Chapter 05: Organizing Oncology Nursing at MD Anderson

Chapter 05: Organizing Oncology Nursing at MD Anderson

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Identifier

HilkemeyerR_01_20000523_C05

Publication Date

5-23-2000

Publisher

The Historical Resources Center, Research Medical Library, The University of Texas Cancer Center

City

Houston, Texas

Keywords

Building the Institution; Building/Transforming the Institution; MD Anderson Culture; Professional Practice; The Professional at Work; MD Anderson History; MD Anderson Snapshot; MD Anderson Culture; Professional Practice; The Professional at Work; Gender, Race, Ethnicity, Religion

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

Renilda Hilkemeyer, RN, BS, Dr.P.H.:

So, Surgery service had X number of beds, Radiotherapy had X number of beds, Gynecology had X number of beds, and so forth and so on. And they were allocated by the unit areas. And so, in order for them to have their patients .... and they were responsible for their own beds for keeping them filled with their own patients, in a sense, because then, the Admission people knew that they could admit so many to this service, so many to that service, and so many to another service. And one of the other things that happened was the same principle. I don't know whether they thought I was stupid lots of days but they tried anyway, but when we got finished with the old hospital, the Southern Pacific, we made a rehab center out of it because we didn't have any rehab and we had, at that point, a physician who was in charge of rehab. And he very much wanted to do rehab. But it was also a good way for us to be able to get people that had to learn to take care of themselves right out of the hospital ward and get them somewhere else where they had more places to go.

So, I made a proposal that what we do is get us a triage nurse. And the triage nurse would see everybody before they went to the rehab center. And we made ourselves a document of how you would determine whether they were suitable candidates for the rehab place or not. And I presented that as a paper in one of the national conferences, and it got a lot of publicity because people had never thought about that. And we did such things as could you take care of yourself? Could you suck your own trach? Could you do your own tube feeding, for example. Could you do your own dressing? Some of it was very simple, but it made the difference between did I need staff to take care of it or didn't I need staff to take care of it? And so, we did that.

And so, every once in a while, what would happen --the physicians would decide that they needed another bed at five o'clock in the afternoon. So, they would hurry up and decide they would send somebody to rehab, and they would give them a bed on the floor. I said, "No way. You don't get anybody in rehab unless my nurse OK's it and she is not going to OK it at five o'clock in the afternoon." Well, that hit Dr. [R. Lee] Clark. He had to take care of that one finally, because it was a hoopla. But it worked. And I think when they found out I wasn't kidding about it and that that was the way we were going to do it, that was the only. . . I could always get Dr. [R. Lee] Clark by saying, "This is going to be the best way to handle the patients."

Just [as] he was getting ready for the legislature to come. And they had been in this place one year and they didn't have anything hardly open. They had one or two wards that they had a few beds open in. So, he called me and he said, "I need to talk to you. They are coming. I really would like to show them that we have got some space to take care of patients. What can you do?" I said, "I'll tell you tomorrow morning what I can do. You give me three wards and I will have those wards full. But you are not going to have patients that need a lot of care. These are going to be primarily self-care. They don't know the difference, whether they are self-care or other kind of care." And that is how we did it. And so, we just added on and said, these wards are open and we have patients up here. You can come through and look. We've got black ones and white ones. Just as if we didn't have good sense. But it worked. And I guess the thing that I was always having to fight about, call it a fight or whatever it was, was to try to get patients taken care of in spite of the sometimes bureaucracy or some of that stuff that was going on. Or heckling with the medical staff over something. And if I said I was going to do it that way, I was going to do it that way. And my staff were going to do it that way. I wasn't going to let them down either, if I bought them in and said we were going to try to handle it this way. And we did.

We could do a lot of things because I had enough good people. I said in the meeting the other day when I was there, I said, "Well, as a matter of fact, when I went to M. D. Anderson, I knew more than the nurses down there did because I had been teaching this stuff for six years," and I did know more. They didn't know what to do with half the patients that they had. And so, we hurried up and started the same thing. I set up committees, got policies written, got procedures written, set up educational programs. Everybody had to have orientation. Everybody got continuing education. Everybody got in service education from aides to this and this. And we brought our people along. And then, when the students came, we did the same with the students. And so, we were able to actually take the people that we had and use them very well, because we could plan the way we wanted to do things. And if I had something that was going to involve a lot, didn’t bother Dr. [R. Lee] Clark for little piddly stuff. I didn't. But if I needed him for something, I got him, believe you me, and he would listen.

Louis J. Marchiafava, PhD:

Was there any point where he was reluctant to go along with you?

Renilda Hilkemeyer, RN, BS, Dr.P.H.:

If you could convince him that this was better for the patient, he would go along with you

Louis J. Marchiafava, PhD:

So, he always took your side?

Renilda Hilkemeyer, RN, BS, Dr.P.H.:

I don't want to say took my side, but he had enough vision that he could see that what you were trying to do was going to be better.

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Chapter 05: Organizing Oncology Nursing at MD Anderson

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