Chapter 05: Nursing in the Department of Developmental Therapeutics
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Description
In this chapter, Dr. Ecung provides a portrait of her work in the Department of Developmental Therapeutics when she returned to MD Anderson in 1978. She explains the physical organization of the clinic (Station 16). She discusses how she reorganized patients by disease type and assigned specific nurses to each disease type to deepen their knowledge so they might be more effective working with faculty and teaching patients about their diseases. She talks about the impact –notably in the retention of nurses.
Next, Dr. Ecung talks about the working relationships between research nurses and clinical nurses in Developmental Therapeutics.
Identifier
EcungWB_C05
Publication Date
9-21-2016
City
Houston, Texas
Interview Session
Wenonah Ecung, PhD, Oral History Interview, September 21, 2016
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; The Leader; MD Anderson Culture; Working Environment; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Discovery and Success
Transcript
Tacey Ann Rosolowski, PhD :
Okay, yeah. Okay, just wanted to get the dates right. Okay. So tell me more, I thought it was really, really interesting that when you mentioned the people you were working with, when you came back. Pretty amazing group. And getting this inside view of Developmental Therapeutics, which was just a pretty amazing place, from what I gather. So tell me about that. You came in, you reorganized things. Why was it in disarray? What were the challenges that you helped them sort out?
Wenonah Ecung, PhD:
Well, they hadn't had a leader in the area for at least the four months I was there. And I think it was several months before [I arrived]. They hadn't been able to recruit anybody there. Developmental Therapeutics at that time wasthe environment was challenging, and it was an open area. It was basically, you were working two hallways. And at the end of one hallway was the library. So you had traffic transversing through the hall that didn't have anything to do with what was going on in the center. So it was an open environment. That added complexity to it. I don't know who theyto this day, I don't know who had led the area prior to [me], but apparently they hadn't been able to get anyone to agree to take an interest in the area. That probably had to do with Developmental Therapeutics at that time. It really meant it was a hodgepodge of diseases. I had Leukemia there, I had General Oncology there, I had Head and Neck there. I had Sarcoma there. So it was just a hodgepodge of diseases which, again, adds a whole other area of complexity; not just learning the disease, but learning the faculty that work with that disease, their preferences, the patients there. But I was able to build an effective team. So one of the first things, when I went there, one of the things that we were doing, this moment you might work with a leukemia patient, and the next moment you might work with a sarcoma patient. And I just thought, this is craziness. There's no wayand again, this is where I said if a physician can specialize in a discipline, why can't we as nurses do that and build our knowledge base? That was one of the first things I did. I organized them into disciplines. I put all of leukemia together. I placed all of General Oncology together. I placed all of head and neck together on a separate hallway. I placed the Sarcoma Group together. Then I assigned my nurses to become onea nurse in that area. So she didn't have to cross, within that same day, within two minutes later, to another area. You could develop deep knowledge in the area. You did have to cross-cover each other, but it would be for whole days at a time. But you knew you had a primary assignment, and that's where your knowledge base could become deep. That's where you could begin to build the relationship with the faculty. Robert Benjamin with Sarcomayou could begin to learn his preferences, learn about the different treatments for the patients. Really begin to dive into teaching the patients about their disease, and how the Sarcoma physicians are going to treat them. You could develop relationships. And I believe to this day that's pretty much the crux of what nursing and medicine needs to be, that true support for each other. But that was the primary way that I organized it, and began to hold onto nurses. It actually became one of the places that people wanted to get into.
Tacey Ann Rosolowski, PhD :
I was going to ask you
Wenonah Ecung, PhD:
It built tenure.
Tacey Ann Rosolowski, PhD :
Yeah, yeah. Obviously that's key, you make a huge investment in nurses.
Wenonah Ecung, PhD:
Right. Right. And then for our patients.
Tacey Ann Rosolowski, PhD :
Yeah.
Wenonah Ecung, PhD:
And you get to come back, and you know Wenonah'sor you call and you know it's Wenonah you're going to talk to.
Tacey Ann Rosolowski, PhD :
Right. Right. Now, how did your patients intersect with the clinical trials that were ongoing in Developmental Therapeutics, because obviously that was a real crucible of that kind of research activity.
Wenonah Ecung, PhD:
Mm-hmm. Mm-hmm. So we had patients on phase I, phase II, and phase III. [ ]So phase I, phase II were the clinical trials. And moving from bench to patient, determining what side effects were going to be experienced. So I don't really know what else to say other than we had patients on all three phases at that time. Not the same patient, but different patients.
Tacey Ann Rosolowski, PhD :
Did that becomeI was wondering if it became a challenge, that there were a lot of different protocols? How did you manage all of that?
Wenonah Ecung, PhD:
No, we always had Research Nurses that we worked with. So I guess that was different for me in Developmental Therapeutics. Now when you had your Clinic Nurse, and you also had a separate Research Nurse that saw the patient, and the Research Nurse was the ones that really managed the trials, which would sign them up for the clinical trial. The clinical nurse would do the teaching, in terms of the drugs that were going to be received, and what they needed to look out for. But it was a Research Nurse that would sign them [up]. So there were a couple of handoffs that, later in my career, I was able to minimize.
Tacey Ann Rosolowski, PhD :
I was curious, how these different groupings of nurses began to create a perhaps unique, I don't know, culture of nursing at MD Anderson. Is there something different about this environment, where there are Research Nurses and clinical nurses who are specializing?
Wenonah Ecung, PhD:
Mm-hmm. Mm-hmm.
Tacey Ann Rosolowski, PhD :
Talk to me about that a bit.
Wenonah Ecung, PhD:
The culturewhen you talk about the culture of nursing at MD Anderson, I know Dr. Summers kind of ended up with that phrase. But I think it startedwe didn't call it that, I guess. But it started even long before then. And I don't know if it was the culture of nursing, or whether it was the culture of care. That partnership betweenas a nurse, developing a true understanding of sarcoma, deep knowledge in that area of the different diseases created a path for you to pretty much become the protégé for the physician. [ ] We did have fellows. But fellows would come and go. At the end of theireach July we'd get new fellows. The constant was the nurse. My philosophy was, if we can become their protégé, we are the ones that they depend on. We are the ones that they literally [ ] teach everything, to recognizing we're going to be the ones [that are] taking care of their patients. Their patients are going to be calling us. We are going to be their eyes and ears, even though we're not inpatient. We're still on the ground. It created that culture of care and trust between nursing and faculty.
Tacey Ann Rosolowski, PhD :
I've never heard anybody use that phrase before, the nurse is the "protégé of the physician." I mean, that implies something really strong.
Wenonah Ecung, PhD:
Mm-hmm.
Tacey Ann Rosolowski, PhD :
Now, what did that look like for you?
Wenonah Ecung, PhD:
We were ablethose trusting relationships resulted in, I think, us becoming really good partners with the physicians. So at that point in time, my nurses, there was nothing that they would say no to in terms of doing. They not only developed a knowledge of the drug and could teach it to the patient, they developed [in depth] knowledge. Again, this is through that close relationship with the faculty. They really came to understand, this is how you calculate the dose that's going to be given to the patient. So if X physician is writing all of these orders, my job as a nurse, because we didn't have pharmacists right next to us, part of my job as a nurse was to make sure my patient was getting an accurate dose of whatever drug we're getting ready to give. So they learned to calculate the BSAs, and the dosages of the drugs based upon that, and be a second check, if you will, for the physician. You can imagine if you're the physician, and I'm coming to you with, "I don't think this dose is quite correct, and here's what my thoughts are." You come to realize yes, you've made an errorthere's immediate trust developed there. I haven't attacked. I've presented it in such a way that we make the correction. Now you know in these stressful days, because we're all human, there's somebody else checking behind you to make sure you calculated the dose the way you want it to be calculated. I think we were one of theI know we were one of the few clinics doing that. I was one of the few nurse leaders that embraced that. Many others saw it as being handmaidens to the physicians. I did not see it that way, because the end product was going to impact the patient. That's why I saw it as protégé. []
Tacey Ann Rosolowski, PhD :
Yeah, I was going to ask about kind of that philosophical difference.
Wenonah Ecung, PhD:
Mm-hmm?
Tacey Ann Rosolowski, PhD :
Because as you were talking, I was recalling some of what Barbara Summers said, this importance of visualizing the nurses in autonomous field of activity. It's not that you're saying that they're not
Wenonah Ecung, PhD:
Exactly.
Tacey Ann Rosolowski, PhD :
But it's
Wenonah Ecung, PhD:
But there is some codependence, or interdependence there.
Tacey Ann Rosolowski, PhD :
That's a kind of a different way of thinking about that.
Wenonah Ecung, PhD:
Mm-hmm.
Tacey Ann Rosolowski, PhD :
Now, I'm curious, when you started to work with this system of calculating dose and double-checking and all that, you talked about that example of the right way to communicate about that. Was that some teaching that you did with your nurses? How do you present this information? Was that part of it? Or did people already know how to do that correctly?
Wenonah Ecung, PhD:
No, I'm sure they didn't already know. But not only was I leading this area, I was out there working the area. So a part of my philosophy has always been to role model how you want this done. Model the way, if you will. So they understood that our goal was to support the patient and the physician. There was a pretty strenuous interview process to get into Developmental Therapeutics with me. It wasn't just interviewing with me, it was interviewing with a panel of nurses that worked in the area. We had all come to share the same philosophy, and as you can imagine, part of that was garnered throughyou tend to choose people that are like you. So those were the folks that entered intoactually, it was called Developmental Therapeutics, or Station 16 at that time.
Tacey Ann Rosolowski, PhD :
So what were some of the things you were looking for as you were interviewing for nurses there?
Wenonah Ecung, PhD:
Someone that was open to partnering with physicians, that didn't feel this burden of being a handmaiden, if you will. Someone that was truly centered around the patient, recognizing everything we did, whatever the outcome was, they were the ones that were going to be impacted. So we needed to do everything upstream as much as possible to make sure that that outcome was what we wanted it to look like. Someone that was keen on working with othersI wasn't looking for long-rangers. Folks that truly wanted to be autonomous. I wanted somebody that really valued the concept of a team, because it was important to me if one area was busy and your area was quiet, I didn't need to go and prompt you to go and help out Tacey. You just went because you saw Tacey needed help. So those were some of the characteristics that we looked for.
Tacey Ann Rosolowski, PhD :
Now at this time, I mean, multidisciplinary work has always been part of MD Anderson. But as I
Wenonah Ecung, PhD:
But the words weren't there.
Tacey Ann Rosolowski, PhD :
The words weren't there. And also, it seems that there were some areas that were doing it more aggressively than others. And obviously, Developmental Therapeutics was one of the areas
Wenonah Ecung, PhD:
Was. Mm-hmm.
Tacey Ann Rosolowski, PhD :
that was doing it very aggressively. So how did that add something to this work you were doing?
Wenonah Ecung, PhD:
Well, I think I mentioned, one, that it was an open environment. So when I reorganized itso with an open environment, you could easily have a head-neck physician next to a Sarcoma physician next to a leukemia physician. Well, that wasn't an ideal setting to host a conversation around, maybe, a leukemia patient. So one of the first things I did in organizing, like I said, was put disciplines together. That started chatter amongst themselves right there. [Dr. Hagop] Kantarjian could turn to McCredie or Michael Keating and speak about his patient with other leukemia experts. Sarcoma experts could turn to each other and speak. I also had a conference room, identified a conference room that they could gather in. We didn't hold meetings in there, this was early on in the process. But it was a physician conference room where they could gather. That didn't mean that nurses couldn't go into it, they certainly could. But it was sort of their own little watering hole that they could go in and hold professional conversations with each other. So I think doing some of those things helped foster that type of environment.
Tacey Ann Rosolowski, PhD :
Now, you were in the position of head nurse from 1980 to 1987, yeah. And that seems like you had segued from 1979, 1980, you were the Nurse Clinician II, and then you kind of segued into this, doing more of the same?
Wenonah Ecung, PhD:
No. What do you mean by, "more of the same?"
Tacey Ann Rosolowski, PhD :
Well, I mean, there was a physicianI can't remember his namewho said if you wanted to apply for the
Wenonah Ecung, PhD:
Oh, Dr. Burgess.
Tacey Ann Rosolowski, PhD :
Dr. Burgess. So how did your role change, then, when you shifted from Head Nurse to Nurse Manager? Or, I'm sorry, from Nurse Clinician II to Head Nurse?
Wenonah Ecung, PhD:
Well, what we'd beenI only functionedwell, Nurse Clinician II was on the inpatient side.
Tacey Ann Rosolowski, PhD :
Okay. Oh, okay. Okay. Okay.
Wenonah Ecung, PhD:
Yeah, that was on the inpatient side.
Tacey Ann Rosolowski, PhD :
Okay. So, well, let me ask this question a little differently.
Wenonah Ecung, PhD:
Okay.
Tacey Ann Rosolowski, PhD :
When you were serving as Head Nurse, I mean, that was for a seven-year period, what did you feel
Wenonah Ecung, PhD:
Probably, I guess.
Tacey Ann Rosolowski, PhD :
What did you feel you had accomplished during that time?
Wenonah Ecung, PhD:
Well, I had brought stability to an area that had experienced turmoil. I had built relationships between nurses and physicians. I had developedI had created an area that nurses wanted to come into, as opposed to running from. And I think in terms of the patient, they were experiencing far greater satisfaction in what was being delivered to them, because now I had a host of not just knowledgeable physicians, but knowledgeable nurses about the diseases.
Tacey Ann Rosolowski, PhD :
What did that period of time do for you as a nurse, as a leader?
Wenonah Ecung, PhD:
Well, I had a whole lot going on with me during that period. I was getting married, I was having my first kid. So
Tacey Ann Rosolowski, PhD :
Your name of your husband?
Wenonah Ecung, PhD:
At that time, Burnett Nelson.
Tacey Ann Rosolowski, PhD :
And your children?
Wenonah Ecung, PhD:
Blair and Britt Nelson. Blair Elizabeth and Britt Elyse. I'll never forget Dr. McCredie, who was world-renowned in leukemia. I had no idea his name was Kenneth Blair McCredie. And when I had Blair and named her Blair, he went back. He sent flowers and he went backthis was just the competitive spirit of all the guys that were therehe went back and told everybody I had named the kid after him. (laughter) And so I had to explain why I hadn't named her Michaela after Michael Keating, orI mean, it was just funny. But I had not just developed a nursing staff that had partnered with faculty. It was the beginning of my MD Anderson family, if you will.
Tacey Ann Rosolowski, PhD :
Did your first husband work at MD Anderson?
Wenonah Ecung, PhD:
No. No.
Tacey Ann Rosolowski, PhD :
Okay. Okay. What year were you married?
Wenonah Ecung, PhD:
Nineteen eighty-one.
Tacey Ann Rosolowski, PhD :
Okay.
Wenonah Ecung, PhD:
And we divorced in 1998.
Tacey Ann Rosolowski, PhD :
Fun, fun!
Wenonah Ecung, PhD:
Mm-hmm. And my mother died in 1998.
Tacey Ann Rosolowski, PhD :
I'm sorry?
Wenonah Ecung, PhD:
I said and my mother died in 1998.
Tacey Ann Rosolowski, PhD :
Oh, wow.
Wenonah Ecung, PhD:
It was a tumultuous time for me.
Tacey Ann Rosolowski, PhD :
Wow. Yeah. Oh, dear. So tell me how you transitionedor, maybe I'll ask actually another question. You were with Developmental Therapeutics for that seven-year period and brought some stability. I mean, Developmental Therapeutics, from what I am gathering, always had a kind of odd reputation, if you will, within MD Anderson. What were some of your observations you made about that at the time?
Wenonah Ecung, PhD:
Other than the fact they were all extremely strong egos?
Tacey Ann Rosolowski, PhD :
Mm-hmm.
Wenonah Ecung, PhD:
Yeah. They were pioneers in the field. We had Jordan Gutterman there, and like I said, Evan Hersh on the Immunology side. We had JP Hester, which was one of the few females on the leukemia side who specialized in apheresis, removing cells, who really was a pathfinder in that area. You had just huge, hugeand rightfully soegos all working together. Yeah.
Tacey Ann Rosolowski, PhD :
It sounds like you found it really stimulating.
Wenonah Ecung, PhD:
Probably. (laughter) It was a different time. A physicianI mean, now we have, and we should, and I applaud that we do, cordial environments. But back then, if a physician got angry, he'd pick up the phone and he'd throw it at you. Or he'd take the desk and throw it off of the wall. So you had to be strong enough to recognize, this isn't being directed at me personally. But, dear buddy, you don't get to behave this way. And handle it. So I had situations like that, too. I had to get over these are very hefty egos, and recognize bottom line, though, they are still people. And we are all people deserving of respect. I think that's one of the things I became known for was, you did not mistreat my nursing staff. You could pull me in and scream at me all you want to, but you did not scream or mistreat my nursing staff.
Tacey Ann Rosolowski, PhD :
What were somewhat issues would come up that would create that kind of inflamed response? I mean, just in an evaluative sort of way?
Wenonah Ecung, PhD:
Right. Oh, it could be bloodwork had been ordered on a patient and the results hadn't come back in the amount of time that that physician felt they should have come back. It could be justI can remember walking, I can remember being reasonably new and walking up to Dr. McCredie and saying, so-and-so, a patient is here, and needs a prescription for X, and him puffing up and saying, "Do you know who I am? How dare you walk up to me and tell me a patient needs a prescription!" Or, Eli Estey maybe being upset when he arrived in the clinic; who knows what went on in the lab, or wherever he was coming from, or what he was dealing with. And maybe one of his patients wasn't doing well. And just exploding. And like I said, taking the phone and pulling it out of the wall and throwing it at the nurse. So I don't always know what would trigger it. I do know the behavior was never appropriate. And that's what we had to address.
Tacey Ann Rosolowski, PhD :
Right. Right. Yeah. That's interesting. I've had a number of faculty members observe the fact that they've mellowed over the years.
Wenonah Ecung, PhD:
Yes. That would be a nice way to put it.
Tacey Ann Rosolowski, PhD :
I guess we all do.
Wenonah Ecung, PhD:
Yes. Yes.
Recommended Citation
Ecung, Wenonah B. PhD and Rosolowski, Tacey A. PhD, "Chapter 05: Nursing in the Department of Developmental Therapeutics" (2016). Interview Chapters. 693.
https://openworks.mdanderson.org/mchv_interviewchapters/693
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