Nursing has always been a challenging but immensely rewarding profession.

Despite huge advances in the treatment of illnesses, medicines and medical equipment, the modern-day nurse faces new difficulties such as the increasing use of illicit drugs, increased aggression from patients, language barriers and the recent COVID pandemic.

In earlier years nurses were exclusively female.

In addition to managing the health and medical care of their patients, they were expected to carry heavy loads, manufacture dressings, gauze packs and swab sticks, carry out some meal preparation and clean the wards.

No patient was ever turned away.

Spare beds were moved into already crowded wards and nurses worked harder to care for them.

Nurse Annie 'Dolly' Norman nursed at the Horsham Hospital in the early 1920s.

In a newspaper article she recalled, "There was an open fireplace in each ward but most heat escaped up the chimney. Nursing staff came on duty at 6am. Before the patients had breakfast at 7am the junior nurse swept the ward, dusted, washed and refilled bottles of water and a glass for each patient".

Old wine bottles from hotels were used for this and to clean them the nurse added a spoonful of rice and shook it vigorously.

Lorna Hoffmann began training at Horsham Base Hospital in 1942.

She had waited two and a half years for the position.

Lorna wrote in her memoirs, "Nothing was disposable or prepacked in my day".

Things like cotton-wool swabs and gauze packs were made from scratch. Bandages were created from lengths of calico, torn by hand, then washed, boiled, dried and rolled.

Glass and metal syringes were washed, boiled and stored in spirit for reuse.

Temperatures were taken under the tongue, rectally or via axilla (armpit).

Thermometers were made of glass and contained mercury which had to be shaken down to zero after each recording. They were fragile and nurses paid for breakages.

Bedpans, urinals and sputum mugs were emptied into a 'slop hopper', cleaned and sterilized by boiling. Nurses made up solutions, such as normal saline, as required.

Mary Fernee wrote for a staff reunion held in 2004 that when she came to work at the Wimmera Base Hospital in 1951, patient care included feeding, bathing and four-hourly back rubs to increase blood circulation and prevent bed-sores.

In addition, she washed water jugs and refilled them, did all the dusting and made sure the bed wheels were in line with the floorboards.

Nurses had to wash soiled linen before it was sent to the laundry.

Junior nurses on night shift cooked and delivered staff meals, made up stock (swabs and gauzes) and dressings then sent them to be autoclaved, as well as their normal patient care responsibilities.

Nursing practices have evolved with advances in medical science.

Lorna Hoffmann wrote in her memoir, "Prior to penicillin, pneumonia was almost always fatal. I was on duty when a young man was admitted with it. He, his bed and all surrounding furniture shook violently as his body temperature rose then fell erratically and dangerously. The senior staff worked frantically to maintain his temperature within normal limits to prevent brain damage and/or total collapse. Senior nurses cold sponged and fanned him or packed him with warm blankets and hot water bags according to his needs. The patient alternately shivered violently or sweated profusely. As a junior nurse I raced to keep up the supply of cold water for sponging and warm blankets and hot water bags".

Against the odds, the patient survived.

The quality of nursing care sometimes makes all the difference.

Tuberculosis patients, before the construction of Horsham's TB chalet in 1948, were nursed in isolation on hospital verandahs.

Fresh air, bed rest and nourishing food was the only treatment.

In the 1940s the invention of the BCG vaccine and chest X-rays helped eradicate the disease.

Wendy Donald recalls that in the 1970s, while in the female medical ward (Ward 6), a tray with thermometers in Chlorhexidine was carried to each bed to take the patients' temperatures per axilla.

In later years patients' thermometers were stored in a test tube attached to the bed head.

Procedure trays and their instruments were washed and autoclaved then laid out and covered with a sterile cloth in preparation for the next day.

Testing urine was very complex involving several processes using litmus paper, tablets and test tubes.

Today's 'Clinitest' sticks make it possible to test urine in a very short time.

If oxygen was required, heavy cylinders were placed next to the patient creating a hazard if knocked over. Today oxygen is piped to each bedside.

Most Ward 6 patients were bathed daily.

As the ward had only two bathrooms and no showers, all patients were manually lowered into and out of the bath by two nurses.

Some patients were overweight and many nurses later developed back trouble.

As late as the 1970s high-care patients were housed in medical wards and were in standard-height beds.

To reduce the number of falls, detachable side frames were added, hinged at the bed-head.

These were awkward and did not solve the problem so, many of the beds were replaced with very low beds.

This meant nurses had to bend down, increasing the physical demand on them.

Wheelchairs have evolved from clumsy devices made from cane then to heavy metal contraptions to today's lighter, folding models.

Electrically controlled beds, patient lifting machines, disposable incontinence pads, slide sheets and other aids have been gradually introduced to reduce wear and tear on nurses and to increase the safety and comfort of patients.