Mrs. Hitz gave each of us our patient assignment and announced “Miss Tiessen, I have a special assignment for you. In addition to caring for your patient, you will also do the 10 o’clock Vitals.” I wasn’t really sure what that meant, but I did know that a patient’s vital signs included temperature (T), pulse (P), respirations (R), and blood pressure (BP). Hospital routines were rigid: every patient had to have their vital signs taken and recorded at 6 and 10 am, and again at 2, 6 and 10 pm daily. One duty nurse per eight hour shift was assigned responsibility for performing this task. Taking me aside as my other classmates left the nursing station to begin their assignments, our Instructor explained that I would be doing the day nurse’s task: the 10 am Vitals. A notebook, called the Vital Signs Book, contained rows listing every patient by name and room number and was lined with columns entitled T P R B/P and BM – for bowel movement. The value obtained by assessing T, P, R, and B/P was to be recorded in the designated column in the row adjacent to the patient’s name. The nurse assigned to do Vital Signs was also expected to ask each patient if their bowels had moved that day. A symbol for either a yes or no answer was subsequently recorded in the appropriate column and line.
After the nurse had visited each patient, obtaining and recording the required information, the Vital Signs Book was returned to the Ward Clerk who then transferred all the data to the Vital Signs Sheet, a simple page of graph paper at the front of each patient’s chart. She recorded each value with a dot at the appropriate place on the graph paper. A different coloured pen was used to record each: the T, P and R while B/P was written in at the 10 am slot of that day’s date. The symbol for BM (yes or no) was recorded in a specific cell at the bottom of the page on the day’s date. The Ward Clerk then connected the dots using the appropriate colour ink thus creating a line on the graph for each value. This Vital Signs Sheet was the patient’s dashboard, the place where physicians and nursing staff checked to see the trend line of the patient’s vital signs. The importance of its accuracy could not be over-emphasized.
Collecting the patients’ vital signs then, was to be my assignment. I was thrilled. Understanding the gravity of the task, I was determined to prove my value. This assignment, I believed, afforded me the opportunity to earn the respect of my Instructor, my colleagues and the entire nursing staff. After an hour and a half of caring for the patient I’d been assigned, Mrs. Hitz encouraged me to begin taking the 10 o’clock Vitals. Standing up straight and tall, I plucked up my courage, walked to the Nurses’ Station with as much confidence as I could muster, and retrieved the Vital Signs (VS) Book. Flossie, the Unit Clerk, gave me a dismissive look as I reached across her desk. My lack of confidence was showing, I thought, but I was determined to persevere. In the Clean Utility Room I collected a thermometer, and a blood pressure cuff; gratefully, I found a stethoscope at the nurses’ station. Feeling very organized, I was certain I looked every inch the competent, no-nonsense nurse I wanted to be.