Chapter 08: Observations about Nursing and Hurricane Harvey
Files
Description
In this chapter, Dr. Porter gives an overview of the strong performance of MD Anderson and of nursing during Hurricane Harvey in September 2017.
She notes her background in emergency management, but explains that in the northeast, where she had prior experience she had had no experience with MD Anderson policy, particularly regarding the strategy of having a “ride-out team” [see UT System article below]. She talks briefly about adjusting to this new policy.
Next, Dr. Porter talks about the key activities undertaken to ensure effective delivery of patient care during the period when MD Anderson was isolated and supported only by the ride-out team. She talks about ensuring that people in the Incident Command Center and on staff in the hospital units were relieved periodically so they could sleep. Dr. Porter also talks about the process by which nurses from four other institutions came to support patient care efforts. She explains how quality of care was guaranteed and comments on the excellent team-building that was accomplished, such that after a couple of days it was not possible to distinguish MD Anderson staff from the support staff from outside.
Next, she expands on the ride-out team policy and notes that a key challenge was to keep this staff safe and effective by getting them to take breaks.
She also comments on the impact of the fourth meal provided by Food Services to patients and to the team, as well as the fact that the fitness center was opened so the team could wash and decompress.
Dr. Porter then notes that the experience underscored that the staff and patients felt cared for, and the Incident Command Center operated in a respectful and caring way. She explains that the patient care areas never ran out of supplies.
Identifier
PorterC_03_20180706_C08
Publication Date
7-6-2018
City
Houston, Texas
Interview Session
Carol Porter, DNP, RN, FAAN, Oral History Interview, July 06, 2018
Topics Covered
The Interview Subject's Story - Overview; Leadership; On Leadership; Working Environment; MD Anderson Culture; Obstacles, Challenges; Institutional Mission and Values; Human Stories; Offering Care, Compassion, Help; Survivors, Survivorship; Patients, Treatment, Survivors; This is MD Anderson; Professional Practice; The Professional at Work; Collaborations; Beyond the Institution
Creative Commons 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
Carol Porter, DNP, RN, FAAN:
Okay, fine. [Dr. Rosolowski] Okay. Are we going back to the hurricane?
T.A. Rosolowski, PhD:
Yeah. Well actually, we haven’t even started talking about the hurricane yet. We were kind of at the point. [laughs] I know you’ve still been dealing with the hurricane, the aftermath of it.
Carol Porter, DNP, RN, FAAN:
So you know that it’s been in a couple of the internal magazines, there’s a lot of information.
T.A. Rosolowski, PhD:
Yes, there is a lot of information. So why—the reason that I wanted to chat with you about it was to kind of first of all, get—because you were a relatively new leader when this came about, and so this was quite an amazing lens through which to see this institution you had just joined, or had relatively recently joined.
Carol Porter, DNP, RN, FAAN:
Right. It was in August, August, 2017, the end of it, the hurricane, and I joined October of 2016. So it was just under a year.
T.A. Rosolowski, PhD:
Yeah, so just under a year. Part of what I wanted to chat with you about was—and of course you brought very substantial experience in emergency management. So here you are, watching an institution go through this huge emergency and respond to an emergency, having just gone through some leadership changes.
Carol Porter, DNP, RN, FAAN:
Sure, sure.
T.A. Rosolowski, PhD:
That’s really the perspective I wanted you to bring, kind of what was it, what did you learn about the institution by observing that process, and then kind of how did you obviously participate very centrally, in stewarding the institution through it. So where would you like to start? I mean, I could ask you specific questions if that would help.
Carol Porter, DNP, RN, FAAN:
Well, I would start when, I think when the hurricane was approaching. I’ve had many—I’ve been through blackouts, 9/11, a direct hit on New York City hurricane, you name it. We had evacuation of a hospital to our hospital, I mean I’ve been through a lot. A nuclear plant, you can go on and on, I’ve got a lot of emergency management background, but I never lived in Texas and I didn’t understand rainfalls here. Now I have a better understanding, almost two years later, that rain is not just rain in Texas, but rain in Houston can be torrential and can flood even though you wouldn’t think it would flood. I believe that my reaction to that hurricane, I guess it was that weekend, when it looked the day before, in the afternoon, it looked like maybe the weather report wasn’t right, because the sum came out. I think that’s what caught a lot of people and was confusing, and then all of a sudden that night, torrential rains in the morning, the streets were flooded. My response was based on my previous emergency management experience, not based on MD Anderson’s policies, to twenty-five years plus emergency management experience in several hospitals, incident command is incident command.
T.A. Rosolowski, PhD:
What were the differences, because I really don’t know what the differences would be.
Carol Porter, DNP, RN, FAAN:
Well, I mean I only experienced one hurricane, but I think it’s not knowing all the rules and regulations around—particular to MD Anderson, I was functioning on kind of a national rules and regulations level. So, when I had them—I called the UTPD [University of Texas Police Department] that morning and said I can’t get in, do you have a high water vehicle, I’m three miles away, and they came out and got me. I went right to the Incident Command Center and again, not everybody knew that about my background, but there were two people in the Incident Command Center and I said, “Okay, you guys can take a break, I’m here,” and they kind of looked at me like yeah? I said, “I have twenty-five years emergency management experience, and I’ve been incident commander in several emergencies in New York City, or always in the Incident Command Center, so I’m good, you guys need some sleep.” So immediately, we started to have about five or six people that were familiar with incident command, that kind of rotated through so that people could get sleep and keep tabs. So I think that it was a fast way to learn all the major players across the hospital, and I think you know, I did question some things that I didn’t understand why we did it. I just really reacted based on my experience, which was fine. I think that there was tremendous teamwork, there was a tremendous focus on, once we got through the emergency two or three days, on how do we allow our people to get home to their families, to take care of their own homes, their own families, and that’s when we started accepting offers for help from outside organizations. So I think that whole piece was different, being able to, you know? A lot of people worked on that, being able to coordinate with four other hospitals and have all their staff credentialed by HR and everything checked and vetted by all of their incident command centers and/or their executive leadership, vetted their staff before they even got to us. And then to bring in four hospital clinical teams, mostly nurses, some doctors, some lab, some pharmacists, was a very concerted effort between nursing, HR, and any mothers, to get them in, make them feel welcome, work with our staff to welcome them, make our staff understand that these people are coming in so you can go home. One thing that I thought was interesting was that our staff are very protective of their patients, our patients, so when they—even though they kind of orientated quickly, this new staff coming in, in the beginning they didn’t want to go home, because they were protecting their own patients. So, we had to work with them to say, as long as you’ve orientated this person, of course we’re going to intermingle MD Anderson with outside staff, but your patients will be safe and we’re going to make sure and we’re going to round, and we’re going to make sure everything is good and everything else. I think it took a couple days before they started to say okay, I’ll go home. So that shows the commitment to MD Anderson, right?
T.A. Rosolowski, PhD:
Yeah, yeah.
Carol Porter, DNP, RN, FAAN:
Then, it was such—I think the biggest thing I was blown away by was that the hospitals that sent staff, within a couple of days, you would not be able to tell who was our staff and who was their staff, because everybody was working together so well. Each hospital sent one or two leadership people with them, most of the time it was nursing leaders who came, one or two nursing leaders, and they stayed while their staff was here and they kind of cared for their staff. And then we bonded with their nursing leaders and then we all looked after everybody. It was an amazing experience that it went so smoothly, that people worked so well together.
T.A. Rosolowski, PhD:
What were the other hospitals that participated in this?
Carol Porter, DNP, RN, FAAN:
It was Northshore, Banner, UT Southwest, and then I believe it was Ohio State. I’d have to check for sure, but it was Ohio State that sent, I believe pharmacists and a couple other disciplines, you know that was the least amount, but the biggest groups came from Banner and Northshore, and they were doing an amazing job at their end, vetting all their staff, getting everything together, we had conference calls with them. It was so—it worked so well. That was a really, really nice thing.
T.A. Rosolowski, PhD:
How amazing. I had a couple of thoughts as you were kind of giving this overview, and the first was that it really surprised me that no one knew about your emergency management experience. How did that happen, that that kind of didn’t come up?
Carol Porter, DNP, RN, FAAN:
Of course a small group knew because they hired me.
T.A. Rosolowski, PhD:
Right.
Carol Porter, DNP, RN, FAAN:
So it would be on my CV. But I’m not in the emergency management role here. Matt Berkheiser knows because of course he would know that I was coming in with emergency management background, he knew.
T.A. Rosolowski, PhD:
He was the one who is tasked with mobilizing the Command Center.
Carol Porter, DNP, RN, FAAN:
He’s in charge of emergency management. Matt and I connected as soon as I came here, because of that common bond. So I started going to the emergency management meetings and everything else, so he knew. Anybody on the emergency management group knew, but when you get outside of that. I think it’s unusual that a CNO has an emergency management background, that’s what’s unusual. I don’t know why but to me, nursing and emergency management are a good fit, but it doesn’t happen often.
T.A. Rosolowski, PhD:
Okay, well that clarifies that, that makes sense. Now, what were some of those—I mean, I don’t want you to speak about anything that might be sensitive obviously, but during that period, in those first days, because the storm made landfall, I think it was the Friday morning?
Carol Porter, DNP, RN, FAAN:
Right, right.
T.A. Rosolowski, PhD:
Or Friday night, and then by Saturday, the rains came to Houston, bang, Sunday things were a mess. So was it Sunday, that you came into the institution?
Carol Porter, DNP, RN, FAAN:
Whatever the day, the morning after the night when it started.
T.A. Rosolowski, PhD:
Yes, that was Sunday morning, you came in. I woke up and looked out my window and somebody was canoeing down my street.
Carol Porter, DNP, RN, FAAN:
Because Saturday afternoon is when the sun came out a little bit, and then probably about eight o’clock Saturday night was when it just came down.
T.A. Rosolowski, PhD:
It just came down completely, right. So in that period, when the Incident Command Center was getting up and running, everybody’s kind of finding out, what were some situations that might have been, you were looking at this and saying huh, what’s this response, and then kind of adjusting how MD Anderson was. You know, like what were these situations that might have made you think two or three times, about what was happening, in response? And here I’m really learning, you know asking you to reflect on what were—what’s the decision making process that MD Anderson was going through and what the rationale was behind that, which may have been different from your experience.
Carol Porter, DNP, RN, FAAN:
Right. Well, I was not familiar with the right out, that kind of methodology, because it’s not used all over. I think it’s used in states that get hurricanes, but many emergencies, you don’t have time to plan. So I guess hurricanes you can plan, but most emergencies you can’t plan. There were a couple of things around that, that I questioned.
T.A. Rosolowski, PhD:
Such as?
Carol Porter, DNP, RN, FAAN:
A lot of HR things, but I mean kind of rules. Again, remember, I was not familiar with all this, right? So I just used basic nursing leadership skills and incident command skills, and reached out to make sure that the people that were in the hospital had come in with clothes and things to stay, because you couldn’t leave. So I guess I was rounding up on the units saying you can’t—there’s no way you can get out of here, because we have a moat around us and we’re in the middle of a lake right now, it’s not safe. So, and then as people were calling in from the outside, I would say, “You can’t get here, you can’t get here,” because it was truly like a lake. So I think making sure—my biggest thing was, and I was part of it, rounding on the staff, looking at—because my experience is during an emergency, especially nurses and doctors, they will not go to sleep. They’ll think that they can work forever, but all the research shows, your decision making is going down and you don’t even know it, you need to get away. And so we were rounding on people and looking at them and saying, “How long have you been working? Did you take your four hours on, four hours off?” Or asking, saying, “Listen, you need to have a break now,” and actually saying Nancy, relieve Carol, Carol is going for break, so that we cannot ask them, just tell them you’re off now for four hours, go take a nap, whatever, and just to make everybody feel safe. The other thing that we did very well, I think, was—and this was our food services. They were feeding everybody, because we had about five hundred plus patients in the hospital, plus visitors, plus staff, all those stats we have, we have tabulated. Everybody was being fed because the visitors couldn’t leave either, right? So they fed everybody on site and all the visitors, and they had three meals a day and everybody got fed. I want to say about the second day into it, Food Service added a fourth meal, so the fourth meal was around eleven o’clock at night, and it wasn’t as big as the three regular meals but it was a meal, and that was a crowd pleaser. I talked to somebody that was in the military about that, and he said that there’s evidence about feeding like that, when people go into battle, that they get extra rations. I don’t know if that’s true or not but that’s what they said. But it just helped people tolerate it and it was such a positive, in a crazy situation, so that was wonderful.
T.A. Rosolowski, PhD:
So did people—were these meals delivered to the individual units or did people take a break and go get them?
Carol Porter, DNP, RN, FAAN:
Both, both. Some were delivered to the units, or some sent people and they brought meals back, or some went to certain pickup points, like the park or different places, to pick up food. There was a big attention focused on providing food and water, and not skimpy, I mean actually very decent, very decent.
T.A. Rosolowski, PhD:
Who made the decision about that fourth meal?
Carol Porter, DNP, RN, FAAN:
It must have been Frank Tortorella, he’s in charge of it. I’m not sure.
T.A. Rosolowski, PhD:
Yeah, interesting.
Carol Porter, DNP, RN, FAAN:
It was wonderful. It doesn’t sound like much but that’s a creature comfort.
T.A. Rosolowski, PhD:
Oh yeah, oh no, to me it makes perfect sense. I mean there’s nothing—you feel cared for, you feel someone is thinking about you, and especially the extra. Somebody thought about me, to give me something more.
Carol Porter, DNP, RN, FAAN:
So if you were at home, you might have made your way to your refrigerator about ten-thirty, you said what’s in there.
T.A. Rosolowski, PhD:
Yeah, exactly.
Carol Porter, DNP, RN, FAAN:
You said what’s in there, but there was no—they couldn’t do that. I thought that was brilliant and it helped make people feel cared for, they did.
T.A. Rosolowski, PhD:
Well and especially if they know they’re going to be up during the night, to say wow, somebody wants me to feel nourished as I’m looking at this.
Carol Porter, DNP, RN, FAAN:
That, and the other thing that was also addressing comfort needs for the staff, is opening up the gym and completely supplying it with towels, washcloths, shampoo, soap and everything else. People would take turns going to the gym, there’s plenty of showers, it was very well equipped, and just using those facilities to take a shower and go back to work, that was another big, big deal. And then of course, when we were able to start sending our own staff home. When, I would say six days, seven days out, we were—people were going home, maybe five days out, I’m not quite sure, but we were at the entrance of the hospital and a nurse came down. Well, I didn’t know whether she was a nurse, but a woman employee came down and she had like a cart with all kinds of personal items on, that she must have brought in when she came in, and she was with a man that was a family member. It was her father and she was a nurse, and she was a relatively new nurse to MD Anderson, and as they were leaving we had—when people were going to try to go home, we had to make sure that their route was accessible. So we were trying to put up maps and making sure that they were able to get back to their home and all that. As they were leaving, I talked to her and I thanked her, and she told me she was a new nurse. I said, “Well thank you so much for helping,” and her father said, “Thank you for letting us.” I mean, that was amazing.
T.A. Rosolowski, PhD:
Yeah.
Carol Porter, DNP, RN, FAAN:
Yeah. Thank you for letting us and thank you for taking care of my daughter.
T.A. Rosolowski, PhD:
Oh, wow.
Carol Porter, DNP, RN, FAAN:
Yeah. So it was a terrible situation that MD Anderson really excelled in.
T.A. Rosolowski, PhD:
What did you learn about the institution as you were going through that process?
Carol Porter, DNP, RN, FAAN:
I knew that MD Anderson has a culture of caring, you can feel it, it’s palpable, but I think that sometimes in emergency situations, the caring part of you doesn’t come out because you’re nervous, and so people could shout orders and things like that, versus working together and coming to agreement and understanding, with the best choices, and then having kind of a structure where a defined incident command group then kind of lets everybody know what the plan is, so that there’s no chaos. So I think what came out over and over again, I’ve heard it from the patients, I heard it from the visitors, was that visitors felt care for, that patients felt cared for, they weren’t afraid. So the fear factor, they weren’t afraid, they knew that we were safe and that the Incident Command Center and everybody that interacted with it, were all respectful and caring, making sure that we were all okay. Everybody was like, “Are you okay, are you okay?” That kind of stuff. But, about two, three o’clock in the morning, it was probably Sunday, going into Monday, where we were it, no one was coming in or out. I was walking down the Skywalk and it was weird, but it felt like a fortress, like you felt safe. It was a safe place, everything was going as best we could, we had no patient events, the staff was being cared for, we had a plan to have these hospitals come and help us and get our staff out. It was just kind of a feeling that we were doing everything possible. I don’t know how to explain that, but it just felt like there was no one out there but me, and it just felt like a very thoughtful moment.
T.A. Rosolowski, PhD:
I had a little bit of a moment like that before the storm hit, because I was here on the Friday and the institution, I mean the library, closed early. I had to be here for lunch and so I was having lunch over near the Apicius Restaurant and somebody was playing the piano and there was all the food smells coming from that restaurant, and everything was so calm and fine, I mean the storm hadn’t even hit yet, but I thought wow, I wish I could just stay here.
Carol Porter, DNP, RN, FAAN:
Right, right.
T.A. Rosolowski, PhD:
It just felt like this was a calm haven, and so it was a little bit of that feeling and it’s hard to put your finger on, how that happens, but I mean that that feeling was even starting. Really interesting.
Carol Porter, DNP, RN, FAAN:
I think anybody that had to ride the storm out felt safe here.
T.A. Rosolowski, PhD:
Yeah, very interesting.
Carol Porter, DNP, RN, FAAN:
Including the patients and visitors. They were being fed along with us, so they felt like part of the ride-out team, they just did. And then even when things were getting a little better and we were rounding in all the different areas of the hospital, maybe four or five days into it, and I can’t remember who I was rounding with at the time, but when we saw people we’d say what’s going on, are you okay, and everywhere we went, they were smiling. The feeling was that everybody knew that everybody was doing everything for everybody, so I thought it was good. I think it was a good response.
T.A. Rosolowski, PhD:
Was there anything that came up during that period, that made you think okay, we need to rethink how we do that? I mean this is a problem, some evidence of a problem has emerged, that we need to address even in our normal operating situations.
Carol Porter, DNP, RN, FAAN:
Right. You always have an after actions meeting, which Matt Berkheiser had several after actions meetings, with several different groups, and then collated all the comments from all the meetings he had, for all the areas that we should tweak or improve or look at. So that all was done immediately, and I’m sure that the list isn’t completely done yet.
T.A. Rosolowski, PhD:
Was there anything that struck you, when you were going through it, like oh yeah, the to do list for after?
Carol Porter, DNP, RN, FAAN:
I think that defining ride on recovery a little better, but they’re working on that, so.
T.A. Rosolowski, PhD:
What was it that kind of came to your attention as needing more clarification or needing better process?
Carol Porter, DNP, RN, FAAN:
I think the understanding of what that means by everybody. Not everybody had a good understanding of what that meant. So I just think a clearer defining of it and more education on it.
T.A. Rosolowski, PhD:
How would you define it?
Carol Porter, DNP, RN, FAAN:
I don’t want to answer that.
T.A. Rosolowski, PhD:
Okay. [laughs] Okay.
Carol Porter, DNP, RN, FAAN:
You know, I have years of not having that, so I’m not the expert in that definition. What I’m an expert at is making sure we have enough caregivers to take care of the patients, whatever you call it. I know we’re working on, we’re still working on that piece of it.
T.A. Rosolowski, PhD:
Are there things in the patient care area, that you felt like okay, yeah, here’s an area? And let me actually—because this will read on the recorder for sure.
Carol Porter, DNP, RN, FAAN:
Sorry, sorry.
T.A. Rosolowski, PhD:
That’s all right, people play with their toys. Is there something in the patient care area that you’re kind of looking at now, or looked at in the aftermath?
Carol Porter, DNP, RN, FAAN:
Well, we had enough supplies, enough food. All that, when a storm is coming, everybody tops their oil and there’s a lot of things that everybody should do, so we didn’t have to worry about that, we had all the supplies we needed, probably for a week or more. Frank and others, once the roads were passable, got supplies in, kept getting more supplies in. So we were okay with that, we didn’t run out of supplies. I can’t say, I mean the—I can’t say anything negative about the care, because we had staffed for what we needed and they were there when the storm hit, so it wasn’t like people couldn’t get in, they were there. They just couldn’t leave.
T.A. Rosolowski, PhD:
Right.
Carol Porter, DNP, RN, FAAN:
So we had our staffing on the inpatient side was fine, and then the ambulatory was just sporadically open, once the roads opened, but they had closed early, which was a good thing. I can’t say that—we didn’t have any patient adverse events, none. I think there was a lot of --communication did a really good job, communicating to the staff, and also constantly having flyers, so that on the trays that they got, they’d have an update, they’d have an update on their TV, of what’s going on, because they could watch the weather, also, this is what MD Anderson is doing. Some of them were hand delivered as the—whoever the nurse leader was on that unit, as they rounded, they gave out the flyer and talked to the patients. Some came on their trays, some can around, handed to them, so there was multiple ways to communicate to the families. Remember, the families were there, they were living there, so they got the information, the patient got the information.
T.A. Rosolowski, PhD:
What was the number of—do you recall numbers of patients and family members that were in?
Carol Porter, DNP, RN, FAAN:
All that is here, yeah. There’s an institutional data, it’s actually probably online.
T.A. Rosolowski, PhD:
Yeah, just curious if you—
Carol Porter, DNP, RN, FAAN:
The number of patients was over five hundred, I just don’t know how many, and I’m sure they’re online. There were many, many presentations done across the organization, that had those stats.
T.A. Rosolowski, PhD:
Yeah, yeah. I was just curious if you happened to—
Carol Porter, DNP, RN, FAAN:
And they’re in the—inside magazines, dedicated to the hurricane, they’re all in there.
T.A. Rosolowski, PhD:
Well we’re at ten o’clock now.
Carol Porter, DNP, RN, FAAN:
Yes
T.A. Rosolowski, PhD:
Do you want to close off for today?
Carol Porter, DNP, RN, FAAN:
Sure, yeah that’s great.
T.A. Rosolowski, PhD:
I’m sure you’ve got more meetings to go to.
Carol Porter, DNP, RN, FAAN:
Yes, yes.
T.A. Rosolowski, PhD:
So, just wanted to thank you.
Carol Porter, DNP, RN, FAAN:
Thank you.
T.A. Rosolowski, PhD:
And we’re closing off our conversation at about two minutes after ten.
Carol Porter, DNP, RN, FAAN:
Great, thank you very much.
T.A. Rosolowski, PhD:
You’re welcome. I wanted to say for the record, that we actually started at about nine eleven this morning.
Carol Porter, DNP, RN, FAAN:
Yes.
T.A. Rosolowski, PhD:
Terrible number. You went through that too.
Carol Porter, DNP, RN, FAAN:
Oh, yes, yes, I did.
T.A. Rosolowski, PhD:
[laughs] All right, on that note—
Recommended Citation
Porter, Carol DNP, RN, FAAN and Rosolowski, Tacey A., "Chapter 08: Observations about Nursing and Hurricane Harvey" (2018). Interview Chapters. 1382.
https://openworks.mdanderson.org/mchv_interviewchapters/1382
Conditions Governing Access
Open
