On-line and in nearly every new nursing student's notebook is the popular "List of Job Duties/Rules For Nurses from 1887". 

Whether you’re a new nurse or have been around a while, it’s always intriguing and often laughable to take a look back at the history of the nursing profession, at least according to someone who created this list. I'm almost certain someone has written one for today.  And I'm almost certain it will have been written by a young nurse with minimal life and nursing experience. 

The following list illustrates the day-to-day tasks and regulations pertaining to the life of a nurse in 1887—before routine charting was even invented. Within each of the listed tasks is a comparison with today's nursing job, at least from a hospital nurse's perspective. 

Perhaps later I will incorporate the tasks for other types of nursing positions. Since the original list seems to reflect the duties of a hospital nurse, this was my focus

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In addition to caring for your 50 patients, each bedside nurse will follow these regulations:

(While it is unknown whether or not 50 patients was the norm or an overly excessive number, we all have a ratio.  Some nursing positions have a 1:1, 1:5 or more ratio in a hospital setting, to 1:35 or more in a nursing home setting, to 1:15 ratio in a community health setting.  Whatever the ratio happens to be for each job, there is always a time when it is too much on the nurse. This can create a safety issue, not just for the nurse, but for his or her patients as well.  The type of acuity for each position dictates what the ratio is, and is almost always dictated by management staff.  There are, however,  nurse practice act rules about safe ratios, but whether they are followed or not is questionable.  If we accept the patients, we accept the ratio, and continue to follow the other descriptions of the job. Otherwise it's considered abandonment.)

1. Daily sweep and mop the floors of your ward, dust the patient’s furniture and window sills.

While most hospitals have a housekeeping department to take care of the cleanliness of patient rooms, it is not always done. 

Depending on the nature of the illness, the amount of people in the room at any time, and the quality of the housekeeping staff/hospital management, the quality of the job done here can be poor.  However, cleanliness of a patient room is extremely important.  Ever see a Patient Care Tech {PCT}  or CNA toss a washcloth with feces or urine or vomit, and it hits the wall and trash can?  Ever notice while visiting your family member, or even while being a patient yourself, that there are roaches, mold, spilled food, wrappers, dirty linens, etc. all over the room?  How can this disgusting sight be healthy - physically or mentally - for a patient and/or family? 

As a night shift nurse in a hospital with a ratio of anwhere from 1:4 to 1:8, I've had time to pick up, wipe up, even mop up the floor of a patient's room.  I've wiped mold from air conditioners, picked up bugs from the floor, and wiped up feces, blood or an unknown "goo" from bed rails, toilets, sinks, and walls.  Gross!

2. Maintain an even temperature in your ward by bringing in a scuttle of coal for the day’s business.

Everyone knows hospitals keep the temperature at some subzero, arctic temperature.  At least in the emergency department they are equipped with a blanket warmer, also known as "heaven".  The hospitals I have either worked at or have been in have an independent thermostat in each room.

Thanks to technology, at least we no longer have to bring in a scuttle of coal for the day's business.  It might go like this: "day shift didn't bring their scuttle, so now night shift has to bring in two scuttles.  Boss, tell them to do it. {falls on deaf ears}".  What is a scuttle anyway?

However, people who are sick and look to us for comfort have different thermostats in their bodies.  Just because we wear long sleeves or a jacket to work does not mean their rooms are hot.  It is up to us nurses to ask, "Is your room too hot or too cold?" - that's from the 3 Bears book if you didn't pick up on it - but remember most of what we've learned, we learned in kindergarten. We let them decide whether they are comfortable or not.  Asking not only keeps them comfortable, but it also keeps them, hopefully, from one more push on the call light.  

For those in the community, it is equally important to know whether your patient has sufficient heating and cooling wherever it is they call home.  Don't expect the patient to tell you if their heating is not working, if their air conditioner is on the blink. And don't expect that if there is a social worker involved, that they will have the time or knowledge of this.  When trouble strikes, use resources from within the communities you live and work in.  You'd be surprised at the amount of help available to a homebound person - police departments, fire departments, churches.  They are always willing to help in some way.

So be glad we don't have to bring scuttles of coal.  Too dirty.  A phone call or two to ensure that your patient is comfortable, is clean and costs nothing.

3. Light is important to observe the patient’s condition. Therefore, each day fill kerosene lamps, clean chimneys and trim wicks.

(Alright, now...trying this again.  Each time yesterday I wrote some of my creative best, the little mouse pad thingy (does it have a name?) on my keyboard got touched and my work was deleted. But I digress yet again.  I'm a nurse.  I can handle that.  In fact, I can handle anything.  Except snakes, scorpions and sushi.)

Light is extremely important to observe a patient's condition. And for many other things, like...um...have you ever heard of patient safety?  Yeah, that thing that seems to be secondary to the "patient satisfaction scores", and I KNOW you've heard of that.  Again, I'm off on a tangent.   Probably waiting for this to get deleted, too.

Thanks again to technology that prevents us from having to fill kerosene lamps, clean chimneys or trim wicks.  I'm sure these are all fire code violations in a hospital anyway.  However, to do a full observation of a patient, we must have the room lights on.  Even at 3am.  And those lights have to work.  What this means is that we check the lights in each of the rooms, and if they aren't working, we CAN change the bulbs.  There is no saying "it's not my job".  Neither is moving the patient to a new room with all their stuff, and takes less time.  It takes no time at all to flip all the switches at the beginning of a shift.  At 3am, while doing rounds, a pen light is usually sufficient to see the chest rise and fall.  But for those patients who may be elderly, may be confused or forgetful, we must have lights on for them at night.  Chances are, no matter how confused or forgetful a person may be, even those who never get up to go to the bathroom, or those who have a catheter, they will want to get up to go to the bathroom.

Many falls in hospitals I have worked on, homes I've gone into, happen at night.  Because of poor lighting and the need to pee.  Checking to make sure the lights work is comparable to filling kerosene and trimming wicks.  It is our responsibility to ensure safety and promote independence.

Another thing I would like to interject here is that as a home health or community nurse, it is also our responsibility to ensure patients in their own environment have a safe path to the bathroom, as well as working lights.  We cannot assume that just because they are in their own environment they will get to the toilet in the dark.  Perhaps we need to bring the bathroom to them - AKA bedside commode.  Make sure electric cords are out of the way, make sure the lights are safe and functioning.  Please don't just go into the home, take vital signs, tip tap on your electronic device, and say good-bye.  Do a thorough job of assessing not only body and mind, but the home environment, too.

4. The nurse’s notes are important in aiding your physician’s work. Make your pens carefully; you may whittle nibs to your individual taste.

Nurse's notes are extremely important in aiding the physician's work.  And for other nurses, managers, and from what we are told, courts as well. I am not sure how to whittle the  nibs on our pens without causing a mess, so while the above instruction is correct, it's not clear in today's verbiage.  

First of all, we cannot use pencils, which I am sure in 1887 were the only things used by nurses.  It would absolutely be important to have pencils sharpened, as one would not want to write an important note only to find that the lead was broken.  So we use pens - not the eraseable kind.  And apparently black instead of blue, which I was once chastised for during a Senior Care 1:1 shift, where leaving the room was not possible, and taking your phone or computer into the patient's room was not allowed.  I used what I had, to chart in the dark.  Yes, no lights were allowed on here.  I never wanted to go back to that department, (after being chastised instead of thanked for filling in) because i would probably use invisible ink.  Digression once again.

Nurses are well known for stealing pens.  There is no better word for it.  We might borrow one from someone whether at work or elsewhere, and because we have so many things processing in our brains, we take that pen and slip it in our pocket.  Especially if it writes well.  We are responsible for buying our own pens, and the cost of the good pens.....let's just say, protect your own.

However, again with technology we do not have to always have a good pen, but good grammar, great spelling, and even better note taking.  I believe this is what is the basis for this task.

Each person that becomes a nurse must go through nursing school.  I don't know about today's courses, but I do know I had to start from English 101, Composition writing, etc. before even getting into the program.  And we have spell checking software built into our computers.  Please use it.  Read what you have written.  And for the sake of your pride, the pride of the position, the hospital you work for, and out of respect for the patient, DO NOT WRITE HOW YOU TALK. Words like "y'alls', 'fixin', and other idiolect does not belong in a nursing note.  Doctors are just as guilty, but blame their speech-to-text software for their mistakes.  We are ALL responsible for the notes we type.  

While I am guilty of typing way too much at times, I have been told "less is more", however it doesn't paint a picture, which we are always told to do in our charting.  That takes a long time and alot of words.  Just take the fillers out.  My bachelor's program at the University of Phoenix came with life time use of the grammar checking software, and I use it as often as I can.  Not sure if I will use it here.  But painting a picture requires details, otherwise it is just a dot-to-dot piece of artwork.  This task seems more difficult now than it was in 1887.

One final word about documentation. The one thing that gets drilled into our DNA is that if it wasn't documented, it didn't happen.

5. Each nurse on day duty will report every day at 7 a.m. and leave at 8 p.m., except on the Sabbath, on which day she will be off from 12 noon to 2 p.m.

What's wrong with this one? We show up before 7 am, and rarely get to take ANY time off between 12 noon and 2pm to eat, pee or attend a religious service on the Sabbath. Although a 12 hour shift is called 7a - 7p, or 7p - 7a we must show up before 7, and don't leave before 7.  Unless you have spent the majority of your 12 hours sitting (that's another topic) and if you haven't done a complete shift of patient care, you won't be leaving by 7.

With hospitals not wanting to pay overtime (except right now, another topic for another page), nurses in hospitals work only three days, or 36 hours. There are rare occasions where we either work only two or must work four or five. However, it's not the norm.

Community nurses, however are generally working Monday thru Friday, with a weekend day shift on occasion. While they are either salaried or paid per visit, their hours are like banker's hours used to be, or 8am - 5pm (of course unless your job has you working an on call position). Then, if you're like most community health (also referred to home health or hospice at home) nurses, you take SOME of your work home. You have the autonomy to do this, whether you spend more time in a patient home charting and taking home less, or spend less time with your patient so you can see more of them (the norm) and charting at home, the choice is yours. Both of those choices have advantages and disadvantages for the nurse, but only disadvantages for the patient.

One piece of advice for the nurse, however. Although we don't get two hours on the Sabbath, hospitals require us to take a break. Take it. Walk away, walk the stairs, go outside. Look at the sun (or in the case of night shift nurses, the stars). Although it may be difficult to do, we must. I would be lying if I told you I took every break given. I did/do not. Then I became resentful towards those who did. Especially the smokers (another blog story for a later time) who took a break probably every hour.

For community nurses, pull over to a park, a gas station, even a cemetery - which is quite peaceful - and kick off your shoes, put your head back, and breathe. It's also a good place to do some of your charting, where it's quiet and you don't have family members, kids or even pets pulling at you for attention.

But what does this 'job duty' really mean to today's nurse? Sometimes it feels like all we are doing is working to take care of others, and that all we will get is one day off a week for "date night" and time to go to church. Or sleep. Or do laundry. The rest of the time we are sleeping.  See below!

6. Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes, or two evenings a week if you go regularly to church.

Sometimes this seems real, sometimes I love a nurse's schedule - at least mine - right now in a hospital setting. It seems there has always been a nursing shortage as long as I have been a nurse (2006).  So at times, it will seem like, or really be, real.

Hospital clinical nurses are generally scheduled 3 - 12 hour shifts per week. Anything after that is considered overtime and is yummy.  But there are so many different types of nurses, nursing jobs and schedules for nurses in 2021.  Those that are serious about patient care seem to put in more hours than those on the less clinical side.  

For instance home health/hospice nurses have flexible schedules between the hours of 8a - 5p.  They may start their day at 9a or 10a, or even 7.  They may finish their day by 3p or 4p. Or even 8p or 9p.  Then there is the paper or computer charting that must be completed.  Some nurses refuse to bring the work home, some love doing it in their pajamas after the kids are in bed.

There are on-call nurses who choose to work nights, often 7 days in a row with 7 off.  Nurse educators may have more regular hours if they aren't doing their study plans at home.  

There are so many avenues today's nurse can go, but it's quite likely that he or she may feel like all they have time for is one night for the family, two if they go to church. 

The hours that are put into patient care - the compassion, the empathy, the brain taxing, the responsibility, the smiling even when you don't feel like it, not crying when you feel you must, takes a toll on us.  Then when we get a day off, we may just want to sleep it off.  But our families need us.  Our pets need us.  Our houses, our refrigerator and even our friends need us.  So then, what about when WE need ourselves?  A date night per week, and an extra to go to church, might just be what we need to recharge.

It's exhausting, nonetheless.

(ps:  it's almost impossible to always remain in good standing with the "director of nurses".  Remember, they get burnt out just as we do, and often the smallest of things - will make them roar. If THEY don't get a date night, it's possible you won't either.  We're just that way.

7. Each nurse should lay aside from each payday a goodly sum of her earnings for her benefits during her declining years, so that she will not become a burden. For example, if you earn $30 a month, you should set aside $15.

While by today's standards, a sum of 50% seems impossible, the concept still holds true.  Unless a nurse has the ability to save 50% of his or her income, any amount is going to help in the long run.  It would be the ultimate self-care goal to be able to retire early and quite comfortably.  

But for most of us who cannot sock away even close to 50%, the goal is still the same.  To not become a financial burden, and also to have the financial freedom to enjoy the fruits of our hard labor is going to be pretty tough.

Most healthcare companies have done away with pensions (unless you are working as part of a union or a state) but have financial savings accounts such as a 401(k) or other retirement vessel.  And those that do often offer a dollar matching benefit, which will match your contribution dollar-for-dollar up to a certain percentage, 5% - 6% for instance.  And the amount you contribute is withdrawn from your income before taxes are imposed. 

This has actually benefitted me quite a bit in the past.  While it's not really meant to be withdrawn before a retirement age, certain tax laws allow it to be withdrawn and used.  For example, an extreme hardship due to a loss of a job, or to purchase a new home.  

What is really awesome is that it's money you really don't notice missing from your pay.  If you start at 3% (usually is the minimum) and keep increasing 1% each year, you don't notice because (most of the time) your cost of living or merit increase exceeds that.  

I worked for a hospital for approximately 5 years, starting my savings with 3%, and ending at 8% of my pretax income.  By the time I left the hospital, I had accumulated over $25,000.  I was able to withdraw a portion of this as a down payment on my house.  

My father used to say that any time you receive a pay increase, you should put that money aside.  Back then they did not have retirement accounts such as these, so he was referring to just taking the amount and putting it into a savings account.  Back then the interest earned was far more than the interest being earned on today's 401k.

Yes, nurses young and old - especially the new AND young.  Please.  Please. Do yourself and your family a favor.  Put SOMETHING away.  This may be a time where you've never made this amount of money.  So you'll survive on a little less of it.

8. Any nurse who smokes, uses liquor in any form, gets her hair done at a beauty shop or frequents dance halls will give the director of nurses good reason to suspect her worth, intentions and integrity.

It's a good thought.  Keep yourself safe, responsible and ready to don your cape.  Let's break these down in today's form.  And please, no negative comments here.  I'm not singling anyone out, just telling it like I see it.  And this is my blog, so I can!

Nurses who smoke.  A controversial issue for sure.  Some companies are a "tobacco free" company and you must be screened for tobacco just as you are for illicit drugs.  Some companies are "tobacco free campuses."  And there are nurses who don't care about the policies if they already smoke.  

One policy that is usually in place throughout health care is to not wear strong perfumes, as they can and do irritate those patients/other staff who have a respiratory illness.  Smokers will either come to work after smoking, or go on break to smoke, and when they come in they stink.  No matter how much perfume or body spray a nurse drowns his or herself in.  Quite honestly, I look down on the nurses who: a) blatantly disregard a policy, b) want to smell like that, and c) don't care about putting their patients at risk of a worsening illness because of their selfish habit.

Another reason companies don't want employees to smoke is it reduces the health insurance costs involved with chronic disease caused by smoking.  

And don't get me started on the cost of work lost to all the smoke breaks a smoker feels entitled to smoke.  Most companies offer ONE 15 minute break per shift.  Along with 30 minutes for lunch.  Any other breaks are not given, or assumed.  They are just TAKEN.  Those that do not smoke, do NOT take those breaks.  I'm sure there is research on the cost of smokers breaks vs those that don't smoke.  Perhaps I'll find it.  

But let's be honest.  Smoking is not pretty.  It's not respectable.  It's not honorable.  It's not something a nurse should do when we are educating our patients on the dangers of smoking.

Nurses who "use liquor in any form."  This one is also a controversial issue.  And one that I can't say I haven't participated in.  Am I proud of it now?  No.  Do I once in a while enjoy a few cold beers?  A glass of wine, yes. But we all know that alcohol impairs judgement, and if over used, causes a chronic illness as smoking does.  

Sometimes nurses need to let their hair down.  Need to relax, and enjoy the time they have off.  Sometimes, it's just necessary.  Maybe when we get home.  However, as it impairs judgement, we then might want to drive somewhere AFTER we imbibe, and might be tipsy.  No nurse wants to or CAN get stopped by law enforcement after drinking, only to be arrested and sent to jail. This would cost us a hard earned, well respected license.

Drinking is not pretty. It's not respectable. It's not honorable. It's not something a nurse should do when we are educating our patients on the dangers of drinking.

Nurses who gets her hair done at a beauty shop.  Now, come on.  We all might say, "We ALL need to go to a beauty shop to get our hair done."  It's almost true that we need to go to a salon to get a hair cut, a hair style.  A perm. I don't know what nurses did for a hair cut back in 1887.  If they were like my mother, they used a bowl and transparent tape to cut straight lines with dull scissors at home.

However, how I relate today to the statement is that some people, both male and female, like to add colors, streaks, mohawks, extensions to their hair.  Is it a bad thing?  Not necessarily.  As long as it is done with some class.  

Hospitals have policies about having "normal colored" hair.  About how long it is for males, how it must be worn for females.  Natural hair is a clean, responsible (not to mention less costly - remember the saving money part?) look for a nurse. When was the last time you saw an advertisement for nursing that had a nurse with long, painted finger nails and purple hair?  Tattooed sleeves? That's right, you don't.

Remember, society - men, women, young, old look up to us for guidance.  They want us to look like the angels, the heros, that we are to them.  Let's look that way.

Any nurse that frequents dance halls.  This final part correlates with the others above.  There is nothing wrong with a dance hall.  There is nothing wrong with going to one now and then.  Frequenting, however can lead to trouble.  The person that "frequents" a dance hall is likely to be a frequent smoker, a frequent drinker, and one whose judgement gets a little (or a lot) impaired.  I've been there.  And at the time I had fun.  But looking back at it, especially since I don't do it anymore, I've realized how lucky I was not to put myself, or anyone else, in danger.  Again, a mugshot in the morning paper right next to a name and designation of RN is really embarrasing, really costly, really sad.  

So, while each of these things individually and done infrequently and in moderation is not bad per se, making it a part of our every day or every weekend lifestyle can put ourselves, our patients, our coworkers and our communities in danger.  We must hold ourselves to a higher standard.

Along with this list I'll add tattoos.  Again, I am not one to judge ANYONE for having tattoos, unless of course they cover your neck and face.  They must not have had tattoos on women in 1887 or this topic would be added to the list.  More and more people are getting tattoos.  More and more people have them before becoming a professional nurse.  However, patients, especially in today's older generation, frown upon them.  

The hospital I worked at in 2015 had a policy stating that tattoos had to be covered up and not exposed.  Even if you used bandaids. When I left their employ in 2020, the policy had been changed to "it's ok as long as it's in good taste and not offensive."  Who determines what is "good taste" and what is "not offensive"?  

Uniform companies now make sleeves, wrist bands, etc to cover them up, to again, keep us looking like the heros we are supposed to be.

We should be who we want to be, because afterall we worked hard to be who we are for everyone else.  Just remember who we became, and why we became, and the pedestal everyone puts nurses on.  We earned the pedestal.  Just look good while you're on it.

9. The nurse who performs her labors [and] serves her patients and doctors faithfully and without fault for a period of five years will be given an increase by the hospital administration of five cents per day.

While sometimes it may feel like all we get for a raise, however the pay to begin with is nothing to shake a stick at, certainly for young new grads it's more than they have ever made.  The theory here is that there is usually a cost of living increase of a few percent, and then often a merit component to it.  The hospital I am at now is a not-for-profit hospital so at the end of each fiscal year they give an "incentive bonus" with the amount based on your earnings (this year it's also based on whether you get your mandated covid-19 vaccine or not).  

To recruit nurses, hospitals and healthcare facilities also will, at times, offer a sign-on bonus.  Depending on the area of the facility, depending on the desperate need, will depend on the amount of the bonus.  And before you get too excited, know that the "bonus" is taxed, and is split often several times, in order to keep you there for a specific period of time.  For instance, a $5,000 sign-on bonus might get you $2,500 up front.  Taxed you might get $2,000.  Then another $500.00 every 5 months until it's all paid.  Should you get terminated or quit before that period of time is up, the bonus is withheld from your final pay, or if you didn't make that much, becomes owed.  Sometimes the bonus is so small, you don't even realize you got it.  However, it is much more than $0.05 per day.  And you don't have to wait 5 years. 

Some things never change, or even if they have, some parts still seem to remain the same.  One thing we can agree on is so much has changed A LOT in the last 130 years.

For me, one thing that has NOT changed is compassion.  The level of caring that is essential to making a good nurse.  Whether you have blue hair, green nails, smell of smoke, or sleeves of tattoos, if you don't have the skill of compassion, you cannot, will not, be a successful nurse.  And THAT will show more than the tattoos, nails, hair, etc.

At some point in my journal writing, I'd like to list a job description so that those reading 130 years from now can shake their heads, just as we have here, and then compare it to a list a younger, newer nurse may create.

What old rule stood out to you the most?