Randi Gravlee, RN, joined Indian River Medical Center in 1971. Most of her career has been in critical care, with a 2-year break during which she served on a team that helped develop the hospital's electronic charting system. The veteran nurse - who described her job as "an art and a science" - offers insights she has gained:

Back in the Day

"In my generation, career choices for women were limited. If you went to college, you became a nurse or a teacher; if you didn't, you were a secretary. Even so, I don't remember a time when I didn't want to be a nurse. From the time I was small, maybe 5 or 6, that's what I told people I would be. When I got to college, I remember asking myself if this really was what I wanted to do - I quickly realized yes."

"Maybe I was meant to be a nurse - people told me I've always had a caring instinct. In high school, I was very social but always the counselor, listening to other people's problems and coming up with solutions. My critical thinking started early.

"My very first nursing job was 40 years ago at a hospital in Indiana - I made $1.98 an hour! I worked on a 38-bed surgical unit - the only RN on the 3-11 shift - with a team of two LPNs, an orderly and an aide.

"In those days, if you went to the doctor and said you had a pain in your right side, you went to the hospital for a big workup. Ten days later, you'd go home with no gall bladder. Today, many procedures are done outpatient.

"The acuity of the patient is by far more critical than anything we saw years ago. Even those patients on the floor are much sicker. We also have more regulations that govern what we do, [but ultimately they help to] provide better outcomes, protect patients and standardize care."

The Reward Remains

"The biggest reward is to know you've made a difference in a patient's outcome - particularly in critical care where interventions can mean life or death.

"I spent a lot of years on this unit as an educator, and it's a great reward to teach people - especially clinical bedside. To have the light-bulb come on and the learner has 'that' moment is wonderful."