A Look At Hospital Nursing During the 1970’s

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You would feel lost and confused if you were transported back in time to a hospital ward in the 1970’s when the nurses who are now at the end of their careers were students. But you would probably not be as out of your depth as a nurse from that era who suddenly found herself on duty in the present.

The world has changed dramatically over the past few decades, and most of the changes are the result of the growth in knowledge and technology. It has been calculated that towards the beginning of the 1900 knowledge was doubling only about every 100 years, after the World War II it was doubling every 25 years, and it is estimated that knowledge currently doubles on average every 13 months. There have also been noticeable social and cultural changes. Generally, life and human interaction have become far less structured and formal, most likely due to the global human rights movement. These developments have had a considerable effect on patient care, nursing, and nursing practice, as you will see from the recollections below.

Nursing students were part of the nursing staff allocation

In 1970, I was accepted as a student nurse into the only degree program at the time. Although we were university students, we were on government bursaries (a monthly “salary”) and therefore answerable to the hospital authorities.

The day after we reported for our course we went to work in our assigned ward for two weeks until lectures started at the University. Students were part of the staffing on the wards, and you had to learn on the go and quickly.

Vintage Nursing Students
A group of nursing students during hands-on training. Image via: Pinterest.

As first year students, we worked five hours per week during term time and a full 45 hours during university holidays except for the regular leave of 30 days a year. Work during term time increased to 20 hours per week in our second and third years (most of it during weekends), and to 40 hours in our fourth year. This while we still had to attend the reasonable number of lectures and study for tests and exams. Registration as a nurse required a certain number of night shift hours, so much of the time during University holidays were spent on night duty.

Discipline

We had to live in the nurses’ residence during our first year. On weekdays, you had to sign in by 19:00 and weekends by 23:00 unless you had obtained a special dispensation from the matron of the hospital. You had to report for duty at least 15 minutes early for the handover report for all the patients on the unit. You were also expected to know the names and conditions of all 30 or more patients.

It was etiquette to allow superiors to go through a door first, and you could often find a group of nursing students forming a “guard of honor” at a doorway

Great respect towards seniors was demanded– the sister-in-charge of the ward, the doctors and especially the matrons were revered. It was etiquette to allow superiors to go through a door first, and you could often find a group of nursing students forming a “guard of honor” at a doorway while the matron was still 20 or more paces away.

Neatness of the nurse herself, as well as the wards, was a priority. Before visiting hours all the bed linen had to be straightened, with perfect hospital corners, the overbed tables had to be in straight line at the bottom of the beds with all the wheels pointing in the same direction. Fortunately, most patients were understanding and endured the trussed up state until the doors were opened for the visitors.

Nurses’ uniforms

We collected our uniforms on induction day – the first of the seven starched white blocks received weekly. There was also a cap in its flat state, a short and a long cape. When we arrived at the nurses’ residence the first order of the day was to learn, under the supervision of the final year students, how to iron the starched block into a wearable dress. The uniform was the double-breasted type, cinched at the waist with a belt. We also had to learn how to fold and pin the caps into what looked like upside-down ice cream tubs and how to fasten them to our hair with clips so that they remained firmly perched in place all day.

Nursing Hats or Caps
Different styles of nursing caps. Image via: Pinterest.

Fortunately, there was a uniform policy change during our second year when we were given a uniform allowance and to buy our own wash-and-wear type uniforms.

Nursing uniforms. Notice the coats. Image via: Pinterest.com

The “mini” was in fashion then, and of course, we all tried to get away with wearing our dresses as short as possible without getting into trouble.

Work allocation

Nursing duties were allocated according to tasks rather than assignment to particular patients. Junior students did the basic nursing duties, such as “beds and backs” or checking all the patients’ vital signs. As you progressed, you do more advanced procedures and tasks. A final year student could at times take charge of a unit if there was no registered nurse (sister) on duty.

Nursing duties were allocated according to tasks. Image via: Pinterest.com

The food was not portion packed, except for special diets. It was delivered in a large trolley and the nurse in charge dished up for each patient. Other nurses would collect the plates, hand it out to the patients and then assist those who needed feeding.

Nurses preparing medications. Image via: Pinterest.com

Similarly, patient’s medicines were not dispensed individually by the pharmacy. There was a trolley with the full range of tablets and from here, using a using a card system to which the individual patient’s prescriptions had been transcribed, a senior nurse would hand out the medicines. Considering this system, it was surprising that very few medication errors occurred.

Patient records

There were no computers and no electronic records. Everything was written by hand. The patient’s file was not kept at the bedside but, usually, in a room just beyond the ward office. It contained the admission records, doctor’s notes, prescriptions and diagnostic reports. There was also a vital signs chart on which the nurse responsible for taking the vital signs of all the patients had to chart them in graph format. Recoding vital signs required the use of three-colored pen to reflect the three different shifts. .

Patient Documentation Medical Records
“Everything was written by hand.”

The nursing process and nursing care plan were only introduced widely towards the late 1980’s although this does not mean that there was no planning of nursing care.  There was a metal flip folder, with a card for each patient from which the report was handed over to the next shift. Throughout the day any abnormal observations, changes in the patient’s condition and treatment orders would be entered on this card. The nurse in charge would enter specific nursing instructions, conveyed during handing over. Her planning of care was also reflected in the allocation of duties at the start of each shift.

Patient stays

A major shift in hospital care has been the reduction in the length of patient stays due to advances in medicine and technology as well as the increased cost of hospital care. Patients remained in the hospital for at least one night even after minimally invasive surgery. After surgery such as a hysterectomy, patients were on strict bedrest for at least two days and remained in the hospital for five days or, most often, until the sutures were removed. There were no pins and plates for treating fractures and a patient with a fractured femur was placed in traction and remained in the hospital for up to three months. (Consider the mix of the type of patients who most frequently end up with fractured femurs, their immobility while not being ill and young student nurses – made for some interesting times.)

Nurses providing bedside care. Image via: Flickr.com

“Beds and backs,” a routine done three times a day, fell into disuse mainly because of early mobilization and shorter patient stays.  Usually, in teams of two, nurses went to each patient, in turn, seeing to patient comfort, making general observations and taking action to prevent pressure sores. Bedridden patient’s backs, hips, heels, and elbows were rubbed and creases and crumbs removed from the linen. Pillows were plumped up, water jugs filled, and the general surrounds tidied.

Cradle lifting a patient. Image via: Flickr.com

Patient requests would be attended to, and anything unusual in the patient’s condition would be reported to the nurse in charge. There was less focus on infection control then, and you didn’t wash your hands between each patient!

Medical technology

Very little technology was in place to assist in monitoring patients. The temperature was taken with a mercury thermometer, you wore a pin watch for counting the patient’s pulse and respiration, and BP was measured with an aneroid sphygmomanometer. In general wards, each bed did not have an oxygen supply – you wheeled in a portable oxygen cylinder when a patient needed it. Intravenous fluids came in glass bottles and if you needed to control the speed of administration you either counted the drops per minute, or you stuck on a length of tape on which you marked the minutes or hours.

Nurse caring for polio patients. Image via: Pinterest.com

Very few intensive care beds were available in the hospital. Most of the ICU’s were converted side rooms of specialist units with two to four beds. For example, the nephrology unit had a two-bed ICU section for kidney transplant patients. A cardiac monitor, a respirator, and a central venous pressure line were generally the only advanced equipment used in these units. There were no intermediate high care units. Critically ill patients were mostly treated inside rooms on the wards where a form of patient allocation was used when one of the nurses on the staff complement of the unit was allocated to “special” one or two patients.

Other interesting tidbits as shared by Pamela F. Cipriano of American Nurse Today

  • Nurses lived and died by the Kardex, a folded card-stock roadmap to all things for the patient, completed in pencil and continuously crossed out or erased and updated.
  • Universal precautions didn’t exist.
  • Electrophysiology studies were done at the bedside to discover and treat arrhythmias.
  • GI bleeds were managed by inserting tubes with balloons (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 I.V. drip rates.
  • White oxford lace-up shoes were the norm for nurses.
  • Only operating-room (OR) staff and physicians wore scrubs.
  • Vital signs recording required a three-colored pen to reflect the three different shifts.
  • Nurses mixed antibiotics without pharmacist assistance.
  • Nurses became proficient in I.V. sticks by practicing on one another.
  • Patients were weighed manually.
  • Requisitions were completed on typewriters.
  • Public health meant well-baby check-ups at the new mother’s home.
  • Grandma died at home.
  • Patients heading for the OR had their body hair shaved with hand razors.
  • Most surgery patients were admitted to the hospital the night before.
  • Nursing caps were still popular.
  • The Physician’s Desk Reference and the U.S. Pharmacopeia, chained to the desk, were the common drug references.
  • Nurses carried trays with cups of pills and med cards.
  • Cancer was a death sentence.
  • Staff and patients smoked in the hospital.

Nursing yesterday, today and tomorrow

Nursing has changed dramatically over the past few decades and will probably change as much or more over the next forty years, and this is why continuing education has become so important. While developments in society, medicine and technology will change the landscape, it could never replace the essence of nursing – caring for other human beings at a time of need.

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Frieda Paton, M.Cur, RN
Frieda Paton is a registered nurse with a Master’s degree in nursing education. Her passion for nursing education, nursing issues and advocacy for the profession were ignited while she worked as an education officer, and later editor, at a national nurses’ association. This passion, together with interest in health and wellness education since her student days, stayed with her throughout her further career as a nurse educator and occupational health nurse. Having reached retirement age, she continues to contribute to the profession as a full-time freelance writer. In the news and feature articles she writes for Nurseslabs, she hopes to inspire nursing students and nurses on the job to reflect on the trends and issues that affect their profession and communities - and play their part in advocacy wherever they find themselves.

14 COMMENTS

  1. What a trip down memory lane! Although, Nursing Process and Nursing Care Plans were a big part of nursing education in the mid to late 1970’s, in my experience.

  2. The biggest difference between the nursing care story related here from the 1970’s and now, is that the story told here relates to nursing training and practice in Great Britain, not the United States. The photographs provided in the story not only all came from the United States student nursing experience, but from the 30’s, 40’s, 50’s, and a couple from the 60’s. None were contemporary to the 70’s, in my opinion.

    This is after having spent the vast majority of my 62 years thoroughly studying nurses’ and student nurses’ uniforms, student nursing experiences, schools, their admission, training and retention requirements, and for a short time, experiencing nurses’ training in the later 70’s myself. We wore pantsuit uniforms in blue and white as students, were required to win our caps following a successful completion of our probationary period, and many of the experiences related here were part of the early 70’s, and had already been supplanted by more technologically advanced practices by the time I got there in 1978 and ’79. A health issue required my leaving training in 1979, and I was unable to return to the medical profession for several years. By 1991, I had done so, entering and graduating in 1993 with high honors from training in a separate profession, focused strictly on Surgical Practice, which I found suited me completely. I enjoyed it immensely, and was quite successful at my profession. However, I never lost my interest in the nursing profession from an academic standpoint, and have never stopped studying and researching its history and progression in all this time. The advent of the Internet has helped immensely, and the more I find to learn, the more I want to learn.

    Having read a great deal over the last several years about the set-up or “scheme” of nurses’ education in Great Britain, I immediately recognized the differences in terminology as it applies to their practice.

    She describes the individual nurses, i.e., matrons, sisters, etc., the training, i.e., beginning work on the wards prior to any type of classroom education relating to patient care, or even the basic sciences, as well as being part of the staffing plan of nursing care, not being regarded as separate student training; the uniforms, i.e., ironing starched “blocks” of materials into wearable uniforms, and most particularly being furnished with caps from Day One, which was never done in the USA, as caps were something to be “won” following successful completion of a specific period of initial training in nursing schools in the USA; and the general practices of “beds and backs;” straightening everything prior to visiting hours, including rigid “hospital corners” on bed linens, lining up overbed tables at the foot of the bed with even the wheels all facing the same directions; wearing a pin-watch to count pulses, (where nurses in the US all wear wristwatches) and IV drips, etc., and many other details related here.

    Also, the description of being University students, while being supported by a government “bursary” or grant fund, which provided all training and associated costs, plus a small stipend for living expense money, as living in the dorms or nurses residences was provided as well. Since that was only required for one year out of four, there were apparently other living arrangements for the following 3 years. This depended on the particular time period involved.

    Much of my study has involved a great deal of non-fiction and historically accurate fictionalized stories regarding the young women who took up the profession of nursing and their detailed experiences, whether they became nurses or took on additional training afterwards to become Certified nurse-midwives. This has also involved viewing videos and documentary style plus fictionalized movies from pre-WWII up through and after the War, and studying captioned photographs. Reading interviews done with retired nurses and midwives has also provided a great deal of historically accurate information as well.

    Pamela Cipriano’s comments toward the end of the post describe experiences relative to American nursing practice during the 70’s, as far as I can tell. Nothing there sounds relative to the English experience. The photo at the top, showing student nurses being inoculated by more senior students is definitely from the US in the 40’s, as this is one of the first images I found relating to nursing training during WWII, which is a time frame of particular interest to me. Several others below that also are from that time. I have seen most all of these in their original formats, complete with identifying captions.

    • Agree pictures were not from the 70’s. Much older pics. Just look at the hairdos.
      Whole article not my 70’s experience. LVN at that time….RN in 1998.

  3. I was trained in 1971 during that period the student Nurses also considered as part of the staff and answerable to the Hospital Organizational. we practice Block system and during 2nd year I was put on night duty. There was no clinical supervisorbutthe ward staff is responsible to look after and take care of us.
    Yes Yesterday was a Memory . tomorrow is mystery but today is reality.
    so we have to update and advance our Professional knowledge to keep abreast with today’s demand and client’s expectations. We nurse always keep up with life long Learning in tanda with our Nursing Etiqque.

  4. I was trained 1974 to 1976. I went to a JUCO or jr college for my ADN program. We were pale yellow striped uniforms..we had a pants suit and a dress. We wore the white lace up shoes and white Hose. If your finger tips were longer than your skirt..u went home to change. We were assigned several pts to work on and learn about..NG tubes were red rubber connected to GOMCO suction machines and you emptied the bottle every shift in tha toilet after measuring it, of course. Length of stay averaged a week..IV bags were being used but had a bottle once in awhile. Alot of IM injections for pain..Demerol and Phenergan or Vistaril we drew up in the same syringe. Nembutol for sleep at bedtime..or Dalmane. And Darvon or Tylenol #3 for pain pills..and loved every minute of the changing world of medicine. Ended up loving Cardiac..TPA given IV and watching the “tombstone T,s ” on the EKG disappear! I am proud I was a nurse in the last 43 yrs and learned so much about the human body AND soul. What a wonderful profession!!!

  5. Just wanted to point out that the student nurses were wearing capes, not coats and they were part of the students uniform.

    • I was at the University of South Carolina from 1963 til 1965 and ours was the first class who did not have the cape. Instead we were instructed to buy a truly UGLY gabardine navy blue coat with the school initials on the collar. I don’t recall ever wearing it.
      Our uniform was yellow with sewn on collar and white cuffs. The cuffs and front of the uniform had pin on buttons that had to be removed for laundering. I left in 1965 to get married and followed my husband in his army assignment.

      I returned in 1973. Then it was a 1 piece dress with buttons. But nonetheless it was a dress. A cap was optional and if we wanted one we could go to a uniform store and buy one. If we wanted a pin, we could go to the student union and buy one there too. When I graduated it was with the rest of the University grads and we had no capping or Nightingale pinning ceremony. In the hospital after graduation it was 2 or more years before pants were allowed still white though. And it was another 20 years before scrubs-still of specified colors were introduced.

  6. Hello from Australia where I started hospital training in 1961. We had to buy our tailor made uniforms and they were starched I DO recall. We also had the “guard of honor’ in door ways. We too mixed our own antibiotics and took IV samples for pathology but did not insert IV lines. Yes we regulated them with the calculated drip/minute system. We worked 40 hours per weeks with education mostly in our own time and study as well but we enjoyed 6 weeks holiday. I worked on &n off for about ten years and retired. After my husband died I went to university to gain my bachelors degree and started again at 67yrs and worked 18 months in aged care till I retired again. Restless at 72n years I began again in aged care. They needed wisdom ^ experience & I could do this rewarding work. I agree the main changes are knowledge and technology. How fortunate science had discovered so much more to assist us coping with our heath and care. Nursing is a dedicated pleasure. Enjoy!

  7. I entered nursing school in 1961. I remember that the doctors were Kings, and all nurses and students had to shelve the charts we were working on if an MD walked in, moving away from the desk to give the docs unhindered access.

  8. I graduated from a three year diploma program then onto a college degree then MSN . I am proud of my nursing education.

  9. some photos appear to be earlier i.e. 1950-60. I could identify with them easily as I completed “training “i as it was called in1957. We provided for those committed to our care with respect and competence. Not an easy task but the most rewarding. My basic education was a diploma from a nursing school ranking third in the state of Pennsylvania at the time.

  10. I love the trip down memory lane, bringing back good memories back. This article took me right back to the patient’s bedside.
    Good reading.

  11. Kids today could never handle the work load then. I worked in pediatrics for 47 years and when I started I had one side of a hall which was 10/12 patients and we did all our own cpt and postural drainage. If we were lucky there were 2 lpns and 1nursing assistant and the nas didn’t do apicals or bps. The rn did most of the meds and all ivs a d if we were t lucky we had 1lpn I rn and 2. Nas.

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