Nursing: Looking back...

My career in nursing is coming to an end and on this page I will be looking back at the last 36 years that I have spent working in a public hospital as a Registered Nurse, with 32 years of that time spent in that strangest of worlds: the world of Intensive Care. I am attempting to not only look back at this time but also to see what I have to take away from such a career into the long years of retirement...

A nursing timeline...

I was not entirely sure how to structure this examination of a long nursing career but when I was interviewed in my workplace about 'nursing in the old days' I could see a few naturally occurring divisions that might help you, Gentle Reader, in making sense of this rather long page. And, dare I say it, perhaps this division will also help me to see the structure in my own nursing career; a career that was neither well organised nor well structured!

Training years...

My entry into nursing was anything but carefully planned. I had dropped out of Sydney University where I had completed 2 years of a Bachelor of Arts Degree (free back in those days!) and I was working as a glorified nursing assistant in a residential care facility for quadriplegics. Enjoying picking a regular wage for a change and totally oblivious and even uncaring about any plans for the future; if I could go back in time I would have a word to that young man for sure. As I was getting married I thought a more solid job would be a better idea and as it happened I saw some advertising for the very last intake of hospital trained nurses before the whole system switched to a University based training with a diploma and the later a degree in nursing. 'Three years of money' was my main thought and in this inglorious fashion my nursing career began back in 1984.

The small hospital that I trained in was actually not completely representative of this older, 'Army' style training as the winds of change were blowing through the system. Many lecturers had already decamped to the upcoming Univerity based system and there was a sense of things being slowly wound down. Nevertheless there was much to learn and a great amount of work to be done as a very junior nurse. The training system started with a Preliminary Training School (PTS) which comprised several months of lectures and practical training in a purpose built building on the hospital grounds. After this training was complete we were unleashed onto the various wards of the hospitals to work regular shifts. Most areas of the hospital did not welcome the PTS nurses as we were considered to be something of a drag on the well oiled machine of a small, busy hospital. You had to learn fast, become efficient, often with not a lot of assistance.

After this baptism of fire there were shorter blocks of learning interspersed with ward work as my nursing group slowly became second and then third year nurses. The third years nurses were a valuable commodity as by this time we knew the hospital routine very well and were fast and efficient with most of the practical procedures required of us. There was a State based exam at the end of this training and then you became a Registered Nurse. But, Gentle Reader, what were the highlights and lowlights of these three years? I give some snippets below; unfortunately some of my great memories from this time have not made it to this page to protect the confidentiality and right to privacy of the people involved. Missing from here (in the manner of Dr John A. Watson perhaps?) is the horrifying story of the man who shot most of his face away, the sad tale of the little girl with the facial abnormality who took my heart, the terrible story of the stillbirth of a baby in the ED and a few others. But those highlights that I can talk about are here:

I remember at the end of this training there was a formal interview with the Matron of the hospital. These were frightening, authoritarian women in their time although when I graduated as a Registered Nurse their time was almost over. The Matrons were 'married to nursing' in this time and were almost always single woman of a certain age and this was the case with the Matron who I spoke to (although she did most of the talking!). After this interview I rang the hospital that I wanted to work at and such was the guaranteed strength of the older method of training that I was given a job over the phone. And for me, along with all nurses in Australia, this was the end of this method of training...

Intensive Care, the long years...

After working for several months in different wards in the new hospital I worked as a new graduate nurse in the Intensive Care Unit and politely asked the Unit Manager if I could stay. And stay I did for the next 32 years and of that time 25 years were spent 'on the floor' providing direct, hands on care for critically ill patients. Why so long? Gentle Reader that is a question that I have often asked myself and the most truthful answer is that the time flew past so quickly that I am now a little horrified to find myself 60 years old and in the process of retiring! And now rather than try to look these 25 years in great detail I will look at the very early years and, if we have time Gentle Reader, then have a flying look at the later years:

Early years in ICU...

The Intensive Care Units of the 80s and 90s were very, very different to the ICUs of the present day. The ICU that I started work in was considered to be screamingly busy if there were two patients being ventilated and these ventilators were either ordinary Bird ventilators or its slightly modified cousin the Mark 4B. My first patient on a ventilator was on that Mark 4B and I will never forget altering the Tidal Volume by adjusting the verical travel of the bellows using a ratchet device. Or for that matter using a Wright's Spirometer to read the Tidal Volumes and Minute Volumes. Always turning the PEEP off first of course!

I learned the ways of Intensive Care very quickly and I found even back then that the technology of ICU came easily to me. In fact for many, many years I was absorbed perhaps too much in this technology at the expense of growing to become a mature, caring ICU nurse who knows the technology well but also can experience fully the joys and sorrows that come as part of the ICU experience. Did I mention before that I was a very callow young man? For the moment though I can look back and see myself energetically learning ventilation, learning the new CVVHD/F machines as they arrived in the ICU, learning how to setup and work with iNO, learning the ins and outs of Pulmonary Artery Catheters, temporary pacing wires, learning to use the various versions of PICCO and friends, learning how to correctly apply, inflate and deflate MAST suits, learning the techniques of Advanced Life Support, learning to care for multi-trauma patients. All of this kept me busy for a bit over a decade before I really even came up for breath. And not a small thing at the time was that somehow I was also bringing up 3 young children and trying as best I could to keep my wife happy, the last being perhaps not the smallest of issues either...

Final years 'on the floor'...

There came a time I think after about 10-12 years in the ICU that I confidently called myself an ICU nurse. I was calmly caring for the most unwell patients in the Intensive Care Unit and I had become a resource person for my fellow bedside nurses. But I confess, Gentle Reader, that I was becoming a bit restless and perhaps starting to feel the effects of too much adrenaline, too much suffering and death, too much life and death drama and perhaps also coming to the realisation that bedside work in an Intensive Care Unit was neverending, it could roll on forever and eventually roll over every bedside nurse, no matter how dedicated and skilled. However I believe that I bought myself another decade at the bedside by a series of strategic secondments away from the ICU which in hindsight kept me away from the terrible burnout that eventually afflicts all Critical Care nurses.

And so, perhaps with no definite plan in mind, I branched out a little. I successfully pushed for an exchange program with a smaller hospital high in the mountains wherein I would go for a month and work in their High Dependency Unit (HDU) and a staff member would come down and work in the ICU. It was highly successful and for the first time I worked in a much smaller hospital where most services shut down at 1700hrs and services where not exactly well resourced during 'office' areas. Some fantastic nurses up there and I had a great time until the HDU was downgraded and the Unit Manager moved elsewhere. But a great experience!

Even back then I had an interest in publishing on the Web; trust me, Gentle Reader, this was considered a little unusual back then! I won some time away from 'the floor' to create the first Web presence for the Intensive Care and with the support of the ICU management this is still in place today. However the current site is a slick, professional site that I could never create, I have remained with writing raw HTML and for the most part nobody does this any more. At a later date I also won some time away to create the web site of an Intensive Care related organisation that at the time was closely associated with my ICU. This site has also been modernised beyond belief but being in at the beginning of such a large project was a lot of fun.

Despite these efforts at the end of 25 years of work on the floor in a busy ICU I could see the signs. I was cranky and tired and there were times that I dreaded going to work; I could see that I was not becoming the person that I wanted to be and oddly enough it took a visit to a Yoga Ashram for me to change direction.

Education......