Evolution of Nursing at BWH
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Many Advances in Nursing Since BWH Founded in 1980
Brigham and Women’s Hospital was born when three separate and renowned institutions—each with a distinguished community of caregivers—blended their rich traditions of excellence. The Boston Hospital for Women, (formed in 1962 from the merger of the Free Hospital for Women and the Boston Lying-In Hospital), the Peter Bent Brigham Hospital (PBBH) and the Robert Breck Brigham Hospital (RBBH) officially welcomed patients as Brigham and Women’s Hospital in the new 16-floor Tower at 75 Francis St. on July 9, 1980.
The last 25 years has seen an explosion in technology, the science of nursing and the development of the discipline. Throughout these years, nursing has remained the cornerstone of the care for which BWH is known. Nurses’ advanced knowledge and technical skill provides reassurance to patients and families as their sensitivity and caring provide comfort.
“As we look back, we can be proud to be part of such a noteworthy community of nurses within an institution that has evolved to be one of the best in the world,” said Mairead Hickey, RN, PhD, senior vice president of Patient Care Services and chief nursing officer.
“We were in small hospitals for years, and then, all of a sudden, you were in the Tower with thousands of people you didn’t know,” said Joanne Salines, a nurse who started at PBBH in 1975 and now works as a corporate labor relations manager for Partners HealthCare. “It took a long time for the culture to change from three separate cultures to a Brigham and Women’s culture.”
In 1980 when Brigham and Women’s Hospital opened with the rise of the Tower, DRGs and prospective payment were not yet implemented, patients were admitted the day before surgery, stayed in the hospital for weeks at a time and were cared for by nurses whose roles revolved around the tasks of team nursing. That model of care called for individual nurses to be assigned specific tasks such as mixing IVs, changing dressings, taking off physician orders, monitoring vital signs, (sometimes as often as every five minutes) and dispensing medication.
In the late 1980s and early 1990s, team nursing gave way to primary nursing.
“With primary nursing and our modified version of that practice, nurses started developing a distinct familiarity with specific patients, and often times it was the doctor calling nurses with questions,” Patricia Kidik, MS, RN, a nurse practitioner in the Weiner Center for Preoperative Evaluation, said. “We knew the patients better than anyone else.” Knowing the patient offered information and insights that were crucial to care.
Back then, the latest technology used for assessment and monitoring included CVP lines, IVACs, cardiac monitors and Swan Ganz catheters. “Early insulin pumps were as big as a patient bed, and now they’re the size of an Ipod,” said Katrina Bickerstaff, RN, BSN, of the PACU, who began as a candy striper in the early 1970s when she was in high school.
Technical advancements in specialty areas have resulted in increasingly complex care. Patients were benefiting from advances in organ transplantation, resuscitation and support of premature infants, obstetrics and critical care.
Continued innovations in technology require nurses to expand their technical skills and dexterity in order to care for patients. The Alaris Smart Pump, eMAR, computerized Physician Order Entry, electronic access to laboratory reports, telemetry, patient monitoring devices, and diagnostic monitoring and technologies have made real time life saving nursing interventions possible.
In high-tech care environments like Radiation Oncology and Neurosurgery, technology advances have had a revolutionary effect on patient care, and BWH is on the cutting edge of bringing new care techniques to the bedside.
“Radiation technology is incredibly sophisticated these days,” said Carol McGarigle, RN, a staff nurse in Radiation Oncology. McGarigle pointed to increasing precision in Radiation treatment that targets cancerous cells and growths while sparing more healthy tissue.
BWH has been at the center of several significant advances in Neurology, such as intracerebral pressure monitors and other scanning techniques, and Neurosurgery, where BWH opened the world’s first MR-guided operating suite in the world. “There have been so many recent advances,” said Neurology Nurse Manager Shaun Golden, RN, BSN.
Both Golden and McGarigle said the advances in technology have brought Nursing to a higher level of technical
“I can’t imagine doing what we do without a computer,” said Jessica Seaver, RN, BSN, a new addition to the MICU.
Education and Practice
Computers were not in sight 25 years ago when “new nurses sat and listened to an overview of policy and then took a few days on the unit to get oriented. Trainers simply presented the material,” said Charlotte Messinger, RN, BSN, central educator for Nursing Professional Development.
Today, BWH’s approach to orientation and ongoing education is based on a comprehensive program of classroom and unit based learning. Continuing education courses and ongoing staff development are part of a philosophy of ongoing learning in the classroom and in the clinical area. This philosophy extends to the newly licensed nurses who also benefit from on unit learning that compliments learning in the classroom. In addition, newly licensed nurses are part of a comprehensive program introducing them to the care of the critically ill ICU patient.
Complex, Expert Care
“Through the last 25 years, nurses here have demonstrated an amazing capacity to integrate cutting-edge technology with BWH’s tradition of excellent patient care,” Hickey, BWH’s chief nursing officer, said. “While the technology advances are most apparent, we must not overlook the developments in practice and the growth in the discipline. This includes the evolving nurse-patient relationship and the increased professionalization of the role. Nurses are still the anchors of this great institution which is all about patient care.”
As complexity increased, nurses were applying critical thinking skills at the bedside and began actively participating on multidisciplinary care teams. Relationships with care team members evolved and nurses were instrumental in coordinating care across disciplines. This reflected a national trend as nurses began to seek long-term careers in clinical practice. Career advancement was no longer tied to leaving direct care for teaching or administrative work.
However, by the end of the 1980s, enrollments in nursing schools declined and nurses were assuming expanded roles in the inpatient and outpatient setting. An acute national nursing shortage occurred. In response, nurses’ work schedules changed as BWH turned to the Baylor schedule to cover weekend shifts. This schedule called for participating nurses to work two 12-hour weekend shifts and be paid for a full 40 hours. Until this time, nurses worked eight-hour shifts with changes occurring at 7a.m., 3 p.m. and 11 p.m. This began a transformation in scheduling practices that continues today with a variety of flexible scheduling options.
BWH nurses have played a role in moving nursing into the forefront of national health care policy as leaders and active members of many national nursing organizations. “Nursing has taken on a national agenda as all professional registered nurses are focusing on competency issues, staff and patient safety and autonomy in applying critical thinking skills,” said Helen Cluett, RN, MSN, a perioperative nurse educator, who started at the PBB School of Nursing as an instructor in 1967.
“There has been a continual evolution in the relationship between academic and clinical environments as the curriculum is based more on best practices, concepts of research and evidence-based care,” Cluett said.
Beginning in 1985 with the creation of the National Center for Nursing Research at the National Institutes of Health (later renamed the National Institute of Nursing Research), there has been an increase in federal resources for nursing research and research training. This enhances the possibilities for interdisciplinary collaborative investigation. At BWH, the Center for Excellence in Nursing Practice was established for the purpose of taking and bringing research and evidence based practice to and from the patients’ bedside, thus translating research into practice. Nurse researchers also conduct independent research. Unlike many nursing centers affiliated with academic institutions, the center is based in the hospital where nurses practice.
Today, BWH offers 747 inpatient beds and expert clinical care in dozens of specialties and subspecialties that rank among the best in the country. The hospital each year hosts nearly 44,000 inpatients, delivers 10,000 babies and receives approximately three million ambulatory visits. Advances in technology, practice and in the discipline continue. Nursing has evolved into a theory and research based practice.
“At BWH, we are privileged to be members of a distinguished community of nurses and an equally distinguished larger community of caregivers, each steeped in a rich and proud tradition of care,” Hickey said. “There are many challenges facing the discipline in the next 25 years, but if our history is any indication of the future, we will meet these challenges with confidence that we will positively shape the future.”