Friday, May 27, 2011

Remembering military nurses on Memorial Day........




What many people tend to forget is that along with the soldiers who go to war, nurses go as well—not to fight in battle, but to help save the lives of injured soldiers and to provide comfort to those soldiers they cannot save. U.S. military nursing has been around for several centuries—since the 1700s. Here are some military nursing facts that you may find interesting, and which might encourage you, as a nurse, to devote a little time this upcoming Memorial Day to paying even a silent tribute to military nurses.

More than 10,000 nurses served in World War I. They traveled across the Atlantic Ocean by ship, and the journey took about two weeks.

Somewhere between 200 and 300 nurses died in World War I. Many contracted illnesses such as scarlet fever and influenza, which took their lives. Some died in military accidents, and some died at the hands of enemy weapons.

In the 1960s and 1970s, the nurses who went overseas to nurse injured soldiers in the Vietnam War were young women who had just graduated from nursing school. This was their first nursing experience, and they served for one year minimum. They could serve longer if they chose to.

As the machines of war evolved, the nurses who served overseas saw and treated injuries they would never have to deal with again. For example, during the Vietnam War, napalm, a flammable liquid that causes severe burns and often death, was a commonly used weapon, and nurses saw its horrible effects.

Today, the nurses who go overseas range in age from 20 to 60, and one-third are men. The service term is six months, but “active duty” nurses can be reposted (sent back) several times.

The Army Nurse Corps became an official branch of the Army Medical Department in 1901. You can learn about joining the Army Nurse Corps on the U.S. Army website.

There are 10 different nursing specialities in the Army Nurse Corps, ranging from Army Public Health Nurses to Perioperative Nurses to Psychiatric Nurse Practitioners.

Military nurses have served in numerous wars, including the Spanish-American War, both World Wars, the Korean War, the Vietnam War and Operation Desert Storm. They have served with NATO troops in Haiti, Bosnia and Kosovo.



During World War II, 67 Army nurses and 16 Navy nurses were held by the Japanese for three years as prisoners of war.

Located near the Vietnam Memorial in Washington, D.C., is a memorial to all nurses who have served in all wars. It’s a bronze statue of a nurse caring for a wounded soldier. As a nurse, hopefully you’ll have the opportunity to visit this memorial someday—if not on this Memorial Day, then perhaps on another Memorial Day, or any day.

Be sure to take time to reflect on your country’s honorable military nursing history, one that still has many pages to be written—since war is unfortunately not history yet.

Read more Scrubs articles about military nurses. http://scrubsmag.com/nurses-important-to-veterans/

ABG eBook.....Click Here

Thursday, May 26, 2011

How alcohol affects the body long term .....

NCLEX - MS Nursing Review on CIRRHOSIS OF THE LIVER

NCLEX - MS Nursing Review on "DIABETES MELLITUS" Part 2

NCLEX - MS Nursing Review on "DIABETES MELLITUS" Part 1

NCLEX® EXCEL! - Adult Nursing ......

NCLEX® EXCEL! - Maternity & Female Reproductive Nursing .......

NCLEX Review Liver Lecture ....

NCLEX Pharmacology Review Part 9 .

NCLEX Pharmacology Review Part 8 ...

NCLEX Pharmacology Review Part 1 ..

NCLEX Pharmacology Review Part 2 .....

NCLEX Pharmacology Review Part 3 .........

NCLEX Pharmacology Review part 4 ......

NCLEX Pharmacology Review Part 5 ....

NCLEX Pharmacology Review Part 6

NCLEX Pharmacology Review Part 7 ....

Happy Nurse..........





Exercise regularly.......


Study......


Be financially prudent.......


Don’t sweat the little things......


Enjoy every moment, it may be your last.........
Wanted: 50,000 Nurses -  Life Magazine January 5, 1942


Less than a month after "Pearl Harbor" the call went out on the cover of LIFE magazine, "WANTED: 50, 000 NURSES" and they went in droves - The world AND Nursing would be changed forever.

"It (50,000) cannot be met by the 1,300 nurses training schools that bestow some of the 23,000 caps a year. This is the problem to be solved by the 100,000 women volunteers. As nurses' aides, they will release nurses to exercise their special skills...."

Wednesday, May 25, 2011

Your role in infection prevention.............






Nursing Made Incredibly Easy!



May/June 2011
Volume 9 Number 3
Pages 36 - 41




Nurses
have the unique opportunity to reduce the potential for hospital-acquired infections. Utilizing the skills and knowledge of nursing practice, you can facilitate patient recovery while minimizing complications related to infections. We give you the basic strategies you need for positive patient outcomes.

According to the CDC, hospital-acquired infections (HAIs) account for an estimated 1.7 million infections and 99,000 associated deaths each year in American hospitals. A recent study found HAIs to be the sixth leading cause of death in the United States, costing the healthcare industry $6 billion annually. Government laws linking patient outcomes to healthcare provider reimbursement have sparked discussion in boardrooms across the country. The current economic climate has healthcare providers more concerned than ever about promoting and supporting strategies to ensure patient safety. Patients and their families are more informed about healthcare services and have expectations for quality patient outcomes.


One patient safety topic of particular interest is HAIs. Infection prevention has become a key focus in the realm of patient safety. Infection preventionists typically provide a variety of services to healthcare organizations; however, it's the nurse who provides care at the bedside who has the ability to directly impact infection prevention, resulting in positive patient outcomes. The actions of the nurse and other healthcare workers directly impact patient morbidity and mortality.

The role of the professional nurse in preventing HAIs is significant. Nursing-sensitive indicators are actions and interventions performed by the nurse when providing patient care within the scope of nursing practice. These interventions are integral to the processes of nursing care and are often performed in collaboration with other members of a multidisciplinary healthcare team. Nursing-sensitive patient outcomes represent the consequences or effects of nursing interventions and result in changes in patients' symptom experience, functional status, safety, psychological distress, or costs.

The nurse is the member of the healthcare team who leads the rest of the team in practicing prevention strategies to protect the patient from infection. Some of the most basic strategies resulting in positive patient outcomes include:

* the practice and promotion of hand hygiene

* consistent use of aseptic technique

* cleaning and disinfection practices

* use of standard precautions

* patient assessment and additional precautions

* patient education

* use of safety devices

* removal of unnecessary invasive devices

* use of bundle strategies for infection prevention

* fit for duty.

Let's take a closer look.
The practice and promotion of hand hygiene


Hand hygiene is the most effective way to prevent transmission of infection. Healthcare workers' hands are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment. Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing HAIs, but healthcare worker compliance with optimal practices remains low in most settings.

You can reduce the transmission of HAIs by performing hand hygiene consistently before each patient contact, after each patient contact, after contact with environmental surfaces and equipment/medical devices, and before and after donning gloves. Keeping fingernails one-fourth of an inch or less in length and avoiding the use of artificial nails, nail extenders, and nail decorations is necessary to ensure hand hygiene products reach hand surfaces and cuticles. Studies in the medical literature have demonstrated that nearly everything in the healthcare setting-from surfaces, to healthcare workers' hands, to medical equipment-can serve as a reservoir and vector for opportunistic pathogenic organisms. Some bacteria and viruses can live on inanimate objects and surfaces for weeks or even months.

It's important to develop the habit of routinely performing hand hygiene when performing patient-care tasks and procedures or handling medical devices and equipment (see When to performhand hygiene). Healthcare providers, including nurses, also need to be empowered to hold one another accountable to ensure everyone is compliant with hand hygiene.
Consistent use of aseptic technique

Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions, with the goal of minimizing contamination by pathogens. It's employed to maximize and maintain asepsis-the absence of pathogenic organisms-in the clinical setting. Aseptic technique protects the patient from infection and prevents the spread of pathogens.

When performing tasks and procedures, such as starting a peripheral I.V. line or scrubbing the hub of an I.V. connector before injection, you can reduce the potential for infection by performing hand hygiene before initiating any task or procedure and following careful technique. Avoiding shortcuts can minimize the potential for disease transmission.
Cleaning and disinfection practices

Nurses and other healthcare workers often use medical devices on more than one patient. You're responsible for cleaning and disinfecting the device between each patient use. There's research reporting evidence of hardy pathogens remaining for weeks on environmental surfaces in the healthcare environment. Housekeeping staff members sometimes avoid touching such equipment for fear of causing damage; therefore, pathogens and dust collect, becoming a potential vector for transmission of infection.

Communicating with environmental services about expectations regarding cleaning and disinfecting sophisticated patient monitoring equipment and computers is vital to ensure cleaning and disinfection occur on a routine basis. Often, practices that clean (remove dirt and other impurities), sanitize (reduce the number of microorganisms to safe levels), or disinfect (remove most microorganisms but not highly resistant ones) aren't sufficient to prevent infection.
Use of standard precautions

Standard precautions are the most basic level of infection control and prevention that should be used at all times when providing patient care at any level (see Types of precautions). This strategy applies to blood and all bodily fluids, secretions, and excretions (except sweat) whether or not they contain visible blood. The use of personal protective equipment (PPE), such as fluid-resistant cover gowns, disposable gloves, masks, and eye protection (in the event of splash), provides safety for the nurse providing care. Prompt and proper removal of PPE followed by performance of hand hygiene is the best practice to avoid transmission of infection to other patients and staff.

Healthcare organizations are responsible for providing and making this protection available to all healthcare workers at no charge. If this protection isn't readily available in your place of employment, discuss the issue with your supervisor.
Patient assessment and additional precautions

When you complete an initial nursing assessment of a patient, you're in an excellent position to notify the physician immediately of unexpected signs and symptoms, thereby reducing infection transmission and expediting patient treatment. The nurse is often the first of the healthcare team to notice and learn about unexpected patient symptoms that require the use of strategies to prevent the spread of infectious agents in the healthcare setting.

Your facility will have infection control and prevention plans, policies, procedures, and protocols for addressing the care and placement of patients suspected of having a communicable disease. Familiarize yourself with these strategies or know how to access them.
Patient education

Patient and family education are critical aspects of providing care to patients and their families. Nurses routinely provide most of the healthcare education to patients and their families about their illness or disease processes. It's the nurse who typically explains to the patient the rationale for strategies and treatments.

For example, the nurse is typically the member of the team who provides the explanation of the concept of multiple drug-resistant organisms, contact isolation, and why the patient is being placed in contact isolation. The nurse explains the rationale for the healthcare staff wearing PPE. It's the nurse who identifies if a language interpreter is necessary. And it's the nurse who reinforces teaching and empowers patients and their families to expect and remind healthcare workers to perform hand hygiene at the appropriate times.
Use of safety devices

Federal legislation in the form of Occupational Safety and Health Administration regulations requires the use of engineering and work practice controls to eliminate or minimize employee exposure to blood-borne pathogens.

It's important to protect yourself from potential harm by using available safety devices when performing tasks or procedures requiring the use of sharps. If there are no such devices available in your place of employment, ask your supervisor, safety officer, occupational health representative, or infection preventionist for assistance with obtaining such devices. By law, nurses should have input into the choice of safety devices used in the healthcare facility. Ask about joining the product evaluation team to provide such input and give feedback to the organization about safety devices used in your facility.
Removal of unnecessary invasive devices

Nursing practice includes evaluating and reporting a patient's response to treatment. Removal of certain devices such as urinary catheters, central lines, and peripheral I.V. lines when the patient no longer needs them is important to returning patients to their optimum level of health and avoiding HAIs. Routine rounding to evaluate the patient's need for such devices is your responsibility.

It's the nurse who prompts the physician and the rest of the team by reporting patient response and improvement. The nurse is aware of the patient's ability to ambulate to go to the restroom with the assistance of one person, and the possibility of eliminating the use of a urinary catheter before it causes an infection. It's the nurse who's typically aware of the increase in the patient's appetite and the patient's ability to drink enough fluids for optimum hydration, which could result in elimination of an I.V. line being used for hydration.

The potential for reducing the risk of acquiring an HAI and restoration of the patient to an optimum level of health is realized when supportive devices that are no longer needed are promptly removed. It may be helpful to have a protocol in place so you can remove devices when the patient no longer meets the indications for them.
Use of bundle strategies for infection prevention

A bundle approach to the prevention of HAIs, such as ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI), has been proposed. The use of bundles has been shown to effectively reduce infections.

For example, the bundle for prevention of VAP includes elevation of the head of bed, comprehensive oral care, and the use of a sedation vacation. The bundle for CLABSI prevention includes the best insertion practices of using maximal barrier precautions during insertion, using chlorhexidine gluconate for cleaning the site, and avoidance of femoral sites. The maintenance bundle for CLABSI prevention includes changing the dressing every 7 days and as needed if loose or soiled, scrubbing the needleless hub before accessing the site, and removing unnecessary lines.

By implementing all elements of the bundle, improvements in patient outcomes can be attained. See "Understanding Care Bundles" from the March/April issue for a more in-depth discussion.
Fit for duty

Communicable diseases can be transmitted to patients who are under the care of healthcare workers who report for work when they're ill. You have the responsibility to look after your own health to avoid compromising patient safety. Dedicated nurses struggle with making the decision to stay away from work when duty calls and they know their presence will be missed by their peers and patients.

Fit for duty includes meeting basic physical requirements for safely performing essential functions of the job without compromising patient safety. This means that staff members are free of active symptoms such as fever, cough, sore throat, and gastrointestinal illness.
Making a difference

As a nurse, you're an essential member of the healthcare team. You can make a difference between a patient having a positive healthcare experience and a negative one. You can also make a significant impact in reducing patient potential for acquiring an HAI.
When to perform hand hygiene

Hand decontamination with an alcohol-based product

* After contact with body fluids, excretions, mucous membranes, nonintact skin, or wound dressings as long as hands aren't visibly soiled

* After contact with a patient's intact skin (such as after taking a patient's pulse or BP or lifting a patient)

* In patient care, when moving from a contaminated body site to a clean body site

* After contact with inanimate objects in the patient's immediate vicinity

* Before caring for patients with severe neutropenia or other forms of severe immune suppression

* Before donning sterile gloves when inserting central catheters

* Before inserting urinary catheters or other devices that don't require a surgical procedure

* After removing gloves

Hand washing

* When hands are visibly dirty or contaminated with biologic material from patient care

* When healthcare workers don't tolerate waterless alcohol products

Source: Smeltzer S, Bare B, Hinkle J, Cheever K. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. 11th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2007:2481.

Types of precautions


Standard precautions

Use standard precautions for the care of all patients. The elements of standard precautions include hand hygiene, use of gloves and other barriers (such as a mask, eye protection, face shield, and gown), proper handling of patient-care equipment and linen, environmental control, prevention of injury from sharps devices, and patient placement (such as room assignments) within healthcare facilities.

Transmission-based precautions

Airborne precautions

In addition to standard precautions, use airborne precautions for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei. When hospitalized, patients should be in rooms with negative air pressure; the door should remain closed, and the nurse should wear an N-95 ventilator (protective mask) at all times while in the patient's room.

Droplet precautions

In addition to standard precautions, use droplet precautions for patients known or suspected to have serious illnesses transmitted by large particle droplets. While taking care of a patient requiring droplet precautions, the nurse should wear a face mask, but because the risk of transmission is limited to close contact, the door may remain open.

Contact precautions


In addition to standard precautions, use contact precautions for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient's environment. When possible, the patient requiring contact isolation is placed in a private room to facilitate hand hygiene and decreased environmental contamination. Masks aren't needed, and doors don't need to be closed.

Source: Smeltzer S, Bare B, Hinkle J, Cheever K. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. 11th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2007:2480-2483.
cheat sheet
Prevention of CLABSI bundle

Insertion

* Proper hand hygiene

* Use of maximal barrier precautions during insertion

* Site preparation with chlorhexidine/alcohol solution (30-second scrub, with 30-second dry)

* Avoidance of femoral sites


* If line is placed in suboptimal conditions during emergent situations, change line within 24 hours

Maintenance

* "Scrub the hub:" Clean needleless ports (5 to 15 seconds) before any access

* Dressing changes every 7 days and when needed if loose or soiled

* Daily review of necessity of central line

Information & Resources

Infection Control Magazine
A great resource for anyone interested in disease prevention and infection control, especially, but not limited to, professional settings. Interesting and timely articles, written for the professional, but accessible for "civilians" as well. Check out the Microbe of the Month feature, courtesy of IA!
www.infectioncontroltoday.com

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
Atlanta, Georgia
The primary government agency at forefront of work in infectious disease, both at home and around the world. Many of our scientific images are based on research performed at the CDC.
www.cdc.gov

ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL AND EPIDEMIOLOGY (APIC)
Washington, D.C.
An international association of ICPs (infection control professionals) charged with providing education and leadership in the field of infection control. A member of APIC probably monitors your hospital for its IC protocols. APIC reviewed the IA production of H.I.D.E. & S.E.E.K! Eight Strategies to Prevent the Spread of Infection.
www.apic.org

AMERICAN SOCIETY FOR MICROBIOLOGY (ASM)
Largest organization of its kind dedicated to promoting the microbiological sciences and their applications.Represents 25 disciplines of microbiology specialization.
www.asmusa.org

AMERICAN PUBLIC HEALTH ASSOCIATION (APHA)
Washington, D.C.
The oldest organization of public health professionals in the world. Dedicated to influencing policies, setting priorities and defining public health.
www.apha.org

ORGANIZATION FOR SAFETY AND ASEPSIS PROCEDURES (OSAP)
An association of infection control professionals whose primary focus in Dentistry. Provides education and leadership in dental environmental safety and infection control.
www.osap.org

NATIONAL INSTITUTES OF HEALTH (NIH)
Bethesda, Maryland
One of eight agencies of the Public Health Service, which is part of the U.S. Dept of Health and Human Services. Massive amounts of information, many links to primary resources dedicated to "uncovering new knowledge" leading to better public health.
www.nih.gov

AMERICAN SOCIAL HEALTH ASSOCIATION (ASHA)
Research Triangle Park, NC
The leading public health voice for education agbout STD prevention.
www.ashastd.org

NATIONAL CANCER INSTITUTE (NCI)
Bethesda, Maryland
The primary government source for information on all aspects of Cancer.
www.nci.nih.gov

WORLD HEALTH ORGANIZATION (WHO)
Dedicated to individual total health : physical, mental and spiritual - on a global scale.
www.who.ch

Monday, May 23, 2011

NCLEX-RN EXCEL

Simple ways to get your sleep.......


After lots of real-life research, here are the top 5 ways I’ve improved sleeping during the day.


1. I always, always, always nap before a 1st night on. I don’t know how nurses go into their 1st night without sleep, but I will say most of the nurses I see sleeping at work are the ones that don’t nap prior to a shift. (And I’m talking non-union sleeping.)

2. NO caffeine after 12 AM at work keeps me from staring at my ceiling when I get in bed at 9AM.
3. When I get home, I go straight to bed. I’ve set up my life so that all I have to do, after an obligatory shower, is crawl between the sheets. The more stimulus I have between getting home and getting in bed, the longer it takes me to zzzzz.

4. No eating right before bed. I grab something light around 5AM while at work, so when I get home, I can sleep because I’m not digesting a huge breakfast. Anytime I’ve eaten a large meal right before daytime sleep I have paid the price of endless tossing and turning.

5. On sleep days, my phones are off, I don’t answer doors, I act like it’s the middle of the night–’cuz for me, it is! I don’t try to fit in lots of errands or activities on my sleep days. I just sleep, eat with my family and maybe work-out before heading back to work.

And if none of my 5 work, I have been known to take a sleep aid–melatonin, RX aids, OTC stuff, etc–if I need some occassional help, I just do it. But usually I don’t have to because I follow my rules. The thing is, most night nurses find a way to sleep because we can’t stay on nights otherwise. Plus, sleepy nurses are NOT safe nurses!
**source title link.....

Weight management tips for nurses.......

 weight management tips for nurses





The message is all around us: To maintain a healthy heart, we need to maintain a healthy weight. As nurses, though, it’s sometimes easier to teach this to others than it is to work on the message ourselves.

Managing your weight doesn’t necessarily mean losing weight. Some nurses are at a good, comfortable weight and only need to be sure it stays at that level. Here are 10 tips to help you manage your weight.

1. Get together with like-minded people.
You may want to join an established weight-loss group or form your own, but whatever group you join, the group mind-set is often helpful to people who are working on losing weight. Setting up a group at work may seem daunting—but a work group has its advantages, the main one being having people around to be accountable to during your work hours.

2. Get your employer on board.

Between working shift work and crazy weather, going out to exercise is not always an appealing option for anyone, let alone tired nurses. What if you could get your employer on board and your workplace became more health-friendly for the employees? After all, healthy employees are generally happier employees. At-work health initiatives can range from holding weekly weight-loss meetings to incentives and room to exercise.

3. Sneak in some at-work exercises.
You may have read some articles geared toward office workers about how they can do some exercises at their desks. As nurses, we do get a good bit of walking done, but we can also squeeze some exercises into our daily routine by taking advantage of our environment. One example is to do toe-rises if you chart while standing. Clench your glutes together while you rise up on your toes, then relax as you go back down. It may not seem like a lot while you’re doing it, but if you steal a few minutes here and there throughout your shift, every shift, there will be a difference down the road.

4. Read Your Care Plan: A Nurse’s Guide to Healthy Living.

The book  Your Care Plan: A Nurse’s Guide to Healthy Living was written by a nurse for nurses. Who better to help advise us on working and living in a healthy way? The book reviews health challenges faced by nurses and offers solutions.

5. Share healthy recipes with other nurses.
Most of us have a favorite recipe or two that we enjoy making and sharing. How about doing a recipe exchange with other nurses—with the challenge that the recipes have to be for healthy, low-fat meals or treats? Who knows? You may end up finding healthier versions of your favorite “naughty” foods. In some workplaces, nurses and other employees have put together cookbooks of their favorite recipes. This initiative is not only helpful for sharing great ideas, but it may also double as a fundraiser for a favorite cause.

6. Lose the self-consciousness.

While this isn’t a verifiable research statistic, it’s likely safe to say that many overweight people who want to go to a gym feel too self-conscious to end up making that commitment of actually joining a gym or group class. If you want to lose weight, it’s important to understand that this goal is about you and only you. Others may notice you in a gym or class, but they’re there for the same thing—so it’s not exactly in their best interest to snicker if they’re in the same situation! Don’t be too embarrassed to go to a gym. Look out for yourself and to heck with what anyone else thinks, if anyone does notice you.

7. Ditch the chaotic eater lifestyle.

If you’re a chaotic eater—eating on the run, grabbing whatever is handy—you will likely have a more difficult time reaching and maintaining a healthy weight than if you have a more scheduled, less chaotic approach to meals. See if you’re a chaotic eater and what you can do about it.

8. Stop thinking of it as dieting.
Dieting has a negative connotation. Dieting feels as if you’re depriving yourself of something. So stop thinking about dieting. In order to lose weight—and to keep it off—we usually need to make some lifestyle changes. This could be cooking healthy meals instead of grabbing what’s available, taking the stairs instead of the elevator and so on. These are changes that we weave into our lives as we go about our day-to-day living. They’re add-ons, not take-aways!

9. Be realistic in your weight loss goals.
You know you need to lose weight. You’ve vowed to lose weight. So why are you this close to failing? Could it be because you set an impossible goal to begin with? You can’t meet an impossible goal, and if you set such goals, you will feel as if you’ve failed. So set realistic weight-loss goals. Either alone or with an expert, calculate the safe and acceptable amount of weight you need to lose. Then look at safe ways to do this. Slow but sure, rather than fast and frantic, will likely help you see you reach your goals.

10. Plan ahead.
Whether you were in the Scouts or not, you likely have heard the phrase “Be prepared.” If you want to lose weight, this is what you need to do. You need to prepare your meal plans, your exercise plans and what to do if your situation or environment changes (vacations, invitations to dinner, etc). By planning ahead, you may avoid many of the pitfalls that affect people who are trying to lose weight.

*see source at title link

A list of rules for nurses…from 1887...........


Image: George Marks | Retrofile RF | Getty 

Whether you’re a new nurse or a seasoned nurse, it’s always intriguing to take a look back at the history of the nursing profession.
This list provided by carenurse.com illuminates the day-to-day tasks and regulations pertaining to the life of a nurse in 1887—before routine charting was even invented.

1887 Nursing Job Description

In addition to caring for your 50 patients, each bedside nurse will follow these regulations:
1. Daily sweep and mop the floors of your ward, dust the patient’s furniture and window sills.
2. Maintain an even temperature in your ward by bringing in a scuttle of coal for the day’s business.
3. Light is important to observe the patient’s condition. Therefore, each day fill kerosene lamps, clean chimneys and trim wicks.
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.
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.
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.
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.
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.
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.

Trigeminal nerve.......