Chapter 12: The Enterstomal Ostomy Team, Infusion Therapy, and the Oncology Nurse Certification Program

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Chapter 12: The Enterstomal Ostomy Team, Infusion Therapy, and the Oncology Nurse Certification Program

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In this chapter, Ms. Alt talks about her participation in an informal group of nursing leaders from the Texas Medical Center; she notes that they all observed that healthcare organizations were shifting nursing leadership from nurses to administrators. She touches on several initiatives undertaken under her leadershi the offsite rehab center that she staffed with nurses; nursing conferences that helped instill pride in MD Anderson nurses; and the development of the discharge planning team. She talks about the strong culture of communication and leadership that was evolving among nurses. She ends the interview with final comments about her time at MD Anderson.

Identifier

Alt,J_02_20180618_S12

Publication Date

6-18-2018

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subjects Story - Overview; Leadership; On Leadership; Building/Transforming the Institution; MD Anderson Culture; Working Environment; Growth and/or Change; Obstacles, Challenges; Critical Perspectives

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

Joyce Alt, RN, MS:I was probably one of the last ones in the medical center to get fired, because we always had a group that meant once a month and yeah, we were pretty honest, sometimes we [argued with] [ ] each other, particularly about turnover, but we shared things. There were nursing directors who were [ ] [hospital administrators].

Tacey A. Rosolowski, Ph.D:

Interesting. So, I’m sorry, when you said a group of you met among institutions in the medical center. Were these other nursing leaders?J

Joyce Alt, RN, MS:

Yeah, yeah.

Tacey A. Rosolowski, Ph.D:

Okay, interesting. So that was just in the air almost, you know it was happening at other institutions as well. Very interesting. A culture shift in institutions for sure.J

Joyce Alt, RN, MS:

Oh yeah.

Tacey A. Rosolowski, Ph.D:

With the economic shifts.J

Joyce Alt, RN, MS:

Yeah.

Tacey A. Rosolowski, Ph.D:

Wow. So when did this group of your start getting together, that support group?J

Joyce Alt, RN, MS:

[ ] [I think it was the nursing director at St. Luke’s who started the meetings.]

Tacey A. Rosolowski, Ph.D:

Who were some other people involved with that?J

Joyce Alt, RN, MS:

Well, that was the VA Hospital, St. Luke’s, Methodist. [T.I.R.R. and the Visiting Nurses Association] [ ] That’s the big guns anyway.

Tacey A. Rosolowski, Ph.D:

So you guys would get together and tell the real truth about it.J

Joyce Alt, RN, MS:

Yeah. Have lunch and get angry. (both laugh)

Tacey A. Rosolowski, Ph.D:

Better vent than stew. (laughs)J

Joyce Alt, RN, MS:

It was interesting too, the problems.

Tacey A. Rosolowski, Ph.D:

Such as? What were you hearing?J

Joyce Alt, RN, MS:

You know it was the takeover, the takeover of nursing.

Tacey A. Rosolowski, Ph.D:

Interesting.J

Joyce Alt, RN, MS:

Yeah. See, Methodist was the first one. Years before I was even employed at my job, they got rid of their Director of Nursing, who had been there oh, goodness, lots and lots of years, and it was taken over by an administrator. Now, I know nothing more than that, you know? But I worked at Methodist for about a couple years. [Then Methodist employed a director of nursing who assumed other administrative departments.]

Tacey A. Rosolowski, Ph.D:

Yeah, I remember.J

Joyce Alt, RN, MS:

And she was one of the toughest RNs, I mean she literally made rounds with her white gloves.[Redacted]

Tacey A. Rosolowski, Ph.D:

Yeah. [ ] What did this group say about your situation as you were nearing the end of your time at MD Anderson?J

Joyce Alt, RN, MS:

Well, by the time I ended, there weren’t that many left, but the person that I got along best with was head of the VA.

Tacey A. Rosolowski, Ph.D:

And her name, his name?J

Joyce Alt, RN, MS:

It’s her name [Margot Snider] and I can’t remember her name, I’m bad at names. But I called her and I said, ‘they got me,’ and she says, “I’m leaving,” she told me “in six weeks” or something like that.

Tacey A. Rosolowski, Ph.D:

Oh, wow.J

Joyce Alt, RN, MS:

But let me tell you, she was—she had [a huge VA hospital System] and [ ] outpatient, clinics, [home care], a very powerful lady --and management of all the funds. I was surprised. But then a lot of people covered it by saying I’m going to retire, and we all knew. [ ]

Tacey A. Rosolowski, Ph.D:

Interesting.J

Joyce Alt, RN, MS:

And St., Luke’s hired some gal from the east that was very well versed in public speaking and publications, and she just left, I mean I know she just left. She isn’t a person who would allow that to happen to herself. It was traumatic.

Tacey A. Rosolowski, Ph.D:

Well, it just, I mean crummy, for the people who had to go through it, but also kind of intriguing that so many of you were going through it at the same time, you know something was going on.J

Joyce Alt, RN, MS:

I’m very thankful that Human Resources didn’t give me the curb, because they could have.

Tacey A. Rosolowski, Ph.D:

It sounds like Dr. LeMaistre went to bat for you.J

Joyce Alt, RN, MS:

He sure did.

Tacey A. Rosolowski, Ph.D:

Yeah, yeah, so that’s good.J

Joyce Alt, RN, MS:

That person called me back she says, “You know [the female who fired you] [Redacted] was not happy with what Dr. LeMaistre is doing for you,” and I said, “I didn’t expect her to be, but I sure appreciate it.”

Tacey A. Rosolowski, Ph.D:

All those relationships you build over the years in the institution hopefully can serve you well, or anybody. That’s people coming to bat for you, watching your back a bit. Was there anything else on your list that you wanted to make sure we covered today?J

Joyce Alt, RN, MS:

Oh, we never talked about the offsite rehab program. Honestly, that sort of took care of itself, and the patients could stay there. They didn’t need to stay in the hospital, but they were too far from home and they couldn’t afford a hotel for two weeks or something like that. Anyway, we called it a rehab center and it could probably hold about a hundred patients at any given time.

Tacey A. Rosolowski, Ph.D:

Where was it located?J

Joyce Alt, RN, MS:

[ ] It was about [fifteen] miles from Anderson and a very close-knit group of staff, it was just fun to go out there. The maintenance man and the yard man and the nursing desk [hostess] and .

Tacey A. Rosolowski, Ph.D:

You don’t remember where it was?J

Joyce Alt, RN, MS:

No I don’t. [I don’t remember the address, but it was off of North Main Street.]

Tacey A. Rosolowski, Ph.D:

Huh, funny. I’ve never even heard of this before.J

Joyce Alt, RN, MS:

Well, see then it moved for [financial] reasons. It had been there for years though. [It moved to several different hotels in the medical center near MD Anderson before the move to the Anderson Mayfair.]

Tacey A. Rosolowski, Ph.D:

The Anderson-Mayfair.J

Joyce Alt, RN, MS:

Uh-huh.

Tacey A. Rosolowski, Ph.D:

Oh, okay, so it was offsite and then it moved in to the hotel.J

Joyce Alt, RN, MS:

Into the hotel.

Tacey A. Rosolowski, Ph.D:

Interesting. Was it effective?J

Joyce Alt, RN, MS:

The patients loved it but some of that was they had [ ] a place to be too, you know? [We were still discussing the original rehabilitation center prior to the moves to various hotels and the Mayfair.]

Tacey A. Rosolowski, Ph.D:

I can imagine this was enormously expensive.J

Joyce Alt, RN, MS:

Yes. Just some maintenance on the bus [was expensive].

Tacey A. Rosolowski, Ph.D:

Right. And did the distance present any difficulties at all?J

Joyce Alt, RN, MS:

No.

Tacey A. Rosolowski, Ph.D:

No, okay.J

Joyce Alt, RN, MS:

Everybody is geared, everybody knew it was there and if they needed the police they were there.

Tacey A. Rosolowski, Ph.D:

So you didn’t have any role in setting this up?J

Joyce Alt, RN, MS:

No. I just staffed it.

Tacey A. Rosolowski, Ph.D:

You staffed it. Was there anything else?J

Joyce Alt, RN, MS:

[No, just making sure some JCAHO (Joint Commission on Accreditation of Healthcare Organizations) standards were maintained.] I didn’t tell you we had nursing conferences?

Tacey A. Rosolowski, Ph.D:

Tell me about those.J

Joyce Alt, RN, MS:

We had national conferences yearly and we had participants across the United States come to that, and it was good.

Tacey A. Rosolowski, Ph.D:

Did you have themes, or how was it organized?J

Joyce Alt, RN, MS:

Actually, what we did is take whatever was hot in Anderson care, we focused on that, and then have sort of a menu of things people could go to.

Tacey A. Rosolowski, Ph.D:

When did it start?J

Joyce Alt, RN, MS:

It started the year after I started [my position], and we did it every year and it got too costly. Well, plus, a lot of the hospitals were getting better, you know, they didn’t need us as much, so we couldn’t keep it going.

Tacey A. Rosolowski, Ph.D:

What was the effect of those conferences? Did it have an impact on nursing at MD Anderson at all?J

Joyce Alt, RN, MS:

No, I think the conferences were a pride thing. It was put on by people who were specialized in the topic, and so it was nice. They got recognition and they enjoyed it, and the hotels were good to us.

Tacey A. Rosolowski, Ph.D:

Well, it’s nice to build a community. I’m sure there were people who found colleagues across the nation and that can always help you.J

Joyce Alt, RN, MS:

The other thing, the development of a Discharge Planning Team.

Tacey A. Rosolowski, Ph.D:

No. We didn’t talk about that, so tell me about that.J

Joyce Alt, RN, MS:

This sounds ugly and I don’t mean it to be, but doctors, for the most part, are not really good about getting the patient home. They [ ] write their prescriptions and [ ] diet, and probably ambulation [ ], but to prepare [patients] to go home, to get the people contacted who may need to take care of them. Just, they didn’t do a very good job, and they really didn’t have time. Discharge planning can be a lengthy process, because you shouldn’t start the day that you’re going home. We established a Discharge Planning Team and they too were assigned by specialties, so when the patient went home who had leukemia, they knew what they needed, the patient knew who they could call. It was just a really good move and they gained a lot of respect.

Tacey A. Rosolowski, Ph.D:

When was this started?J

Joyce Alt, RN, MS:

I’m going to say, the [early 80s]…

Tacey A. Rosolowski, Ph.D:

That’s fine and you’ll have a chance to review the transcript, so you can think about it a little and stick a date in. That’s fine. I’m just interested, because I’ve had—a lot of people have talked about that phenomenon of survivors, people actually survive and go home, and how do you be a survivor or how do you help a person be a survivor? So it sounds like this is just one of the first steps, doing everything necessary to help the person go home and be functional.J

Joyce Alt, RN, MS:

We’ve got really, the idea, because of our ostomy patients.

Tacey A. Rosolowski, Ph.D:

Oh, okay.J

Joyce Alt, RN, MS:

Then, it just spread to different modalities.

Tacey A. Rosolowski, Ph.D:

Who did you work with on this Discharge Planning Team?J

Joyce Alt, RN, MS:

We had a nurse [Annette Bisanz] that came to us from the east, who was really into discharge planning, and she came down and talked to me and I said golly, that’s a wonderful concept. She was our leader and she decided where we needed it, and we dedicated some resources. She was very well respected and her specialty was ostomy care and bowel training, which is a big factor patients get in chemotherapy. She did a lot of lecturing just on that factor. But anyhow, and she just helped grow the team.

Tacey A. Rosolowski, Ph.D:

Yeah, very neat. How did this team, how was it mobilized? Did a clinician say, ‘Oh, I have such and such a patient going home,’ or did the physician call or did the nursing team call, or how did these people get their assignments?J

Joyce Alt, RN, MS:

They were assigned by unit, so they knew who was going.

Tacey A. Rosolowski, Ph.D:

Oh, all right, so the team kept tabs on where it is.J

Joyce Alt, RN, MS:

[ ] [Nurses could contest a member of the discharge planning team if she felt the plan was still in need of something. It was a great system.]

Tacey A. Rosolowski, Ph.D:

So I’m getting the sense that this time, there was pretty good communication among all of the different units and the services that were available for nursing support.J

Joyce Alt, RN, MS:

Yeah. Our Head Nurses met once a month too, and they shared a lot of grief and they were just, it was a good group of folks; strong and knew their resources, they really did.

Tacey A. Rosolowski, Ph.D:

So they helped keep that communication going too, so people knew what was needed. Interesting. Did you see that changing over time, as the institution grew and kind of patient load grew?J

Joyce Alt, RN, MS:

I’ll tell you, I guess I saw more change in them, that they were reacting and became stronger people.

Tacey A. Rosolowski, Ph.D:

Oh, interesting. Like how did they express that change?J

Joyce Alt, RN, MS:

Just through their actions and less dependence on a supervisor who they didn’t have, less calls to the Director of Nursing.

Tacey A. Rosolowski, Ph.D:

Interesting. That must have been cool to see.J

Joyce Alt, RN, MS:

Yeah it was.

Tacey A. Rosolowski, Ph.D:

Yeah, to see these people really coming into their own as leaders. Very neat.J

Joyce Alt, RN, MS:

And then well, we had—and then I put in, which was hard to do but I knew was coming, I made it a requirement to get at least a bachelor’s. That was hard.

Tacey A. Rosolowski, Ph.D:

Why was that hard?J

Joyce Alt, RN, MS:

A lot of them were older, family was dependent on them for income, and they weren’t ready to study. (laughs) You know?

Tacey A. Rosolowski, Ph.D:

Right. So this was a requirement if they wanted to keep their position, they needed to go back to school.J

Joyce Alt, RN, MS:

Yeah.

Tacey A. Rosolowski, Ph.D:

Why did you feel that was an important requirement to have?J

Joyce Alt, RN, MS:

It was coming. They were fading out the Diploma Schools, the AA Schools were still there, but it was inevitable.

Tacey A. Rosolowski, Ph.D:

Interesting. Was there anything else that you wanted to…?J

Joyce Alt, RN, MS:

I don’t think so. Anyway, you’ve got a copy of what I thought about.[Later addition via email, 8/27/2018: I wished to include some thought on the educational opportunities for the hospital aide and licensed vocational nurses. In our monthly discussions with representatives from various units I learned that so many of the hospital aides and licensed vocational nurses were either putting their children through school, had completed the stated, or were nearing the end. Now they had time for themselves but money was spent and they felt they were too old. I mulled this over for some time and came up with the thought of the possibility of having the Houston Community College come to Anderson, provide opportunities for the hospital aides and licensed vocational nurses to begin the first rung of their new career. The benefit for us was to have progressive caregivers, i.e., hospital aide to LVN and LVN to beginning the foundation for a registered nurse career. This could happen while they were employed, allowed time to attend classes, money for tuition, and support from staff if tutoring was needed. Fortunately Dr. LeMaistre and Mr. Gilley thought it was a good idea and financial support was given for classes, head nurses supported time off for attending some classes during the week and after months of support of every kind, we were able to publish our first LVN graduating class and future R.N. graduates. Magical!!]

Tacey A. Rosolowski, Ph.D:

Yeah, yeah. This has been really interesting, it’s a really interesting perspective on this time and kind of jumpstarting that whole process.J

Joyce Alt, RN, MS:

I wouldn’t say it was fun. It was worthwhile. You know you felt like you were accomplishing something, and the people told me they had appreciated it.

Tacey A. Rosolowski, Ph.D:

Did you anticipate, early in your career, that you would want to be a leader or that you could be a leader?J

Joyce Alt, RN, MS:

No. I left Methodist to become a Head Nurse, but beyond that, no. I don’t know why I kept going. I don’t know. (both laugh) I really don’t. I enjoy people and working in a larger circle. Anyway…

Tacey A. Rosolowski, Ph.D:

Well, is there anything else you’d like to add about your time here at MD Anderson?J

Joyce Alt, RN, MS:

It was a great place, you know? I’m glad I was there, glad that it was in my life. [I was blessed to have worked with so many committed to the care of patients with cancer. I am blessed to have been able to serve our patients and learn from them. Because of it I have a better appreciation of life. For me the past thirty years have been truly “an experience in life” for me.]

Tacey A. Rosolowski, Ph.D:

What do you think it means to patients?J

Joyce Alt, RN, MS:

Everything, it’s a savior for them. I believe that. Anderson takes raps every once in a while, but the majority of the patients and their families, there’s no place like it on earth.

Tacey A. Rosolowski, Ph.D:

What makes it different?J

Joyce Alt, RN, MS:

I think there’s a lot of people that are truly caring, so many, and I think they have faith that if anybody can help them Anderson can, and so they go there.

Tacey A. Rosolowski, Ph.D:

Is there anything else you’d like to add?J

Joyce Alt, RN, MS:

No, I don’t think so.

Tacey A. Rosolowski, Ph.D:

Well thanks for your time.J

Joyce Alt, RN, MS:

Well, thank you.

Tacey A. Rosolowski, Ph.D:

It’s been really, really interesting, I’ve enjoyed our conversation.J

Joyce Alt, RN, MS:

Thank you.

Tacey A. Rosolowski, Ph.D:

Well, I just want to say for the record that I am turning off the recorder at about 2:42.[End of Audio File]

Chapter 12: The Enterstomal Ostomy Team, Infusion Therapy, and the Oncology Nurse Certification Program

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