Chapter 06: Nurses Delivering Chemotherapy—A Radical Idea
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Identifier
HilkemeyerR_01_20000523_C06
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; Discovery and Success; Building/Transforming the Institution; MD Anderson Culture; Professional Practice; The Professional at Work; MD Anderson Impact; MD Anderson Impact; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care
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
Renilda Hilkemeyer, RN, BS, Dr.P.H.:
Chemotherapy. I used this example in my talk the other day. Chemotherapy, by law, was medical practice. Just like IV therapy was medical practice. Nurses were not permitted to do it. And I had already set up a system at M. D. Anderson when I got here that if we had something that was medical practice and we wanted to get the nurses to do it, then I had the guidelines already written out. And that was, we would see what the new job was, we would see what it would entail, how much education had to be done, who was going to do the education, how much practice you had to have before you got approved that you could do it. So, we were doing chemotherapy. Well, chemotherapy was given by, in the early days, the nurse could, at that point, and we taught all of our nurses who came on the staff who did not know how to do IV therapy, we taught them. We used one section in the clinic where we had a lot of IV therapy and that is where we sent them to be taught. And they had to stay until the supervisor head nurse over there said that they were qualified and they were passed. And then, we documented it in their record because not only was I concerned about the medical practice, but in Texas, the Practice Acts for nursing were so poor that I was concerned that we could get in trouble if we weren't careful. So, we were down a lot and we weren't going to have that happen.
So, anyway, we decided with the chemotherapy, the nurse would start the IV. He would have to mix, or she could mix up the drug, and then he would come along and stick it in the tubing, give the drug. And then, that was it. That was the end of the process. Well, what it evolved into, if he decided he was going to see six patients and 10 charts, some poor old soul would be sitting there for two hours waiting to get their IV therapy, and I thought that was stupid. Well, it was stupid. So anyway, I had these nurse friends of mine that were in cancer at Memorial Sloan Kettering, Roswell Park and the National Cancer Institute, and the [NIH] Clinical Center --about four or five of them. And the HCS nurse. And if I was going to do something that I wasn't sure which end was up, I would call to see what they were doing. And if some of them were doing it or thinking about it, I would think, well then, probably I am not way out in left field. But what I said to these people that day at the meeting was, I called four of my good friends and said I am about ready to have the nurses start giving chemotherapy. And they asked me what moon I got off of! You must be out in left field for sure today. And they weren't kidding either. And she said, "Do you mean to tell me you are actually thinking about it?" I said, "Not only thinking about it. Probably going to be doing it before another week is up."
So then, I wrote a proposal to the Executive committee because that was medical practice, and said, we are going to consider having the nurses do chemotherapy, investigational drugs, under the following circumstances: 1) all drugs will have to be stored in the pharmacy. Not any more in the doctor's office or wherever he decides that he was going to stick them --in his desk drawer; 2) they could be issued out only upon written order of the principal investigator; and 3) we had to have adequate information on the floor that would tell you the drug and the dose and the side effects and anything else you needed to know about it. And then, the nurse could give it. And then, I had decided we had fiddled around long enough trying to get the chemotherapy taken out of the nurses into the pharmacy. And in addition to that, then they had to start to mix all the drugs in the pharmacy and take care of it. But we passed it. And, of course, we hardly got it under our belt that we were doing it until everybody in the country wanted to come down and see what we were doing with chemotherapy. What nurses are doing with chemotherapy. They kidded me the other day, they said, "And you really did that?" I said, "Yes, ma'am, I really did it. Frankly, I was tired of the poor patient sitting there waiting for some doctor at his convenience to come and shoot them when the nurse had as much sense to shoot that drug as he did." And that is exactly what we did. So, I always, if it was medical practice, wrote the recommendations, sent them to the Executive committee [of the Medical Staff], asked to go to the Executive committee to discuss it and get the approval from the Executive Committee, because that took care of the medical practice angle.
Recommended Citation
Hilkemeyer, Renilda RN, BS, Dr.P.H. and Marchiafava, Louis J. PhD, "Chapter 06: Nurses Delivering Chemotherapy—A Radical Idea" (2000). Interview Chapters. 1600.
https://openworks.mdanderson.org/mchv_interviewchapters/1600
Conditions Governing Access
Open
