.  Why I was wearing the pin on a scrub dress is beyond me.  This reminds me…. We came to work and had to change clothes before we went into the nursery.  A clean sterilized scrub dress was donned before this important job.  I believe that the practice today… of coming to work with in very clean areas with uniforms done at home—has increased infection issues to a huge degree.  We all know human nature and how well things are laundered, how often they are changed and where they go before they come into areas such as INTENSIVE CARE.  Color me cautious.  I would return to the hospital LAUNDERING and supplying uniforms in certain areas but I am OLD SCHOOL.

My summer ended with having learned so much and very ready to return to DUKE.  This would be my last summer away from DUKE until my graduation in 1957,

DUKE.. SECOND SEMESTER -- LOVE COMES

For your information:  I have started this blog using GOOGLE and am having difficulty with seeing what I am doing.  The screen has gotten huge and  I cannot figure out how to solve the problem.  Any help would be appreciated...unil I can figure it out...please be forgiving...

My second semester at Duke brought to me many things.  I didn’t really realize how much happened and their impact until many years later.  We still were not even close to doing nursing.  We continued to watch the upperclassmen come and go with their starched uniforms, caps, and capes with a feeling of wonder and respect.  I felt that the day would never come when we could wear the uniform.We were being oriented to our profession by THELMA INGLES

THELMA INGLES  Nursing History 1954

who taught us HISTORY OF NURSING.  She more than any other person gave to this class of 1957 a set of philosophies and ideas that carried many of us through over half a century of nursing.  She wrote this in the Tar Heel Nurse,

“ A new kind of nurse is being born, and we who are older in the profession must nourish her development carefully and thoughtfully … The nurse will be a true colleague of the physician – she will play a much more vital role in the orientation of patients to care, evaluation of nurse must learn to work more harmoniously with the physician; an essential function of the nurse is to promote harmonious cooperation among all members of the medical team … We must also change some of our methods of education. There should be more programs in nursing offered at the master’s level, and programs in nursing should be started at the doctoral level … Many nurses with advanced education too often have ceased to the nurses and have become, rather, psychologists, sociologists, educators … The fundamental objective of advanced education must be to prepare nurses to become expert practionioneers of nursing … I believe too much research is being carried on for the sake of research – it is time we do more research for the sake of the patient … I believe more nurses must learn how to carry on research … We must have the courage to face honestly our weaknesses as well as our strengths, to investigate areas of dissatisfaction as well as satisfaction, to look at ourselves as we are, and to decide what we want to become … And we must examine our many functions carefully and have the courage to relinquish those which might better be carried by other personnel. 

Since our minds were fresh and searching, these concepts became ours. We knew and we believed we were a new  kind of nurse. We were colleagues of doctors.  We were not afraid.  We were not subservient. She taught us that doctors did not know more, it is just what each of us knew was different.  This is perhaps one of my most deeply held beliefs.  Even though we were required to pass ORGANIC CHEMISTRY in the same classroom with medical students and with the same exams, we took ANATOMY from DR. MARKEE side by side with medical students, and our PHYSIOLOGY class was the same as students of medicine somehow the belief of some was that our minds were not as good. Not so for this class at Duke.

From this time at Duke came many things. There was many historic events forged here.  The first clinical masters program began in my years at Duke.  Not the least,however, was the seeds of fragmentation of patient care.  Nursing came to the table as the less powerful partner as DR.EUGENE STEAD, after trying to bring medicine and nursing together along with THELMA INGLES, began his quest for the Physician’s Assistant and NURSING began its quest for independent nursing practice.  These years in the fifties were the beginning of what we see today in the form of Nurse Practitioners, Physician Assistants, and all the sub specialties that make communication so difficult when it reflects on the care of each patient.  In these years the simplicity of care was clear.  There were DOCTORS, NURSES, PRACTICAL NURSES, NURSING ASSISTANTS, LABORATORIANS, DIETITIANS, PHYSICAL AND OCCUPATIONAL THERAPISTS, SOCIAL WORKERS, HOSPITAL ADMINISTRATORS, AND THAT WAS PRETTY MUCH IT. Of course there were a few people in business offices, janitorial services (but not too many).  Doctors and Nurses were in most of the administrative jobs carrying their clinical knowledge and experience into the delivery system. There was much short-sightedness as we look back.  We complicated things so much that now our health care system is in chaos. More later……

THELMA INGLES taught us  “the care of patients was more important than the growth and prestige of the profession we belong to.”  We all took this with us for our lifetime being a DUKE NURSE.

As I learned the seriousness of my profession, my life was taking a turn that could not be expected by me, but was probably very predictable.  On one April day in 1954, my friend, PAT LARUE, asked if I would go on a blind date with her and her high school sweetheart who was at UNIVERSITY OF NORTH CAROLINA.  I decided to go with her.  That night on APRIL 9, 1954 I met HERMAN BUNCH.  I fell deeply in love.  He was from Clinton, NC and was a junior at UNC.  He was busy with the athletic teams there while finishing his degree.  He lived in Winston dorm,

Winston

just across the street from the gym and athletic facilities with Steve Marcinko his roommate.  He was tall, blond curly hair, and very handsome.  In just a month he asked me to wear his pin.  Being pinned was one of the things that each of us dreamed about.  I never dreamed I would be the second girl in my class to wear a fraternity pin. 

I never dated anyone else until our relationship ended five years later. 

I spent football Saturdays being picked up, taken to Chapel Hill, dropped downtown on Franklin Street, having brunch at Danzingers with Viennese coffee, walking across the campus to the football stadium and watching the game.  I would wait in his beautiful car for him until he finished the chores of the day and returned to me.  I studied, read, and knitted a drawer full of argyle socks for him while I waited.  Our relationship was filled with waiting --waiting for him to get done and return to me.  We would go to someplace to eat, to a movie and then park behind Hanes House, or Keenan Woods to share our dreams, our kisses and our lives.  I loved the Ivy Room in Durham

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where we would eat fried chicken covered with honey.  Basketball season was pretty much the same except I would wait outside the Gym for the Basketball game to be over and return to Durham for a snack at THE REBEL or Blue Light drive in. 

I was so sad when summer arrived.  I had to return to Greensboro and to work, Herman to Clinton and work, and three whole months not seeing him and not being at Duke.  I left wearing his pin.  I waited for letters every single day.  He began a game for us.  He took Baptist collection envelopes from church, on one side he would have a riddle, and on the other side the answer. (The offering envelopes, it occurs to me, are long gone. In those days, we would put our Sunday offering in one side, and in the other side the money for missions.  There was a perforation between the two sides so that when you sealed the envelope, you had two separate sides.)  I would open one side, find the riddle, then open the other side to see if I was right.  I loved getting his letters. It seems silly today that we did not see each other, that the drive was just too long...

This was perhaps the most important semester in a formative way.  I was learning in a broad educational sense, I was in love for the first time, my base for understanding nursing and patient care was being formulated and I was getting ready for the harder days ahead with its highs and lows.  

FINISHING UP MY FIRST SEMESTER AT DUKE

The first semester at Duke went very fast.  There was a short visit to GREENSBORO at Thanksgiving, but the first big break was at Christmas.  It would be the last time I would spend Christmas at home.  I didn’t know it at the time, but we would be required to work two of the three remaining Christmas holidays while we were in school.  The students in the MEDICAL SCHOOL AND NURSING SCHOOLS were required to cover in the hospital, and each had to rotate being off on holidays.  The first year at DUKE for our class, the first GENERIC BSN program, was just like the other students but after that year we were clearly very different in our schedules.

The three weeks I was to spend at home had been committed to working in my old job as a Nursing Assistant at WESLEY LONG HOSPITAL.  I needed the money.  My grandparents sent me $20 a month for my needs. That was a real stretch for them. I know my GRANDFATHER never made over $300 a month, but our needs were always met.  Now I did have more needs than before.  Even in the fifties, I needed to be careful in how I spent the money.  I needed personal items such as toothpaste 29 CENTS a tube, COKES in a bottle from the vending machine 5 CENTS, JERGENS lotion 39 CENTS, REVALON LIPSTICK used sparingly was 50 CENTS a tube and it had to be bright red. These were just some of the items that came out of that TWENTY DOLLARS a month.  There was money to be saved for a movie….but remember in those days, the guys paid and movies were the place to go. We as a group had cramps every month.  We soon learned that we could go to the student health nurse and get our “drugs” for free, but we still had to buy MIDOL when the office was closed.  I had to have things like paper for my typewriter and ribbon replacements (we used one ribbon until it was frayed), carbon paper to make copies, pencils and ink for our Shaffer fountain pens.  Later we would need both black and red pens for charting.

Going home for the holidays meant stocking up.  There would be some new clothes, snacks, and perfume to bring back.  That year I got my first bottle of WOODHUE and I thought it was so wonderful. It was woody and smelled of the place I had to leave behind in GREENSBORO. 

Needing more money meant working over the holidays.  I was excited to get back to see my friends at WESLEY LONG HOSPITAL.  Of course, I had not learned anything of a practical nature so far, but I seemed to have a bit more respect and was included in conversations in a different way.  I worked almost nonstop and was able to return to campus with a little bit of cash. 

I was assigned to the CENTRAL SUPPLY.  The nurse that had this job for years was unable to stand up and do it because of a health reason.  She was there to tell me exactly what to do.  EVERYTHING was reusable.  We would receive items from all the areas and clean them.  They were covered in blood, mucus, feces, sputum….and anything else that came out of the human body.  We would take them and dump them into a bath of GREEN SOAP.  Each item was washed carefully, rinsed and gotten ready for reassembly.  If it was a syringe, you matched the number on the plunger to the number on the outside and made sure that they stayed together.  After rinsing the syringe carefully both pieces were placed on a clean towel on a tray. These syringes were done in batches if they were small, and one by one if larger.  This tray would be covered with a double cotton cover, folded according to procedure, taped together with AUTOCLAVE TAPE, labeled, dated and put into the autoclave.  The needles were done separately from the syringes.  This was quite a procedure. After the initial washing of the needles, they were flushed with ether.  Imagine flushing a hundred or so needles and smelling the fumes while you worked.  Ignorance was bliss.  Following the rinsing, we would test each needle for spurs by dragging them across a cotton sponge.  If it caught and you had a snag, you would smooth the imperfection in the metal with a small whetstone.

 The AUTOCLAVE sterilization method is steam under pressure.  It turned out that I was considered really brilliant on one occasion during my junior year at DUKE.  The discussion was regarding what really killed the spores and bacteria.  Was it the pressure or was it the steam.  I knew the answer and not one single other student had a clue.  It was a bit scary when the steam went into the autoclave.  I was told that it would not explode, but I was always a bit skeptical.  The nurse who oversaw the activity taught me more than I ever realized during those three weeks.

The job of getting the rubber gloves ready was one that today would be considered unbelievable.  The gloves would come to us, usually on a used tray, covered with body stuff.  They were washed off, both inside and outside, laid out on towels, patted dry on the outside.  They were then turned inside out and patted dry again.  You would flip in the air to fill it with air and pop out all the fingers. The gloves would then go into a big drum to be thoroughly dried and powered.  We would then pull them out of the dryer and match them by size.  There was a glove holder and you would flatten the glove in proper position right glove on the right and left on the left.  These were packaged in an outer cover, autoclaved, dried and ready for use.  The operating room used 100 pairs a day.  I do not know why I remember that number, funny about memory. 

 One of the most rewarding things was to have the room clean and everything sterilized, on the shelves and ready to go back out to the floors. I felt very grown up and respected that I had been given this very important assignment with a very skilled nurse to teach me. I was to return here the when summer came.

I left to return to school with a lot of sadness but with much anticipation.  As soon as I returned there would be exams and it was my first experience with blue books. Much of the examination was in essay form and required a number of books and brought with you the number of books suggested by the professor.  They were examined by the teaching assistnant, passed out, and you did not get your own.  There were many exams that were multiple choice, but in most of the liberal arts courses it was write it all down!!!  It is amazing to me today that grammar doesn’t count.  I think it is because professors are lazy.  They have to know and grade gramatical error, and they just do not have the drive or the knowledge to make it important.  The day we arrived back on campus, we started studying and getting more and more scared.  In a month or so we were all ready for the psychiatric ward.  Despite all the drama, we made it through to exam time.  We had our grades posted outside each professor’s office and it was with heavy feet that we went to find out our grades.  Never mind privacy.  They were listed in order with the highest grade first, BY NAME.  My grades were excellent, thanks to GREENSBORO SENIOR HIGH and LOUISE SMITH.

INSPIRATIONS

We never know what words will inspire, change the direction of a life, or create wonderful new options.
It is rare that you take time to look back and see what inspired you. This blog is a place that I can take time to do just that.  You may have asked nurses what made you want to be a nurse?  Their answer if frequently very short, for fear that they may bore you.  In a blog, you should be prepared to be bored, suffer through minutia and generally take time to contemplate.  

There are a number of POSITIVE inspirations, influences, and motivations that have driven my career.

There are many words that have influenced me and created SIGNIFICANT EMOTIONAL EVENTS for me.  I learned of SEE'S from one of my favorite theorists in human behavior, MORRIS MASSEY. He  has influenced me greatly and the work he has done has stood the test of time for me.  

These six sayings that had an impact on me and that provided significant emotional events.

#1  "IF YOU HAVE DONE IT TO THE LEAST OF THESE, YOU HAVE DONE IT TO ME".          DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU.

#2   ABOU BEN ADHEM

#3   "GATHER YOUR ROSEBUDS WHILE YOU MAY"

#4  "TO THINE OWN SELF BE TRUE"

#5   "THE HOTTEST PLACES IN HELL ARE RESERVED FOR THOSE WHO, IN TIMES OF         GREAT MORAL CRISIS, MAINTAIN THEIR NEUTRALITY."

#6   A RITUAL: FLORENCE NIGHTINGALE PLEDGE

#7   A RITUAL: A CHARGE TO KEEP 

#1

"IF YOU HAVE DONE IT TO THE LEAST OF THESE, YOU HAVE DONE IT TO ME".

"DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU."

I grew up in a family that had strong and profound faith.  That is not to say that we were in church when the doors opened, we were not.  Did we read the Bible every day?  No.  It is not to say we prayed a lot.  We said our mealtime prayers, our bedtime prayers, and when there were big events in the family.  The Bible was not always held out to be taken very literally.  HOWEVER, if there was a person who came to our home they were treated with utmost respect.  People were not talked about in a negative way.  If anyone needed anything, because they were our fellow-man we did anything we could for them.  I watched this practiced day in and day out.  

NURSING is just that.  My favorite definition is the one THELMA INGALLS taught us that first year at DUKE. I learned that nursing were those who did for others , what they would do for themselves if they were able.  Later, Virginia Henderson published a definition that was so much more eloquent.  "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge" 

I have always found that keeping that definition as the basis of practice meant some profound things. 

Fast forward to my time as a nurse surveyor for JOINT COMMISSION (JCAHO). Much comes together with this little anecdote:  I will never forget surveying a very prestigious hospital.  I was a seasoned surveyor and was a member of what was referred to as the "A" team which usually surveyed large organizations and medical school affiliated facilities.  The process for survey called for the nurse surveyor to choose a patient randomly from the Kardex of a nursing unit.  There would be a visit to the patients bedside at which time the care plan would be compared to care given.  This was done through observation, interview with the patient and interview of patient care staff at all levels. The patient I choose was an older black woman, maybe 60, and she had been in the hospital well over a month.  She had been brought in unresponsive, with deep leg ulcers infested with maggots and cockroach eggs. Rat droppings were in her clothing.  Both legs had been amputated shortly after admission.  

I went into the room to talk with her.  She was certainly not an educated woman, but she communicated openly and clearly.  She was very grateful.  As I talked to her, my eyes were drawn to her head.  I asked when she had been given a shampoo.  Her answer was astounding.  She had not been able to wash her own head for over five years.  Since her surgery she felt better than she had in all those years.  

She had not had her head shampooed since she was admitted.  ....." those who did for others , what they would do for themselves if they were able. "  Not one nurse in this very prestigious hospital had thought to wash her hair. The hair under her arms and her peritoneal area had the same lack of attention.  It would seem to me if you have vermin in your leg ulcers, you certainly would in long and very matted hair.  Not a physician, not a nurse, no one had looked into what was growing in her hair.  I can assure you that before the day had ended, that this woman had been given one of the best baths and shampoos that could be provided. Actually her hair had to be shaved and there were open sores found. They had been confused as to why she kept having a low grade fever. This hospital had an infection control practitioner in a major national leadership position. You can also rest assured that the Board of Directors, Medical Staff, Administrative Staff and others were clearly aware of the level of care being delivered as was the Central Office for JCAHO.  I thought of that woman, mother, and valuable human being and her care for weeks, months and now it has been years.

Closing your eyes to the obvious.  Doing the minimal.  This is not what "doing it to the least of these" or "do unto others really means.  

I have often though of my first clinical instructor, LOIS KNOWLES would have done if we had left a patient in this condition for an hour, much less more than a month.  I would not be a DUKE NURSE and am sure I would not have spent another night in Hanes House.