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By Teresa A. Andrasik, MA, BS, RNC
Many experienced nurses have put retirement aside to continue to work in these tough economic times. That has been a plus for many of us who benefit from their years of expertise. One such treasure is my coworker, Ruth Isely, BSN, RN.
Isley stands 5 feet and 1 inch, 106 pounds and 72 years young, with vivid blue eyes, snow-white hair and a dynamic spirit of nursing.
Ruth married and traveled the world with Ray Isely, a pediatrician and public health physician. They raised four children: a nurse practitioner, NICU nurse, legal assistant and respiratory therapist. In earlier years this unique family traveled with the Methodist mission board, worked with Peace Corp staff, and contracted work with Federal Aid to Developing Countries.
Widowed for 20 years, Ruth works fulltime in the NICU at George Washington University Hospital, Washington, DC. An RN since 1956, this remarkable follower of Nightingale's lamp light reveals her story and hopes for the future of nursing.
Q: Why did you choose nursing?
Isley: It's in you. It's about service - something we need to look inside ourselves to evaluate and discover. If you don't have an interest in people, don't go into nursing.
Q: You graduated first from a 3- year diploma program at Deaconess Hospital in Minneapolis, then went on to a BSN in administration and education from Washington University in St. Louis. What prepared you to practice most effectively?
Isley: I attribute 90 percent of my education to my head nurses. They managed the unit, the staff, as well as the patients. In my day the head nurse ran the unit - she did not do payroll or staffing, and she was not called away to outside meetings. Her primary role was mentoring young nurses and students. I felt secure because she was there. I learned how to behave as a nurse by being around my head nurses.
By the way, physicians used to lecture student nurses. Surgeons and physicians were our mentors and friends. We were used to spending loads of clinical time in the hospital - it was not a foreign place to us when we began our careers.
Q: How did you start your career?
Isley: When I started nursing I began in med/surg. No one hired into a specialty then. I have since worked in med/surg and pediatric units. As a staff nurse at Cooper Hospital in Camden, NJ, in the early 1960s I worked in a newly established adult intensive care unit. I remember one of my first patients was a 78-year-old woman who ingested lye to commit suicide. It was quite a traumatic experience.
In the beginning we diploma nurses were issued four starched white dresses, routinely laundered by the hospital for us. The entire outfit included white stockings, white shoes and a black wool cape with a mandarin collar, all lined in soft gold-colored wool. We wore our pins just so and our caps, too. I still have my cape - it's hanging in the downstairs closet.
We relied mainly on our senses and stethoscopes to assess patients. We had glass mercury thermometers and mercury-loaded manometers for blood pressure readings. We didn't have cardiorespiratory monitors, istat machines or oxygen analyzers. We had our own eyes and ears to work with.
We did our own lab work, centrifuging blood tubes for hemoglobin and hematocrit levels. We checked triglyceride levels by drawing blood in a capillary tube and letting it sit. We would estimate the amount of lipids coming to the top of the tube by eyeballing it and would then adjust the patient's IV lipid drip by estimation.
Q: Did anything else change?
Isley: Oh yes, oxygen use has. I began nursing with glass incubators [for preterm infants] with a hole in the top where oxygen tubing was put in. If you opened the incubator all of the oxygen came out! You didn't regulate the amount of oxygen then-it was 100 percent or nothing. We had blind children as a routine outcome! We then had isolettes where you put a hood over the infant's head and controlled liter flow of oxygen inside the hood. We did not measure the percentage of oxygen then, either.
And the development of the pain scale is tremendous. We went for many years believing that babies don't experience pain as we know it. Now we face the truth. Pain affects all systems in the neonate and we now have established guidelines for relieving pain in infants.
And perhaps the most significant advances I've seen have been made in diabetic research with expectant mothers and their babies.
Q: What kind of medications did you give early in your career?
Isley: We used to give Paregoric (camphorated opium tincture) to treat narcotic withdrawal; it was later replaced with phenobarbital. (Paregoric was made with camphor, a central nervous system stimulant and contained alcohol, anise oil and benzoic acid). Another drug we used was Priscoline (Tolazoline hydrochloride), used to treat persistent pulmonary hypertension. Today NICU's are more likely to use Dopamine and/or dobutamine to support infants in this condition.
Q: What has changed within the profession?
Isley: When I started nursing, the acuity of the patient indicated to the head nurse what nurse-to-patient ratio was needed. In later years, we classified a system whereby the patient's needs were judged according to more specific criteria - not just "acute vs. stable" - but a detailed analysis of needs. Now we have a staffing grid that rarely takes into consideration the higher acuity nurses are faced with. Today the dollar interferes with the profession of nursing. It crushes our ability to give full patient care. I think the best, most scientific method, in consideration with primary nursing, is the classification model.
Q: You spent 11 years nursing overseas. What countries did you live in?
Isley: We went to the ends of the earth: Zaire, Cameroon - where I was a U.S. embassy nurse - Senegal, The Democratic Republic of the Congo.
Q: What was it like to nurse in other countries?
Isley: It left me with the greatest impressions, learning new and varied cultures: European, Scandinavian and African. The close acquaintance with poverty at its true and continual presence surrounded us wherever we went . We had no car, no washing machine, no refrigerator.
Q: Is there a reason your work overseas ended?
Isley: There was much strife going on in Zaire. Earlier a couple of American missionaries were held prisoners and an American pilot was shot at the airport. We evacuated. When we came back to the states everything was specialization! Back in the states, I interviewed for a position and the head nurse asked me if I would consider working NICU. I said, "What is NICU?" I had never heard of it, never seen an isolette, or a tiny BP cuff, never anything so small!
Q: What advice do you have to share with nurses today?
Isley: I urge everyone in our profession - especially those who have chosen hospital bedside nursing - to look within yourself, your heart, and assess your service. Our automated world teaches technology, but you teach yourself your own dedication of love and service. You meet your own individual level of productivity. My professional life has been a source of sustenance and satisfaction.
Teresa Andrasik is a NICU team leader for George Washington University Hospital in Washington, DC, and manages the Special Diet Support Group for St. Mary's Hospital in Leonardtown, MD.
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