Chapter 05: Working as a Registered Nurse in the 70s: An Overview
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In this chapter, Mr. Brewer talks about nursing at MD Anderson in the 1970s, beginning with his work on the Head and Neck surgical floor after graduating as a registered nurse on the staff. He recalls how ill patients were and how brutal their surgeries might be. He compares the state of treatment and supportive care then to today.
He then discusses Dr. Jesse’s philosophy that it took a team to care for a patient, noting that this thinking was ahead of the curve in offering multi-disciplinary care, and it was a “hallmark” of the Head and Neck practice. He also explains that the team approach was the beginning of subspecialization for nurses, and how this was of help when a patient was transferred to other services. Nurses worked across units and shared their expertise with others.
He then comments on radiation therapies offered at the time and the types of research conducted. He notes the collegial environment where young nurses were invited to multi-disciplinary conferences and asked for their input.
Mr. Brewer then sketches his series of promotions into management and leadership positions, discusses the organization of nursing and the wards, and describes how technology made changes in deliver of care. He gives the example of dose delivery systems that had a positive impact on patient care.
Identifier
BrewerCC_01_20190516_C05
Publication Date
5-2-2019
City
Houston, Texas
Interview Session
Cecil C. Brewer, RN, BSN, MS, Oral History Interview, May 02, 2019
Topics Covered
The Interview Subject's Story - Overview; Overview; Experiences Related to Gender, Race, Ethnicity; Professional Practice; The Professional at Work; MD Anderson Culture; Working Environment; Multi-disciplinary Approaches; Mentoring; On Mentoring; Technology and R&D
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
Cecil C. Brewer, RN, BSN, MS:
~ And when I graduated from my—from Prairie View University College of Nursing in 1972, I just transitioned being in my role as a student nurse, LVN, to that a registered nurse, which was the title of the staff nurse at the time. And I remained on the same floor that I was working as a student. I started working at MD Anderson on the Head and Neck Surgical floor, and at that time, we had a very dynamic group of physicians.
Tacey Ann Rosolowski, PhD:
Were you given a choice in where you would work, or was that an assignment?
Cecil C. Brewer, RN, BSN, MS:
Well, at the time, I think it was an assignment. I think the directors, at that time, probably felt that as a male nurse, I would do better work with head-and-neck patients because there were more male patients than female.
Tacey Ann Rosolowski, PhD:
Hmm, oh, was it?
Cecil C. Brewer, RN, BSN, MS:
Mm-hmm, at that time.
Tacey Ann Rosolowski, PhD:
I mean was this smoking related, mostly—
Cecil C. Brewer, RN, BSN, MS:
Yeah, because you know—
Tacey Ann Rosolowski, PhD:
—smoking related?
Cecil C. Brewer, RN, BSN, MS:
—if you look at the dynamics of the demographics that more males have this type of cancer than females, but now, it’s beginning to change. Those dynamics are changing.
Tacey Ann Rosolowski, PhD:
They certainly are, yeah.
Cecil C. Brewer, RN, BSN, MS:
And I was assigned to Head and Neck. At the time, they hired about like two or three more student nurses that we all, kind of, grew up together at MD Anderson. Debbie Houston—
Tacey Ann Rosolowski, PhD:
Mm-hmm, yeah, I interviewed her.
Cecil C. Brewer, RN, BSN, MS:
Did you?
Tacey Ann Rosolowski, PhD:
Yeah.
Cecil C. Brewer, RN, BSN, MS:
And [Gary?] Houston, he passed away, that was Debbie’s husband. And there were one or two other students—student nurses as the time. And Debbie and I we all grew up at MD Anderson together and worked our careers here together. And we would compare notes, you know?
Tacey Ann Rosolowski, PhD:
Sure. What were some of the challenges? Did you feel stigma from patients, and were there some areas that you felt you were really starting to excel in a particular kind of cancer care or nursing role?
Cecil C. Brewer, RN, BSN, MS:
Working as a professional nurse, as a staff nurse after I graduated from Prairie View, I did not feel at MD Anderson a stigma. I think I was career building from day one, I was focused, I felt I was prepared educationally for the role. I was in a learning mode, and I didn’t have time for small talk or those types of things. I had developed a certain level of—a high level of respect, I had good integrity, I could be trusted, and I think those things led to not having the—I wasn’t stigmatized by being the only nurse, male nurse or being a male nurse. I think the doctors, the physicians at the time respected me. They could depend on me to care—well—to take very good care of their patients.
Tacey Ann Rosolowski, PhD:
Who were the physicians that you interacted most with at the time?
Cecil C. Brewer, RN, BSN, MS:
Well, in 1972, my chief of surgery was Dr. Richard Jesse. He was the chief of Head and Neck Surgery. Alando J. Ballantyne was another one, a surgeon, Oscar Guillamondegui, Robert Byers, Dr. MacComb, Dr. Sinclair. Sinclair was the first plastic surgeon here at MD Anderson. Those were the major head-and-neck surgeons at the time. Now, there were a number of fellows or residents who rotated through Head and Neck, and I got the chance to grow up with those guys because I stayed within the same profession for many years, and I got to see them from residents to, whatever, owning their own practices throughout the country.
Tacey Ann Rosolowski, PhD:
Interesting, yeah.
Cecil C. Brewer, RN, BSN, MS:
And we kept in contact because in that era, the care was so radical, the patients were so sick that it required not only that you have a tough stomach because of what you would see, but the level of compassion that it took to care for those patients. And how great for the patients were and how great for the doctors were to know that they felt safe in leaving their patients in the care and that when they return the next day that their patients would be okay. So Dr. Jesse, he was a no-nonsense physician, a great surgeon as well as Dr. Byers who I worked with for many years. And as the Head and Neck Department grew—well, let me back up. The care that was given in that early years, say, from 1972 to 1976 was quite different. This is what I mean by that. We had very limited resources as far as high—technology is concerned, just that everything we did was manual. Blood pressure machines were manual. We didn’t have any intensive care units, so if a patient became critically ill, they need to be placed on a ventilator. We cared for that patient on the floor. We didn’t have code teams.
Tacey Ann Rosolowski, PhD:
Now, just to clarify, did you—you worked on the floor or did you also work in the operating room?
Cecil C. Brewer, RN, BSN, MS:
No. I only worked on the floor. The Head and Neck floor called Five East. Five East now is Six Blue. The original Anderson wing, they called it the Blue. That the original—not the original. That is the hospital wings that I worked on starting in 1970. And I believe the Anderson Hospital is the original hospital when MD Anderson moved from the Baker Hospital to MD Anderson. So the blue zone is the original MD Anderson, and we got many, many stories we can tell about that unit.
Tacey Ann Rosolowski, PhD:
I bet. So you were talking about the differences in care in that period, ’72 to ’76, how—no intensive care units, you had to put patients on a ventilator. I mean, what else are you remembering that was so distinct and required—
Cecil C. Brewer, RN, BSN, MS:
Well—
Tacey Ann Rosolowski, PhD:
—special actions on your part?
Cecil C. Brewer, RN, BSN, MS:
—a lot of things that were very, I call it, elementary or rudimentary at that time. You didn’t have basics. The charts—so documenting was very rudimentary. You had metal charts, and you did block charting, which you wrote from seven o’clock to three o’clock, this is what happened, and you do it at specific intervals. Like today, you documented on a line, and you said, “At 4:05, this is what happened if you—” you know, it wasn’t time dated. You didn’t have disposable items. Everything was recyclable. All the instruments, your bedpans were recyclable, your urinals were recyclable, your water pitchers were recyclable. And the nurses and the orderlies and the aides had to wash them in a certain type of disinfectant and dry them. We didn’t have automatic dispensing machines for medications. Medications were placed, and you counted those in a manual way, and you carried it in, what you call, a medication tray. You probably see on TV where nurses in the old movie, they’re walking with a tray in their hand with the medication.
Tacey Ann Rosolowski, PhD:
Absolutely, yeah.
Cecil C. Brewer, RN, BSN, MS:
That’s how we did it, and you had a little medication room, and you counted your pills out of a bottle. And you find out which pills this patient is getting, and you pour your own pills and things like that.
Tacey Ann Rosolowski, PhD:
Now, a couple of questions are occurring to me because we were talking before the recorder came on about Renilda Hilkemeyer is division head at the time and so she was starting that amazing process of making it possible for nurses to give chemotherapy. So you’re here at a time when those big changes are taking place in the practice. From what you were describing earlier too about your sustained role on Head and Neck, that was almost the beginning of subspecialization of nurses, a nurse staying with one practice area and really learning what does it mean to take care of this particular type of cancer patient. So I’m wondering about that and then also all of the people—a lot of the people that you were mentioning were involved in some way in research, so there’s that going on. So tell me more about that big environment. What were you picking up on with that, and how were you getting involved in all that?
Cecil C. Brewer, RN, BSN, MS:
That’s a big question. That’s a—
Tacey Ann Rosolowski, PhD:
I know it is. I asked you like five questions, shame on me. (laughs)
Cecil C. Brewer, RN, BSN, MS:
Let me start out and say that the whole thing and the whole notion about care. Dr. Jesse had a philosophy that—early on that team—that it’d take a team to care for the patient. He was ahead of the game as far as multidisciplinary care and the involvement. He involved the whole team in the process of caring for the patient.
Tacey Ann Rosolowski, PhD:
How did he do that?
Cecil C. Brewer, RN, BSN, MS:
Oh, in multidisciplinary conferences when you—when you’re making rounds, you’re invited to participate in the discussion about the patient. The sharing of knowledge openly about the signs at that time, what’s going on with cancer care, those are the hallmark in Head and Neck. Head and Neck is known for—that’s a hallmark even today about the Head and Neck surgical practice. And remember, I said I was working on the Head and Neck surgical floor. In 1970, there was no chemotherapy per se for care of the head-and-neck patient. That didn’t occur until the ’80s. I believe that there were three modes of treatment for a cancer patient, surgery, medicine, and—
Tacey Ann Rosolowski, PhD:
Radiation.
Cecil C. Brewer, RN, BSN, MS:
—radiation, that was it. So when you do surgery, your goal in surgery was to eradicate the cancer so that meant pretty radical surgery. And you’re talking about the head and neck part of the body, so you’re going to see a lot of anatomical dyfunc—distortions and deformity going on. Every nurse, a lot of nurses, most of nurses did not want to work in that environment, which is too demanding and too offensive if you will for them. So that’s when that subspecialization you’re talking about comes into play. The subspecialization really materialized during my era or during those eras because like you were saying, you talked with—spoken with a person named Debbie Houston. Well, Debbie’s specialty was thoracic, and I don’t know what she said in that interview, but I know that. I became known as the go-to guy for head and neck. She became the go-to person for thoracic, another nurse became the go-to person for leukemia, another person for urology. And so we stayed within our subspecialization, and we super specialized, and we became so ingrained in our specialization that we became the experts for nursing. If you want to talk about—so if a head-and-neck patient was admitted to a different floor, and for some reason happened to be on the urology floor or the thoracic floor, the nurse on the head and neck floor—it’s almost like an expectation that we provide them with information and leadership and guidance in the care of that—of those patients. And—
Tacey Ann Rosolowski, PhD:
Can you give me an example, I mean, because I don’t—I know nothing about how care would’ve taken place for a head-and-neck patient at that particular time? So say a patient of yours had been transferred to another floor for some reason, what might be the sort of support you would provide that new team?
Cecil C. Brewer, RN, BSN, MS:
The type of support that I provided as a nurse for another floor even in 1972 as I began to—not necessarily—I was still a novice, but say 1973. Say if the patient had the laryngectomy, a fresh laryngectomized patient, the patient had the voice box taken out, about one of the—by the surgeon. This is a surgical procedure. Now, that requires a certain skill set to care for that patient. You have to know that the anatomy, you have to know about the airway, you have to know about some of the psychological impacts on the patient, so the feeding, some of the nutritional issues that go on with the patient, some of the physical limitations the patient has. And if that patient happens to be on a floor where all of those aspects of care are not a daily routine, I would be expected to go and support those nurses and maybe teach them how to suction, keep the airway open, clean. I became an expert in that over time. That’s one of my specialties—specialization. Or what to watch for as far as the complications with skin integrity or how not—how to avoid complications as far as when you’re feeding a patient with a feeding tube. Everyone, all nurses are not comfortable with feeding tubes or with suction tubes or how to administer oxygen, how to keep the patient, their airway from becoming dry and keeping it moist. It’s so many little detail that you—that nurses in other units were called upon that specialization for support. And vice versa, if we—you may have a urology patient that has a complication with maybe colostomies or problem with their bladders, etc. So we became interactive, across borders if you will, across units and because we do, we had the resource for it. But chemotherapy was not an issue for Head and Neck because it was not a primary modality of care for the patients.
Tacey Ann Rosolowski, PhD:
What about radiation at that time because that was also a tough area of the body to irradiate.
Cecil C. Brewer, RN, BSN, MS:
Radiation was the primary mode of treatment for head-and-neck patients, surgery and radiation, okay. And our patients were getting high-dose radiation especially those who are having either preoperative radiation to their necks, head—(inaudible) or even getting postop radiation. And many times, those patients would have lots of issues with their skin and exposure to major organs and major blood vessels, and we always had to be on the keen eye on—for complications. Patients back then were getting cobalt treatments, and we had patients who would travel to Texas to College Station because they had the only high-dose radiation machines up there. And we would have to prepare those patients every day, get them up, make—see what their needs are for the entire day. A nurse would travel with them if they had to have a certain type of suctioning, feeding, they have prepared a—if they had a tube feeding, they prepared the formulas that would go with the patients and the dressings and, etc. And they will be gone all day to get their treatments and come back to Houston in the evenings, and they would go up there several times a week to receive their radiation treatment. Now, the complications were serious because the dosing was not as precise as it is today. And patients would have exposed blood vessels, muscles and sometime, those would erode, and it became a life-or-death exposure. As head-and-neck nurses, we knew what to look for. A patient could bleed to death in a second if you didn’t know what you were doing, and we always had to be on keen notice. We call them carotid artery exposures or the jugular vein exposure. If those veins were to erode, we had very limited time to work to stop the bleeding, and those patients generally would go to surgery immediately for it. Because they would have to go into surgery, the surgeon would have to ligate those vessels to stop them from bleeding because there was—because you couldn’t mend them because the radiation had basically destroyed the tissue around them. And so, obviously, you talk about collateral circulation, and I don’t want to get into that, but those were other issues.
Tacey Ann Rosolowski, PhD:
Well, these were early days of the research on the impact of radiation on normal tissue.
Cecil C. Brewer, RN, BSN, MS:
Yeah, you talk about research, those doctors Jesse—Dr. Jesse, Byers, Dr. Guillemondegui, Ballantyne, they wrote the book, MacComb, [Frye?], and those guys from other—Memorial Sloan Kettering, they were all colleagues. They wrote the books on the care of the head-and-neck patients, and even today when they have head-and-neck conferences and they are talking in their multidisciplinary conference, they refer back to studies that these guys conducted and the books that they wrote.
Tacey Ann Rosolowski, PhD:
Yeah, it’s foundational.
Cecil C. Brewer, RN, BSN, MS:
Foundations for head and neck nursing, and they involved us too. They involved us as nurses in their research.
Tacey Ann Rosolowski, PhD:
How so?
Cecil C. Brewer, RN, BSN, MS:
Well, I know several nurses who are listed as co-contributors to the actual research, the collection of data, the mention of nurses being an integral part of the care of the patient. They gave credit where credit was due.
Tacey Ann Rosolowski, PhD:
That’s great. That’s great.
Cecil C. Brewer, RN, BSN, MS:
They involved us. As a young nurse, you’re invited to these multidisciplinary conferences and asked for your input. The doctors approach you and say, “I have a patient with this type of problem, I want you to be the one to care for them. I want you to go up to the next floor and check on my patients to make sure they’re receiving the right care, the appropriate care.” That’s the type of collegiality that we had when working with head-and-neck patients.
Tacey Ann Rosolowski, PhD:
Now, you advanced to head nurse and then to supervisor of the surgical service, so tell me about that movement in your career. I didn’t find specific dates related to those, so I’m curious too on how fast track you were in getting to those promotions?
Cecil C. Brewer, RN, BSN, MS:
Well, the first in 1972, I was staff nurse. About 1973, I was a charge nurse on the floor, I was leading others, not following. The third year, I was promoted to a head nurse. That’s how the progression of the career was going as far as—your first part of your career is technical, skills, more skills, how you’re able to do these skills, doing things that are very manual, skill sets., demonstrating organization—organizational type of skills, functionality skills. And that’s how these—the—your supervisors evaluated you on how technically skillful you were and how delicate you were as far as being able to get others to do—to lead others in your teams and to get the work done. If you did well enough, if there were challenging units other than the one you were on and there was opportunity, then you were—you were sought out. And so in 1973, ’74—1974 maybe—’73, I became the head nurse on the—no, 1974, I was a charge nurse on the 3:00-11:00 shift on the head and neck, I believe, and I was approached by the assistant director at the time Ms. Hilkemeyer or Ms. [Levereturn?] or either Ms. [Good?] or Ms. Bane. Those were the executives of nursing, Renilda Hilkemeyer, Catherine Bane, another lady, another nurse, her last name was Good. In the old structure of nursing, we had supervisors on different shifts, so on a day shift, you might have—you’ve heard of the name Ethel Fleming?
Tacey Ann Rosolowski, PhD:
Hmm.
Cecil C. Brewer, RN, BSN, MS:
She was the first black nurse to work at MD Anderson, and she was the first black supervisor, management at MD Anderson. The Brown Foundation Award that’s given out today was—was named after her, Ethel Fleming Arceneaux. And then you had Ms. [Carlson?] and as far as the evening shift, Ms. (Inaudible) on nights, and [Mabel Graham?] on nights, but these are the supervisors that you respected, that you looked up to. They’re the ones who gave you guidance and support on your different shifts. They were the eyes and ears of the nursing units throughout the hospital in a centralized way. And so they gave feedback to Ms. Hilkemeyer who they felt were her next potential head nurses. And I was chosen to go to Four West, which was a surgical unit where patients were getting a different type of care, and it wasn’t head and neck. This was just general surgical patients, Four West, which is now Five West—Five Blue. And remember, all of our environment on these units were basically ward environment. We had like four big ward rooms, four patients to a room connected by a bathroom, eight patients for one restroom, no shower, just only a tub. And you had like four semi-private rooms and four private rooms. That was the template of the hospital. The template was the same whether you were on the east end or the west end of the—of Anderson. And so Four West was my—was the unit that I started my head nurse duties on, and those type of patients were patients who were having abdominal surgery—basically abdominal surgery and the different types of surgery that go along with that, colonectomies and colonoscopy—I mean colonoscopies and colostomies and on and on. And I was there for—and I worked with very famous surgeons again that had lots of respect. Dr. Richard Martin, Dr. Ed White, Dr. Romsdahl, all these guys are kingpins in the area of general surgery today. And a few of the hematologists would come through with Dr. [Gamble?], Dr. Freireich, and the likes. And so I did well on the surgical floor. When I was there, we—this is around the time where, again, technology is improving in the—around 1975. And I was very fortunate to be on that floor at the time where we decided—where the decision was made to move from the old-fashioned way of preparing medications with a tray to a medication cart, which is the predecessor for automated (inaudible) machines.
Tacey Ann Rosolowski, PhD:
Oh, wow, mm-hmm.
Cecil C. Brewer, RN, BSN, MS:
But we started on Four West, we called it unit-dose medications, and we implemented unit-dose medication carts starting in 1975, myself and another—my—the person who came after me as head nurse when I ended Virginia Romsdahl. She was Virginia Allen at the time or Virginia Romsdahl, and we implemented. She was my charge nurse and then she became the head nurse, then I went back up to Head and Neck because there was a void in the position on Head and Neck, and they knew I knew head and neck, so I went back up to Head and Neck, and we implemented the first unit-dose medication carts at MD Anderson.
Tacey Ann Rosolowski, PhD:
And let me just ask you because it’s almost 4:30, so before we close off today, what was the impact that that had on care of the patients?
Cecil C. Brewer, RN, BSN, MS:
It was not the care of the patients. It really impacted the care—it had the impact on the safety of medication administration, and the efficiencies of the administration of medication. And I guess the impact would be the safety of a patient because the medications were prepared by a pharmacist and delivered in a tray, which goes into the unit-dose cart. And a specific dose of medication for John Doe not in a little open cup. So you got all types of safety, hygiene, efficiencies built into that, and the nurse was able to push the cart from room to room and not have to break and to be distracted and also have appropriate infection control of her medication about how to have a tray that you sit, may—and happen to have to sit down a patient’s bedside table while you would give the patient a pill.
Tacey Ann Rosolowski, PhD:
Right, right, huge.
Cecil C. Brewer, RN, BSN, MS:
And also you had all of the things that you needed to administer your med. You had water, you had juices to offer the patient while you were administrating that medication. You had your syringes, too, for your vials of medication that you may give injections. So this cart brought about—had all the efficiency and safety for the distribution of medications.
Tacey Ann Rosolowski, PhD:
Very cool. Well, why don’t we leave it off for today?
Cecil C. Brewer, RN, BSN, MS:
Okay.
Tacey Ann Rosolowski, PhD:
And we will make another time to talk for sure. I mean we’re just getting into your story.
Cecil C. Brewer, RN, BSN, MS:
Okay.
Tacey Ann Rosolowski, PhD:
So I’ll just say for the record, thank you very much for joining me today, and I am turning off the recorder at 4:30.
Cecil C. Brewer, RN, BSN, MS:
Okay. Well, I enjoyed it.
Tacey Ann Rosolowski, PhD:
Yeah, it’s really interesting.
Recommended Citation
Brewer, Cecil C. RN, BSN, MS and Rosolowski, Tacey A. PhD, "Chapter 05: Working as a Registered Nurse in the 70s: An Overview" (2019). Interview Chapters. 907.
https://openworks.mdanderson.org/mchv_interviewchapters/907
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