Jane Ingalls

Jane Ingalls has been a nurse and nurse educator in the Fredericksburg region since 1966. She received a BSN from the Medical College of Virginia (now part of Virginia Commonwealth University) in 1966 and began working at Mary Washington Hospital and teaching at the Fredericksburg Area School of Practical Nursing. In 1984, she began teaching at Germanna Community College and retired as the Dean of Nursing and Health Technologies in 2009. She received a MSN from Catholic University and Doctor of Nursing Practice (DNP) from George Mason University. She served on the Mary Washington Healthcare Board of Trustees from 2001 to 2009. In 2011, Governor Bob McDonnell appointed Ingalls to the Virginia State Board of Nursing.

Jane Ingalls was interviewed by Jess Rigelhaupt on December 15, 2014.

Discursive Table of Contents

00:00:00-00:15:00
Beginning career at Fredericksburg Area School of Practical Nursing in 1966 after graduating from Medical College of Virginia (MCV) with a bachelor’s in nursing—Earliest memories of Mary Washington Hospital—Mother graduated from nursing school at Mary Washington Hospital in 1930—Working as a nurse’s aide at Mary Washington Hospital while in school at MCV—Teaching at Fredericksburg Area School of Practical Nursing and coordination with Mary Washington Hospital

00:15:00-00:30:00
Germanna Community College opens in 1972 and begins an associate degree nursing program—Nursing education at Mary Washington Hospital in the 1960s and 1970s—Working part time as a RN at Mary Washington Hospital—Earned a master’s in nursing from Catholic University in 1971

00:30:00-00:45:00
Returned to teaching at Germanna Community College in 1984—Began serving as the Director of Nursing and Allied Health programs at Germanna Community College in 1992—Changes at Mary Washington Hospital in the 1980s—Collaboration between Germanna Community College and Mary Washington Hospital in the 1980s

00:45:00-01:00:00
Collaboration between Germanna Community College and Mary Washington—Germanna works with other hospitals in the region—Service on the Mary Washington Healthcare Board of Trustees—Support for a nurse to serve on the Mary Washington Healthcare Board of Trustees

01:00:00-01:15:00
The new Mary Washington Hospital on Snowden Hill—Development of cardiac surgery at Mary Washington Hospital—Partnerships between Mary Washington Hospital and the nursing program at Germanna Community College

01:15:00-01:30:00
Healthcare assembly, community health care needs, and community benefit—Service on the Mary Washington Healthcare Board of Trustees—Increasing use of evidence-based medicine and benchmarks

01:30:00-01:45:00
Quality benchmarks and patient satisfaction—Stafford Hospital—Magnet status for nursing at Mary Washington Hospital

01:45:00-01:52:05
Changes in nursing since 1966—Important role for nurses on boards of trustees—Concluding remarks on Mary Washington Healthcare

Transcript

00:00:06
Rigelhaupt:
It is December 15, 2014. I am in Fredericksburg, Virginia, doing an oral history interview with Dr. Jane Ingalls. And to start, I would like to ask about your return to Fredericksburg after you graduated from the Medical College of Virginia in 1966.

00:00:27
Ingalls:
I was recruited out of the Virginia Department of Education to come back to Fredericksburg to teach in the Fredericksburg Area School of Practical Nursing because they needed someone who at least held a bachelor’s degree in nursing. And at that time, that was not very common. I had been a good student at the Medical College of Virginia and they knew that I was a Fredericksburg area resident. I was recruited and I liked the idea because I was getting married to my teenage sweetheart. We were going to be getting married in August here in Fredericksburg and he had decided to take a job at an engineering firm out in Stafford County, which brought us back home to be with our family members. It was just wonderful. We got married on the 20th of August, and about the 28th of August I reported to James Monroe High School for orientation as a faculty member. Actually, I was employed by the Fredericksburg Public School system, but the program was a joint program run with all students coming from the high schools in the Planning District 16 area. Also, it was a program that had adults. For three years, right out of college and having nursed as a student nurse, I got recruited to come teach anatomy and physiology, nutrition, human growth and development, fundamentals of nursing, and basic nursing care right in the basement of Mary Washington Hospital, which at that time was on Fall Hill Avenue.

00:02:33
Rigelhaupt:
Well, we’ll come right back to continue asking some questions about teaching there, but if I could actually potentially go back even farther—what are your first memories of Mary Washington Hospital?

00:02:42
Ingalls:
My first memories of Mary Washington Hospital involve my mother because she was a registered nurse and she had attended the Mary Washington Hospital Training School of Nursing in 1927. [03:00] She graduated in 1930 with her diploma and was one of the nurses that took her licensing exam here in Virginia. My earliest recollections are of my mother. At the time when I was a child she did return to nursing part-time and she’d work at nights on all different units. She would work at nights so that she could be home, of course, when she would be getting us off to school and when we would come home from school. My memories of my mother certainly are very clear about her days working at the hospital, and she was a wonderful nurse. Those nurses that had graduated from the Mary Washington Hospital School of Nursing, which of course was located down on Sophia Street, where there are townhouses now, next to the library, near the library. That was the school where the hospital was. In fact, I think it was interesting to note that at that time, 1927 to 1930, the nursing students were the nurses on the units, on the floors, to the patients. Once one graduated from that school of nursing, most people either went into private duty nursing or they may have gone into visiting nursing, or what we call today public health nursing. Right from the start she had a group of colleagues and peers who graduated with her that were dear friends, and they all were working at Mary Washington Hospital. Of course I was part of that with her: her nursing and her friends. Over the years she then continued on and she worked full time and she worked on a floor called 1-East. 1-East was a very special medical floor and that’s where all Fredericksburg’s finest would be when they needed to be hospitalized. When I was seventeen and I started off at Medical College of Virginia, I had the opportunity, after completing my first year of the four-year program, to be a nurse’s aide on that 1-East. I got to work alongside my mother. I was doing patient care, basic patient care that I had learned in my first year at school. [06:00] It was really neat to work with her and her friends and I think I learned a lot from her. She was about five-foot-two, maybe, at a stretch. I can still see her now. When she would need to go to a patient’s room she would walk so fast down the hall, and I got that. I think the students would tell me when I was out at Germanna Community College, and even when I was nursing, myself, on the units at Mary Washington Hospital later as a registered nurse, I didn’t have any trouble getting down that hall either. I think it was probably because she showed me how to move. That’s from my earliest recollections of Mary Washington. Of course I was born at the Sophia Street Hospital.

00:07:07
Rigelhaupt:
What do you remember most about what you learned the first summer that—I presume it was the summer after your first year working as a nurse’s aide, what you learned from other nurses, including your mother?

00:07:23
Ingalls:
Oh, my goodness. What did I learn, watching them? They were able to nurse. They were able to care for the patients. I think they were very smart. They were the hands and the eyes of the doctors. The doctors really counted on them and respected them tremendously and were like colleagues. I can remember my mother telling me, before she went to work at Mary Washington, how when she was doing private duty nursing it would be routine for a doctor who needed to get to a patient out in the county someplace, one of the counties, that the doctor would pick up the nurse, they would travel together, and take care of the patients. While they weren’t doing that in the sixties, there was still a little bit of that carry-over of a collegiality and camaraderie between the docs and the nurses. Maybe it wasn’t quite an equal playing field as I’m trying to describe because I remember when the doctors came, and if those nurses were sitting and charting, they would get up. [09:00] They’d stand up and let the doc have the seat because they knew he needed to do the charting too. I learned and I came through a time of change where I observed that as a freshman in a small community hospital compared to where I was at school. At the Medical College of Virginia, there were just so many nurses and residents and interns and doctors that we were all scrambling around for any space we could find. We would keep our space if we needed it. That’s an observation I have and then I have to have in my mind a picture of—there were private duty, private rooms on one side of the hall, and there were semi-private rooms on the other side of the hall. I just remember the nurses I observed—and who I learned from—go to the patients. Certainly everything that was needed medication-wise, procedure-wise, was administered, but also, you know, backrubs were a given. Maybe even during the day, if a patient was having pain or suffering and needed something to help them relax, the nurse would be there and giving them backrubs and standing or sitting by the bedside. That’s what I learned about nursing: is that as we had changed and grown into a world of technology and electronic medical records and so many more complications with medicines and knowledge of medicines. We’ve lost some of that ability to simply be still and at the patient’s bedside. And certainly a backrub is not something that you hear of much today.

00:11:43
Rigelhaupt:
So when you started teaching just after you graduated from college, this was a time where more and more nursing programs were coming through colleges and hospitals were no longer running nursing schools. This was a moment of change. [12:00] How much coordination was there with the hospital? Was there still a holdover from when your mother went through nursing school at the hospital—I imagine there was some? It was in the basement. What do you remember about the coordination as you were teaching with the hospital?

00:12:19
Ingalls:
The Fredericksburg Area School of Practical Nursing, I think, had started in the ‘50s and that school of nursing had to have a clinical site. The only clinical site for acute care nursing and learning about surgery, obstetrics, pediatrics, even psychiatry, and medicine across the lifespan had to be at Mary Washington Hospital. I knew that there was a Fredericksburg Area School of Practical Nursing and I knew that it had been a very successful program even by the time, 1966, when I became associated with it. The public schools had a contractual agreement with Mary Washington Hospital to provide all their clinical experiences. Certainly we at that time were also into long-term care facilities, so Mary Washington wasn’t the only facility that we had contracts with. At that time, 1966, and before I came on, the hospital provided a large area—we had a classroom, we had a large laboratory area, and we had office space in the basement of that Fall Hill building. It was a natural fit: when students had learned in the lab and in the classroom what they needed to know, it was a natural to go right upstairs to have your clinical experiences right there. I taught there for three years and it’s real interesting. I don’t think there are many today, 2015, but most of the practical nursing students that I taught did graduate and became licensed practical nurses. At that time, for the most part, they were employed almost 100 percent by Mary Washington Hospital. It was a relationship: here you have your students, your student nurses, in house, almost. My salary was not paid by the hospital. It was just giving us the physical plant to have the school, and then a natural to go right to their units, or floors, we called them, to have the clinical learning experience. Then the students graduate, become licensed nurses, and they become employed. [15:00] That was the ‘60s and that reminds me in 1972 Germanna Community College opened. It opened with an associate degree in nursing program, which led to licensure as a registered nurse. Now, the practical nursing program continued, but eventually it moved out of Mary Washington Hospital and moved out into what is now the Spotsylvania Vocational Technical Center. I don’t know if it was physically in that plant right then, but it probably was. The practical nursing school of Fredericksburg area continued until just this past year. So, what? Sixty years. At the same time that Germanna was starting its associate degree program leading to licensure as a registered nurse, that practical nursing program was also going, and the hospital needed both LPNs and RNs. The community was able to provide LPNs and RNs to Mary Washington.

00:16:30
Rigelhaupt:
Thinking about the nursing program at Mary Washington Hospital when you started teaching, how did it compare to Medical College of Virginia? A teaching institution—what were some of the strengths of the nursing program, or differences that you saw with MCV?

00:16:48
Ingalls:
MCV at that time and today, of course, has such a diversity of health care students—I had classes with medical students and dental students and pharmacy students. I took anatomy and physiology with the same person that was teaching the medical students and the pharmacy students and so on. So many experts and resources at the big hospital, the big urban hospital, compared to, of course, the community. We were small then. This community, in the 1960s, the hospital—I’m trying to think how many patients would even have been in Mary Washington Hospital over there on Fall Hill Avenue. How many? Maybe it was 100, 150 beds? Four floors and a basement. [18:00] Whereas Medical College of Virginia, I’m up on the seventeenth or sixteenth floor. Much smaller, fewer complications here with the kinds of health issues, but certainly serious health issues here that we were dealing with. We didn’t have the diversity of providers that I was used to at Medical College of Virginia. I always said, though, when I came back to Fredericksburg and my job was teaching the pre-clinical piece and the basics to high school seniors from Stafford, Fredericksburg, James Monroe, Spotsylvania, Caroline County—I don’t think we had any students from Westmoreland County—and then adults. I taught them everything—the basics. I was the one with a class of about, maybe, twenty-five students. And I was trying to think—at that time, I think we just had one class from nine until twelve, something like that. I would say that those students got a Medical College of Virginia education because I had just come from there and I had such a good education at the Medical College and I gave them everything that I had. And boy, I think they were the best. I started to say, “It’s been a long time.” I would see those students after they graduated. Many of them remained practical nurses, licensed practical nurses. Some went on and got their registered nursing. The change that we’ll probably talk about more as we go on is that hospitals and patients and health care just grew in its complexity and the evolution—just the complexity of clinical decision-making, critical clinical decision-making, and more and more it’s the role of the registered nurse who would be tasked with those responsibilities. The hospital of course, working with Germanna Community College, was eager to bring in every one of those registered nursing graduates that they could. Over time the hospital evolved and now practical nurses are needed, but they are not usually today found in acute care settings. They are more in more residential settings, long-term care settings possibly, and assisted living settings. [21:00] So that has changed.

00:21:14
Rigelhaupt:
What do you remember about your first shift in Mary Washington Hospital where you were nursing?

00:21:20
Ingalls:
My first shift as a registered nurse? I was part-time because I was full-time at the Fredericksburg Area School of Practical Nursing. I think I probably was working on 1-East—we’re still back on Fall Hill Avenue, because this is the latter part of the ‘60s, early-‘70s. And I just know—I don’t know if it was the first time, but it was most likely—I was determined to try to give medications on time. I was determined to do my assessments as they were to be done and I was determined to keep my charting current because I thought it was important to keep up. I can remember: no, I wouldn’t go to lunch, or no, I wouldn’t take a fifteen-minute break. I didn’t need that. If I got to lunch, I maybe got to lunch and you had thirty minutes maybe for lunch, and I maybe didn’t need that. Maybe I took fifteen minutes. I tried to be on task and to be current with my care and delivery and the documentation of it. I was able to do that, for the most part. There were times I’m sure that I got behind and had to stay over and that was important to me, to do my work and not be distracted. I did and I can remember coming home and being exhausted because I put everything into what I do. It was probably on 1-East that I had my first experience: it’s just giving meds, meds, meds, meds, pushing the med cart round, round, round, round. And just staying on task.

00:23:45
Rigelhaupt:
Did you mostly stay in 1-East for the years you were there until you went back to get your master’s?

00:23:53
Ingalls:
I moved up to the post-surgical step-down unit. I really enjoyed the surgery, the post-surgical patient. [24:00] I think I spent most of my time, as I’m trying to think, working part-time. For a while I didn’t do anything. Well, I did do a lot: I was taking care of two children at home. Back in the late-‘70s, early-‘80s, I went back to the post-surgical step-down unit. I went to the post-surgical step-down unit and worked part-time, sometimes 11:00 to 7:00, 3:00 to 11:00. I did have my children then, and so again, it was part-time, and I tried to work weekends or nights when my husband could be helping out at home. Those were good days. I had a lot of fun and I liked the people that I worked with. Mary Washington Hospital nurses were always just good colleagues to work with and the doctors were, I thought, very helpful to me. I felt like we were all giving good care to the patients.

00:25:29
Rigelhaupt:
Well, right about this time is also an era of expansion for Mary Washington Hospital. In ’79 they added a wing and a number of floors. What do you remember about that era of expansion? Was it a sign that the hospital was growing, that the community was growing?

00:25:50
Ingalls:
I remember. You’re right. They added some floors. See, from ’69 until probably ’79, I would have been a citizen. I would not have been an employee. I was home taking care of my children, raising my family. I had family members who were patients in the hospital, and of course I had my children in that hospital. To me it was very familiar territory. I think my mother continued to nurse there. I want to think when she retired—that’s one of the things I’ll have to look up and come back to tell you later. She was even working full-time until about maybe 1965 and so it was still very comfortable to me. In the community, certainly we were growing slowly and growing enough to certainly need more rooms. [27:00] It would be interesting to know how many beds we did add at that time. I’m just trying to think—I’m just thinking about my father, who had some serious surgery. He had bladder cancer. We had a urologist, a Dr. Gray, who did his surgery, and my father had two-thirds of his bladder removed. I can remember how he was cared for as I was coming in to visit him. The nurses still, even in that time—we’ve moved on now, we’ve moved on to the ‘70s—the nurses were still charting everything by hand, medication administration. You had had care teams. On the team were the RN, an LPN, and a nurse’s aide. Your care was delivered by the team. Again, we were the only health care provider, the only hospital, in the community. I think we were growing to meet the needs of the growing community. I’d like to think back about moving into the ‘70s—it doesn’t compare to what’s happened in the last two decades, especially the last decade. I think things continued to move along rather slowly in Fredericksburg in the ‘70s.

00:29:05
Rigelhaupt:
Well, let’s jump forward then. So if my notes are correct, you returned to teaching at Germanna in 1984.

00:29:15
Ingalls:
Yes. When I left the Fredericksburg Area School of Practical Nursing in ’69, I was fortunate enough to receive a federal traineeship to go get my master’s of science in nursing. I did that, finishing it in early 1971. I commuted back and forth to Catholic University of America and got my master’s. I had a master’s of science in nursing, where hardly anyone had a master’s of science in nursing in Fredericksburg. And I did not want to work. I had the opportunity and was blessed to be able to stay home with my children and grow my children up. [30:00] When they became about ten I did go back. In ’79, I started working part-time at the hospital. Every so often I received calls from Dale Featherston from Germanna Community College, who was the director of the associate degree nursing program that started in 1972. She needed master of science in nursing prepared faculty. She called me up and I said, “No, Dale. No, Dale, I don’t want to work full-time.” So here I was, 1983, ’84, and I was working part-time in the post-surgical step-down unit at Mary Washington and I got a call. I said, “Okay. I’ll come out and we can talk.” She was very interesting. And I don’t know. I read the information that you gave me about this interview and that I’m supposed to sign that nothing should be scripted here. I can tell things that I shouldn’t tell. [laughter] I can remember, I had an appointment to go to have an interview. I can’t remember exactly when—it was probably spring or summer 1984. I was working 3:00 to 11:00 the night before in the post-surgical step-down unit. I lost a patient that night. It was difficult. This patient had had major surgery and had a major bleed-out that night. We got the surgical team in and everybody tried to repair the bleed-out, but she didn’t make it. I think it was a relatively young, maybe a middle-aged lady. I think she was married and she had children, and it really upset me, as you can tell—how many years later? And so I had an appointment to go have an interview for this teaching position the very next morning. Here I’d worked 3:00 to 11:00, stayed late that night, because, of course, things were complicated. Then I got to my appointment and I really wasn’t in any shape for an interview. I got through the interview, and of course, I was offered the job. [33:00] I don’t know if the events of that night made that much of an impression on me that I decided, “Jane, you’ve had the most wonderful experience of getting the best education at the Medical College of Virginia and here the federal government has entrusted me with the opportunity to get a master of science in nursing degree. I want to teach. That is my love.” I loved learning and I think I realized that it was time for me to do what I really could do. At that point in time with my children, they were old enough and they were in school and everything. I accepted the job in 1984. I think I came in as an assistant professor, teaching first-year nursing students, again, fundamentals of nursing, med-surg nursing, at Germanna Community College at the Locust Grove campus. Taking those students into the clinical setting. What clinical setting? Mary Washington Hospital. Now, Germanna Community College sat out there in the center of its service region at Locust Grove and we were blessed to also be able to have clinical experiences at Culpeper Regional Hospital, Fauquier Hospital in Warrenton, and of course, at Mary Washington Hospital. Mary Washington being the largest of those community hospitals is where we had many clinical experiences. We had clinical experiences comparably with a placement of students at Culpeper Regional Hospital and in Warrenton at Fauquier Hospital, as much as they could handle, but certainly Mary Washington Hospital was able to handle more. Because I lived here in Stafford County, that is where I would take my students. I did that as an assistant professor and eventually an associate professor and eventually a professor until 1992 when I became the Director of Nursing and Allied Health programs at Germanna. I don’t know if I’ve answered what you really asked me—I diverted there.

00:35:57
Rigelhaupt:
I wasn’t after anything in particular, so that’s not an issue. [36:00] Was the nursing program and the way Mary Washington Hospital was functioning as you came back, and seeing it—I mean, watching it carefully as an instructor, you really know what’s going on. Was it similar in 1984 in those first couple years you were back teaching or had it changed a lot over the decades since you had left?

00:36:31
Ingalls:
Of course it had changed. Newer doctors were coming in and newer services were being offered as the health needs of the community were becoming apparent. Health care develops. Certainly just the building of the hospital, going back a little bit, was with the monies that were available from Hill-Burton. It was important to be able to have the services and provide the services that were going on. Of course more was being done in hospitals. We’ve evolved. Health care back in the ‘30s and ‘40s was in the home. Mary Washington Hospital has been there since, what? 1899. Sure, we just developed more services. More programs were being offered. Bringing the community more into the operation of the hospital. But still, I think it was in the ‘90s, the early ‘90s, that the community really began to have a presence as a stakeholder. By 1993, it had become MediCorp Health System—I don’t know the date that it started, MediCorp Health System. Mary Washington Hospital had evolved into a system, MediCorp Health System. It wasn’t just a hospital. The MediCorp Health System had not only the hospital, but it had Carriage Hill Nursing Home and it had some medical clinics or services. I think we were even having a nursing home down in Colonial Beach. [39:00] There was this system development in the latter ‘80s and ‘90s. In 1993, the Healthcare Assembly was formed, which was an effort to bring citizens representing Planning District 16 together to identify what are the health needs of the people. There was sensitivity to what are the health needs of the people. What are the services and programs that MediCorp Health System would be providing, not just at Mary Washington Hospital? Does that get at what you’re looking for? Help me. Give me a prompt.

00:39:58
Rigelhaupt:
Absolutely. So you’re teaching—

00:40:05
Ingalls:
1984, I started.

00:40:08
Rigelhaupt:
In your position, was there a close enough working relationship that you had noticed the new CEO Bill Jacobs had come in? Was there a relationship between the administration and Germanna Community College?

00:40:22
Ingalls:
Of course there was. Of course there was. Even at that time, at Germanna Community College had close ties to Mary Washington Hospital—and when I say Mary Washington Hospital, right now that can be slash MediCorp Health System—they were funding faculty positions. They were looking to Germanna Community College to provide, at that time, registered nurses. Practical nurses were still coming and being recruited, but they were still coming from that Fredericksburg Area School of Practical Nursing. We were all on the same page. We were collaborating not only with Germanna Community College—when I say “we,” we were collaborating with not only Mary Washington Hospital. Remember the other two, too, because they would be very upset if we did not include them, Culpeper Regional Hospital and Warrenton. Talk about politics—we were working with the Fredericksburg Area School of Practical Nursing too. We were all trying to help our community meet its health care needs. Mary Washington/MediCorp was critical to Germanna Community College. [42:00] I did read something—I went on Google this morning, just to try to give me some ideas of what I did do and that was very interesting. You should try to Google me or look at YouTube. I think in 2009, it was noted that Mary Washington Hospital/MediCorp Health System is really the largest corporate benefactor to Germanna Community College. In 2009 they had given over $1.4 million. A lot of that had been faculty positions.

00:43:01
Rigelhaupt:
So thinking about the 1980s, and no particular year, but the second half of the eighties when you came back and were teaching at Germanna, who do you remember working with the most? Do you remember meeting Bill Jacobs, who was a senior nursing director at the hospital? Who were you—

00:43:14
Ingalls:
It would be Bill Jacobs and Dorsye Russell, the vice president of nursing. In those days it was the vice president of nursing. It had been director of nursing, but became vice president of nursing. We worked very closely with the vice president of nursing. We had an advisory board and critical to that advisory board was having Bill Jacobs, later Fred Rankin, and the chief nursing officers, whatever they would be called. They were all critical for our advisory board at Germanna Community College. Certainly I would be bringing students on the units and I knew every one of those head nurses on those units. Those nurses that were delivering the nursing care, I mean, we were colleagues. The success of our students at Germanna Community College, of course, was tandem to the support of and that facility, Mary Washington Hospital. It was the system: we had students having clinical experiences at Carriage Hill Nursing Home and wherever the system was trying to meet patient needs and health care needs, we would also have our students being able to partner there. [45:00] Of course, we did it too on a much smaller scale at Culpeper Regional Hospital and Fauquier Hospital.

00:45:08
Rigelhaupt:
So again, thinking about the second half of the ‘80s, can you think of, at the advisory board that you described or perhaps a separate meeting, a program that either you or nursing faculty brought to the hospital and said, “Hey, we would really like to start this, could you help out?” Or vice versa? Do you remember some of the new initiatives?

00:45:31
Ingalls:
There were several of those. First of all, I’ll mention the fact that the hospital and the area needed phlebotomists. We worked together to have a phlebotomy program. Phlebotomy is people that draw blood—well, they draw blood for the most part. There was a need for pharmacy technicians. I had recruited a chief pharmacist, Larry Alston. He came and taught in our pharmacy technician program that we started. We were providing pharmacy techs. We were providing phlebotomists. We provided nurses’ aides. Mary Washington did for a while run its own nurses’ aide program, but they were in the business of delivering health care. We are in the business of education at Germanna Community College. We were able to do that and provide those. We continued to do that, trying to meet those health care needs. But the thing that I also want to emphasize, though, in addition to that, is the fact that there was this looming nursing shortage. Now we’re talking about and we’re moving forward to 2002. We worked with Mary Washington Hospital/MediCorp Health System to develop a business plan to grow a nursing program so that there would be registered nurses, especially that the hospital needed. The outcome of that, I think, was working closely with Fred Rankin—thank goodness for him. [48:00] We were able to go forward with—I’m trying to think—I think it was a total of $500,000 between the MediCorp Foundation and the Mary Washington Auxiliary. They came forward with $500,000 to help us increase enrollment. For example, in 2000—oh, goodness, I’m trying to think—it would be nothing to graduate maybe twenty-five, thirty-five students. But when you’re talking about a looming nursing shortage, which we were expecting to have something like—I think Virginia was going to experience something like a 27,000 gap and needed something like 27,000 nurses by maybe 2020. I know I’m getting way out there. But something had to be done to grow those nurses. With the relationship that Germanna Community College had from the start in 1972, when it started, with Mary Washington Hospital and later MediCorp Health System, the health care system really was looking to Germanna to provide those registered nurses. In 2002, I believe, we began to work out a business plan for MediCorp Foundation and the Auxiliary Foundation to help Germanna grow its program. We were graduating, by 2007, 2008, 2009, we got to where we were graduating maybe sixty, sixty-five, seventy. We were successful in starting that at that time. Fred Rankin—I don’t remember when he came on, but I know he was one of the players around the table. Certainly our partners: I have to say, our partners at Culpeper Regional Hospital stepped up and Warrenton Hospital stepped up, but nobody can step up to the extent to which Mary Washington and MediCorp Health System did at that time to grow all those programs. [51:00] That has continued. I don’t want to jump too far ahead of you, but in 2009 when I retired, the challenge was that we didn’t have the teachers that were qualified to teach nursing. We have to have at least the minimum of master’s prepared faculty for registered nursing in the state of Virginia and to be an accredited program. You want to be an accredited program and it means you’re even better than the minimum of what the state requires. We needed master’s prepared faculty. Not all, but we certainly needed a vast majority, a significant majority of faculty—and all those teaching the registered nursing students at Germanna Community College had to be master’s of science in nursing-prepared. Fred Rankin, again, was vital and central to seeing that the hospital stepped up and they established upon my retirement—I retired in 2009—a fellowship. It was $500,000, $100,000 for five years, 2009-2014, to provide faculty that needed to get master’s of science in nursing. I’m really proud of that. It’s the Jane R. Ingalls Nursing Educator Fellowship. I think it has been successful at Germanna and all of the faculty that need to be master’s-prepared are either master’s-prepared now or in the process of becoming master’s-prepared. That was $500,000 that Fred Rankin went to bat for us. We were successful in getting that. It’s interesting in that in 2001 it put me in an interesting position of being, at that time, director of nursing and Allied Health programs for Germanna. I was asked to be on the board of directors, later the board of trustees, for MediCorp Health System. [54:00] I think that worked well for the community. I did ask my president at the time, Dr. Frank Turnage, what he thought and he encouraged me. I appreciated his encouragement. I think MediCorp Health System realized that they needed a nurse, an informed nurse, on their board. They had had one other nurse, some years back, Phyllis Bartley, I believe. I don’t know if she had left the hospital or if she was retired. I don’t think she would have been employed at the time that she served—maybe she served on the hospital board. I was asked to be a trustee on the MediCorp Health System in 2001 and I did that until 2009. I think that I’d like to talk about that later, about being a board member. Now I’m talking about it from the perspective of being a trustee or board member and also director of nursing and allied health at Germanna Community College. I can honestly say that when I served as a trustee, I was serving in my capacity as a citizen of the community and as a nurse who happened to be the director of the nursing and allied health programs at Germanna. I never made any decisions in my role, my dual role there, that was biased to Mary Washington or the MediCorp Health System. My objectivity was critical because I had to answer also to the board of directors of Culpeper Regional Hospital as well as Warrenton Fauquier Hospital. I owed that objectivity to those hospitals and to the community agencies in the entire Germanna Community College service region. [57:00] I feel good about that because I know how I maintain that. I think it could be sensitive. It could have caused some angst or some concern to some of the very, very central leaders of those respective health systems. I was in an interesting position, but I kept my two roles separate, I guess is what I’m trying to say. I was successful at that. Perception is something that you have to be very careful about, and I do think that the perception was that I maybe was closer to Mary Washington, that health system. Physically, I was closer. Historically, when I talk about my mother, and my growing up and being a nursing student and coming back here as a nursing student in the summer to work as a nurse’s aide—certainly perception is that I had a relationship. But when I was in that role of my role at Germanna, I was very, very certain to maintain that objectivity. So where do you want to go now?

00:58:54
Rigelhaupt:
I’m going to come back to the board with a few questions in a moment. But I want to ask you, as someone who is active in a health care leadership role as a nursing educator and by the late 1980s, at least a mid-career faculty member if not a senior faculty member at Germanna—what do you remember about the first word, or maybe rumor even, that Mary Washington was going to build a new hospital across the street?

00:59:23
Ingalls:
Across the street? You mean across the river? That hospital on the Snowden property.

00:59:31
Rigelhaupt:
They were going to build one on the site at Snowden across from Fall Hill. What do you remember of the first time you heard that there might be a new hospital?

00:59:39
Ingalls:
Wonderful. On Snowden Hill? Absolutely. Buying all that territory? Forward-thinking. It was indicative of the demand that is going to be in this community and the growth all around this community. [01:00:00] Being a bedroom community to northern Virginia—now we’re just as much a bedroom community to Richmond and probably west too, I don’t know. That was where we needed to be. People who were making that decision were on the cutting edge. I remember they bought all this territory and then there were going to certainly have the opportunity for medical practices to have a partnership or to buy parts of the parcels of that land. I can’t think of anything but positive, wonderful reactions that I had and the community had, certainly I would think. That was my filter.

01:01:08
Rigelhaupt:
Did you have a sense as you first heard that there would be this new hospital—was there a sense that this was going to transform it from a community hospital into a regional medical center? Was that an idea that was talked about even before it was built, or was that—

01:01:29
Ingalls:
Was it talked about? I’m sure it was talked about internally. Remember, I was still on the periphery in the earlier days of those days. Mary Washington moved to the Hill, what, 2001? No, 1991?

01:01:51
Rigelhaupt:
1993.

01:01:52
Ingalls:
1993. So where was I in ’93? I was still at Germanna, of course, teaching, and I knew we needed more clinical sites for our students and the changing health care system. The delivery: you needed a new physical plant. Certainly when I was on the board, we did. I remember sometime between 2001, earlier on there, we did recognize ourselves as becoming Mary Washington Health System, MediCorp Health System, being recognized as a premier regional health care provider. I’m sure in the earlier planning stages before I came on the board that that was their thinking. I certainly think it should have been their thinking. [01:03:00] I do remember working on our mission or our values statement or something where we became a premier regional health care delivery center. It certainly became that up there. We brought in the cardiac surgery with Dr. Armitage and then I can remember more recent than that was becoming a trauma center. I was there during all of that as a member of the board of trustees.

01:03:51
Rigelhaupt:
Well, you mentioned cardiac surgery, which is certainly one of the more important clinical programs in the organization’s history. And they just celebrated their twentieth anniversary of the first cardiac surgery in 1994.

01:04:11
Ingalls:
‘94. You know probably who was one of the very first recipients of that surgery—not the first, but one of the first? In fact, it was the first double-system surgery, where the cardiac bypass surgery is done and a kidney—he had a tumor on the kidney or a kidney was removed. It was my father-in-law, Harry Ingalls. Dr. Armitage did the heart. He’s going to really get me now, but I can’t think of his name, who operated on his kidney. That was the first double procedure done there. Sorry, what else do you want to know?

01:05:17
Rigelhaupt:
No, but that’s good, to have the first-hand accounts of what you remember and that could happen here. I mean, that was also part of cardiac surgery, that when—

01:05:25
Ingalls:
That couldn’t have happened in Fredericksburg until the hospital became a regional health care provider.

01:05:26
Rigelhaupt:
That wouldn’t have happened here. I mean, that would have been in Richmond or—

01:05:30
Ingalls:
Yes. Oh, yes, yes. Now we can do more. With the onset of Mary Washington becoming a premier regional health care provider, we were able to begin offering more and more of those services and people could stay right here in in their hometown. Of course, over the years, it’s continued to increase. [01:06:00] Now, with the radiation center they brought in and we brought in there are all of these wonderful opportunities so people don’t have to travel to UVA or outside to get the radiation procedures that they need, such as stereotactic radiation, especially for brain tumors and things like that.

01:06:31
Rigelhaupt:
That’s one of the programs, in terms of cancer care. But thinking about maybe the 1990s, after the new hospital opened, cardiac surgery, the NICU grows—what did that mean for nursing education, and what did those programs represent to you as a nursing educator about opportunities that would be available for your students?

01:07:01
Ingalls:
Certainly we were able to provide our students with a first-class education. They were getting the opportunity to take care of and nurse those kinds of patients who were having cardiac bypass surgery. Students had the opportunity to have the radiology experiences, the infusion, the IV infusion therapy, and treating patients that way. Gosh. The NICU you speak of and to be able to have our students with it—Germanna Community College’s nursing program was always on the forefront. It was always on the cutting edge, even here in sleepy little Fredericksburg. We maybe didn’t have the sophisticated acute care services at Mary Washington, but we certainly had sound medical-surgical, across the lifespan—pediatrics and obstetrics. Psychiatry came on a little late, with the building of Snowden. Then when we began to grow as a community and our people needed all of these services, and the leadership of Mary Washington Hospital/MediCorp Health System and Bill Jacobs. [01:09:00] With Bill Jacobs’ leadership it was creating a system: going from a standalone acute care to develop a system, which did receive some kickback from the community, but it was furthering health care delivery. Even in 1972, twenty years, maybe, before we became a system, Germanna Community College nursing program was already teaching health care, not just sick care. That we owe to the first director of the program, Dale Featherston. She had a vision that was so far into the future. Here we are today, in 2015, and all we’re talking about—we’re finally realizing—is prevention. That’s what community health is about, teaching prevention. Germanna nursing program was already, I think, teaching and preparing its graduates. The bulk of the graduates, seventy-five percent of the graduates, went to Mary Washington. Seventy-five percent. Then with the expansion and these services that came on—cardiac surgery, the opportunity to have the NICU, the dialysis that was into the center—it gave our students, again, the opportunity to get these experiences that they were learning about. We stay on the top of education and what is going on in the development of the delivery of nursing care. They were able to experience it hands-on here locally as Mary Washington grew. To the extent, and as best that our partners in the western part of the region could, were also able to provide these services. Sometimes I would use the analogy of a diamond in the rough: Germanna Community College and its nursing program. I have to say Germanna Community College, period. Its nursing program is just one aspect of it. But don’t get me going. That program had the opportunity to take advantage of all of the advances that Mary Washington could afford, as well as our partners in the west could afford. [01:12:00] I still say that today for the graduates of that program. Under its current leadership of Dr. Patti Lisk, it is competitive with any associate degree program in the country and it’s certainly an excellent preparation for those that are moving on to get their bachelor’s degree. And I’ll keep it at that. Sorry.

01:12:40
Rigelhaupt:
But this in some ways alludes to what you spoke of earlier, in the sense of nursing becoming more technical, more difficult clinical decision-making, particularly in a hospital setting with a much higher acuity of patients than when you probably started.

01:13:00
Ingalls:
Oh, my gosh. Yes.

01:13:01
Rigelhaupt:
So hasn’t there been a kind of symbiotic relationship between Germanna and Mary Washington Healthcare, in the sense that the higher level of services that the hospital provides important educational opportunities for the students?

01:13:14
Ingalls:
Absolutely. You said it. It’s a partnership. It’s been a partnership. From a community college aspect, it’s critical to be in partnership like that with your service region. Certainly we had that partnership with our partners to the west of our service region, as well as here in the east. Two-thirds of Germanna students, at that time while I was at Germanna, two-thirds of our students lived in the eastern part of the service region of the college. It was a positive experience. Today, so many of those nurses from Germanna have been the backbone of and continue to add to that community that make up the nursing staff. Now, it’s not just nursing anymore, remember? We work with them with phlebotomy and the pharmacy tech. It seems like there were others. Mary Washington Hospital has its own school of radiologic technology, but we were working in some relationship with them so that people could go on and get advanced degrees from the diploma that they would get there. [01:15:00] Right now I know that they are working very hard to get a PT, physical therapy, program going. I think that will be kicked off at Germanna very soon. The clinical environment is definitely symbiotic.

01:15:31
Rigelhaupt:
So you mentioned earlier the Healthcare Assembly—1993, 1994, that this is an interest in then-MediCorp wanting to be more in touch with the community, learn about community health care needs—

01:15:47
Ingalls:
Input from the community as to what were the health care needs. It started, I believe, around 1993 and it was chaired by a community board member, Marguerite Young. When Marguerite Young completed her tenure on the board—you could serve three three-year terms—I believe I was the one that was recruited in 2001. I think it was upon the completion of her tenure or thereabouts. I was sort of the citizen/registered nurse member that they had the slot for on the board of directors, later board of trustees. One of my responsibilities assigned to me in 2001 was to chair the Healthcare Assembly, which at that time was made up of maybe twenty-five, thirty people. People would apply to represent the planning district—Westmoreland, Spotsylvania, Caroline, Stafford, and City of Fredericksburg. Marguerite had laid such a good foundation in her tenure of bringing care to the hospital’s communities, especially dental care and access to dental care. There was just a tremendous need there. I came in in 2001 and assumed the chairwoman of the Healthcare Assembly. We would meet, I think, monthly, at Mary Washington Hospital. [01:18:00] It was about the community bringing forth what they saw in their networks out in the planning district, what they saw as health needs, and probably some of their work continued. Again, the access to dental care, continued to be a problem in our community. Eventually bringing on the Lloyd Moss Free Clinic. The idea was to have the community input as to what was needed, and then bring that, as the chairperson, those needs to the board of trustees of MediCorp Health System, at that time, and for MediCorp Health System to go to work and to meet those needs. It was interesting. We were under the Healthcare Assembly. I would say a couple of things. First, we were under, like, the community outreach part of the operations of the system. Eventually, Xavier Richardson would actually overall head up and lead this department. I can remember there was Steve Mills, who worked with me, and the volunteers at the hospital. Really, we were volunteering as the Healthcare Assembly. Steve Mills worked closely with us on the Healthcare Assembly to try to identify what the hospital could do and what the health care system could do. You know, it’s not the answer to everything. It doesn’t have infinite resources to solve all the problems. There was a need to prioritize, but at least to know what are the needs out there. Then to see, in turn, what could the board of trustees do to see the system being able to operationalize to meet those needs? I mentioned Steve Mills. Maybe he had a staff person assigned to him, Adelaide Smith-Buckner. She had graduated from Germanna Community College. She had become a practical nurse and then she came as an LPN to RN and graduated from our program. [01:21:00] She became a registered nurse and she was working with Steve Mills to try to bring community needs before the Health Care Assembly to try to research and learn more about it so we in turn could have the information and the data to give to the board of trustees. Maybe it was Xavier, Steve Mills, Adelaide, and then this volunteer group—maybe fifteen of us would come of the twenty, twenty-five, every month. Over time, probably by 2008, we changed the name from Healthcare Assembly to the MediCorp Healthcare Advisory Council. HAC. Something like that. Doesn’t that sound like another acronym of another entity that might have been coming around in 2008, ’09? HCA. And we were HCA—the MediCorp Healthcare Assembly. HCA. Interesting, but we’ll talk about that later, maybe. We changed the name to the MediCorp Healthcare Council, or something like that. “Assembly” we felt, was maybe elitist sounding—elitist because we were having trouble getting community members to come and to participate. We changed the name. Pretty soon after and just about the time I was ending my three three-year terms as a trustee, a whole department was created. There was a federal initiative out there about non-profit hospitals, or nonprofit entities being tax-exempt. If you had enough community benefit, you could prove that you as a health care system were creating a significant community benefit that justifies your tax-exempt status. To me it’s interesting that here we went from maybe all volunteers and a couple of staff. [01:24:00] Now it’s a whole department of people that are working on securing community benefits for those who have not had access and do not have ready access to meet their health care needs. There’s still a community group, and it’s called something like the Community Advisory Council, CAC. I’ve been on that. I have not been active in that in the recent past, but that’s still going on. But it’s really interesting to me that here we were, just a little skeletal group, and how it’s exploded into a whole department of resources to meet community needs. Of course you could say, on one hand, well, it had to happen, given especially the emphasis on bringing about the Affordable Care Act. It had to happen to be in compliance and for MediCorp Health System, now Mary Washington Healthcare, to continue to be a tax-exempt, nonprofit organization. But I think it was really neat how we tried, as a group of volunteers, and this eventually grew into a real vehicle for making an ongoing difference in meeting the health care needs of the community.

01:25:58
Rigelhaupt:
Could you tell me about how you got recruited to the board? Did you get a phone call, or how does that process go?

01:26:03
Ingalls:
At that time, I got a phone call that they were interested in asking me to be a trustee. I had an invitation to go to lunch with Ray Merchant. I don’t know if Ray Merchant, if that’s a name that should ring a bell with you at the Mary Washington Hospital, because I think he had something to do with Mary Washington College at that time. Well, he was a trustee and he was a director at that time. He was on the nominating and governance committee. And he invited me to lunch. And do you know when Fred came? Can you tell me that?

01:26:52
Rigelhaupt:
He started in 1992 and then I think in 1994, 1995, when Bill Jacobs left, he became the CEO of MediCorp. [01:27:00] But he’d been the president of the hospital for, I think, three years before becoming CEO.

01:27:10
Ingalls:
Yes. You’re bringing back memories of that. Fred may have been also at lunch. I want to think it was at the Fredericksburg Country Club that I was invited to have lunch. Certainly I was very interested. I did go back to my boss at Germanna Community College and asked Dr. Frank Turnage, could I do it? At that time he said I could. I think he understood where I would be coming from, but I wasn’t playing any favorites with anybody in serving our service region in total. It was up for an election; you were elected. At that time we got ballots in the mail if you had any kind of a relationship—and I wonder what that relationship was, now that I think about it. You were elected. It was a community thing. Although it was a community group that was certainly associated with it, I don’t remember exactly what that group is now. I was elected and certainly my first assignment was to chair the Healthcare Assembly. That continued throughout my term as chair of that. That’s how I was recruited. What else about it?

01:29:03
Rigelhaupt:
What are some of the areas of expansion? I mean, you alluded to—certainly the organization continued to grow between 2001 and 2009. What stands out in your mind that the board put its energy behind?

01:29:24
Ingalls:
Oh, my gosh. Everything became evidence-based, outcomes-based. That’s when health care and outcomes really began to be ramped up. It was very critical to us to focus on outcomes, such as patient satisfaction. Certainly outcomes in relation to not only patient satisfaction but to complications: hospital-acquired infections, pneumonia following ventilator—people who were put on ventilators. [01:30:00] Quality benchmarks—dashboard. There was a dashboard that we were a part of. We were able to submit by pulling in data—that was something you didn’t really talk a lot about in the ’60s and ’70s. Certainly by the ’90s data was driving things and in 2000 and after the turn of the century, data drives everything. Being able to grow in those areas was critical. Being able to have a dashboard that shows how we compare to like hospitals of the same size. I think we grew. We built at Mary Washington Hospital up on Snowden Hill and we expanded there too. Again, at one time I want to think that we were a 350-bed hospital and then it was closer to a 400-bed facility. There were times I remember the house was full, with all those beds full during that time. I don’t know what’s going on there right now. At that time, the focus was quality care and delivery of quality patient care. There was that triangle that you want to be able to achieve: access, quality, and patient satisfaction—to get all of that done. I know that there was a great emphasis that we spent a lot of time on in that area. Medical affairs: where were their problems? You grow and you have issues. Sometimes there are medical affair issues—means a problem with the delivery of care, but also with the deliverer of care. [01:33:00] I was involved with strategic management in 2002. We hadn’t started talking about a second hospital. But by, what, 2005 or ’06, I was chair of the strategic planning committee, I believe, 2006, 2007. I’m not real sure about that. But that’s when we began to talk about expanding. Why did we talk about that? Of course we were hearing about another health care system interest in the community, and certainly there were those in the community that said, “Competition is good.” And competition is good. How should the board of trustees, how should we respond to not only one system, but any other group or organization looking at coming into the area? Look at the area. By 2005, we had grown significantly, and we certainly were an established delivery system with not only an acute-care hospital, but how many? Twenty-some, maybe, extensions into the community. We began to explore that concept of expanding, and I was very interested in that and involved in that. It did come about. I don’t know if I was on it at the time, but the Rappahannock Area had a COPN group, a Certificate of Public Need. I had been on that committee, representing—I don’t know who I was representing; I was representing, I guess, maybe Germanna Community College as a nurse educator. Maybe that’s the way I was asked to be on that committee. Of course, our application to build a second hospital and then HCA’s application to build Spotsylvania Regional Medical Center were coming—that was bubbling up. [01:36:00] Of course the outcome of that final certificate of public need was that both hospitals were going to serve the community well and that they had a resource right here that they were looking to meet their human resource needs for health care providers. All levels of nursing, the pharmacies, the phlebotomies, nurse aides, and whoever else we were coming along, they were seen as adequate resources to provide the manpower to have those two hospitals. And one thing I’d like to tell—recently, and this is off the point. I have a fifth-grader, a grandchild, at Ferry Farm, whose teacher, Ms. Sloan, has a grant from the 350th-year anniversary of Stafford County. She has a grant to put together a little project that the students in the fifth grade are doing that’s a learning experience for the students, but also is another piece of the history to be kept. My husband and I were asked to come into the classroom to be interviewed and recorded. They asked me some things, who I was. I told them who I was. Did I have a special thing to say about Stafford County? Now, of course, I’ve lived in Stafford County now for about forty-eight years, and one of the things I was most proud of, they wanted to know what that would be. I said that I was involved in the building of Stafford Hospital. One thing that fifth-graders—and I’m a fifth-grader at heart. I said one of the most exciting things for me, as a member of the board of trustees, was I got to go and write my name in big letters on one of the largest central beams that makes the top of that hospital. I wrote “Jane R. Ingalls.” I may have written Jane Rollins Ingalls and maybe I did include R.N., Ph.D. That will be there for perpetuity. That was one of the things that they remembered. I’m proud of that. We made the hospital come about. [01:39:00] It has a special NICU there for preemies. Stafford Hospital has a Level II NICU and that was a good thing. Interesting to watch: hospitals come into the area as new hospitals and to see how and the time it takes for them to grow. While we had certainly great information provided to the board, everything that we needed, you know, numbers, need, finances, that were provided us to help us make decisions, I don’t think we realized when we were moving forward as quickly as we were, I don’t think we realized the financial impact on Mary Washington Hospital or even HCA. For Mary Washington Hospital, when you lose your status as a single provider and you lose that status, you lose all kinds of reimbursements. When I think and look back, I think that we did not realize it was going to take so much time—more time for a new hospital—a 120-bed hospital, 100-bed, 125-bed hospital—to be able to become full. It has been a significant impact on Mary Washington Hospital from losing that status as a single provider.

01:41:23
Rigelhaupt:
The building of Stafford was clearly an important milestone in terms of going from a one-hospital to a two-hospital system. And another milestone that the organization achieved while—I think the last year you were on the board—was Mary Washington Hospital achieved Magnet status for nursing. Now, what did that mean to you, as a board member but also at that point—

01:41:49
Ingalls:
A provider.

01:41:54
Rigelhaupt:
—with thirty-plus years of nursing education?

01:41:56
Ingalls:
It’s wonderful. It’s wonderful. [01:42:00] It’s all about the evolution to the profession. It’s all about evidence; nursing is evidence-based. My mother did hands-on backrubs. There was no evidence base. Certainly there was a body of knowledge. A lot of it was passed on. My education in the ’60s—I had such a good education, but, no, I wasn’t being educated like they are today with the focus on research that nurses are focusing on in undergraduate school—even undergraduate school—to get that bachelor’s degree. Even though I came out in 1966 and I have said this and it sounds crazy. Our greatest assessment: assessment is the key to patient care. Assessing the objective and subjective signs and symptoms: what’s going on with your patient? I was thinking about when I came out and it will be fifty years since I’ve graduated come 2016. They taught us and I knew how to take blood pressures and vital signs. I don’t think they taught us in 1966 assessment on bowel sounds, breath sounds, CV, or central venous pressure readings, —none of that. But I had an education that allowed me to continue to learn as I grew up in the profession. Being in education, I had to know how to do everything as I was teaching that as well. I had to be able to do it too when I’d take those students into the clinical setting and show them how to do it and to see that they were doing it right. Nursing, to be Magnet, means a couple of things to me. Nursing is in a leadership position. It’s not that “stand up when the doc comes in.” I respect physicians, but we’re equal. Leadership means being at the table. Who better to have knowledge of what is going to impact patient satisfaction and quality delivery of care than the nurse? Those two things make for growth of your health care delivery system and people wanting to come to your health care center, [01:45:00] So Magnet status, yes, it did come along about 2009. I hope they’re still doing it. I trust they’re still doing it. Magnet status just ensures quality, patient satisfaction, and growth. Those are three things that the nurses are about. Still, even in Fredericksburg, I don’t like the image of a nurse so oftentimes that is portrayed. A nurse to me, and I have tried to model my life after it, has been somebody who I’m involved in my community. I need to be at the table. I know how to be at the table and I know what it takes to be at the table, meaning the knowledge of the whole picture of the delivery of care. And I challenge Mary Washington Healthcare to ensure that there’s a nurse at the table. Is there a nurse at the table right now?

01:46:37
Rigelhaupt:
I don’t know everyone on the board, but I think, you know, the vice president and chief nursing officers, senior administration—

01:46:44
Ingalls:
Oh, yes. Thankfully the chief nursing officer is there, but that’s not the board of trustees, what I’m talking about. An aside: you go and YouTube VNA, Virginia Nurses Association. You should YouTube Terry Brosche’s interview of Nancy Littlefield, who was the chief nursing officer at Spotsylvania Regional Medical Center. You’ll see what I mean about how the nurses need to be at the board. And again, an aside—the Institute of Medicine and, you know, has a roadmap to put nursing where it needs to be in the health care delivery. Virginia has a Virginia Action Coalition, and that, along with the Virginia Nurses Association, they are very active in getting nurses onto all boards, all kinds of boards. We do have that knowledge that it’s more than the finance, the dollar, or the bottom line. [01:48:00] Members of many boards certainly have to have that knowledge acumen to really understand the cost of delivery and the return on the cost of delivery. We nurses need to have that too, but they also bring the direct experience with the patients and the families of the patients, the friends of the patients, significant others of the patients, and we are about evidence-based outcomes. Research. Maybe your experience on the West Coast was that that was more realized, but it’s slowly coming about here. Certainly to be a Magnet-based hospital, those nurses have to be doing their due diligence with providing evidence-based nursing.

01:49:34
Rigelhaupt:
We’re approaching time.

01:49:35
Ingalls:
I bet. It’s 12:00.

01:49:36
Rigelhaupt:
The way I’d like to end is to ask a last question that’s actually two questions. One, is there anything that I should have asked and I didn’t? And two, is there anything you’d like to add about the history of Mary Washington Healthcare?

01:49:54
Ingalls:
Asked—you didn’t ask—I don’t know what you didn’t ask. I think we covered one of the things that I had noted that was of interest to me. I think we covered pretty much everything. What was the last question? What was the last part of it?

01:50:32
Rigelhaupt:
Is there anything you’d like to add about the history of Mary Washington Healthcare?

01:50:37
Ingalls:
One thing right now and it’s not history, but I know the hospital’s going through a lot of changes and the health care system is going through a lot of changes and challenges and struggles. It’s been really interesting to me to have people who are in the community and they have experienced the delivery of health care. [01:51:00] They have just accolades to give to the nursing care—that’s right— at Mary Washington. I recognize I’m passionate about nursing, a little crazy-passionate about nursing. It takes a whole team, and I don’t mean to leave out anybody, even the people that are cleaning the floors and bringing the meals up. It’s the whole team. My experience out in the community has been that the people see the nursing care as just being outstanding. I’m real proud of that. That’s about it.

01:51:58
Rigelhaupt:
That’s good. Thank you.

01:52:05
Ingalls:
Good luck.
[End of interview]

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