Chapter 07: The Administration and Growing Support for Nursing Innovations
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Identifier
HilkemeyerR_01_20000523_C07
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; Leadership; On Leadership; MD Anderson Culture; Working Environment; Understanding the Institution; Discovery and Success; Building/Transforming the Institution; MD Anderson Culture; Critical Perspectives on MD Anderson; MD Anderson Impact; MD Anderson Impact
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
Louis J. Marchiafava, PhD:
You mentioned earlier about the bureaucracy. Was it a complex organization in which you had to deal with everyone? Did you have to deal with more than Dr. [R. Lee] Clark?
Renilda Hilkemeyer, RN, BS, Dr.P.H.:
Part of the problem with the system was Dr. [R. Lee] Clark was the head. We had a business manager who was Joe Boyd. We had "a Division of Patient Care" which had an associate administrator and a couple of administrators -half of them wet behind the ears yet, just barely out of school. And those people were the ones that, technically speaking, I was supposed to report to. And I would report until I got tired of it. Then, I just jumped the fence and would go see Mr. [Joe] Boyd and get what I needed to get taken care of. But all the other people were in the same boat, like the Pharmacy and the Dietary Department and Housekeeping and all these people, were under the division of patient care. Everybody and their uncle was under the Division of Patient Care because that is the way the system was. Some days, I drove myself crazy trying to get something taken care of. Simple things. We were ages and ages getting such things as disposable needles and disposable syringes, and Housekeeping cleaning up after their own mess, and taking care of their own rooms and stuff like that. They wouldn't budge. And then, I would get to the point where I would just get mad and I would hit somebody until I could find somebody sometimes that needed to get it done. Now, they won't admit it but that is exactly the way the place ran. And you mentioned Art [Arthur] Kleifgen's name and they will all know who he is. He came with Dr. [R. Lee] Clark when Dr. Clark came here, and that was his boy.
Louis J. Marchiafava, PhD:
So, he caused you some grief?
Renilda Hilkemeyer, RN, BS, Dr.P.H.:
Yes, he did, and I would tell him so. I would tell him. And some days, I would get mad and I would just say, "Well, I am going down to see Mr. [Joe] Boyd," and he would say, "Well, you'd better not," and I would say, "I am already halfway there." I really did. And the same way with my staffing.
I knew how to justify a budget. I never had to do anything to that extent because the budgets here had to go to the state legislature, too, for funding, and everybody had to do their budget, and justify the things that you needed. Well, I could sit there for hours and do what I thought needed in equipment. He would go right around and get what he thought we ought to have, that kind of thing. And it was the same way in the other departments that worked under that system. But they weren't going to change the system, so I just got to the point where I just evaded the system. Period.
We had a system on call after five o'clock at night for the administrative people and nursing. And I always had a supervisor in the house, but we had on call people, too. And the supervisors would say to me, "I am not going to call and ask him anything anymore. He doesn't help me. He doesn't do a thing." I said, "You do what you think is best and you tell me tomorrow morning and I'll take care of it. I am not going to have you hassle with anybody just to get somebody taken care of." But it was interesting. Really. It wasn't interesting lots of days but . . .
Louis J. Marchiafava, PhD:
Was there a turning point that you could see? I don't mean one that changed overnight but was there a time that you could sort of pinpoint where bureaucracy began to change its attitude toward what you were doing?
Renilda Hilkemeyer, RN, BS, Dr.P.H.:
Well, see, I had a couple of things going for me. I was on all these national committees and most of the people weren't. And I was on them like crazy. And so, I would say to them, what are you putting me on this for? And the stock response I always got was, you are clinically sound in oncology nursing and you are not afraid to speak up. And that was about the truth. I wasn't afraid to speak up and if it took speaking up, I spoke up. But anyway, I think the other thing ... we had a very good Department of Nursing. We had an excellent Department of Nursing. And it was known for that all over the USA and outside the USA. And I am not bragging. It is the truth. And anybody will tell you that. I had a lot of contacts and if I wanted to find out something, if I wanted to get something, I could get it done one way or the other. I just didn't worry about it.
It is just like some of the physicians. When I first started, we were trying to do the laminar flow area, and Dr. [Gerald] Bodey and his crew came down from NCI and they wanted to start working with the laminar flow and the sterile environment and all this stuff. So, Dr. Bodey came down to see me and he said, "Can you help me?" And I said, "Well, if I know what it is we are going to do, I suspect we can help you." So, I got about four of us in Nursing, and he had some other people in Pharmacy and people from the lab and whatnot and we started working with mock-up areas and things of that type. And I said to him, "Are you really going to get this going?" and he said, "Yes." I always enjoyed new things because you had enough of the stat stuff every day, every day, every day. Like chemo. It was a Godsend when we got the chemo. We worked that out. We worked that to portable pumps. We worked that to this, that and the other thing --long line catheters. Everyone that was a nursing project, we would get some doctor that could work with the people to get those new things started. And then, we would have to teach everybody. Well, that was fine, we could do that. That wasn't any problem.
But anyway, I ran into Dr. Bodey in the garage a couple of weeks ago and I said, "I am going to go over to San Antonio and talk to this outfit of nurses on what it was like in the 1950s and the 1970s(60s?) around here. Do you have any ideas?" He said, "Yes, Ms. Hilkemeyer." He always had a twang sort of when he was talking. He said, "Tell them they ought to have been around when we had carbenicillin, and it came in 1 cc vials and we had to add another cc to it and we took 12 vials for one dose. We almost all went crazy, didn't we?" And I said, "Yes, we almost did and you are the one that got us almost crazy with it, too." So then he said, "And the other thing you can do --you can just tell them if it wasn't for you, I never would have gotten my laminar flow rooms, because you worked so hard and you had the nurses helping. You got the space for us and you showed us how." And we did, we had excellent data. I didn't know anything about research in those days, research like they call it now. We were just doing clinical stuff every day and every day.
And so, one morning, I was talking to him and I said, "Are you going to ask for money for this project?" And he said, "Yes, I am going to write a grant." I said, "Well, I'll tell you what. I want you to let me put a nursing section in your grant. It is going to NCI-competitive bid?" And he said, "Yes." I said, "There is no way that I have enough money in my budget to get enough nursing help to get your project even started, or much less continue it." Well, I wrote it, and I didn't know what I was writing because there was nothing out there. Nobody knew anything about it. So I sat down and I figured it out. I said O.K., if it takes you X amount of staff to do a regular bed, how much is it going to take to do a bed like this, three times, plus Central Supply, plus this, plus that? So, I put the grant in and would you believe, I got everything I asked for? Including a whale of a lot of supplies and equipment for Central Supply and a whole new gas sterilizer and a whole new supply department because everything had to be sterile and you could only use it once.
Louis J. Marchiafava, PhD:
A gas sterilizer?
RH:
Yes, because we couldn’t put in a lot of the stuff in other sterilizers it had to go through gas. And so we got to prioritize, role everything in, and get it done like that. And the central supply supervisor. It was a very good project. We had a lot of good things like that.
Another one of the fellows came and he said, "I don't know whether I ought to talk to you or not." I said, "What is the problem?" He said, "Well, two of the fellows tell me I should talk with you about what I want to do and two of them tell me l'd better just stay away from her!" Well, he wanted to do a project with the intravenous hyper-alimentation fluid program for the patients. And so, I said, "Well, what are we going to do?" So, he sat there. I would sit down and write their job descriptions, and I would say, O.K., what part of this is medical? The medical, you would have to be responsible for. The nursing, I will be responsible for. They will be in my department and we will work it that way. And that is how we did it. And it really worked. And I got money just about every time I wrote. I got over $600,000 the time I was here. I found my sheets last week or so for projects and contracts and stuff like that that I had gotten. So anyway, we did a lot of good work and I was very proud of the stuff. And I really tried when I could to try to help them as best I could.
When I was complaining about our pumps and we were working with the company out in California. I went by her section in the clinic and she said, "This is that new pump. It is not worth a darn. They bust and this, this, and this." She was fussing up a storm. So, I called the doctor who was working with the company out there and I said, "We'd better do something about these pumps. The nurses don't like them in that clinic." so, he said, "I will call them. I will get back to you." They called me and said, "They want you to come out and meet with their engineers out in their company to see what we need to do to change the pump situation." So, I went by the clinic and I said, "Go get your suitcase packed. We are going to California in the morning." "We are doing what?" I said, "We are going to California in the morning. We are going out to see the Alza people." And she said, "You've got to be kidding." I said, "I am not kidding at all." "What am I going for?" I said, "You are the one working with the pump. I am just going to pump you up a little bit and take your part and see that we get taken care of what it was we need taken care of." And we did. We got taken care of. We came back with a new bottle. So, we did a lot of trial and error, but everything I think that we tried to do ... I know, in Nursing, we tried to get better care for the patients because that is what it was.
The other thing, we've got these units out here, our triangular nursing units. That was my idea. When we did the Lutheran Hospital in 1975. And we got ready.
Dr. [R. Lee] Clark hired a group of people from California to do the planning for us at that one. They came with the Chief of Material and they said, "We want you to take it for your department, fill it out, give us the questions back and give us the answers. Then, we will start working with you." Well, I took it seriously because we had a lot of things we wanted to change in the nursing area. And we had a firm that had done all of our building around here early. And when I said I wasn't taking any more long hauls and any more dead end hauls . . . I was having triangular ones and I was having totally open units so we could see the patients and the patients would see us. He said, "That can't be done."
Renilda Hilkemeyer, RN, BS, Dr.P.H.:
I don't know what I was trying to tell you. So, Dr. [R. Lee] Clark said, "Hilke has told you two or three times that is how she wants it done so let's do it," and we made it. And, in addition to that, we did a mock-up room so that we could work in the room and have physicians, nurses, anybody that needed to do anything for the patient also available to try it out before we actually decided on the final room. So, that was another great big project and it really did payoff.
Recommended Citation
Hilkemeyer, Renilda RN, BS, Dr.P.H. and Marchiafava, Louis J. PhD, "Chapter 07: The Administration and Growing Support for Nursing Innovations" (2000). Interview Chapters. 1601.
https://openworks.mdanderson.org/mchv_interviewchapters/1601
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