Chapter 06: Inspirations and Observations About Changes in Nursing
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In this segment Ms. Houston talks about people who inspired her. Renilda Hilkemeyer, “a phenomenal nurse and pioneer,” and the first Director of Nursing at MD Anderson, inspired Ms. Houston to be progressive. She learned how to conduct project and test out new work flows from Joyce Alt, the second Director of Nursing. And her late husband, Gary Houston, the first male nurse hired at MD Anderson and a Nurse Manager, involved her in many programs. This segment also includes Ms. Houston’s observations on how technology has increased the pace of care delivered, creating a rush in the work place and altering nurses’ relationship to patients and each other.
Identifier
HoustonDA_01_20120726
Publication Date
7-26-2012
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The Clinical Provider; Influences from People and Life Experiences; Portraits; MD Anderson History; MD Anderson Culture; Growth and/or Change; Obstacles, Challenges
Transcript
Tacey Ann Rosolowski, PhD:
I guess we have gotten to the point where I wanted to ask you about the people who have really influenced you during that part of your career—your whole nursing phase—take a little pause here. Back on again.
Deborah Houston:
One of the people that—first people that I think of when I think about who has inspired me or mentored me in my career as an oncology nurse was probably the original Director of Nursing here at MD Anderson and that was Renilda Hilkemeyer. Everybody—when I saw her name everybody laughs because it’s such a funny name, but she was—she was just a phenomenal woman and lived for oncology nursing and is one of those pioneers but really cared about her staff. I remember many things—her laugh is one of the things I always remember. There’s a couple of things about her that I remember was one time when I was a student. We got paid very little money. Back then, that was big money. A friend of mine who worked here as well—we had worked a couple of weekends and were supposed to get paid. Paychecks came out on Friday. We came to get our paycheck, and we didn’t have a paycheck. We were going to New Orleans for Mardi Gras, and we didn’t have our seventy dollars or sixty dollars—whatever it was we were going to get paid. We were just irate and were probably making a scene in the nursing office. Back then, it was like three rooms, you know. She came out of her office. She wanted to know if we wanted her to write us a personal check for our sixty dollars—that she would do that, and it’s like, “No ma'am, we’re okay.” Probably from me making a fool of myself, she always remembered me. I remember we would go into her office and talk to her about various things. She was one of these people that wrote everything down on yellow tablets. You would go into her office and she had this huge wooden desk with all these stacks of yellow tablets everywhere. You’d say, “Ms. Hilkemeyer, remember I needed to talk to you about this.” She would go and in her stack she would pull out the yellow tablet that had her notes from when you had talked to her—how she did that I don’t know. She was just a really kind woman that really wanted to promote the profession and wanted to keep up the practice.
Tacey Ann Rosolowski, PhD:
What were some of the big messages that she communicated about oncology nursing that were so persuasive and powerful for people—for you?
Deborah Houston:
I think for me it was that you have an opinion and your opinion counts and that you are the person that is making that patient’s life different—affecting that patient’s life. The physician is there for a few minutes a day, but you’re there eight hours, twelve hours—whatever. The nurse is the one that is really providing the care for the patient. I think that’s been a message that I’ve taken to heart. She was—she tried to be progressive. She was one of these people that wore her white uniform and her cap as the Director of Nursing. When she came in one day in a pantsuit, everybody was shocked because it was like, “Oh, my god. It’s okay. We can wear pants now.” She was one of those people. She would just laugh and we’d have a good time. She was a wonderful woman.
Tacey Ann Rosolowski, PhD:
What was her style with patients herself?
Deborah Houston:
You know, I never saw her take care of patients. I don’t ever remember seeing her on the unit. There were supervisors that kind of did that role, so I don’t know. It was just her style with us—with her staff that was memorable. She was always somebody that I felt like she would do—she knew what I was talking about and understood what I was talking about and would get up—I felt like she would get up and go do my job if she needed to. That’s something I’ve always taken to heart is that I needed to be able to do the job of the people that work for me. When I was a head nurse, if you couldn’t start the IV, I would go start the IV or if you didn’t have time to catheterize a patient or do something like that, I would do it. There was not a job that I wanted you to do that I wouldn’t do myself.
Tacey Ann Rosolowski, PhD:
Now how does that make a difference?
Deborah Houston:
Well, I think it tells your staff that you’re willing to work just like they are. You work hard just like they do. I think they will work with you when you work with them. That was a message I always gave the staff that I worked with. I was not someone that was in my—stayed in an office by myself. I was out visiting with the patients, helping the staff, passing food trays if lunch came and they were sitting there, making rounds with physicians, trying to help facilitate their care—their work so that everybody could get taken care of.
Tacey Ann Rosolowski, PhD:
It was clearly you understood what their work was—
Deborah Houston:
Well, and what was going on on the unit that I was responsible for. Life was different then. It was very different then.
Tacey Ann Rosolowski, PhD:
How so?
Deborah Houston:
It wasn’t as technical. We didn’t have as much documentation requirements. I mean, not that we didn’t document appropriately, but it was—you hear about “life was simpler then.” I think—I don’t know. It was just different. People were, in many ways, more pleasant to each other. They weren’t as rushed, even though the staffing model was crazy. When I first started working here at night, when I first got out of nursing school as a new graduate, I was the only nurse for thirty-four patients on the evening shift on a unit. One nurse. One registered nurse. If I was lucky, I had an LVN to help me give medications and a couple of aids for the 3:00 to 11:00 shift. That’s unheard of today. It’s just unbelievable—to think about that. There were no IV pumps. There were no central IV lines like we have today. It was just different.
Tacey Ann Rosolowski, PhD:
I was going to ask you about technology and how that had changed the role of the oncology nurse. How did you—?
Deborah Houston:
Well, I think one of the things was the advent of just chemotherapy. Everybody had to be in the hospital for chemotherapy when I first started working here. Pretty much everybody was in the hospital. If you had breast cancer, you came in the hospital for a week and got continuous infusion chemotherapy. With the invention of small portable infusion pumps and central IV lines, these catheters that they can put in patients, chemotherapy moved to an outpatient setting, which allowed us to admit more patients because you could—we weren’t full of patients getting chemotherapy. They were in the clinic. That’s one thing. Then, I just think the equipment at the bedside of the nurse today—the infusion pumps that they have that calculate drip rates and alarm and tell them when things are wrong. Bed alarms, when patient’s try to get up. We didn’t have those things like that. Computers that you can look up lab reports on instead of finding them in the chart in the little pieces of paper in the record—having to put them in the record with tape.
Tacey Ann Rosolowski, PhD:
It’s kind of interesting because you’re telling me all these things which sound good, but they sort of added up to a work situation that seems like it’s not quite as pleasant, maybe, as it used to be? Am I getting that right?
Deborah Houston:
Well, I don’t know that it’s not as pleasant, because I think today the nurse doesn’t have that—you have time to spend with your patient today. I didn’t have time—I mean, when I worked the evening shift by myself, I didn’t have time to sit and talk to patients or really—you were rushed. If I would stop and talk to a patient about something or try to do teaching about their surgery the next day because a lot of people came in the day before for surgery—we don’t do that anymore. They need pre-op instruction and all that kind of stuff. You would have to do that. Well, that meant you were late the antibiotics to the guy in the next bed or whatever. The physical environment was very different. We have four patients in a room connecting with a bathroom to four more patients.
Tacey Ann Rosolowski, PhD:
How many patients are there per room now?
Deborah Houston:
One. That’s—everybody has their own bathroom. That’s very different. We had beds that were not electric. It sounds like the ancient days, but that’s when I started working here. That was our environment. Glass bottles that held chest tubes that were boxes made by the people down in facilities to put the bottle in. It was hard to ambulate people around and things like that. Those were challenges that you had. Today, the technology is better. The equipment is better, so the nurse is able to take care of the patient better. I don’t know. We talk about the art of nursing. I sometimes think that the art of nursing is not the same, but probably my colleagues that are in nursing today would say it’s better. It’s been a long time since I’ve actually taken care of patients, so it’s hard to say that.
Tacey Ann Rosolowski, PhD:
When you made your shift, did you feel that the art of nursing had improved from the time that you began?
Deborah Houston:
I think it was different. It was different. Nursing went from—nursing was a lot about physical care—physical comfort. Then we got into things that we could do to patients or provide patients that provided that comfort, so the nurse didn’t have to do it, for example. I think that’s where we kind of lost some things. We used to do what was called p.m. care. That was—we would chart that in the chart—p.m. care given.
Tacey Ann Rosolowski, PhD:
And what is that?
Deborah Houston:
The p.m. care was you made sure the patient got up, went to the bathroom, if they could. If they couldn’t get up, you offered them a bed pan, washed their face, washed their hands, brushed their teeth—those kind of things. Gave them a back rub, positioned them, quieted things down—turn down the light. Just made sure they were comfortable in bed—offered them sleep medications or water or whatever. We put patients to bed, does that make sense?
Tacey Ann Rosolowski, PhD:
Yeah.
Deborah Houston:
That was what you did. I don’t know that we do that anymore. Is it because we don’t have time because there’s so many other things that they have to do, or the patients are so sick you don’t have time to do that. I don’t know. Now is that something unique to oncology nursing? No. I don’t think so. Those are things probably you would do if you were taking care of your mother in the hospital. “It’s time to go to bed. Let’s go to the bathroom. Okay. Let’s go to sleep.”
Tacey Ann Rosolowski, PhD:
Just somebody being attentive in that way.
Deborah Houston:
Yeah. I don’t know that we have time to do that anymore. So, we were talking about mentors—Ms. Hilkemeyer.
Tacey Ann Rosolowski, PhD:
Yeah. I was going—
Deborah Houston:
Another one was Joyce Alt, who was the second Director of Nursing. She was my mentor when I was in nursing school. She was the nurse manager of the recovery room here at Anderson at that point. That’s where I did my management rotation. After that, when I came to work, Joyce became one of the supervisors and was my supervisor, so I learned a lot of things from Joyce about how to do projects, how to change, try new things.
Tacey Ann Rosolowski, PhD:
Like what, give me an example. That’s kind of neat.
Deborah Houston:
Oh, we tried things like we had a thing were the nursing office tracked who was working on what shift, and they would kind of even up the numbers of staff. You might work on Five West today. You’re going to work on Three West tomorrow. The phone would ring ten minutes into the shift, and they wanted you to send one of your people to another unit. One of the things we did—everybody hated that. So myself and my friend, Virginia, who was the nurse manager on the other end of the floor, we said, “Let’s do something where we’re not going to get help from anybody but ourselves.” Joyce kind of helped us, and then her recovery room staff. So, if the recovery room wasn’t busy. Believe it or not, they used to not be busy sometimes. They would come up and help, or if they had an emergency or something, we would send somebody in there to help them. That was just heretical, if that’s even the right word. “Oh, my God. You’re going to staff your own unit. You mean, we’re going to call you if you have a call-in.” It’s like, “Yeah, we’ll take care of it.” That was very new and innovative and different. Joyce was like, “Let’s try it and see how it works. If it doesn’t work, we’ll say King’s X we made a mistake.” She was one of these—she was supportive of new ideas, so I learned from her the ability to make a decision, try something new, and if it doesn’t work say, “Okay. It didn’t work. Let’s go back.” Let the people that work for me make decisions and support them in that. That was a skill or a trait I learned from her.
Tacey Ann Rosolowski, PhD:
Yeah, real leadership role model, yeah.
Deborah Houston:
Then, my husband, Gary Houston, was a nurse manager here. I met him here at work. He was also someone—he was in management more than—not more than I was but sooner than I was. He got into the management role—the tract—here in nursing. He was one that was encouraging me all along to do different things, try different things. He would get me involved in various activities. We had programs that he would try to make sure the clinical perspective, not just the management perspective, of the nursing staff was involved. That was helpful.
Tacey Ann Rosolowski, PhD:
What were some of those programs?
Deborah Houston:
We had the Career Ladder Program we had at MD Anderson back in the ‘70s where the nurses—the idea was you could have a clinical ladder that you could progress up or you could have a management level that you could progress up. That was one of the things that he was involved in—that I was involved with him in.
Tacey Ann Rosolowski, PhD:
Did you take part in that Career Ladder Program?
Deborah Houston:
Technically, yes, because I was a title called “Clinician four,” which was the title you could have before you got your master’s degree to become a Clinical Nurse Specialist.
Tacey Ann Rosolowski, PhD:
And when did you get your master’s?
Deborah Houston:
‘84.
Tacey Ann Rosolowski, PhD:
‘84.
Deborah Houston:
1984.
Tacey Ann Rosolowski, PhD:
Okay. And how did that Career Ladder Program work?
Deborah Houston:
It was in effect for a long time. We sort of have a version—I think a version of that today. They don’t call it the Career Ladder anymore, but they call it the Professional Development Model. It’s similar. We had a Clinician one, two, three kind of thing before. Now I don’t know exactly—they’re called clinical nurses, but they have different levels within their—I think their performance measures that they use in nursing today. It’s similar so that you can still be bedside nurse, but you can progress in what you’re responsible for and your salary based on experience and performance.
Tacey Ann Rosolowski, PhD:
Now how else did your husband support or influence you as you advanced?
Deborah Houston:
Well, he was one of the people that encouraged me to apply for the Administrative Director job. Then, when we made the switch into the Center Administrative job back then, he encouraged me to do that. During that process, we were sort of influx, and nursing was sort of reorganizing. That’s when John Crosley had come in, so they were kind of re-designing how we were going to organize nursing. At that point, Gary—there was going to be one less director job, and Gary made the decision to take an out, so he left Anderson at that point. He had been here about twenty-five years when he left Anderson.
Tacey Ann Rosolowski, PhD:
Before we kind of move on to your switch into the next (talking at once) part of your career, I wanted to ask you how you felt—let me back up a little bit. In a lot of conversations I have been having with people for this oral history project, people have talked about leadership development and how key it is. I’m wondering what your perspective is on that—how you felt you gained your skills. We have talked about some of the people who inspired you, but were there other things that you did to develop your leadership skills? Did you feel the institution offered you good opportunities and resources?
Deborah Houston:
I think, well, again, when I started here, education was not what it is today at MD Anderson. I would say most of my leadership development has been on-the-job training, just life experience kind of thing. I got involved in the mid-‘70s in the Oncology Nursing Society. Again, my husband, not at the time my husband—my friend, Gary, at the time—was active. There was a lot of—obviously lots of the staff here at Anderson are part of that organization. We got involved, and I got involved—I was in the local chapter involvement and leadership through that and then got involved with the national level in that society through committee work and then was on the Board of Directors of ONS for three years. I actually ran for president—didn’t win—I think that organization itself helped me with leadership—developed with speaking, that kind of thing, as well.
Tacey Ann Rosolowski, PhD:
So, it was the experience you got simply being involved with an organization at a pretty high level.
Deborah Houston:
Uh-hunh (affirmative). Uh-hunh (affirmative). Then here, just day-to-day work. I think my leadership of people. Personally, I think people leadership is one of those things that you almost have to have in your soul to do it well. We have lots of leaders that aren’t really leaders.
Tacey Ann Rosolowski, PhD:
What is that distinction that you make? What do you mean they’re not really leaders?
Deborah Houston:
Well, I think there are people that do it well, I should say—they’re not leaders—they’re leaders, but they may not be as respected or as good a leader as others. I think it’s the way they interact with people—the way they manage their staff. The things people are willing to do for you is a trait that leaders develop over time and with experience. As a leader, you have to be willing to take risks and try different things yourself and your staff. To me, it’s a sign of a good leader when you go away on vacation for a couple of weeks and nobody even knows you’re gone because your staff are managing and everything is going along just fine, or when you leave and change jobs, how many people want to follow you because they like the way you treat them, they like the way you manage and organize your staff. I think that’s something that, hopefully, we have lots of people that apply here.
Tacey Ann Rosolowski, PhD:
Over time, were there more mechanisms that were put in place to help nursing staff develop leadership skills?
Deborah Houston:
Yeah. I think over the—nursing for many, many years was more on the clinical skills of the staff. Then I think over time, the management kind of fit in. I think, even today, a lot of that is through the HR education programs, not necessarily nursing. They have a new program, I think, now for how to—developing clinical leaders. Again, that’s clinical care kind of things. I think the management of people, management of businesses, that’s all done through kind of HR—things that anybody does, which you need to know that. It’s appropriate. Faculty needs it.
Tacey Ann Rosolowski, PhD:
Everybody needs it. Absolutely.
Deborah Houston:
Depending on the school that you go to as a nurse, you get leadership or you don’t. Texas Women’s University, as a senior that was what you were expected to do. You took a class. You were expected to be a leader. That was the experience you did. I don’t know that all schools have that as part of their curriculum. All bachelors’ universities might. I’m not sure. That was just one of the—that was the expectation. That was the class you took—nursing leadership.
Tacey Ann Rosolowski, PhD:
That’s interesting. Yeah. Probably much stronger now and much more widespread as a philosophy in nursing schools, I’m sure.
Deborah Houston:
What I think is interesting is—I know my nursing colleagues here laugh at me because I’ll go to meetings and they’ll be talking about something. I’ll just sometimes just start laughing because it’s things that we did thirty years ago. It’s kind of like everything comes full circle and comes back—from the way they do nursing assignments, policy changes. It all comes back. So, I think that’s kind of funny.
Recommended Citation
Houston, Deborah A. and Rosolowski, Tacey A. PhD, "Chapter 06: Inspirations and Observations About Changes in Nursing" (2012). Interview Chapters. 889.
https://openworks.mdanderson.org/mchv_interviewchapters/889
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