Lisa Lucas

Lisa Lucas started working at Mary Washington Hospital as a nursing assistant in 1983. Soon after she became a licensed practical nurse (LPN) and then a registered nurse (RN). She began working in a cardiology unit at Mary Washington Hospital and stayed in cardiology for the majority of her career. She received a BSN from George Mason University, a MBA and a master’s in health care administration from the University of Phoenix, and a doctorate in nursing practice (DNP) from American Sentinel University. She was the Director of Cardiovascular Services at Mary Washington Hospital from 2000 to 2012. Lucas began serving as the Director of Clinical Informatics for Mary Washington Healthcare in 2012.

Lisa Lucas was interviewed by Jess Rigelhaupt and Jack Manning on November 17, 2014.

Discursive Table of Contents

00:00:00-00:15:00
Decision to become a nurse—Serving as Director of Clinical Informatics—Career trajectory at Mary Washington since starting in 1983 and leading up to current position as Director of Clinical Informatics—Education and advanced degrees in nursing—Gender in the nursing profession—Increased medical and surgical specialties and departments in Mary Washington Healthcare—Role of nurse manager

00:15:00-00:30:00
Earning a doctorate in nursing practice in external leadership (2014)—Increase in the use of technology—Working relationship between nurses and physicians—First shift in 1983 and early work experience at Mary Washington Hospital—Learning to provide care in the cardiac unit—Patients in the cardiac unit

00:30:00-00:45:00
Early discussions of beginning interventional cardiology and open heart surgery at Mary Washington Hospital—Early discussions of a new hospital—Working in the new hospital (1993)—Developing the cardiac surgery program

00:45:00-01:00:00
Training and new procedures in cardiac surgery—Managing the cath lab—Serving as Director of Cardiac Services in the mid-1990s—Use of evidence-based medicine at Mary Washington Hospital in the mid-1990s—Collaboration in the cardiac surgery program

01:00:00-01:15:00
Opening of Stafford Hospital—Doctoral dissertation on use of electronic medical records to reduce medical errors at American Sentinel—MBA from the University of Phoenix—Different perspectives and training, MDs, RNs, MBAs, and problem solving at the hospital—Work as Director of Clinical Informatics—Work as Director of Cardiac Services

01:15:00-01:17:24
Achieving Magnet status at Mary Washington Hospital

Transcript

00:00:00
Rigelhaupt:
It is November 17, 2014, we are in Fredericksburg, VA at 2300 Fall Hill doing an Oral History Interview with Lisa Lucas. The first Interviewer whose voice you’ll hear is Jack Manning. I will come in a little later in the interview as the second interviewer and my name is Jess Rigelhaupt. So I’ll turn things over to Jack for the first question.

00:00:31
Manning:
All right, so let’s start off simple. What made you want to become a nurse?

00:00:38
Lucas:
It’s nothing mind-blowing. I was a senior in high school and I had finished all of my credits except for one to graduate. I had free time after one class—that’s all I had left—and so I had decided to take nursing in the Spotsylvania vocational center to complete my day. I took the LPN course there. Best decision I have ever made.

00:01:13
Manning:
How long after that did you actually start practicing nursing?

00:01:14
Lucas:
Actually, at that time you could practice while you were in school. In my senior year I started working as a nursing assistant and I actually fell in love with it. I had great experiences with the folks who I worked with. I started in cardiology and stayed in cardiology for the bulk of my career. I worked on the 3-East at Mary Washington Hospital and just had a tremendous experience working with patients and nursing staff. I really got to understand the profession and it was a very good choice to take that vocational training and to become a licensed practical nurse.

00:01:40
Manning:
Now, what is your current nursing position?

00:01:43
Lucas:
I’m currently the director of Clinical Informatics, which is a new role at Mary Washington Hospital. It was developed a little over two years ago. I work closely with the CMIO [Chief Medical Information Officer]. The department is growing, as it started small being only two years old. I actually started working in informatics in 2006. During that timeframe—well, a little before that, in 2000 we brought up medication administration check. With every patient’s medication you had to bar scan the patient and you had to bar scan the medication. That was about in 2000. Then about 2006 we wanted to continue with our electronic endeavors and I was asked to help nursing develop their electronic documentation. I worked with nursing and we designed their electronic documentation system for all of nursing, physical medicine, and respiratory therapy for both hospitals. What’s nice is that it was the same time we were opening up Stafford and in 2009 we went live with Stafford completely paperless for nursing at that time. Mary Washington went live in 2009 as well. [03:00]

00:03:01
Manning:
Now, between being a nursing assistant and becoming the clinical director of informatics, what other positions have you held throughout the hospital?

00:03:10
Lucas:
When I graduated I was an LPN and then I went back to school and I got my RN. I had been in charge nurse positions. Also, I have been a nurse manager for the cardiac step-down units. I also held an administrative director role for cardiology. I had all of the cardiac units including the intensive cares, the outpatient areas, which were the cardiac cath, EKG, echo, rehab, telemetry, stress testing, and cardiovascular research. I held that position probably for about twelve to thirteen years and then I transitioned into being the director of clinical informatics.

00:03:55
Manning:
You talked about your receiving an LPN and your RN, what were the nursing education requirements when you first started and how have they changed over time?

00:04:05
Lucas:
There were a lot more LPNs, Licensed Practical Nurses, when I started working at Mary Washington Hospital. There wasn’t really a significant pressure to go back and get your advanced degrees. Certainly the hospital did support you in doing that: they paid tuition reimbursement and most of the time they paid up front for you to go to school. I went to Germanna to get my RN then went back to George Mason to get my BSN. All the programs were supported by Mary Washington Hospital and Mary Washington Hospital actually had George Mason come onsite to Mary Washington to provide the classes. I didn’t have to travel at all to get my BSN, which was wonderful. A lot of other nurses were able to use that program and did not have to travel to Northern Virginia.

00:05:01
Manning:
What were the benefits of getting advanced degrees and furthering your education in the nursing field?

00:05:10
Lucas:
There are some restrictions on your practice depending on what role you’re in. Certainly LPN’s can only function under the guidance of an RN and so there are certain tasks that they cannot do and other tasks they have to be delegated to. The RN maintains control of that practice. It does mean that you [a LPN] can’t practice independently without the RN. To be a nurse manager you had to have your RN, which is a little different now because now you actually have to have a BSN as well. You can’t just have an associate’s degree in nursing. The requirements have changed over the years for your education level to advance. And that’s not just at Mary Washington Hospital, that’s globally. [06:00] Mary Washington is a Magnet facility and a Magnet does require that a certain percentage of your nurses have certain degrees, Bachelor’s and Master’s Degrees.

00:06:10
Manning:
So this being a Magnet Hospital, how does having nurses with advanced degrees affect the quality of care given here or the experience for patients and nurses alike?

00:06:27
Lucas:
When you have your advanced degree, whether it’s a bachelor’s or a master’s, you do go through several courses that are in leadership as well as nursing research. You learn to do research. You learn evidence-based practice. You learn all those tools to make sure for the patients you’re having the evidence-based practice. You know the practice guidelines and you’re able to do research. You’re able to say for my patient this is the best course/intervention based on the outcomes you are looking to obtain. I certainly did not get that in LPN school.

00:07:08
Manning:
Moving away from education a little bit. Historically speaking, nursing has generally been regarded as a female dominated profession. What would you say it was like when you first started and how has that changed throughout your career?

00:07:24
Lucas:
When I first started certainly male nurses were very sparse. It’s changed over the years. I think the last time I looked at the statistics it was about 9.8 percent globally of nurses were males. But pretty much the male dominance is in more of the non-bedside nursing fields, such as nurse anesthetists. Over time we do have more RN’s that are males at the bedside, which is very nice. One of the things that has occurred over time is that everybody is going back to school for something. I just finished my DNP [Doctor of Nursing Practice] in June. Getting a doctorate is certainly an experience in itself. When I look at the males in the field from when I first started working here, female doctors were pretty much nonexistent. I remember having one female doctor here, that was Dr. Bigoney and she’s still here. But pretty much that was it. All the nurses were females and all the doctors were males. That was just the mix of the generation at that time. I do think we will progress to a point where we will have an increase in male nurses, especially when you have so many fields you can go into now. I think IT is a pretty popular field right now for anyone to go into and I know there was an increase in males in that area. [09:00] One of the other things that we’ve seen too is an increase in extenders. For a long time it was just that the primary care physician who managed your care. Now you see many extenders, such as PAs [physician assistants] and nurse practitioners that are managing patient care. It gives the doctors more an opportunity to be in their office, seeing patients, which is why they really try to focus on prevention as opposed to managing a patient’s care inside of the hospital. When you look at the mix of PAs and NPs, for PA’s it’s pretty much male dominated in that field.

00:09:42
Manning:
You were talking about different specialties and different departments and things of that nature. When you first started were there as many departments? And how has health care expanded throughout your career?

00:09:59
Lucas:
There were not that many departments. There were certain areas that you specialized in. I was in cardiology. There was a cardiac unit, there were medical units, and then there were surgical units. It was a very basic type of care—a small community hospital. Patients came in, they stayed for weeks. They sort of just resided here for a while until they felt better. If they didn’t feel better they could stay longer. As time has gone on, you see that we’ve actually developed centers of excellence where we actually use evidence-based protocols to guide our care. For patients that have had heart attacks or strokes, there are specific guidelines to treating those patient populations. We’ve seen those centers of excellence in stroke, and in joints, in both our hips and knees, as well as cardiovascular surgery and neurosurgery. We did not have those specific programs when I first started here. To the point that we weren’t even doing cardiac caths. All of our patients when I first began my role had to be transported in a rescue squad and most of the time we went to MCV [Medical College of Virginal, now part of Virginia Commonwealth University (VCU]. Being one of the nurses on the floor, I typically would volunteer to ride in the rescue squad with them. A nurse had to go with them with the drug box. I spent a lot of time on the road driving to Richmond to take patients down there to get a cardiac cath. Later, in the early ‘90s we started performing cardiac caths here at Mary Washington Hospital. We actually had two physicians who came up. One was from Henrico. But they came up and did cardiac caths and actually started the program with those two physicians, Dr. Martyak and Dr. Vossenberg. We didn’t really start doing interventional cardiac procedures until we moved in to the brand new facility, the new hospital, where we had full time cardiologists on board and we had all of the staff that was needed to perform those procedures. [12:00]

00:12:05
Manning:
You said you started out in cardiology, how after you furthered your education and received those degrees did your responsibilities evolve in these departments?

00:12:17
Lucas:
Pretty much right away. When I became an RN, I started doing charge right away in both step-down and the ICU. I had a number of years of experience as an LPN working night shift and working both in the ICU and step-downs. When I got my RN, probably a few years later I became permanent charge nurse on the cardiac step-down units. Then within a year or so after that I started taking on more responsibilities from the nurse manager. Ultimately, I took over her position when she transferred to the emergency department to be the director. I became the nurse manager of the step-down units.

00:13:05
Manning:
What would a typical day be like as a nurse manager in charge of all these people? How many people would you be in charge of?

00:13:16
Lucas:
It depends. There have been times where I have had as little as seventy and there have been times where I have had over 300 reports depending on how many departments I was managing at the time. As a director I had nine departments in cardiology. As nurse manager I had two step-down units. So it was between seventy and 120 people. I truly enjoyed my entire time I was in the nurse manager/director role, just working with the staff and with patients. It was very rewarding seeing staff grow and mature into different levels and transferring into positions that they had wanted to do. The step-down unit was pretty much the unit that staff would come to and get their skill level to be able to work in the ICUs. We see a lot of staff being mentored to be able to go and work in the ICU or the ED [emergency department]. That was enjoyable making sure they had a career path for themselves. But it was typically between seventy-five and 100 when I was a nurse manager. And you asked me about my typical day as a nurse manager: I don’t think there is any typical day as a nurse manager. You come in and you have a calendar and you think you are going to get certain things done and that really never happens. I think that the important thing is that you really pay attention to the staff and the patients. You might miss a few meetings, but you can make those up later. Often I would make rounds in the morning on all my staff and on the patients and then progress with the rest of my day. I’d always be available by phone or by pager for the staff. [15:00] And then we do have a lot of meetings. Like most businesses we have many meetings that we go to. But rounding is a very important part of any manager’s day. To make sure the staff are available and that you’re available for your staff.

00:15:21
Manning:
You talked about how getting your RN started immediately getting you these added responsibilities. How did getting your BSN change your career and how, recently getting your doctorate, how has that affected your career?

00:15:38
Lucas:
When I obtained my BSN, I was already in a director role. It’s required to have your BSN when you are in a director role. My role didn’t change very much from what I was doing, but the education behind more evidenced-based practice, how to do research, and leadership helped me. My bachelors’ degree really helped with that portion of my role. My doctorate—I just got my doctorate in June—is not required for any of my roles. I wanted to get my doctorate just for personal reasons. Having to do a dissertation and a research project really has helped me look at my role especially when trying to analyze best practice for our staff members and in the EMR [electronic medical record] world. We want to adopt all new technology and we think technology is going to fix every problem that we have, when in actuality technology enhances your work. If you have a broken process, putting technology over top of a broken process just means you have an electronic broken process. The key is getting staff to understand and to take a step back to figure out what problems we are trying to fix. Does technology actually fix that problem? If it does, let’s go research and figure out what is the next best technology to implement.

00:17:03
Manning:
What sorts of technology did you have available when you first started compared to now, and how has aided the health care process?

00:17:12
Lucas:
We didn’t have any technology. [Laughs] Literally, everything was on paper. The only technology we had were heart monitors. I remember when I was a nursing assistant I also was cross-trained to watch heart monitors because someone had to watch them all day. That was one of my duties when I was working as a nursing assistant. For twelve hours I would sit and watch the heart monitors and I would notify the nurse if there was an alarm that they had to go and check on. As much as technology has advanced, we still have people that watch heart monitors all day. That hasn’t changed. It would be nice to think that technology has sort of improved upon every process that we do but it just hasn’t. I don’t think that we can take humans out of the picture all the time. But as far as that, there was nothing that was electronic. [18:00] Everything was on paper. There was tons of writing when I first started and we wrote nurses’ notes. At that time, when we went to nursing school, you were taught to do detailed nurses’ notes. It wasn’t that every couple of hours you wrote a little brief note. You wrote detailed SOAP [Subjective data; Objective data; Assessment; Plan] notes. It was a lot of documentation.

00:18:31
Manning:
Did receiving an education help with your abilities to write effectively and effectively report what you needed to?

00:18:41
Lucas:
It certainly did. That was one of the things that we had much practice in. We actually had to do many, many notes. We had to do care plans on paper that were critiqued during your clinical rotations. While you were taking care of patients your instructor was there with you. You learned how to write great notes and you learned how to write exceptional care plans. It was a good learning experience that you took with you after you graduated.

00:19:19
Manning:
From what I’ve read in nursing history, the relationship between doctors and nurses is constantly changing. What was the relationship with doctors when you first started compared to now?

00:19:36
Lucas:
It was a bit different. When I first started, being a teenager starting to work in that environment can be a little intimidating. The physicians pretty much ran the department. We had nurse managers of course, and we had RNs and LPNs. When I first started, if the provider came in and you were sitting down, you got up and they sat down. They pretty much set the tone for the unit. They were not as focused on safety in terms of the environment. It wasn’t a smoke free campus when I started here. I’ve never smoked, but certainly, people smoked at the nurse’s station when I first started. It was a different environment back then. Of course we didn’t have as many physicians as we do now. You didn’t have all your specialists. You had your primary care physician who managed most of your care. We did have some cardiologists and a few other types of specialists, but there wasn’t a significant amount of resources that you had at your fingertips at that time.

00:21:00
Manning:
Just one last thing. With Mary Washington Hospital helping nurses further their education, how has that advanced the health care from Mary Washington Hospital?

00:21:14
A great deal. I think without the help many of the nurses would not have been able to go back to school to get their degrees. So you would have limited your nursing pool. There were many LPNs and CNAs who have gone back and become RNs. That actually changes your whole scope of resources you have on your unit. You have LPNs who cannot manage certain patient populations. You have CNAs who practice as nurse’s assistants but can’t do the role of an RN. Helping them get their degree only helps the organization being able to commit to having more nurses to take care of patients. And that was the ultimate goal: having more RNs who can work autonomously and take care of patients as opposed to having nurse’s assistants and LPNs with a limited scope.

00:22:05
Rigelhaupt:
I want to go 1983 if you can—I know this is a couple of years ago, so it may not be easy. Your first shift, could you describe what you remember about your first shift when you were officially in the hospital as an employee, even from parking your car to walking in. What was the space like?

00:22:25
Lucas:
We are in this building [2300 Fall Hill] now and this is the building the hospital was in. I don’t remember a lot about parking per se, but I do know that prior to my first shift I had done clinical rotations here, so I knew the unit. It’s sort of different having an instructor oversee your practice as opposed to coming in and now I’m a nursing aid and there is no instructor, but I do have a nurse assigned to me. Being able to be part of the team and they are allowing you to help with a task that you weren’t necessarily allowed to do while you were in school. Now that you are actually working with a licensed nurse on the floor you got to do quite a few tasks that you didn’t experience in school. The biggest thing to me was that I got to do many, many things in the first week that I hadn’t done the entire course that I had been in. That was great. I think that one of the key takeaways was that Mary Washington Hospital (MWH), at that time, had all semi-private rooms. There were two patients to every room and often times we were at capacity and we had patients in the hallways. We frequently had patients in the hallways. That was an eye opener, especially when you think about privacy now and having semi-private rooms and having patients in hallways. We’ve come such a long way to ensure the patient, number one, has privacy and that we are providing an environment that is conducive to patients being able to rest and get well. [24:00] One of the things I do remember was getting advice from the cardiologist at the time when I was very young. They would come up to me and give me tips and pointers on how it was going to be ten years from now. It was always interesting to work with different physicians when they would come and make rounds. When they made rounds, there was always the nurse that was in charge of the unit that rounded with them. Whatever they were doing they stopped when the physician came to make rounds. They had to do it with every physician that came in and it wasn’t like they did it for just one group. That person stayed pretty busy doing rounds.

00:24:43
Rigelhaupt:
What were some of those things you learned in that first week you said?

00:24:48
Lucas:
Really, it was how to take care of patients during emergencies. We were a cardiac unit. We had quite a few patients that had irregular rhythms. We had patients that needed treatment and we’d hold them over until we could get them to the intensive care unit. We did things like rotating tourniquets, shocked patients, and did cardio versions on the unit. I remember the nurse telling me, “Just go in and hit him in the chest.” The patient was in an irregular rhythm and you go in and you just thump them in the chest. So I went in and I just thumped him in the chest. [laughing] That actually converted the rhythm, but the patient was quite shocked by my action. The lesson learned from that is that you need to tell them you are going to hit them in the chest first and the reasons why. Sometimes you don’t necessarily have enough time to do all that. It was very interesting times we had.

00:25:54
Rigelhaupt:
What was the scope of practice? What were some of the things you did in the cardiac unit that pushed the limits of the cardiac practice in the hospital or were even pretty standard things that you did?

00:26:10
Lucas:
I don’t know that we pushed the limit. I think that in my role as nurse’s assistant we pushed the limit but only because there weren’t really defined limits as there are today. As far as cardiology, there were a lot of procedures that we just couldn’t do because we just didn’t have the expertise in our physicians until we started recruiting for that service. We did many of the standard things. The goal was to try to keep the patient out of the intensive care unit. A lot of times, we had one nurse for one patient so we could manage that patient without having to take that patient to the ICU just to give them an increase of the skill the level of the nurse. [27:00] Being on night shift we sort of ran with the graveyard shift. We had higher nurse to patient ratios. There were some times when you had to bring nurses from the ICU over for a certain period of time in order to manage patient populations. We did that as well. You learn from the experts. I remember being a night nurse and learning to start IVs and doing very well at it. Eventually you would get called from all over the house to come start IVs. It was just a matter of when you are a small community hospital and you work on certain shifts, people understand and learn who they can call upon, and that’s really what we did.

00:27:38
Rigelhaupt:
I know there is probably not a typical reason by any stretch but, how did most of the cardiac patients end up in the hospital, was it post-surgical, was it congestive heart failure? What were some of the major disease processes that brought them into your unit?

00:27:53
Lucas:
I think that hasn’t changed a lot over the years, unfortunately. Typically it was congestive heart failure and chest pain. We still have a significant chest pain population that comes in and congestive heart failure. People that actually have heart attacks are still a significant population, but it’s not as large as you’d think. There are a lot of patients that come in because they are having chest pain and they ultimately rule out—they’ll either have a stress test or they’ll go for a cardiac cath. But they ultimately do rule out. People that actually do have heart attacks are much smaller than the patients than come in with chest pain. Even back in the early ‘80s and when I started in cardiology years ago, chest pain and heart failure were still huge populations for us and that’s pretty standard. You also see patients with irregular rhythms, such as atrial fib or those patients who need a pacemaker or an ICD. Fortunately, we have great physicians now who can do those roles. Back when I started, you went to Richmond to get a pacemaker. Implanted defibrillators weren’t something that you received here as well. Starting the electrophysiology program was really exciting for our hospital and community.

00:29:13
Rigelhaupt:
What were some of the advances in cardiology in the hospital during the second half of the 1980s before going in to the new facility or what were some of the things that happened here that advanced the program?

00:29:28
Lucas:
I think the biggest thing is being able to standardize stress testing to rule out chest pain for that population. Also, there were several medications that we started using for heart failure patients: Dobutamine Infusion was regularly used and helpful for the heart failure population. And then we started doing cardiac cath procedures. For patients that actually had chest pain and their stress test may have been positive or may have been borderline, we were able to do a cardiac cath on them instead of sending them to Richmond to have that done. I think that was the biggest in cardiovascular, probably the biggest thing was the cardiac cath.

00:30:14
Rigelhaupt:
What were some of the things that might have followed up a cardiac cath that would have sent someone to Richmond or otherwise kept them here? How were those decisions made once you got results?

00:30:26
Lucas:
The results were right away. The physician doing the cath was the one who would dictate the results and so they knew right away. Pretty much it was anyone who needed an intervention. Balloon angioplasty was big in the late ‘80s. We weren’t really doing stenting much at that time. Stenting was still at the research level and they were still looking at that. But if you needed angioplasty or open-heart surgery, you went to Richmond.

00:31:00
Rigelhaupt:
Was there a discussion of expanding the cardiac program to include open heart surgery while the hospital was still here or did those discussions really take off once the new hospital opened?

00:31:13
Lucas:
There were discussions here because one of the requirements for any interventional cardio cath program was to have surgical backup. Surgical backup meant an open-heart team on standby if needed, and for most of the programs that was standard of care then. If you’re thinking about doing interventions they went hand in hand at that time.

00:31:34
Rigelhaupt:
And what do you remember about some of the early discussions about doing interventional cardiology and having an open heart surgery program?

00:31:42
Lucas:
The big thing about discussions was we knew we could get the equipment and we knew we could train and staff, it was getting the physicians with the skill level to do those procedures. We had cardiologists who commuted from Richmond that actually did the procedures at the hospital. They drove up to do the cardiac cath and they did intervention procedures at their primary facilities in Richmond. We knew that they knew how to do the procedure. The bigger thing is how do you recruit for an open-heart surgery program because you actually have to have the physicians before you can build a program. Oftentimes you wonder how long is it going to take to build a program because you have a cardiovascular surgeon here not doing surgery because the program is in development. Trying to make sure that there is not a lag time between doing procedures and when we get the program off the ground.

00:32:42
Rigelhaupt:
Let’s come back to the start of the open heart surgery program because that follows the new hospital, but I want to ask a few questions about the new hospital. What do you remember about the first time you heard the possibility, maybe water cooler talk, about building this hospital up on the hill. What do you remember about the first times you heard about it as a possibility? [33:00]

00:33:03
Lucas:
I was very excited because being one of the units that always stayed beyond capacity, we knew the need was there. We did not have enough rooms for our patient population. I was more so excited that we would not be at capacity all the time, but also that there was a possibility that we would have private rooms. That was the talk: “Are we really going to be able to have private rooms and have enough rooms for everyone?” That was very exciting as well. We knew that once we expanded the facilities we would be able to expand some of the procedures that we wanted to offer. We had sort of maxed out in space in this building. Even if you wanted to have new programs, I’m not sure where you would put the new footprint for a new program. For instance open-heart surgery, those operating rooms are much bigger than standard operating rooms. Even if you wanted to provide services not having the physical space was a limiting factor.

00:34:06
Rigelhaupt:
Did you and your colleagues as nurses have input or have discussions with what the new space would look like? And what the new cardiac units and floors would look like at the new hospital?

00:34:16
Lucas:
Yes. Working with the architect, they provided design specs and had walk-throughs with all levels of nursing. Not just nurses, but secretaries and CNA’s were able to look at the plans, look at the designs, and where things should fit logically in the workspace. When first designing the step-down units there was sort of a suite where the family could stay and help learn how to take care of the patient before they went home. That was the model. That was a very interesting model to have a mini-suite and we’re going to show you how to take care of your family member before you go home so you’ll know how to do it when you get home. Nursing was very involved with the design. The operating room—the OR nurses were very involved because that’s their specialty. They know how to maneuver in an operating room. Bedside nurses on the step-down units weren’t so much involved with that portion of the design. But at that time we did have the PA and the NP from the cardiac surgery practice who were very skilled and experienced in doing cardiac surgery. They helped build the program as well as the design of the units.

00:35:28
Rigelhaupt:
So the design and the build of the step-down units were already thinking about the possibility of an expanded scope of practice. I mean you have open-heart, interventional cardiology—

00:35:42
Lucas:
Yes.

00:35:44
Rigelhaupt:
Okay. Do you remember your last walkthrough or the last visit to this new hospital when there were no patients there and it was an empty space and you knew it was going to open? And if you could tell me what it was like to walk through this new facility, but there is nobody there. [36:00]

00:36:03
Lucas:
Yes. It was very strange and it looked overwhelmingly big back then. And even when we actually moved patients into it, it still felt big. It doesn’t feel that way anymore because we have been there for so long. It was very quiet when you walked through. I think we did tours for all the staff and when they first walked in it was amazing that we have an atrium that looks like this. We still get tons of compliments on the appearance even today and on the atrium and when you first walk in. Then when you walked on the units it sort of set the stage for a different patient care model for nursing. Nursing was used to having one nurse’s station somewhere in the center of the unit and that was that. In the new nurse’s station there was a main nurse’s station but there were three other nurses’ stations in a triangular shape which meant that if I had patients in this corner I could work out of this corner without having to migrate back to the main nurses station which would save me steps. There was some thought that went into workflow for nursing, which was very accommodating for nursing at the time.

00:37:22
Rigelhaupt:
Were you working the day that patients were moved?

00:37:35
Lucas:
No. I actually took off for two weeks.

00:37:29
Rigelhaupt:
What was it like to come back from—well probably it was a little sad coming back from a two week vacation, but other than that—not only are you coming back from vacation but you are coming back into this brand new hospital. What was your first shift like there?

00:37:44
Lucas:
I was working mainly as a charge nurse back then. I had to reorient myself because I had never taken care of patients in that environment. It was good that I probably was more in the charge nurse role and not patient assignment because I had to get my bearings on where everything on the unit was, as well as where everything else in the hospital was located—the lab, the pharmacy all being in different places than when we were over here. You really have to re-acclimate yourself to where you are physically.

00:38:25
Rigelhaupt:
And once you became comfortable with where everything was and found everything, what in those first week— I don’t know how to date the orientation period, once you became oriented—what were some of the best parts about practicing in the new hospital?

00:38:43
Lucas:
Some of the best parts about practicing right away was that we didn’t have patients holding in the ED waiting for beds. Secondly, there seemed to be more space. [39:00] It’s just like moving into any new house or place that you move to: everything was clean and it was uncluttered. We had large supply closets. It was more on-demand supplies than what we had before because we had to call materials quite a bit for supplies because of just not having space to store things. On the new units you had plenty of space and so you always had equipment readily available and on supply. That was very nice. It was also nice having satellite work stations so you didn’t have to be in one area all the time or walk as far all the time. One of the things that was thought out well for cardiology was that all of the cardiology units were on the same floor as the operating rooms. That area transferred the patients to and from quite a bit. If you’re in ICU, of course, you’re going to go to the step-down before you go home, but you’re on the same floor. Surgical ICU was right across the hall from the OR. When it did come time to do our cardiac surgeries, it’s just straight across the hall. The layout was well thought out.

00:40:10
Rigelhaupt:
What do you remember about the first conversations about the possibility of recruiting a surgeon who could lead an open heart program?

00:40:20
Lucas:
That was very exciting because I knew that we weren’t managing a patient population that we could manage if we had the cardiovascular surgeon. We were sending patients to other facilities outside of the community for care. No one really wants to leave their own community to go for care. Not only are you going to an environment that you are not used to, but it also takes a toll on your family driving back and forth to see you when you are at another facility. It was very hopeful that we could do something to keep our patients here in our community.

00:41:00
Rigelhaupt:
Did members of the cardiac care team—did they have any role in interviewing or talking with surgeons that might come in to lead the cardiac program?

00:41:16
Lucas:
We did. We were able to spend some time with interviewing the leadership team. The final decision was of course made by the board, but we did have an opportunity to meet all of the applicants before they were hired.

00:41:35
Rigelhaupt:
Do you have memories of meeting Dr. Armitage?

00:41:38
Lucas:
I do.

00:41:40
Rigelhaupt:
What was he like on an interview?

00:41:41
Lucas:
Very personable. I think that never changed throughout his stay. I mean, physicians are physicians, but one of the things I often hear about him from all of his patients is how much they loved him. [42:00] He was just so caring and accommodating to the families and the patients and they really thought highly of him and respected him. If you can win over your patients in that manner, that’s huge. Certainly Dr. Armitage had the skill level that we were looking for. He was very skilled not only in surgery, but how programs should be managed.

00:42:27
Rigelhaupt:
What were some of the first things you remember about when he started? It was a little less than a year between when he started and the first open heart surgery.

00:42:38
Lucas:
Probably about that.

00:42:40
Rigelhaupt:
The process of building the program. What are some of the memories of how things got put in place and changes that might have been made in cardiac care?

00:42:50
Lucas:
I think when he first came on board one of the big items that we talked about was what equipment do we need to do these types of procedure? Making sure we understand the capital costs associated with the program is significant. Once you understand that, then equipment needs and what procedures will be performed are the next steps. Open heart is very standard and open heart with valve replacements is as well. It doesn’t mean that you are going to do every single procedure that someone may need. Actually developing a scope of services that you are going to offer. Another key element is having Dr. Armitage working with the cardiologists. That would be the biggest referral base for Dr. Armitage and so there was significant amount of time spent making sure that he knew all the different cardiologists, that they were working together, especially the interventional cardiologists who would be sending him patients from the cardiac cath lab post procedure. Building those relationships and understanding how those referrals would occur also took some time.

00:44:03
Rigelhaupt:
One of the things I read and heard a little bit about was that with something like a surgical subspecialty like open-heart surgery, is it as important as the physician and the surgeon it is always a team. What were some of the things that other people, including nurses, contributed and really had to begin to change what they did to support the growth of that practice?

00:44:35
Lucas:
The PA and the NPs on Dr. Armitage’s team were very skilled. They worked with our clinical specialists in our ICUs and step-downs and really put together an educational training program for the nurses. Taking care of open-heart patients, they were used to that, but for our nursing staff it was very new to them. [45:00] So they developed an entire training program for all of the nurses to be able to manage patient populations, whether it’s just standard open hearts or valve replacements. That was significant because it did take a significant amount of training to be able to manage not only the patients, but all of the equipment that was attached to the patient, which was very new. They were used to having ventilators and IV pumps, but now you are having balloon pumps and all these other devices attached to a patient that required a tremendous amount of education and skill. They did a fabulous job of putting together a program and making sure nurses were educated and felt comfortable.

00:45:39
Rigelhaupt:
What do you remember about what you learned at some of the training sessions, the pieces of equipment, the procedures that you were most excited to learn about?

00:45:48
Lucas:
At that time I was a manager, so I didn’t do the training. The ICU staff went to training because they were taking care of the patient populations. We did sit in on some of the education to learn about the equipment. I had the cardiac cath lab. It reported to me at that time and we were already using some of the equipment in the cath lab because of the type of patient population. But the classes were pretty intense and we grew over time because when we first started getting our open-heart patients it was a one to one ratio regardless of the patient’s condition. As patients came out of the OR, there was one nurse for one patient and that was your assignment and that’s what you managed. Over the years, you don’t necessarily need to have one nurse for one patient anymore because we knew how to care for those patients and manage those patient populations. We also have an intensivist program in the ICU and that has helped as well.

00:46:47
Rigelhaupt:
So what year did you become manager of the cath lab? Do I have that right? That was the manager position?

00:46:57
Lucas:
I can’t remember exactly what year that was. It was in the ‘90s when I picked up the cath lab along with the step-down unit and eventually I had a total of nine departments.

00:47:16
Rigelhaupt:
Certainly before ‘94. It sounds like before the open heart program came in.

00:47:21
Lucas:
It was before the open heart program, yes.

00:47:23
Rigelhaupt:
And was it before the new hospital opened?

00:47: 27
Lucas:
No, it wasn’t before the new hospital opened, no.

00:47:30
Rigelhaupt:
So I’m going to go with ‘93. Those are two dates that I know. Okay. After having been a nurse manager you moved into being director of the cardiac unit. Could you tell me the exact title and when you became in that position?

00:47:49
Lucas:
The title has changed, it was Director of Cardiac Services and then we did some reorganization and I became Administrative Director of Cardiac Services. [48:00] When I was director, I didn’t have the ICUs and then eventually I did pick up the ICUs as well. It was just sort of a timing, rearranging staff and managers in different positions. I typically had step-down and the cath lab most of my time in cardiology and then picked up the other areas. I had all the outpatient areas like stress test, EKG, echo and rehab, and research for a significant amount of time as well.

00:48:31
Rigelhaupt:
And what were some of your goals as you became director of cardiovascular services? Places you saw you wanted the practice to expand.

00:48:42
Lucas:
A primary focus on was providing the right services. Are there things that we should be doing that we aren’t doing and are there some things that are a little outdated that we should stop doing? I was trying to make sure that we researched and figured out what was the scope for those areas. Making sure that we did look at best practice and how we are meeting the needs of our customers. I think one of the things that we tried to focus on was do we have the right people in the right roles? As I may have mentioned before, stress testing was one of my departments. One of the things that we found out was that cardiologists don’t really have a significant amount of time to perform stress tests on sixteen patients a day. They are typically in procedures or in the office. We put together a program where we had nurse practitioners that we hired to do all of the stress testing. We were able to expand from doing eight stress tests a day to sixteen because you weren’t waiting for a cardiologist do the procedure. The nurse practitioner just stayed in the stress lab and was able to do the test. That was good for our chest pain population because that was a population that all required a stress test.

00:49:56
Rigelhaupt:
This may be jumping backward in time a little bit but you just mentioned best practices and you mentioned already evidence-based medicine. When do you remember evidence based medicine becoming part and parcel to practices in the hospital? I think in the 1980s evidence-based medicine was not necessarily something that every hospital was doing.

00:50:25
Lucas:
It’s not and I know it’s sort of a buzz word now that you hear it all the time. That’s because it’s written in a lot of the standards especially for Magnet and different nursing standards. I think as an organization we really began to look at it in the ‘90s. The reason I say that is because we wanted to start new programs and with new programs comes research behind it. Is this the right thing to do? I remember trying to work on business plans and part of that was having research to support it. Is this an acceptable treatment for whatever population? [51:00] We had to do that when we were developing our EP program and looking at what are the standards of care for patients that have these conditions that require pacemakers and ICDs. What are the mortality rates? What is best practice for that population? I think our push to evidenced-based practices, at least early on, was because we were advancing programs. Today, it’s because it’s sort of ingrown in our culture and what we do: we need to go out, research, and make sure that it is best practice. Many of the governing bodies such as American College of Cardiology have practice standards and guidelines for the care and treatment of all the populations from chest pain to open heart and so those guidelines are established today.

00:51:43
Rigelhaupt:
And it sounds like all the units within the hospital are much more driven by evidence based practices and best practices since the early 1990s.

00:51:56
Lucas:
Yes, and more recently we developed our electronic plan of care for our nursing staff to use instead of using paper plans of care. We have a vendor that actually has allowed us to embed evidence into the electronic plans. If I want to know why we selected a certain intervention I click on the link and it tells me where the evidence came from, what governing body it came from. The same way with our policies and procedures. We actually have to have a resource referencing where we are getting our information. It can’t be that Lisa decided she wanted to write an order set or policy and it got approved. There has to be some reference of where that came from to support the change.

00:52:43
Rigelhaupt:
In looking at the history of Mary Washington, the cardiac program stands as a turning point. I’m sort of asking a leading question, which I’m not supposed to do but I’m going to do it anyway. It sounds like one of the benefits beyond just people being able to receive those treatments here is that there was more evidence-based practices because you started that program, you had to develop best practices, and it was something that then spread within the organization. Is that fair?

00:53:22
Lucas:
I think so, as well as any of the other programs whether its neurosurgery or stroke care: it all started with the basic concept of what is the best practice and going out and researching that. Then from there, developing standards or adhering to the guidelines from that governing body. I think that everything has moved and progressed toward evidence-based research and that’s been a significant move because there is so much research out there today that you can get overwhelmed with what is the best research and what’s not really good research. I go back to your question about the benefit of advanced degrees and nursing education: you have the training and knowledge on how to find and the difference between good research and not so good research.

00:54:18
Rigelhaupt:
So best practices and the development of new programs contributed to best practices and shaped how things would be done on a med-surg floor, in a med-surg search unit. And it sounds like now electronic medical records, order sets being put in, contain the research.

00:54:37
Lucas:
They contain the research. We have built electronic work flows around different processes, such as urinary catheter infections for the medical units. We have put in alerts and reminders to nursing to do different things at different points in time. All of that is based on research, but we have been able to make it electronic. For example, the urinary catheters will send alerts to the nurse. The ultimate goal is to get their catheter out earlier in their stay to reduce urinary catheter infections. That’s all based on evidence that has been done by many bodies and many organizations.

00:55:17
Rigelhaupt:
Do you recall other units and practice areas within the organization being receptive to the emphasis on best practices and evidence-based medicine from cardiology even if it wasn’t specifically about cardiac practices, but as a method of implementing new practices in different units?

00:55:38
Lucas:
I think that’s evolved over time. Just like with everything else early on, people were a little skeptical of best practices and what we needed to do because it was foreign to them. But now it’s something that’s every day. It’s considered in practice every day and it’s expected.

00:56:03
Rigelhaupt:
Part of running a hospital involves medical staff, it involves nurses, it involves the administration, and even the board. Did you get a sense as a nurse manager at the time the cardiac program was expanding that there was a lot of collaboration between those different pieces of the organization?

00:56:25
Lucas:
Yes I did. There had to be because ultimately there were so many parts to starting up any new program and different layers of responsibility that everyone had a role to play. Everyone had to be on board and understand what was the outcome and what were the remaining steps to get there. I think oftentimes the board sort of sets these standards of what the organization is going to do, but there has to be education from the nurse level to the board level to understand the implications of “Okay. We’re going start an open heart program.” What does that mean? [57:00] It means, understanding these are the procedures we are going to do and this is the literature behind that and understanding that there are some pros and cons for every program. There will be patients that will not survive this procedure because there is an expected mortality rate based on patient populations. Understanding that certain patient populations are high risk—even though we offer open heart, we may refer them to another acute facility. All those things need to be under consideration when you are talking about an open-heart program or any program you want to start. Trying to narrow down your scope. From nursing to the board, I think everyone needs to come together and understand that if we opt to do this, we need to weigh the pros and cons and develop a program that we can maintain and manage at our organization.

00:57:57
Rigelhaupt:
In the years that you were director of cardiac services or cardiovascular services, what were some of the areas of expansion or growth that you were most proud of having seen developed within the unit?

00:58:10
Lucas:
Certainly the big one would be cardiac surgery. Second, would be the expansion of the cardiac cath lab to be able to do interventional procedures and not just cardiovascular procedures, but peripheral procedures on your legs and carotids. They have expanded quite a bit. Moving from standard stent to drug eluting stents. That was huge ten years ago to having drugs inside of your stents. The EP program, electrophysiology, being able to offer pacemakers and implanted defibrillators has been a significant program for our population. I think that we tend to think of this happening for older patient populations, but there is a large portion of patients that are in their thirties or younger that receive these services. It was needed in our community. We still at this time only have two physicians that do EP. I think for a community our size we may need to look at getting a few more physicians who actually can do that role because I know they stay pretty busy with their volume. But looking at the evidence over time, it’s also helped our heart failure populations because our heart failure populations are now getting implantable defibrillators as preventative measures before they reach the point of where they have a life threatening event.

00:59:49
Rigelhaupt:
Were you still director of cardiovascular services when Stafford Hospital opened?

00:59:53
Lucas:
Yes

00:59:54
Rigelhaupt:
What were some of the things that you wanted to see that were best practices here to make sure that were a part of Stafford? [01:00:00]

01:00:02
Lucas:
I worked with the team that designed the cardiac areas at Stafford. The only challenge was to understand the scope because it was not going to be a full service hospital the way Mary Washington is. We were not going to have open-heart surgery there so planning the scope of services was different. Fortunately, we were able to offer cardiac cath and intervention services, which was very nice to be able to offer that package. Stafford Hospital offered all the standard diagnostic services and it pretty much mirrored what we do here except for the open heart piece.

01:00:42
Rigelhaupt:
For the physicians doing stents and interventional cardiology, they are still part of a group practice contracted with the hospital or are they hospital employees?

01:00:54
Lucas:
No, they are not hospital employees.

01:00:56
Rigelhaupt:
So do they get called in? Are they always staffed 24/7? How did you make decisions about best practices on something like that?

01:01:06
Lucas:
For cardiology, for interventional cardiology, and for each service there is a medical director. The medical director always worked with me and the other cardiologists to come up with all the policies and procedures, the call schedules, and the types of patients that required a cardiologist to come in. When we get a call from the emergency department after hours about a patient who is having a heart attack, there is always someone on call. That cardiologist gets a page and the cath lab staff get a group page all at the same time. It’s called a Code Stemi. They all know it’s a heart attack and they all come in within thirty minutes.

01:01:55
Rigelhaupt:
Did having a background in expanding and planning new programs, such as the cardiac program, did you play a role in starting trauma?

01:02:06
Lucas:
I did not. I didn’t work with trauma at all.

01:02:15
Rigelhaupt
Could you tell me a little bit about what your dissertation is on and your doctorate?

01:02:23
Lucas:
My dissertation was on the use of electronic medical records to reduce medication errors. I did that because in 2012 we implemented CPOE at both hospitals. Physicians were no longer handwriting their orders and they were using an electronic system. An inherently just by using this system transcription errors should decrease. We do track our compliance rate with using CPOE by provider and we also track our compliance rate with medication errors. [01:03:00]

01:03:01
Rigelhaupt:
Are there any things you learned in the dissertation that you have tried to apply to practices in the organization?

01:03:07
Lucas:
There are and one of the bigger things that I’ve learned is that we need to be able to track our medication errors differently. Often time’s things are bundled together and required you to do a manual review of the record to understand how the error happened. I think we need to look at how we track our medication errors. My dissertation was a six-month time frame because that’s what I had at the time and it needs to be a longer time frame to look at the data.

01:03:44
Rigelhaupt:
And where did you—I didn’t jot it down—where did you go for your doctorate of nursing practice right?

01:03:50
Lucas:
Yes. My doctorate is Nursing Practice in External Leadership.

01:03:51
Rigelhaupt:
Where were you in school?

01:03:53
Lucas:
I went to American Sentinel in Colorado.

01:04:00
Rigelhaupt:
And I also wanted to ask you in terms of education about what I saw in your signature in your email: the MBA and HCM. Could you tell me about the decision to pursue those degrees?

01:04:16
Lucas:
Since I already had a bachelor’s in nursing I didn’t think I needed a master’s in nursing. I wanted to lean more towards business. What I found that when I had been in cardiology being a director or nurse manager is that we all have our units as our own businesses that we need to manage. You’re managing your people, you’re managing your budget for supplies and expenses, and you’re doing program development and business planning. I really thought that having a business degree would help me manage my businesses better. I have a minor in health care because I wanted to have a concentration in health care as that is my industry of choice.

01:05:02
Rigelhaupt:
And where did you go to school for the MBA?

01:05:04
Lucas:
I went to University of Phoenix.

01:05:09
Rigelhaupt:
Do you remember some of the first things you learned that you tried to apply on the job?

01:05:16
Lucas:
We spent quite a significant amount of time on accounting courses. Working with our finance department on the accounting methodology and trying to understand that process was very helpful for me. Although the program was an MBA, we spent a significant amount of time on IT and understanding how to use IT to help business practices. Many programs of study incorporate information technology into their curriculum.

01:05:51
Rigelhaupt:
One of the things that is interesting about management and health care is how many different perspectives there can be from MBAs, from RNs, to MDs, and you have a background in many of these. [01:06:00] Are there meetings that you have been in, particularly thinking about your time as director of cardiovascular services, where you saw productive tension between different perspectives on how to solve problems. Because you are dealing with physicians, nurses, people from the business side of it. Do you have any memories of how the different ways of problem solving produced good outcomes through a kind of productive tension?

01:06:37
Lucas:
I guess I see that a lot in several meetings I attend and I say that because we all do come with a different perspective. When you have finance in the room and you have medical physicians in the room in different conditions they all come with a different perspective and what their goals are for that meeting. One of the meetings I used to chair quite a bit was the quality value analysis team, which is actually the team that receives and reviews a request for different supplies or procedures you would like to start. One of the things that we had to review was the research behind it. So someone came with research and we had to review any regulatory issues with the products and the regulatory team was present to review. There was a business person there to talk about financials, meaning what DRG or diagnosis this was going to fall under, what is the typical reimbursement, and what is the return on investment. Then you had your providers there talking about quality and why this is a procedure that should be done for the patient population. Whenever you have clinicians talking about quality and patient safety they are always very passionate about that, as they should be. However, there is always weighing a balance of who else has been doing this procedure, should it be done, how safely can it be done, and what is the overall cost. It is still a business that you manage even though it is in health care. That group works well in trying to understand each perspective and then understanding we can certainly do this service or procedure, but this is going to be the overall impact. Once you get to that level of explaining and showing the overall impact, you get people on the same page. Then you can make decisions. What you don’t want to do is come to the table and you don’t have all of the facts and you are trying to make decisions about a product or a service and you can’t show people the benefits, or the pros and cons, for them to make an educated decision.

01:08:43
Rigelhaupt:
Can you think of an instance where starting a new area, practice, or bringing a new procedure was particularly controversial?

01:08:54
Lucas:
We did start on one procedure that wasn’t so controversial, but not a lot of places were doing it and we weren’t sure of the impact. [01:09:00] Would it actually be a benefit to our patients? The procedure was done in cardiac rehab. The procedure was for patients who had stents before and continued to have chest pains. There really weren’t any medical interventions left for us to do for them. Would this procedure help them? We had a great physician supporter and we ultimately implement the program. Actually, it was highlighted in the Free Lance-Star a year or two after we started doing the procedures. It had actually benefitted quite a few of our patients. Patients who couldn’t walk to their mailboxes were now walking to the mailboxes and they were out participating in activities. But that was one of the programs that the literature really didn’t support the benefit as we hoped it would, but it turned out that it did make a difference in our patients’ lives.

01:10:03
Rigelhaupt:
Can you think of one that was ultimately decided, that the organization decided not to start?

01:10:16
Lucas:
Off the top of my head, I can’t.

01:10:21
Rigelhaupt:
What’s been the best part of your job since you’ve been director of clinical informatics for the last couple of years?

01:10:28
Lucas:
It’s been very exciting because we are going through meaningful use right now. I think one of the things is not only that you’re learning all the regulations for meaningful use, but actually working with our clinicians and nurses at the bedside because they are the ones who really have to practice it. We are making sure that they understand what that means and helping design tools that, number one, they can easily use and meet the requirements for meaningful use. It’s a very exciting time in health care IT right now. It’s a challenging time and you can see by most of the hospitals in the United States are not at stage two meaningful use yet. They just aren’t there. A lot of hospitals have met stage one, but a significant challenge is meeting those regulations. From a nursing perspective, we’re doing many things for meaningful use and I think we are losing perspective of what that means. We’re not just doing things to meet meaningful use: we are doing things to make the patient’s experience more meaningful. We’re not trying to just check a box to say we did this. Behind the scenes we need to make sure that whatever we put in place does improve patient safety and enhances the quality of life for the patient.

01:11:48
Rigelhaupt:
What would you most want the public to know about your job—and I want to ask about maybe your career as a nurse leader, as a charge nurse, as a nurse manager—that might not be common knowledge? [01:12:00] Maybe not just about your job but what it means to be a charge nurse and a nurse manager in general and if you want to base it certainly off of some of your personal experiences.

01:12:13
Lucas:
First thing is I think it’s a very rewarding job, but it’s one that you shouldn’t take lightly. If you get the opportunity to be in any nurse leading position, you really need to take the opportunity to make sure that you are mentoring your staff and that you are the leader that you would want to be working for. That you do the right thing even when it’s making hard decisions. That you do it fairly across the board. I think we have a great opportunity to mentor nurses into getting into roles that they have not been in before. I think sometimes nurse managers struggle sometimes with, “Well, I have another nurse who wants to go to an ICU now but I’m going to be lose a nurse.” Well yeah, you will lose a nurse but that is going to be a great experience for this nurse. Creating opportunities for people because as nurse leaders we all have someone who created opportunities for us.

01:13:18
Rigelhaupt:
Same question: What would you most want the public to know about your being director of cardiovascular services?

01:13:27
That has been the most educating, rewarding experience I’ve had. Working at many levels, from the board to physicians to nursing staff, you see diversity in all those populations and gain an understanding of what each person brings to the table. To understand that a CNA to a board member—whomever—has such insight and value to what we bring to our patients because of their experience with the patient. We need to make sure that we listen to everyone’s point of view when we are practicing.

01:14:05
Rigelhaupt:
Same question: What would you most want the public to know about being director of clinical informatics?

01:14:12
Lucas:
We are embarking on a challenging and exciting role. Clinical informatics is still sort of a buzzword right now, but in a year or two it won’t be. It will be commonplace and there are some significant expectations for anyone in a clinical informatics role in regards to the public and the care they are going to receive based on the mandates from the federal government. If you have not heard of clinical informatics you soon will because everything you do as far as health care will be electronic in the future.

01:14:46
Rigelhaupt:
What would you most want the public to know about Mary Washington Healthcare that might not be common knowledge?

01:14:53
Lucas:
I think that Mary Washington Healthcare has great leaders that are in front with the vision for the health system. [01:15:00] We have come a significant way in a short period of time. It may not seem like a short period of time, but coming from where I was in ‘83—from smoking on the unit and everything being paper and patients staying two weeks—to a regional health system that in three days you can have an open heart surgery and you are home and doing very well. Doing neurosurgery and having centers of excellence that have been honored by national awards. The hospital has come a long way for providing services that the community wants and services that they need.

01:15:43
Rigelhaupt:
Jumping backwards just a little bit, 2009. The hospital earns Magnet status. What did that mean to you?

01:15:52
Lucas:
The opening of Stafford?

01:15:54
Rigelhaupt:
No, no. Magnet status. Achieving Magnet Status.

01:15:57
Lucas:
I actually worked on some of the documents that went to Magnet and that was critical because it was a big reward for nursing. We have a lot of awards for the hospital and for different departments in the hospital, such as radiology. But when you get an award that just talks about the excellence in nursing practice and how they manage patients and care for patients. That is huge for the community because you spend five minutes with your doctor but you spend your entire time that you are here with your nurse. Making sure that they do practice within the guidelines and they do practice evidence-based, which is what Magnet is all about, is significant for our nursing population and our community.

01:16:44
Rigelhaupt:
My last question is two questions: is there anything that I should have asked and I didn’t, or is there anything that you would like to add?

01:16:55
Lucas:
You’ve asked me quite a few questions. I don’t know that there’s anything you didn’t ask. I guess as far as my journey here at Mary Washington Hospital, it’s been very exciting, I’ve had many opportunities given to me by the organization and continue to have opportunities. I can see Mary Washington continue to grow and expand and I’m thankful for my time here.

01:17:23
Rigelhaupt:
I think that’s a nice place to end. Thank you.

01:17:24
Lucas:
Thank you.
[End of interview]

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