Chapter 05: Director of Nursing and Center Administrative Director
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Description
Here Ms. Houston goes into detail about the operation of the different units she administered during the nursing phase of her career. She begins by speaking about the stresses associated with serving as a Director of Nursing ((’86 – ’95) in a “very physician-driven environment.” She notes some of the initiatives she took on: adding services for patients and a mentoring program for nurses, as well as setting up a satellite laboratory on the eighth floor of the Ambulatory Care Clinic. (In-patient nurses would work a week in the Clinic so they could see patients who had gotten better.) She then talks about her role as Center Administrative Director of Hematology responsible for four inpatient units. Most patients, she observes, were involved in research studies, and she describes the difference between nurses focused on patient care and research nurses, but goes on to explain the research element of all nursing at MD Anderson, as clinical nurses help the patient understand the investigational protocol.
Identifier
HoustonDA_01_20120726
Publication Date
7-26-2012
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The Administrator; The Administrator; Professional Path; Institutional Processes; Building/Transforming the Institution; Multi-disciplinary Approaches; On Research and Researchers
Transcript
Tacey Ann Rosolowski, PhD:
Now when you were Director of Nursing, did you have any particular goals—things that you wanted to achieve during that time?
Deborah Houston:
Survive, no.
Tacey Ann Rosolowski, PhD:
How demanding a job was it on a scale of one to ten?
Deborah Houston:
Well, probably ten. When I was over just the medical clinics—those areas—the problem is you would get called if there wasn’t enough staff. I don’t know how I was supposed to create people, but people were moved around to cover in different clinics. You would get called—I would get called by physicians at night who wanted to complain about a nurse or something like that. Those are some of those special physicians that will always remain a permanent part of your history. Again, if they didn’t have enough—they would call you. It’s like, “Well, you know, am I going to come in and do the work? “ Sometimes you felt like you had to. You were like trying to then figure out how to move staff around to cover. It’s stressful, because if the physicians—this is a very physician-driven institution. If the physicians don’t like what’s happening in their environment, they’re going to tell you about it or they’re going to tell your boss about it, so they better tell you about it. It’s better for you to know about it than your boss to know it before you.
Tacey Ann Rosolowski, PhD:
Absolutely. Absolutely.
Deborah Houston:
One of the things I tried to do was be visible in the areas and see what was going on.
Tacey Ann Rosolowski, PhD:
What are you particularly gratified that you were able to achieve over that nine-year period?
Deborah Houston:
I think some of it was organization—looking at how—trying to add some services to patients. One of the things were started when I was in Hematology was we added a satellite lab for those patients up on the 8th floor of the clinic because there’s such a volume of patients coming in everyday that need lab work done. The Diagnostic Center—it’s just backed up. Backed up is a bad word, but it’s crowded. These are people that are immunosuppressed. We added a lab area separate from that upstairs by the clinics where they could get their labs drawn and, hopefully, get results back sooner, and that’s still there today. That was nice. That’s probably one of the nicest things. It was a very stressful job because I had outpatient and inpatient areas. Hematology—those are very sick patients. It was nice because I could see—the staff could—we kind of rotated staff occasionally. We had a program where the inpatient nurses could work a week in the clinic. It was easier for that to happen than take a clinic nurse and put them in the hospital setting. They could see the patients in the clinic and see when they were better—not as ill.
Tacey Ann Rosolowski, PhD:
Why did you want to do that?
Deborah Houston:
For staff satisfaction, staff retention. Some staff, openings would come up in the clinic and they would transfer from the floor to the clinic. At that time, there was a pay differential to work inpatient than clinic. I don’t know if that still continues.
Tacey Ann Rosolowski, PhD:
Which way did it—which was—?
Deborah Houston:
It was higher inpatient because in the clinic you were working Monday through Friday.
Tacey Ann Rosolowski, PhD:
Right, right.
Deborah Houston:
It was a little bit different opportunity for them. That program worked. We also did a kind of mentoring—not official mentoring program—but kind of a mentoring program. We also had an education program with the woman that was the clinical specialist, working with the staff on clinical experiences and clinical training that we set up formally.
Tacey Ann Rosolowski, PhD:
What kind of things did that deal with?
Deborah Houston:
Things like symptom management of transplant patients, for example—is a good example. She would lecture and then work with the staff and kind of mentor the staff when they would have particular patient challenges. That kind of thing.
Tacey Ann Rosolowski, PhD:
You mentioned earlier that you thought there were some organizational things you were really happy with. Are these the things you’re referring to?
Deborah Houston:
Yeah. Yeah.
Tacey Ann Rosolowski, PhD:
Okay. I just wanted to make sure we weren’t leaving anything out.
Deborah Houston:
We also started the—when I became a Center Administrative Director, one of the things they wanted us to do that that time was they wanted all the Center Administrative Directors to have a MBA—have that business background, and I’m like, “No.” I said, “I don’t want to get a MBA.” I said, “We can hire somebody that has a business/finance background a lot easier than I can get a MBA.” At the time, it was $40,000/$50,000 a year job that can do it. So, we created the Center Business Manager job that has perpetuated since. I think they do encourage the CADs to have MBAs, but we also now have a business role because you can’t manage everything. The expectations of those—the outpatient managers are just really high, so we’ve got the business component, as well.
Tacey Ann Rosolowski, PhD:
Now, when that was suggested—that was in the 90s when they were trying to—
Deborah Houston:
Early ‘90s, yeah, yeah.
Tacey Ann Rosolowski, PhD:
—make everybody kind of double up on all kinds of tasks.
Deborah Houston:
Yeah.
Tacey Ann Rosolowski, PhD:
Did you—were there instances in which you felt a lack of kind of financial background or did you always feel—?
Deborah Houston:
Not me, personally. Even today, my philosophy is I don’t have to know everything. I just have to know where to get the information—who I can go to to get the information.
Tacey Ann Rosolowski, PhD:
Who did you partner with at the time? Where did you go to get the financial information at the time when you were dealing with those financial issues?
Deborah Houston:
There was someone that was in nursing that was kind of their finance person that I worked with.
Tacey Ann Rosolowski, PhD:
Who was that? Do you remember that person’s name?
Deborah Houston:
No.
Tacey Ann Rosolowski, PhD:
Okay.
Deborah Houston:
We hired someone pretty quickly.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative). Did that make a big impact? Were they correct in thinking—was the administration correct in thinking—
Deborah Houston:
I think so. I think so.
Tacey Ann Rosolowski, PhD:
What kind of difference did you see?
Deborah Houston:
Well, I think it let you be—let me not worry about some stuff, you know. Not only was she keeping up with was the billing for the day and that kind of thing. She was able to do—order supplies and do other things, organize some of the clerical functions that I didn’t need to worry about. Then, over time, we’ve even added—we even added an administrative assistant kind of position. It’s just more and more and more things.
Tacey Ann Rosolowski, PhD:
Now tell me a little more about your role because—let’s see. Your Director of Nursing role lasted from ‘86 to ‘95 and then from ‘95 to ‘97 you were the Center Administrative Director for Hematology.
Deborah Houston:
Right.
Tacey Ann Rosolowski, PhD:
We kind of touched on it, but really what was your formal role there—in Hematology—the CAD?
Deborah Houston:
I was over the leukemia, lymphoma, and bone marrow transplants—that is what they called it at the time—clinics. That included the Aphaeresis Unit. Then, I had four inpatient units, as well, which were the inpatient lymphoma unit, the inpatient leukemia unit, the inpatient transplant unit, and the protective environment, at the time.
Tacey Ann Rosolowski, PhD:
Did you have—and nurses who were under your administration—did they have any role in working with physicians on research projects with patients?
Deborah Houston:
Most of the patients were on some type of a research program because the chemotherapy they were getting was research-oriented. The staff that worked for me were not research nurse titled staff, but they worked with the patients on explaining the drugs or answering questions. The research nurse roles were the nurses that managed the protocols and did lots of patient teaching, as well, with the patients.
Tacey Ann Rosolowski, PhD:
Now, did the non-research nurses—did they administer those drugs? I mean, I’m wondering how all these folks were integrated—
Deborah Houston:
Yeah—no. At our—here at MD Anderson, the physician sees the patient in the clinic, and then they go to the Ambulatory Treatment Center to get their therapy. A lot of the Hematology patients are admitted to the hospital for chemotherapy. It’s not given outpatient because of the illness. I mean, acute leukemia that needs induction therapy needs to be in the hospital. Transplant patients that are getting chemotherapy for that have to be in the hospital, so a lot of that is inpatient. What a lot of our staff are doing is teaching patients about what they need to do before and after that kind of therapy and, then, monitoring the patients during their course and watching their blood counts and that kind of thing and watching them for signs of infection and getting them in for transfusions or antibiotics or whatever—doing a lot of phone triaging with the patients. The patients get that therapy either in the hospital or in the clinic. In the Ambulatory Treatment Clinic, we have space—they had space there where patients that had already had a bone marrow transplant—after they were discharged would come back into the Ambulatory Treatment Center everyday and get fluids or be checked by the nurse practitioners or something like that. So, they could leave the hospital, but they really were still monitored very, very closely. That’s still going on today.
Tacey Ann Rosolowski, PhD:
Did you every wish that you had gotten more involved in the research part of it? I’m just curious.
Deborah Houston:
No. It’s not that I didn’t want it. A lot of the nurses’ role—well, I shouldn’t even say, because I never did the job, but to me the research nurse role is a lot of getting patients enrolled, explaining the protocols to them, tracking and making sure they’re getting labs done and whatever if they’re not here in the hospital. Some do drug studies—some of that kind of stuff, then doing a lot of data collection for a particular study. Research nurses that work in like the Phase I area. They do lots of actual administration of those drugs in their clinic.
Tacey Ann Rosolowski, PhD:
And what does—oh, Phase I means Phase I drugs.
Deborah Houston:
Phase I drugs—early drug development. I never had an interest in that. I probably would have liked it had I don’t it, but it was something that I never thought about.
Tacey Ann Rosolowski, PhD:
Yeah. You were really attracted to the actual patient care part.
Deborah Houston:
Yeah, yeah, yeah. But there’s a huge research nurse component to what we do here and what oncology nursing does in general.
Tacey Ann Rosolowski, PhD:
And that is?
Deborah Houston:
I think helping the patients understand what they’re doing and making sure they’re following the instructions they need for their therapy. If a patient is getting investigational drugs or any chemotherapy—put on an investigational protocol—and they’re not getting the drug at the right time or getting their labs drawn at the right time, it can affect the study, as well as affect how well they do. They could get side effects. If they don’t get back and get their rescue medication or start med at a certain time, they can get sicker. The drug may not be as effective as it could have been.
Tacey Ann Rosolowski, PhD:
So you were—it may have been on the periphery, but you were certainly involved in the effectiveness of these programs.
Deborah Houston:
Yeah. I wouldn’t say I was ever a research nurse.
Tacey Ann Rosolowski, PhD:
Yeah, no, no. It’s just interesting how these pieces—everybody’s sort of a puzzle piece and it fits together. It makes it all work.
Deborah Houston:
Yeah, we have a lot of specialized nursing roles.
Tacey Ann Rosolowski, PhD:
Now, when you were talking earlier about the things that you are particularly glad about having achieved, were those things that were also instituted when you were the Center Administrative Director for Hematology—creating the lab. I’m wondering if they were—
Deborah Houston:
Yes, they were.
Tacey Ann Rosolowski, PhD:
Okay. So that was all—
Deborah Houston:
Yeah.
Recommended Citation
Houston, Deborah A. and Rosolowski, Tacey A. PhD, "Chapter 05: Director of Nursing and Center Administrative Director" (2012). Interview Chapters. 888.
https://openworks.mdanderson.org/mchv_interviewchapters/888
Conditions Governing Access
Open
