Chapter 03: Nursing at MD Anderson in the Mid-Sixties

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Chapter 03: Nursing at MD Anderson in the Mid-Sixties

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Ms. Alt begins this chapter by explaining how she became aware of a job opening at MD Anderson for a Head Nurse in the Perioperative Care Unit. She sketches the work environment for nurses in the 60s, where the MD was the boss in a unit, the head nurse ruled next and nurses followed the chain of command; nurses has no real opportunity for advancement unless they went into management. She observes that nurses may have had good ideas for how to improve workflow or patient care, but there was no culture to support local innovations by individuals not in leadership positions. Next she talks briefly about her work on the Nursing Procedure Committee, which codified all of nursing activities. She recalls that she served as Head Nurse for about three years before advancing to supervisor. As an example of her work, she describes her work with the head of Pharmacy, Roger Anderson. She again observes that the work culture was very resistant to change. After the interviewer observes that Developmental Therapeutics had a reputation for constant innovation, she tells anecdotes about that controversial department.

Identifier

Alt,J_01_20180529_S03

Publication Date

5-29-2018

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subjects Story - Overview; Joining MD Anderson; Overview; MD Anderson Culture; Working Environment; Discovery and Success; Healing, Hope, and the Promise of Research; The History of Health Care, Patient Care

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Tacey A. Rosolowski, Ph.D:

I can understand that. So how did the MD Anderson opportunity come, because in June of 1965, you were [in the Surgical Unit at Methodist] less than a year, and then in June of 1965, you went to MD Anderson.J

Joyce Alt, RN, MS:

Just, I met some nurses at church and they said why don’t you come over, and so I interviewed there.

Tacey A. Rosolowski, Ph.D:

And what was that like?J

Joyce Alt, RN, MS:

Honestly, I can’t remember that much about it. I remember Ms. Hilkemeyer. She was very persuasive, highly recognized in the community, and wanted me to come. So I got the job of Head Nurse in the Postoperative Care Unit.

Tacey A. Rosolowski, Ph.D:

Now, how did you find oncology nursing, I mean that’s quite a different focus.J

Joyce Alt, RN, MS:

Never bothered me. I’ll tell you, I was in the surgical units where you sort of got your feet wet because surgery then was not so radical or so different than as we grew into surgery of major, major procedures. So, I had also worked with Dr. DeBakey’s group at Methodist.

Tacey A. Rosolowski, Ph.D:

On heart.J

Joyce Alt, RN, MS:

Yeah.

Tacey A. Rosolowski, Ph.D:

Yeah. I mean, I’m just saying for context for the record.J

Joyce Alt, RN, MS:

Working in intensive care units, just you know, it wasn’t that drastic a change, so.

Tacey A. Rosolowski, Ph.D:

So you didn’t find—I mean some people say when they come, they find it very… you know at first emotionally very draining, to work with cancer patients.J

Joyce Alt, RN, MS:

Depressing, draining.

Tacey A. Rosolowski, Ph.D:

Did you find that?J

Joyce Alt, RN, MS:

No.

Tacey A. Rosolowski, Ph.D:

So you were kind of suited to it. J

Joyce Alt, RN, MS:

Again, I entered an area that’s protected. I soon found, I mean in time I found out, you don’t jump into an oncology pediatric unit unless you really [understand the impact it would have]. We also found out that mothers with children had a hard time going into pediatric oncology. So you learn that and so…

Tacey A. Rosolowski, Ph.D:

So tell me what nursing was like at MD Anderson in those very early years. It’s hard for me to imagine. I mean I know some nurses here oversee workflow and all of that, but what was it like in the ’60s?J

Joyce Alt, RN, MS:

The physician was the boss. You sort of lived on your own unit. You weren’t integrating with other units. I mean it was—nothing against Ms. Hilkemeyer, that was just how life was at that time in nursing.

Tacey A. Rosolowski, Ph.D:

Right, right. What were the advantages and disadvantages of that now that you look back?J

Joyce Alt, RN, MS:

The disadvantage is that—and why I went into my master’s thesis to study this; you’re promoted to a level that you’re not prepared for and that the only way in nursing that you can get ahead, to go into management. Education, I thought was good for the orientation at that time. Continuing education was still out there. We were grappling, nursing was grappling with where do we go, you know what do we teach? People were very --not subservient, but the Head Nurse was the Head Nurse, you know? You ruled. And that’s just --again, it wasn’t a whole lot for a democratic process, you followed the chain of command, and things like that.

Tacey A. Rosolowski, Ph.D:

What were the downsides of that? And I’m asking because, I mean what you’re describing is a kind of culture of a field, you know, and a culture that had been developed for understandable reasons, but has some downsides.J

Joyce Alt, RN, MS:

Well, putting it bluntly, if you wanted to be a follower, it was good. If you wanted to be a leader or advance, it was very limited. So, I mean that’s the way it was, and nursing took care of nursing and physicians took care of physicians. You could be friends, but the planning together didn’t occur.

Tacey A. Rosolowski, Ph.D:

Did you consider yourself an ambitious person at the time?J

Joyce Alt, RN, MS:

No, I don’t think I did. I enjoyed challenges and I didn’t like the status quo a lot, but to go fight for a job, no. No, no, no.

Tacey A. Rosolowski, Ph.D:

Now the status quo, what are you thinking of when you mention that? What was the status quo that you weren’t satisfied with?J

Joyce Alt, RN, MS:

Just if you had ideas, what do you do with them? I guess you sort of dreamed by yourself. Those opportunities weren’t there and the chain of command was Head Nurse, supervisor, three supervisors; day, evening and nights. And then for large part, directly to Ms. Hilkemeyer, and then she would start putting in levels of associates and that kind of thing.

Tacey A. Rosolowski, Ph.D:

Now when you were in the Head Nurse role, were there ideas that you had to improve things that you felt you couldn’t act on?J

Joyce Alt, RN, MS:

I focused more on environment.

Tacey A. Rosolowski, Ph.D:

On environment. Can you give me an example so I understand?J

Joyce Alt, RN, MS:

Patient flow within the unit, better ways of just doing things, you know? I don’t know how I’d say anything different. It wasn’t anything major. It was just workflow and improving it. Then, when we started having patients stay overnight, my staff just almost [thought I had lost my mind] because I didn’t want to send patients back to the unit without being bathed.

Tacey A. Rosolowski, Ph.D:

Oh. Huh.J

Joyce Alt, RN, MS:

That was a hard, hard thing. They were laying here all night, their families want to see them, and let’s not send them back like they’d been in a wreck. That was a hard thing but we did it.

Tacey A. Rosolowski, Ph.D:

You don’t think of all the details of bringing a patient in and getting them through all their procedures, and then all of that. I mean, I think it’s hard for people to understand all the stuff that goes into working with a patient when they’re at the hospital.J

Joyce Alt, RN, MS:

Yeah. So that was… I did a lot of work with the Procedure Committees.

Tacey A. Rosolowski, Ph.D:

Tell me about the Procedure Committees, because I noticed that on your CV but I had never heard of that committee before. What was it about?J

Joyce Alt, RN, MS:

It’s a nursing procedure committee. You’ve got to have a procedure for everything, including mouthcare, bathing, shampooing hair, getting patients. Everything you did, you had to have a procedure, because when you have new people, this is how we do it, and that took a lot of work, a lot of work. Then you think of all the medication administration, starting IVs, those kinds of things. Everything you did to a patient had to be documented, and when JCAHO [Joint Commission on Accreditation of Healthcare Organizations] came in, if they weren’t there and revised with a date or reviewed, that’s bad.

Tacey A. Rosolowski, Ph.D:

JCAHO?J

Joyce Alt, RN, MS:

That’s the accrediting body for hospitals.

Tacey A. Rosolowski, Ph.D:

Yeah, okay. So how long were you in your Head Nurse role, because then you were promoted to supervisor. Do you recall kind of what the dates were on that?J

Joyce Alt, RN, MS:

No.

Tacey A. Rosolowski, Ph.D:

About how long were you a Head Nurse, five years, four years?J

Joyce Alt, RN, MS:

Maybe three, somewhere in there.

Tacey A. Rosolowski, Ph.D:

So what did becoming a supervisor mean? How was your role expanded at that point?J

Joyce Alt, RN, MS:

I made rounds on patients, generally with the Head Nurse or by myself, [of designated units] just to see how are we doing, making sure that new people were being welcomed and taught the ropes at Anderson. Making sure that we’re staffed, making sure they had the proper equipment and that it’s usable and not in need of repair. Interfacement with other departments, like Pharmacy and Nursing, were very close, and our functions had to be. We were very lucky to have the head of Pharmacy that we did.

Tacey A. Rosolowski, Ph.D:

Who were the heads at the time?J

Joyce Alt, RN, MS:

The person I interfaced with most of all was Roger Anderson. He had a tremendous reputation and he worked with Nursing. [Redacted] The nurse managers, I think got along pretty good with medical staff, but [redacted] [working service groups didn’t plan together very well. Management decisions were handed down.]

Tacey A. Rosolowski, Ph.D:

It’s kind of interesting, because people who are in Developmental Therapeutics…J

Joyce Alt, RN, MS:

Oh Lord, yeah.

Tacey A. Rosolowski, Ph.D:

(laughs) Why do you say that, why do you react that way?J

Joyce Alt, RN, MS:

It was just such a [challenge].

Tacey A. Rosolowski, Ph.D:

Was it really?J

Joyce Alt, RN, MS:

They were such a volatile group of people, so intense, so dedicated and so do it my way or the highway, and it just, it was rough.

Tacey A. Rosolowski, Ph.D:

Yeah. How was it rough?J

Joyce Alt, RN, MS:

Gotten a lot of criticism for not deserving it, you know just got—you either didn’t do it fast enough or right. They couldn’t help it, they want to cure leukemia right now, you know?

Tacey A. Rosolowski, Ph.D:

Yeah, yeah.J

Joyce Alt, RN, MS:

I remember when I was promoted, I got to talk to Dr. [Emil J] Freireich, who was an unbelievable man. He was so intense, because most of the time, he didn’t care anything about directors of nursing, I mean they were unnecessary, I mean a necessary evil. Later on, because I wanted to go around and meet him, and he got down on the floor and I said what are you doing, what are you going to do? He says, “Now listen, Ms. Alt, until we find the secret of life, we will not cure cancer, remember that.” I thought, “You’re probably right, you know?” But they were just that intense and it just wasn’t with us, I mean [there was friction among them].

Tacey A. Rosolowski, Ph.D:

Yeah. They were definitely, I mean there are words like ‘the Wild West’ that have been used to describe those folks, but when you hear them tell the story, it’s always innovation, we were always trying new things, you know the whole world was open to us. So it’s interesting to hear you worked in another dimension of MD Anderson and you’re like, ‘Well, no, things were kind of closed down, it was hard to get new things done, even if it was worth changing.’ You know so it’s interesting, there were these two parallel universes almost.J

Joyce Alt, RN, MS:

Yeah, yeah. I never felt any animosity if I stayed my distance, and that doesn’t mean we couldn’t introduce things. There were just things, you don’t tangle with them.

Tacey A. Rosolowski, Ph.D:

Interesting, yeah.J

Joyce Alt, RN, MS:

Because it’s not going to get you anywhere. [It was a group who resented authority figures and they would make their own way.] But, they got along, most of the time, with the nurses at the unit level, so that’s where it counted

Chapter 03: Nursing at MD Anderson in the Mid-Sixties

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