February 5, 2016

A Day in the Life of a Visiting Nurse Circa 1970

By Jamie Stier, Clinical Director, Manuel R. Grell Home Care & Dr. Matthew S. Shwartz Hospice
In the middle of a snowstorm, I arrived at the visiting nurse office to prepare for my day. I was dressed in the required navy blue uniform dress, tights (no pants allowed), regulation overcoat, and required uniform hat. The hats resembled military hats with points at the front and back. We were frequently mistaken for “stewardesses”. I did wear the allowed boots. It never occurred to any of us that we should bundle up in parkas, wool hats, mufflers and warm pants. It “just wasn’t done”.
I received my assignment of patients requiring visits that day. They all lived within a mile or two of the office. I planned my route for the visits depending on patient needs and proximity. Of course, we walked from the office to each patient’s home, or possibly utilized the bus system. Personal cars were not allowed and there were a few company cars to be used. Again, this was the way visiting nurse services were provided and we usually cheerfully walked two to three miles a day to cover our “territory”. It was a wonderful way to really learn the area and become part of the fabric of the neighborhood. We did not always remember how “wonderful” it was in the blowing snow.
My preparation of my nursing bag included refilling my soap bottle from a common jug of liquid soap in the office, folding packets of three paper towels  (it must be three) to be used for each hand washing. I re-filled my bottle of alcohol in the same manner, along with a bag of cotton balls (who knew the future would bring pre-filled bottles of Purell and individual packets of alcohol wipes). Since I was going to be changing a dressing, I gathered a few packs of sterile gloves (we did not use “clean” technique in those days, but believed every dressing needed to be sterile). I gathered the patient records to take with me. Each record consisted of a stapled group of 3×5 cards with demographics and a few notes on the cards. No one had heard of computerized patient records. Actually, no one had heard of computers…
After a brief team meeting, we all headed out on our “appointed rounds”. We often agreed to meet at a local diner for warming up and lunch.
My first patient was a diabetic who required an insulin injection. I took my metal syringe tray with lid from my bag, placed the patient’s glass syringe and re-usable needle in the tray, filled it with water and set it on the stove to boil for sterilization. As the syringe boiled the requisite ten minutes and then cooled, I tested the patient’s urine sample with a small strip of paper called a “dip-stick” which was treated with colored chemicals to indicate certain properties of the sample. There was no method in the home to test the actual blood sugar level. I administered the ordered amount of insulin, discussed diabetic diet with the patient (he did love his doughnuts), made a note on the patient record card and moved on to the next patient.
As I trudged through the snow, a local shopkeeper stopped me and insisted that I come into his store to have some coffee and warm up. I welcomed the respite and caught up on neighborhood news of a recent birth and a neighbor’s illness.
The next patient required a dressing change. To do this I needed some instruments: a sterile field and sterile gloves and dressings. My patient had obligingly boiled two pairs of tweezers and a pair of scissors in a saucepan, leaving the lid on, as instructed. I drained the water from the pan, used the lid of the pan as my “sterile field” and poured saline into the pan. Oh yes, the saline had been made by boiling a mayonnaise jar, putting measured amounts of boiled water and salt into it and sealing. There was no such thing as prepared bottles of sterile saline to take to the home. Donning my sterile gloves in the proper fashion, I re-dressed the wound using the tweezers, scissors and sterile gauze soaked in the saline. This was an odd mixture of primitive and sterile technique, but we had very few wound infections. As every visiting nurse does, I reviewed the patient’s vital signs, reviewed all their medications and answered questions. As they had no biological family, their “family” were characters on their favorite soap opera, so we discussed all their recent “trials and tribulations” and they felt as though I had taken an interest in their family. They promised to sterilize the instruments for my next visit and I went on my walking tour of my territory.
As I look back on my “adventures” as a visiting nurse in the seventies, I am struck by the fact that so much has changed in this field of nursing, yet so much has stayed the same. We use newer treatments, newer technology and must move at a faster pace, but, at the heart, we still provide the same family centered, compassionate, skilled care to all those who need our care in their homes.