Chapter 06: Moving into Management Roles in Nursing

Chapter 06: Moving into Management Roles in Nursing



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In this chapter, Mr. Brewer sketches his promotion track and reflects his leadership qualities and on the working environment for nurses at MD Anderson. He notes that his career evolved in tandem with advances in technology and cancer treatments: he had the ability to keep up with the changes required as nursing became more specialized, adapting research into bedside care practices. He gives examples of specialization and of his contributions to management. He talks about a program he initiated to make nurses more aware of the need to be good stewards of resources.



Publication Date



Houston, Texas

Topics Covered

The Interview Subject's Story - Overview; Overview; Professional Practice; The Professional at Work; Leadership; On Leadership; MD Anderson Culture; Working Environment; Multi-disciplinary Approaches; Mentoring; On Mentoring; Technology and R&D

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.


History of Science, Technology, and Medicine | Oncology | Oral History


Tacey Ann Rosolowski, Ph.D. I’m Tacey Ann Rosolowski, and it is quarter of 11:00 on June 6, 2019, and I am sitting in the Historical Resources Center Reading Room with Cecil Brewer, and that’s how you prefer your name to be said, isn’t it?

Cecil C. Brewer, RN, BSN, MS:

Yes. Tacey Ann Rosolowski, Ph.D. Okay, because last time, I think I said “Sesel.” I sort of anglicized it, and you were polite enough not to correct me, but I want to make sure that we have the correct pronunciation for the record, so Cecil Brewer. And thank you so much for coming in again today.

Cecil C. Brewer, RN, BSN, MS:

Great being here. Tacey Ann Rosolowski, Ph.D. Great. Okay. Well, last time, we talked a lot about your early years after you got your RN, you had already been working here for a number of years at MD Anderson as an LVN and got your degree, and you talked about general observations about nursing in those first few years. And I wanted to get a sense of how you—the scope of your responsibilities in the different roles that you took on, and really not so much the details of what you did but how the kind of moving up in level of responsibility gave you a different perspective on what nursing was at MD Anderson and what it could be. Oh, I also want to say—oh, I did say for the record what time it is. So I guess my first question is you became supervisor of the surgical service and then coordinator—clinical coordinator of Head and Neck, then assistant director of nursing medical surgical. So some of these I don’t even know what they are—and director of nursing medical oncology. So maybe you could just take me through that track and show how those different titles showed how nursing at MD Anderson was evolving in interesting ways.

Cecil C. Brewer, RN, BSN, MS:

May I start back a little bit— Tacey Ann Rosolowski, Ph.D. Absolutely.

Cecil C. Brewer, RN, BSN, MS:

—because everything is kind of linear in my career. My career path starts, like you’ve already mentioned, as an orderly early on in my days then where I evolved from being a non-licensed provider, which is an orderly, nurse-assistant-level person, to a licensed individual to a licensed vocational nurse. And from that evolution, becoming a registered nurse, a registered nurse is a baccalaureate degree in nursing from Prairie View and taught in the career in—at MD Anderson, and using those skills from the bedside to more of a leadership role as a registered nurse and as a head nurse and—which not necessarily the “true leadership" but management. Management being a nurse manager or a head nurse, a nursing supervisor, which is more management, having a broad spectrum review of what’s going on within the clinical areas every day and guiding all levels of staff to a level of top performance. The directorships, which all started in the 1980s. I’ve been thinking that was 1981 when I was promoted from being a clinical coordinator, which in that role, I was working more as a clinical expert in the area of Head and Neck nursing, and that was a very global position where I was responsible for having the overview of all the patients on that service in the hospital to make—to ensure that they were getting the best possible care they could. So that meant doing consultations as well as review of the clinical care of those patients. From that role, which honed my leadership role as far being able to look at the big picture, I was offered a position as an assistant director of nursing, and I believe that section was medical surgical nursing. And I worked in that role maybe a few years, and I was promoted to an assistant director for medical oncology. It was just changing— Tacey Ann Rosolowski, Ph.D. What were the years there? Do you have sort of general—?

Cecil C. Brewer, RN, BSN, MS:

I would say 1981, I was assistant director of medical surgical. Nineteen eight-five is more like medical—assistant director of medical oncology. And the difference in those roles is that it becomes more highly specialized. The medical surgical is a mixture of disciplines where you are providing leadership for surgical teams and medical teams, and you’re really not totally focused on one particular item, I mean, clinical service. With the medical oncology, the focus is specific to a patient requiring medical care. Medical care meaning that they’re not receiving surgery. [Whether they be?] radiation therapy, chemotherapy, immunotherapy, biological therapy, that would be the domain for medical oncology focus. Tacey Ann Rosolowski, Ph.D. Well, and this is following a sort of transformation at MD Anderson because one of the—I’m working with Charles Balch on a project right now, and we’re having a lot of conversations. What is that shift? How did that shift happen within surgery, from surgery as what they’re calling reactive surgery to a medical oncolo—a surgical oncology perspective? And that seems like it’s tracking within the institution as a whole. How are we taking an oncology approach rather than point-by-point, all right we have to do that, we have to do that, sort of treatment management. So tell me, talk to me about that.

Cecil C. Brewer, RN, BSN, MS:

The evolution of my career at MD Anderson also followed the track of the evolution of oncology at MD Anderson. As the technology changed over the years, there were tremendous improvements in the surgical treatment of patients. It got more sophisticated, more complex. Medical treatments, chemotherapies were getting more complex. We began to do more innovative type of treat—therapies such as bone marrow transplants. And so the ability to manage and to, if you will, keep up with all of the changes going on required specialization. And when working with the physician groups, they were so highly sophisticated and knowledgeable of was going on in the research. Nursing adapted a framework that modeled the physicians and the advances that were being made in cancer, in cancer care moving from, say, a medical-surgical multitask, multi-care perspective to a more focused perspective with medical oncology.

So, for example, medical oncology, my units were like lymphoma and myeloma, which is hematology, and bone marrow transplant. So my nurses that I hired were all educated and trained specifically to provide the highest level of care for that patient population, not trying to be all things to all people and not taking care of a surgical patient and not taking care of urology patients and not taking care—they are very capable of taking care, providing basic care to all oncology patients and we talk—only talk about oncology. But the world is getting so sophisticated that it’s too complex for the nurses to manage these patients, so we organized each of the nursing units according to a specialty. And the nurses were hired into these specialties, and the organizational structure that we put in place was designed around that disease process such as leukemia or lymphoma. And with that specialization, we were able to accomplish a lot. Tacey Ann Rosolowski, Ph.D. When was that practice put into place? Was this— [00 08:59]

Cecil C. Brewer, RN, BSN, MS:

I think the practice has been an evolution. I think when I came to MD Anderson, there was a portion of the specialization I started because MD Anderson was organized surgical and medical when I got here in 1970, and I worked on the Head and Neck Surgical Unit. Why is that? In the 1970s, the technology for chemotherapy, immunotherapy, biological therapy was so limited. There was not even any chemotherapy regimen in place for a head-and-neck patient. Surgery was done to cure the patient. Some of the surgeries were so radical. Then, there was a urology’s floor, there’s a thoracic surgery floor, then you had your medical floor. But when you look at the technology involved in the care of this patient in that era and you’re looking back, you could say it was not as complex as it started to get as the research started to evolve in the ’80s. But when you go from the ’70s and everything is—you could get your hands around the care of those patients because you’re not (inaudible) with these sophisticated protocols and algorithms. But in the ’80s, more developments occurring. Now, you’re getting into your advanced chemotherapies and your advanced immunotherapies and your biological treatments and your radiation—radiation oncology is evolving and is moving from just a one-horse town if you will to a big city.

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Chapter 06: Moving into Management Roles in Nursing