1. Smith, Deborah Charlene

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Really, I did not actually practice with Florence Nightingale, but sometimes, it feels like I did! I have been a registered nurse (RN) for over 40 years. My entire adult life has been ensconced in nursing, with neuroscience as my specialty and certification. ICU patients scare the stuffins out of me but give me a brain and spinal cord, and I'm happy as a clam!


My nursing career has been spent in one of the Midwest's largest healthcare networks. I have been privileged to work alongside some of the most innovative and influential leaders in the industry. Times are a changin', but the message is still the same-the disease is under the sheets, and we as nurses are responsible for the care and nurturing of our patients. Gone are the days when patients were admitted for 4-5 days to complete their annual physicals. Physicians would bring their patients into the hospital to have their complete spine films, upper and lower GI series, and blood work out the yin-yang. All while enjoying the comforts of "24-hour room service" with a steak dinner and glass of wine every evening and massages with warm lotion every night at bedtime. Ah, those were the days!


Remember IV series: multiple glass IV bottles hanging from an IV pole with connectors to each bottle. Talk about a nightmare trying to calculate intake and output and keeping the bottles from breaking when the patient was transported. How about taping glass vacuum bottles to the floor with chest tubes? Did you ever stub your toe on a glass vacuum bottle or lower a bed too far and cracked the vacuum seal? Now, we have the Pleur-Evac system and the even more convenient Heimlich valve that allows the patient to move about more freely. Talk about technology!


Back in "the day," patients came to the hospital to "get ready" for surgery and would stay for a couple of weeks before being allowed out of bed, let alone discharged! Bulky dressings would be left in place for a week so the incision would "close." Sutures were left in forever, and wound infections were the order of the day as we dispensed antibiotics like candy. Today, patients arrive a couple of hours before their procedure and are often discharged a few hours postoperatively, allowing them to rest and recover in the comfort of their own home. We even have robots performing surgery (with the able assistance of a surgeon, of course)! If we keep this up, someday soon, we will be performing drive through craniotomies! Just kidding, but who knows what advances technology will make in the very near future.


Patients with cervical fractures were placed in skeletal traction with Gardner-Wells tongs. Spinal cord injuries were placed on circle electric beds or Stryker frames. Nurses were always afraid that the screws and belts were not tightened enough, and the patient would slip out onto the floor while being turned. Imagine what was going through the patients' minds as we strapped them in and tossed them like flapjacks! Nowadays, we immobilize their necks with halo braces or other types of specialty braces. Although a bit cumbersome, they allow for ambulation and a feeling of independence.


As a new graduate in the '70s, this writer worked the night shift on our mixed neuroscience unit and was the only RN for 21 patients. There were two nursing assistants assigned as well. We were considered the "poor man's ICU" with fresh craniotomies and ventilator patients. Our patients with stroke and patients with spinal cord injury wore knee-high TED hose and had high-top tennis shoes applied on 2 hours and off 2 hours, around the clock to prevent foot drop. Chart checks were done by the charge nurses at the beginning and end of each 8-hour shift. Rarely did we work longer than 8 hours per shift. The charge nurse rounded with the physicians and scribed for them, taking notes and writing orders. Patients with stroke stayed in the hospital for 4-6 weeks before discharging to their homes. Home healthcare was only coming to the forefront, and acute rehabilitation hospitals were a "gleam in an administrator's eye." Back in the "good ole days," neuro patients with life-threatening trauma or disease were sent to nursing homes for the remainder of their days, and we hoped for the best. Today, top of the line, evidence-based rehabilitation hospitals are available to restore form and function to our patients with debilitating disease and/or trauma. It is truly miraculous to see patients regain form and function, whenever possible, returning to family and society.


We had our share of patients with Guillain-Barre in iron lungs. Care was next to impossible. Ever try giving a bath in a metal tube? The patients had to learn how to talk, eat, and breathe as the machine cycled. They were forced to lie on their backs for days on end. Unfortunately, many developed aspiration pneumonia because they "swallowed wrong" or off cycle. Iron lungs have now been relegated to medical museums and are, thankfully, a thing of the past.


This writer was a diploma graduate when she began her nursing career back in the early '70s. Degrees were reserved for administrators. Many nurses of my generation were diploma graduates and put their careers on hold to raise their families. Many have reentered the workforce since their families have grown. There is much to be said about the "older nurse" who brings a wealth of knowledge and life experience to the bedside.


The healthcare industry has jumped on the technology bandwagon. Proliferative Web sites abound with all manner of healthcare information. Many institutions have adopted an electronic format, with financial incentives being awarded by government agencies for transitioning into the digital world. The ultimate goal behind all this technology is putting the patient first and providing them with the tools that they need to recover or to prevent illness and readmissions.


This writer is privileged to have accomplished certifications in neuroscience nursing and stroke. It is up to those of us who have been pounding the pavement for over 25 years to pass the baton to our younger colleagues to help prepare them for the years ahead. As this writer's nursing career winds down, she has begun reflecting on all that has been learned, all that has been seen, and all that has been shared. This writer can truly say, "Neuroscience Nurses, you've come a long way baby!" And we are just getting started!