Chapter 03: Nursing and Nursing Management at MD Anderson in the Seventies

Chapter 03: Nursing and Nursing Management at MD Anderson in the Seventies

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Description

In this segment, Ms. Houston talks about the progression of her nursing career. She first summarizes her experiences as Staff Nurse (“72 – ’76), when she worked with a number of units: Surgical, Thoracic, General, and Head and Neck. The separation of these units causes her to observe that although multi-disciplinary treatment was a goal from MD Anderson’s inception, it became a reality in the 90s with centralization of patient services. She also comments on the role of nurses in the team of care providers, noting that before the hiring of physicians assistants, nurses helped physicians manage their patients. Next she talks about her role as a teacher and mentor once she became a Nurse Manager (Head Nurse) in 1976, and she helped nurses under her to learn how to care for lung and esophageal patients. At the time, there were only three people in nursing staff development (now there are over thirty).

Identifier

HoustonDA_01_20120726

Publication Date

7-26-2012

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Clinical Provider; Multi-disciplinary Approaches; Institutional Processes; Professional Practice; The Professional at Work; Professional Path

Transcript

Tacey Ann Rosolowski, PhD:

Now, when you came, you said you were particular impressed with the working relationships among the staff. I was curious about how—since MD Anderson was always about multidisciplinary and kind of a team approach to care—okay. It sounds like maybe you have an observation to make on that.

Deborah Houston:

I just need to see real quick who texted me.

Tacey Ann Rosolowski, PhD:

Sure.

Deborah Houston:

When I first started working here, we had a—the unit that I worked on when I was a student and right after I graduated from high school was a medical—general medical—well, it was kind of an overflow unit of a little bit of everything, then it became a medical unit. Then I transferred to a surgical unit. So we had thoracic surgery, general surgery, head and neck surgery. Then there was a unit that had medical oncology, and there was a unit that had hematology patients, so it was very—then, there as a pediatric unit. There was a GYN unit. It was pretty much specialty oriented. On the medical unit, you would have breast cancer patients and bladder cancer patients and lung cancer patients and sarcoma patients—all those patients getting chemotherapy. In the clinic, we had a surgical—general surgery clinic, a thoracic surgery clinic. Then there was a breast medical clinic, so if the patient had breast cancer, she went to the general surgery clinic to see the surgeon and then went to another clinic to see the medical oncologist. So the multidisciplinary concept that came in and our multidisciplinary clinic concept that came in in the ‘80s was more of the—or really ‘90s—was more of the—we have the Breast Center where we have medical, surgical, radiation doctors all—the patient goes to one place, and we come to the patient, which originally it wasn’t like that. The patient went various places.

Tacey Ann Rosolowski, PhD:

Okay. At another level of organization, I was curious on how you, as a nurse, were integrated into the team of people taking care of this patient or were you pretty much separate, because the patient was going here, there, and everywhere?

Deborah Houston:

Well, up until the late ‘80s, I worked inpatient.

Tacey Ann Rosolowski, PhD:

Oh, okay.

Deborah Houston:

I didn’t work in the clinic at all. I didn’t have any clinic responsibility, so I was—I came and I worked my eight-hour shift or twelve-hour shift, whatever many hour shift I did or I managed—I became a manager. So I was the head nurse, at the time, was the title we had of the Thoracic Surgery Unit. Then, we moved to the—what was called the Lutheran Pavilion—the new building, which is the Purple Zone now. That was a thoracic surgery/thoracic medical unit. It was a combined unit. I was part of a team and, then, I helped provide the inpatient care and supervise the staff that provided the inpatient care for all of those patients. I worked with the physicians, made rounds with the physicians, you know, so I knew what they wanted and what their expectation was.

Tacey Ann Rosolowski, PhD:

How did they—how were you treated, basically? I mean, was there a good sense of collegiality and quality?

Deborah Houston:

Oh, I think so. Oh, yeah. I think so.

Tacey Ann Rosolowski, PhD:

Okay. So there was a sense that—

Deborah Houston:

Oh yeah. I think—there was always a good relationship with the staff. I mean, the physicians, I think—back in the day—they didn’t have the physician assistant mid-level nurse practitioners like they have today. There weren’t any of those people, so they were relying on the nurse on the floor to help them manage their patients, so they knew when you called the physician you needed to have all your information together. You called him about several people. You didn’t just call him about one at a time. The better that you communicated and helped give the right information to the physician, the more they respected you and the more they treated you like you wanted to be treated.

Tacey Ann Rosolowski, PhD:

So tell me about your own career arc. So you were director of nursing for nine years, and what—when did you take on that role and what were your responsibilities.

Deborah Houston:

Well, I was a staff—I guess I became a nurse manager—head nurse, whatever—I think back in like 1976. I did that for several years and then went into sort of clinical supervisory type roles and became a clinical nurse specialist then in 1984.

Tacey Ann Rosolowski, PhD:

What does that mean?

Deborah Houston:

Okay. That role, at the time, was kind of what they are now introducing as a clinical nurse leader on the unit. There would be a manager to take care of the management of the nurses, but I was there to help the nurses learn to care for the patients and sort of be there to help them with the more acutely ill patients.

Tacey Ann Rosolowski, PhD:

What were some of the skills that needed to be learned in that situation?

Deborah Houston:

By the staff or by me?

Tacey Ann Rosolowski, PhD:

Well, you said you were helping other nurses—

Deborah Houston:

Well, that role was with the thoracic patients, so it was lung and esophageal cancer patients. They would not know—a new nurse coming in would be frequently challenged or didn’t feel comfortable taking care of patients that had chest tubes in after surgery, or they didn’t know how to do tube feedings on an esophageal cancer patient, or they didn’t know how to manage patients with large wounds or fistulas or things like that. I would work with the staff to help them learn to care for the patients—teach them how to start IVs. There were nursing instructors, but if you were around, I would help them do that or help them with more difficult patients and things like that.

Tacey Ann Rosolowski, PhD:

How well do you feel—was that an issue of nursing training at the time—really not preparing people for the oncology specialty itself or was—how did your training prepare you?

Deborah Houston:

Well, I think in nursing school itself, I may have had an hour or two of lecture about cancer. I think now maybe they teach more of that. I mean, I went to a bachelor’s degree program, and the philosophy of the school is they’re training people to be leaders. I used to tell people this—I learned to be a nurse and how to take care—do physical care and take care of patients by working at MD Anderson on the weekends. In school, I knew how to write nursing care plans, and I knew how to do all those kinds of things, but you don’t really learn how to take patients, I don’t think. When you get out of school and you come to work, you may not have ever taken care of a patient with a chest tube or had their lung removed or something like that—to know how to position them or what to do. When you come to work, you have to learn those things from somebody. You learn that from the nurses that have worked there that have learned things from other nurses or from the physicians or things—people like that. At the time, we had nursing instructors, and there were staff development instructors at MD Anderson, but there weren’t the volume that we have today. There might have been—when I came to work here there were two people—three people in nursing staff development. Now there’s probably thirty; I don’t know how many are in there.

Tacey Ann Rosolowski, PhD:

Wow.

Deborah Houston:

It was just—it was different. The staff on the floor helped the nurses—you kind of had a buddy that taught you how to do things.

Tacey Ann Rosolowski, PhD:

Was there an attrition rate—where nurses might come but then realize they couldn’t handle oncology nursing?

Deborah Houston:

I think—there is. I don’t know what the rate was. It seemed like nurses came and either really liked it or they left usually within a year or less. Frequently, if people stayed, it seemed to be—the people that I knew about—they stated until—if they had children or something, they didn’t want to commute into the medical center or something like that. People came and liked it or they left.

Tacey Ann Rosolowski, PhD:

I was reading in some source that at the time there was a real difficulty in attracting people to oncology nursing because of the presumption that it was depressing, death, and—

Deborah Houston:

Oh, yeah, yeah. How do you work with those patients all the time? Right.

Tacey Ann Rosolowski, PhD:

Uh-hunh (affirmative). How did you work with those patients all the time?

Deborah Houston:

Again, I think I looked at the quality of their life and not at the fact that they were dying. They could have a terrible prognosis, but you could still laugh with them and make them comfortable and joke around. I mean, it’s okay. I don’t know. It’s one of those things that you just—I never even thought about.

Tacey Ann Rosolowski, PhD:

Yeah. I think people have different kinds of interpersonal gifts.

Deborah Houston:

Yeah. I never even thought about it.

Tacey Ann Rosolowski, PhD:

There are some people who can handle that situation.

Deborah Houston:

I can’t remember that I had—I don’t ever remember—a lot of people say, “Well, I took care of my grandmother that had breast cancer” or “my grandfather who had prostate cancer.” I don’t remember that in my background. I had a grandfather that had a chronic leukemia, but that was diagnosed right at the end of his life when he had complications of a bunch of other things, and he didn’t die from that. I don’t remember that there was some cancer thing that made me want to go into oncology. It’s just—I don’t know.

Tacey Ann Rosolowski, PhD:

It was discovering a particular gift, really, kind of by accident, yeah.

Deborah Houston:

I guess, because I’ve stayed here forever.

Tacey Ann Rosolowski, PhD:

It sounds like it—well, not forever but—

Deborah Houston:

Close.

Tacey Ann Rosolowski, PhD:

Enough to demonstrate a real devotion.

Deborah Houston:

Yeah. Yeah.

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Chapter 03: Nursing and Nursing Management at MD Anderson in the Seventies

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