Mary Loyd

Mary Loyd is a registered nurse (RN) at Stafford Hospital and works in radiation oncology. She began her nursing career in 1985 at Northern Illinois Medical Center. She worked at Loyola University Medical Center, first in the cardiovascular ICU from 1987 to 1991 and then in the emergency department from 1991 to 2003. Loyd has also worked at Washington Hospital Center, Mary Washington Hospital, Georgetown University Hospital and has experience in the operating room, health and wellness, education, and training and simulation.

Mary Loyd was interviewed by Jess Rigelhaupt and Christian Zapatero on November 18, 2014.

Discursive Table of Contents

00:00:00-00:15:00
Beginning as a nurse in Chicago in 1985—Dynamics between nurses and physicians—Working as a nurse in Chicago—Working as a nurse in Washington, D.C. at Georgetown University Hospital and Washington Hospital Center

00:15:00-00:30:00
Working in radiation oncology at Stafford Hospital—Using nursing experience and clinical skills—Being a caregiver—First shift at Northern Illinois Medical Center in McHenry, Illinois in 1985—Education at nursing school (Kishwaukee College) and from preceptors

00:30:00-00:45:00
Work in a medical-surgical unit—Work in the cardiovascular ICU at Loyola University Medical Center, beginning in 1987—Started in the ER at Loyola in 1991 (through 2003)—Teamwork in the ER—Trauma training at Loyola—Development of clinical skills in the ER

00:45:00-01:00:00
Development of listening, observation, and patient care skills in the ER—Use of new technology—Work at Washington Hospital Center and Georgetown University Hospital—Work in training and simulation—Started in health and wellness at Mary Washington Hospital and then radiation oncology at Stafford Hospital

01:00:00-01:15:00
Work radiation oncology at Stafford Hospital—Evidence-based medicine—Cancer resources at MWHC and long term oncology care, such as home health

01:15:00-01:26:45
Cancer navigators—Integrative medicine—Changes in nursing school curriculum—Community benefit—Summary statement on being a nurse—Summary on MWHC

Transcript

00:00:06
Rigelhaupt:
It is November 18, 2014, and we’re in Fredericksburg, Virginia on the campus of University of Mary Washington, doing an oral history interview with Mary Loyd. The first interviewer will be Christian Zapatero. He will ask the questions first. I will come in a little bit later and my name is Jess Rigelhaupt. Christian, why don’t you kick off?

00:00:25
Zapatero:
I looked up on a little bit of your pre-information. You got into nursing in Chicago in 1985?

00:00:33
Loyd:
Yes.

00:00:34
Zapatero:
Why did you get into nursing?

00:00:36
Loyd:
I’ll tell you, I started school with the hopes of becoming a vet. My freshman year I took eighteen credit hours, was running cross-country, and didn’t do so well in some of my classes. I thought, “Well, maybe this is a little too much for me?” I decided to go into nursing. I never really had an aspiration to be a nurse, but I was always a big helper throughout my life. So in hindsight, it was a natural fit.

00:01:07
Zapatero:
You talked about your education, what were some of the educational requirements to be a nurse in the 1980s?

00:01:13
Loyd:
You had to take your general education: English, sociology, a couple of years of psych, child psychology, anatomy and physiology, math analysis, stats. Then of course, once you got into your 300- and 400-level classes it was more clinical experience: your med-surg, psych, and ob-gyn were the main clinical parts of it. Then of course we had some didactic that went along with that.

00:01:45
Zapatero:
How was the field of nursing in the mid-1980s when you first got into it?

00:01:51
Loyd:
It was exciting! We still had to wear white. We had a white dress on and I remember it was polyester with a zipper, which you never see anymore. White tights, white-tie shoes, and of course we wore our nursing cap, and we had our pin on our nursing cap. That’s something you don’t see any more either. I’m not so sure that we worked any differently than we do now. I remember just the dress being different, but I had great mentors. It was an overall really good experience.

00:02:28
Zapatero:
Hindsight being 20/20, were you able to see a different dynamic between physicians and nurses between the mid-1980s and now?

00:02:39
Loyd:
Definitely! In the ‘80s a doctor would come on by and I can recall nurses saying, “Oh, would you like to sit down?” Giving up their chairs. When I worked in small community hospitals, calling a physician in the middle of the night to say, “Hey, something’s wrong,” and this physician having a major attitude. [03:00] Nurses really didn’t speak up to doctors. Today, nurses I think have a stronger voice. Very professionally and politically correctly, they will address the issues so that the best outcome happens for the patient.

00:03:15
Zapatero:
Are there any specific gender role you were either expected to follow or unintentionally followed in the mid-1980s?

00:03:26
Loyd:
Gender roles? I don’t think so. I would say that there’s definitely, as far as gender goes, less male nurses back then compared to today. But as far as other roles, I’d say probably not.

00:03:43
Zapatero:
As you said there were less males as nurses, did that add to the dynamic between male physicians and nurses? Were there any combative issues between them?

00:04:08
Loyd:
I don’t think so. But I will tell you as far as gender issues, now that I’m thinking about it, the guys mainly went to the operating room or the emergency room to work. When I was working in Loyola’s intensive care unit in the ‘90s, a lot of the guys that were ER nurses or ICU nurses then went on to become perfusionists in the operating room for cardiovascular surgeries or they went on to be flight nurses. You rarely saw guys in oncology, home health, or working on the floor. It was mainly those types of specialty units.

00:04:37
Zapatero:
Do you feel that society thought women were more suited to—what’s the word for it—better sense of caregiving? You say that were they able to define that women had a more caregiving need than men or was that a stereotype?

00:05:10
Loyd:
A stereotype. I think it’s one of those things. My mom was a nurse back in the 1950s. Back then you usually graduated from a Catholic school and you only had a couple of ways that you could go as a woman: as a nurse or as a teacher. There were very few careers. Today it is very different as far as education goes.

00:05:42
Zapatero:
Switching it up a little bit, because Chicago was a big city, as compared to different parts of Virginia. Were there any societal factors that made its way into the field of nursing? [06:00] Right now, just to give you an example, how Chicago is the murder capital of the USA, but obviously that wouldn’t have been the case back when you were working in Chicago. Obviously the trends originate or develop, did the societal factors influence your field or make it more burdensome?

00:06:17
Loyd:
Now that’s a good question. I’ll tell you, when I started my career I started in med-surg. I knew I always wanted to make it to the emergency room to work, so I built my career on the steps I needed to do to get there. I started on the floor, worked in the ICU for four years and then made it to the ER. You know how they call some nurses who work in the ER or ICU “adrenaline junkies”—I think that’s actually who I am. I’m not sure which came first: if it was me that was drawn to that or if that was drawn to me, but I actually ended up loving it. With the city comes homelessness, comes gangbangers dropping people off on the ramp that were shot in the head, domestic violence, child abuse. You see it all. That’s just part of working in the emergency room in a city. You get some of those things. Sometimes that happen in rural areas or in the suburbs, but it’s very different. Societies are very different depending on where you work.

00:07:19
Zapatero:
Reflecting on the past, are there any experiences that still linger with you today because they were very profound?

00:07:30
Loyd:
Absolutely. I was sharing with your professor when we had the American Nurse film night. I was due with my son. He was actually ten days overdue and I was assigned to the trauma room. It was about four o’clock in the afternoon and I can remember every detail of this day. We got a call, probably about thirty miles outside of the city where I was working in Loyola. A father was teaching his daughter how to fly and they went up a couple thousand feet and the engine malfunctioned and went down. The daughter was dead at the scene and they brought the dad in by ambulance. He had brain matter coming out of his nose and his ears. His pressure was really low. We had him on a lot of medicines and IVs to kind of squeeze the blood vessels and to shunt all of the blood to the core of his body. With the brain matter coming out of the nose and ears somebody doesn’t stand a chance. Basically we were just going to bring him to the scanner to just say, “There’s nothing happening there. We just need to contact the family. Stop life support.” His wife was the person that running the CAT scan machine. She looked at us and said, “What’s his name?” Not only were we dealing with this horrible tragedy, but then we were also dealing with his wife being the person that was receiving him to do the CAT scan. [09:00] I can remember that like it was yesterday. There are lots of those stories.

00:09:08
Zapatero:
That’s powerful.

00:09:09
Loyd:
Yeah.

00:09:14
Zapatero:
Switching it up a little bit, why did you move to Virginia?

00:09:19
Loyd:
My husband’s job. He works for the Postal Service. He worked in the Great Lakes area and got this great job working in D.C. We ended up here in 2003.

00:09:32
Zapatero:
I looked up that it said you worked at the Washington Hospital Center, or you had done training, and you also taught classes at Georgetown for their nursing. I looked at the Mary Washington Healthcare and Washington Hospital Center’s mission, vision, and value statement. I was just wondering how you were able to relate the values that they tried to push in your daily life?

00:10:00
Loyd:
Living the mission is easy because being a nurse you carry a set of professional nursing values no matter where you go. It’s the caring, the compassion, the empathy, the honesty, and the integrity. It all comes along with a nurse no matter where that nurse goes, whether its Mary Washington, Washington Hospital, or Georgetown—those values never change.

00:10:23
Zapatero:
What type of training did you receive to be able to perform in the operating room?

00:10:33
Loyd:
I went to Washington Hospital Center in 2007. The reason I went up there was because the operating room was something I had never done before. I thought, “Let’s give this a try.” They had a wonderful program, an internship. It was a year-long internship where you were mentored in multiple different cases: I did general surgery, thyroid cases, and orthopedic cases. I was involved with traumas. Then because of my history of teaching, the educator that actually hired me got involved with doing education and training with the operating room staff with code blue scenarios. Then I left the OR in 2008 and went down this education path. The operating room was really neat.

00:11:22
Zapatero:
Well, it said that you taught classes at Georgetown’s nursing school, taking on that role as more of an instructor, rather than a pupil, was that able to broaden your horizon on the field of nursing?

00:11:36
Loyd:
Absolutely! And what I did is I coordinated the medical student program at Georgetown, but I was involved with education and the simulation training group at Washington Hospital Center. That’s where most of the training was. We did a lot of code blue training where we tried to get the defibrillation times down by several minutes. We were really successful. [12:00] The team was a doctor, a clinical specialist, and some of our educators. We would go to the different units in the hospital and do live training and mock drills to get those times down. Then I worked very closely with faculty to develop ob-gyn simulation training for the residents. Some of that involved code blue scenarios. Then we also worked with the general surgery department, some of which involved developing games to assist the residents with their training.

00:12:34
Zapatero:
Sticking on that, because they always say, “When you teach somebody something, it helps you understand it better.” When teaching other people the intricacies of nursing were you able to become more sensitive to what your field demands of you?

00:12:57
Loyd:
Great question, Christian. I’ve been a nurse and I’ve been in a lot of these situations. First of all, with the nurse comes a lot of responsibility. You are in a lot of scary situations where somebody’s life is touch-and-go. As far as the code blue thing, I’ve been in a lot of situations where it’s so scary. Somebody has a cardiac arrest and the team comes together and you’re working your best to do what you need to do. Sometimes they make it and sometimes they don’t, even when you give it your best. The other thing that happens when nurses are in a really scary situation is it can affect their cognitive ability to think. They may know how to run a code so well, but when they’re in that situation they can’t think of what to do. I’ve been in that situation and when I would develop the education and training I would come up with mnemonics and a very systematic way of teaching. I instilled a lot of confidence in them and that’s how we were able to get our times down. When you’re doing a lot of the education and training and when you’ve been in that situation and you’ve felt the fear and felt that anxiety, you know how to teach it better because you’re trying to help them to overcome the same fears you’ve had. I’m passionate about that!

00:14:10
Zapatero:
Moving on then a little bit, it said that you got into radiation oncology just a few months ago?

00:14:17
Loyd:
Yes, in June.

00:14:18
Zapatero:
Why did you get into that type of field?

00:14:21
Loyd:
I left Georgetown in June. The reason I left Georgetown was traveling up to D.C.: it’s about two hours up and two hours back. It was a full-time plus job. I had my associate degree. I had four years of school behind me, but an associate degree. My whole life I’ve done these great things that have involved a tremendous amount of hours doing education and training, but I needed to stop. I needed to take care of myself and pull myself back so that I could finish my degree and move forward that way. There’s only so much that you can do before you have to have your degree to move forward. [15:00] I’m hoping to complete my master’s and move into the education and training arena.

00:15:08
Zapatero:
Just because this is sort of a new department, are there any requirements that are different in the radiation oncology department than a regular nurse would have to do? Are you required to do more, go “above and beyond”?

00:15:23
Loyd:
Let me back up because I didn’t finish answering your question. The reason I came is because the job I have now is part-time and it’s local. It’s enabling me to go to school. But to answer your question about radiation oncology: there was probably about a good month of orientation with all the nurses to learn the ropes. The doctor I work with is excellent. There’s constant teaching going on. You can never learn everything you need to learn in a small orientation period: it’s ongoing for years. Oncology is something I’ve never done before. I’m learning the radiation aspect of it, but I’ll tell you Christian, we have patients that are very sick. Let me give you a good example, we had a lady who had a very large tumor in her neck that had gone on for quite some time. The tumor had grown so large it was starting to press into her airway. When she saw us she was still breathing okay. A little bit of time went by where she had to have a few procedures done to get her ready for radiation and chemo. She came back to us almost a month later and the first day she came back for her treatment she was walking down the hallway and I could hear that she was having difficulty breathing. I thought, “Oh, this is not good.” “A” [airway] comes first no matter what kind of nurse you are. If you don’t have an A, then we have a problem. We sent her to the emergency room and she was actually trached [received a tracheotomy] in the emergency room. What I’m trying to say is the skills that you have as a nurse, the acute perception to see that something’s wrong and to act on it, it doesn’t matter where you are those same skills will follow you. There have been several patients like that, that have presented themselves very sick just coming for radiation. When we get them on the table in the position they may not be able to tolerate it. Their oxygenation goes low, sometimes their blood pressure goes low and then of course the nurse and the doctor come in to intervene and help that person. It’s very complex. All the things that you look at—you’re looking at each patient as an individual with their own set of issues and you address those issues rather than just looking at the radiation oncology aspect of things.

00:17:46
Zapatero:
Because you brought it up earlier in the interview, talking about how you always felt you were inherently a caregiver, do you think that your personality helps you with the job of being a nurse? [18:00] I’m sure not all nurses—they do have a caregiving aspect, but they don’t have such a jolly personality or that type of personality. Could you elaborate on that? How you think your personality helps you with your field?

00:18:22
Loyd:
When I come to work every day, I’m very humbled by the patient population I’m taking care of. I know that I have to be at my best for them because they’re not feeling well for the majority of the time. I actually get energized by being able to give to these people, even if it’s just, “Hey, how are you?” Giving them a hug when they’re walking down the hallway. What I give, I also receive. I always feel really good every day. Sure there are some days that are heavier because someone gets a poor prognosis. Knowing that you’re there for those people spiritually and giving them what you can possibly give, it feels really good. So to answer your question. That’s one thing with nurses: in order to give, nurses also have to take really good care of themselves. A lot of nurses are also moms that are dealing with a lot of other things. Sometimes self-care comes last, right? In order to be able to give you got to take good care of yourself. I’d say for the majority of the nurses I think it’s innate. You can’t be a nurse because you’re in it for the money. You become a nurse because you want to help people. I think people that are in it for the money are really going struggle.

00:19:47
Zapatero:
Doing a comparison, because as you said when you were in Chicago you were in the emergency room, but in radiation oncology, like with your example and how that woman with the tumor is there, is there a difference in the dynamic between patient-nurse relations? Do you feel more intuitive now as compared to the in department you were in back then?

00:20:14
Loyd:
As far as the intuitive piece of it, that is there no matter what. When people are coming into triage you have this sense about what’s going on with them even though they may not be telling you exactly what’s happening. You get this sense about them that kind of guides your questions to pull the information out of them sometimes. It’s the same thing with patients in radiation oncology. The difference though Christian, is that in the emergency room things happen a lot faster. You’re going, you’re getting the information, and you’ve got several patients you’re kind of circulating around to. In radiation oncology, you can spend a little bit more time with them. You see them on a daily basis. In the emergency room, you’re seeing them and they’re either going home or they’re going upstairs to be admitted. [21:00] The nice thing about radiation oncology is the continuity. I love seeing these patients every day. The same lady I told you with the tumor: we saw her on Wednesday and, when she came in on Thursday, she was having a really hard time breathing. We see her everyday. I collaborated with the physician and she was admitted into the emergency room because she was declining. It’s just different the amount of time and the place where you’re spending with these patients.

00:21:36
Zapatero:
I’d hate to play devil’s advocate. I feel that would be sort of a double-edged sword: because yes, in the emergency room you’re more fast-paced, you have more patients to worry about and when you’re able to focus more on one you, everybody develops, especially nurses, they develop that personal connection, that loving connection. Yes, it’s good that you get to know the person, but does that also make the grieving process or the process of losing someone, just in the case if they were to be lost, does that have a more emotional toll on you that you were able to know the person more than you probably would have?

00:22:13
Loyd:
That’s a good question. And that’s actually happened a couple times. What I think about that is we’re kind of getting into the death piece of things and how we’re all human beings and this is what happens. I think if we can give people the greatest amount of comfort that we can, they get to the point where we see them suffer so much that you know when their life comes to an end that they are in a better place. I think that brings comfort because we are seeing them suffer on a daily basis. I always think that I’ve made their time, their last few days on this earth that much better by bringing them that kind of comfort. It’s just something that happens. I just pray, take good care of myself, and continue to give on a daily basis to my patients. I guess is how I deal with it.

00:23:15
Zapatero:
To keep going off on that, in those cases, because I’m sure you’ve had cases where you’ve felt a deeper bond with certain patients than with others, does make the reflection process whether they are lost or whether they get better. Does that connection that you made with that person enhance the reflection process in either way?

00:23:40
Loyd:
It does. I think about people when I’m doing yoga. I think about people when I’m driving in the car. When reflecting, I think a lot about their families. I think about what they’re left to. If they were younger and they had children. [24:00] I mean, as I’m talking to you right now Christian, I’m having flashes of people just in the last few months that I have talked to. You see the fifty years of marriage and think, “Oh my gosh. What is this husband going to do without his wife?” This thirty-two-year-old mom with breast cancer that now has metastasis all over her bones and she’s got three kids. “Oh my gosh. Her three kids are going to be without a mom.” Those are the kind of things I think about. It’s like when I worked in the emergency room and we would have a terrible trauma. You’ve got this seventeen-year-old that was involved in a gang that was shot in the head laying there. You feel sorry for the person, but then you see the family come in. I think that is what I would always remember: the tears and emotion from the family. There’s nothing we can do about the poor soul that’s laying there with a bullet in his head, who’s lost his life, but then you see the family come in. I grieve for the family then at that point. Grieving is a process. It doesn’t come at the end. I think we grieve sometimes for people going through it. You feel their pain. You feel their emotion. Then at the end its almost like there’s a sense of peace for that person because they suffered, especially in oncology. But then you’re grieving for the family. It’s a very complex process that I think takes place over periods of time depending on the situation.

00:25:21
Zapatero:
My last question is would you say that the experiences you’ve had in nursing, and this generally happened to everybody I guess it relates to everybody, you guys take your work home with you?

00:25:40
Loyd:
Definitely. When I used to work in the emergency room sometimes it was really heavy. My husband’s great. He would have dinner on the table after I worked a fourteen hour shift and he would say, “Hey how was your day? And I would say, “I just can’t talk about it right now.” It’s amazing what a good night sleep does for you. Then I get up in the morning and have a cup of coffee and I’m ready to talk about the whole thing. I think it’s your body’s natural way of—you absorb so much. You just kind of have to shut it down until you’re ready to talk about it. And again, self-care, Christian—whether your thing is running, yoga, socializing with friends, or going to church. That’s all important. That’s what feeds your soul. If you’re not feeding your soul, it’s going to be a rough road.

00:26:28
Zapatero:
Thank you.

00:26:29
Loyd:
You’re welcome.

00:26:31
Rigelhaupt:
I want to go backward in time a little bit. Can you walk me through your first shift as a RN in 1985? Whatever you remember, even if it’s parking the car, or getting off the El [elevated train in Chicago] walking in. What was that first shift like?

00:26:47
Loyd:
It was at Northern Illinois Medical Center, which was in McHenry, Illinois and was just south of the Wisconsin border. It was on nights. I was working on an ortho-neuro unit and I was the only nurse. [27:00] Sometimes I got an aid, sometimes I didn’t. It was sixteen patients and it was a surgical unit. I had about three months of orientation. I learned how to put IVs in, how to be a very efficient nurse, and learned how to time manage. Six o’clock in the morning would come and I’d have all my antibiotics lined up ready to go from room to room, hanging Ancef, one gram and Ancef two grams—that’s the name of an antibiotic. I was getting them all set to go until the next shift would come in at seven o’clock in the morning. One thing I remember as you talk about that is, I’ll never forget: it’s about three o’clock in the morning, maybe my second week, and I walked into a room. It was a floor and nobody had monitors on their heart. I had a patient that was dead. He died in his sleep! I was so traumatized by that. Of course my supervisor said, “Mary, there’s nothing you could have done. His vitals were stable. I’m not even sure what the cause of death was.” But that stuck with me for a little while. That was my first experience and I remember that first day like yesterday. I think most nurses do.

00:28:10
Rigelhaupt:
What did you experience that was most different from what you were taught in nursing school about what it would be like?

00:28:20
Loyd:
I don’t think we were really told what it would be like. My clinical practice would be: we were assigned maybe one or two patients to do a complete bed-bath. I’m thinking of my psych patients, where we have to sit down and talk to psych patients, but no more than two people. We’d dabbled a little bit in giving medications, giving insulin, and starting IVs. It was more monumental milestone things in nursing school. More than, “You’re it! Go. Sixteen patients.” That really didn’t come until we were out of nursing school and we got a job and then you were learning the ropes on the job. Very different than nursing school.

00:29:03
Rigelhaupt:
Where did you go to nursing school?

00:29:04
Loyd:
I went to Kishwaukee College, which was a small community college about ten miles south of Northern Illinois University, in a town called Malta, Illinois.

00:29:20
Rigelhaupt:
What were some of the most important things you learned from preceptors during orientation as you were on the floor?

00:29:29
Loyd:
I can remember my first preceptor’s name was Anita. She taught me how to do IVs. That was a big thing on a surgical unit when you were getting people ready for surgery. She taught me time management and she taught me how to give good care in a very efficient way. Those were skills that you had to walk away with or you were going to fail, being the only nurse on nights, maybe with an aid, for sixteen patients.

00:30:00
Rigelhaupt:
All of these were pre-surgical patients?

00:30:05
Loyd:
Pre-surgical patients, going to surgery. Not all of them were going to surgery the same day, but I can remember probably about seven or eight antibiotics lined up across my med cart. Probably half of them were going to surgery on a daily basis. Then of course we would have some people that were in Stryker contraptions. People that had fractured spines from motorcycle accidents or falls that you had to care for. Our heavy patients had to be turned every two hours. I would have to call an aid from another floor to help me turn patients. Some of these people had various broken bones and were on these special types of beds. They had pieces of the beds that actually came down and were removed, to put a bedpan under, and then put the piece back under. It wasn’t just getting everybody ready for surgery it was the actual care of patients for eight hours on that unit. It was intense.

00:31:04
Rigelhaupt:
How long did you stay in this unit?

00:31:07
Loyd:
A year and a half. Like I told Christian, my goal was to get to the emergency room. I wanted to be a big city emergency room nurse. Back then you really had to have a lot of experience under your belt to work in the emergency room and I knew the next step was to work in an ICU somewhere. I was only at that hospital for a year and a half. And then I was finally in at Loyola in the cardiovascular intensive care unit. That happened in 1987.

00:31:36
Rigelhaupt:
What was your first shift like at Loyola’s cardiovascular ICU?

00:31:40
Loyd:
Oh my. Let’s see. I was on nights—twelve-hour shifts. I don’t remember my first patient on that unit, believe it or not. Part of that unit was trauma, part of it was transplant, and part of it was the cardiovascular ICU piece of it. I’m sure as a new nurse I probably had a lot of what we call “chronic patients.” They’re patients that were taking a lot longer to recover and on a lot of medication to help them get through. Taking care of those patients was okay. I’d prefer the ones that were freshly out of surgery that had a lot going on with them, where you’re titrating the drips up and down and it’s kind of touch-and-go. Those are my favorite kind of patients. I will tell you and I’m dating myself, I did take care of one of the very first patients that had a Jarvik Heart. Do you guys know what the Jarvik Heart is?

00:32:37
Rigelhaupt:
I know the name.

00:32:38
Loyd:
Dr. Jarvik. People were waiting for a heart transplant. What happens is the heart fails and the heart continues to fail. If they’re waiting for a transplant and if the transplant doesn’t come on time people, of course, would die from that. Dr. Jarvik invented a mechanical heart that actually went into the patient. [33:00] I’ll never forget this patient. He was a healthy guy and did wonderful after surgery. I remember him being on a bike in the room and I remember looking up on the monitor and of course there’s no heart rate, right? The leads transmit the electrical activity on to the monitor where you see a heartbeat. Because his heart was being pumped from this machine there was no heart rate. I just remember that feeling and it stays with me. When I walked in his room, how odd that this guy is alive with a machine in his chest. He did very well and finally ended up with a transplant, but that was one of the first patients I can remember that sticks with me.

00:33:37
Rigelhaupt:
Could you tell me about some of the things you learned and some of the clinical skills you were most proud of developing in the ICU?

00:33:36
Loyd:
Stamina and endurance. I say that because there is one patient that stands out that I can remember. It was somebody that was really ill who we were really trying so hard to prevent him from getting intubated. Intubation is when you’re not able to breathe on your own and they have to put a breathing tube down and it’s hooked to a machine. I was a relatively new nurse and I worked on this guy for twelve hours, from 7:00 p.m. to 7:00 a.m., suctioning him. We had a nasal trumpet that went in his nose and we just kept suctioning him, sitting him up, and stimulating him. We worked so hard to keep him from getting intubated. In fact, when the physicians came in at six o’clock in the morning they couldn’t believe that the guy hadn’t been intubated in the middle of the night. Sometimes you can push people to make it over the humps and he did. He did very well, but that took a lot of coaching and support to get them through. I think stamina and endurance are two big skills that you learn, and of course time management is going come into play no matter what you do. Doing your very best for the patients and advocating for them is also a big thing. That never goes away.

00:35:06
Rigelhaupt:
Was Loyola a teaching hospital?

00:35:09
Loyd:
Yes. Big teaching hospital, and a wonderful place to work. In fact, I’d probably still be there if we didn’t move.

00:35:21
Rigelhaupt:
Because there were physicians who were residents, probably physicians on faculty who stayed, did you feel that you had a working relationship, particularly the ICU, a very specialized unit, a closer working relationship between nurses and physicians?

00:35:35
Loyd:
Absolutely. I don’t remember so much medical students in that unit, but definitely the residents. Then there were fellows. There was fellows who did their cardiovascular fellowship program and we worked as a team. They knew if we called them in the middle of the night and said, “Listen, we got a problem. I think we better open up the operating room.” They would listen to us because if they didn’t they knew that we’d be doing CPR on whoever was going back to the operating room to meet him there. [36:00] So yes, the relationship and trust, you had to have it and it worked really well.

00:36:11
Rigelhaupt:
Was that unique to the cardiac ICU because it was a teaching hospital, residents are there 24/7. Did you see that you saw on other floors or other units?

00:36:22
Loyd:
I saw that when I worked in the emergency room at Loyola too. I don’t remember so much the residents. The residents would come down from the specialty units. If we had an ortho issue they would come down. It was mainly the attending and the nurses, and yes, we all worked together. That’s when really good things happen. When you have a great team of physicians and nurses who truly respect each other, there are amazing things that happen. I’d say I pretty much had this along the way. I can remember just a couple physicians that were more difficult to work with, but for the most part it has been fabulous.

00:37:04
Rigelhaupt:
When did you start in the ER at Loyola?

00:37:07
Loyd:
I started in the ER in 1991. I was in the cardiovascular ICU from ’87 to ’91 and not in the ER until 1991. It was a dynamic place to work. We were kind of the “Mecca,” as they call Loyola. We were involved with a lot of different training things. They would do mass disasters at Soldier Field. I can remember me and one of my colleagues, Keith, were called into the room where you take command and you’re triaging people out to all the different medic units that were out there in the field. We had a decontamination room and we would do decontamination drills where they were coming in from triage and into the “decon room.” Then we would have critics in the room with us while we we’re all gowned up. I can remember going to teach the monitor with my glove and the attendant going, “Wait! Wait! You’re contaminated on your gloves.” There was lots of excellent training. Unique patients came in through that emergency room, such as transplants. There were a lot of dynamic things that were going on at that time. “Of course they get sick and where do they come? The emergency room.” We would say that.

00:38:27
Rigelhaupt:
What were some of the best parts about working in the emergency room?

00:38:32
Loyd:
Working as a team. It’s not so much the saving life thing, but it’s just being in those unique situations and being a part of it. Even when we did have an adverse outcome for a patient, just doing what you had to do—maybe waiting for the donor team to come in. We had hospitals that were coming up. [39:00] I can remember when Providence Hospital was coming up and their nurses came to Loyola to train. We were taking those nurses under our wings and training them. They had BSN students from Loyola School of Nursing that came through. The whole education piece of it was awesome to be involved in and that nurses were really well respected. We were pulled into different groups where we learned how to be preceptors. We learned how to be good trauma nurses. We had lots of educators around us. We were very well supported. It was just a fabulous place to learn and work and to educate others.

00:39:40
Rigelhaupt:
Could you explain what trauma training looked like for example?

00:39:45
Loyd:
Sure. I remember our educators for six weeks at a time took us through different trauma training. There was the ability to become a trauma nurse specialist in the state of Illinois. That was additional training. And then of course you could get your pediatric trauma training. I had so many certifications behind my name. When they called the trauma there were of course the attending physicians, there were about three educators that came up, we had two nurses on each side of the bed and we knew what our roles were. Everything we learned—everything in trauma is very step-by-step. It’s easy to grab on to. Then we were so well-supported when those traumas came in. There was lots of conversation and lots of collaboration. The training was impressive and that wasn’t going to school. That was on the job training where we were taken off of the units and we were going to classroom learning this stuff. And then we would come out and we were the trauma nurses. I think training still happens, but I’m not so sure it happens to the degree that it did back then. I’ve seen a decline, if you were to talk about how it changes. Budgets are tighter and I think the longevity of training is different. I think that’s why a lot of people go to Washington Hospital Center for those internships. They’re giving their nurses year-long internships whether you’re a new nurse or you’re an older nurse. If you want to bridge into the ICU or the operating room those opportunities for learning are there.

00:41:31
Rigelhaupt:
Did you stay [in the ER] through 2003?

00:41:34
Loyd:
Yes.

00:41:37
Rigelhaupt:
That’s almost a dozen years in the ER. Were there other things that you did, besides picking up certifications that were relatively consistent work, as much as being in the ER could be consistent work?

00:42:00
Loyd:
You just keep up with your certifications. I had my CCRN and lots of pediatric stuff. Then of course you’re ACLS. You had your PALS, your Pediatric Advance Life Support unit. Your neonatal advanced life support, your adult cardiac life support—lots of different things to keep up with. Being that it was an academic institution most of my colleagues were going on for their BSN, if they already didn’t have it, or their master’s. At that time, the doctorate programs for nurses were starting to come up and I remember some of those nurses. You were able to teach at the master’s level in the universities. They were teaching during the school year and then they were going on taking their doctorate classes a little bit in the school year. Then they would crank it up and do their clinical part in the summer time. I remember them all coming through. But I had kids. I had a husband that traveled. I think school has always been inside of me. But again, being a caregiver: there’s grandmas to take care of, there are dads to take care of, and kids to take care of. Now it’s my turn. Little late, but it’s okay.

00:43:12
Rigelhaupt:
What were some of the clinical skills that you were proud of having developed in trauma versus the cardiac ICU?

00:43:23
Loyd:
Assessment skills. Your assessment has to be so sharp, especially when you’re in triage, because you’re determining whether they’re going to be able to sit in the waiting room for six hours, or three hours, or if they need to come back right now. Like I said, some people are really poor historians and they don’t tell you what’s going on with them—like we’re talking. They have different complaints that are not related, but that’s what they’re telling you. You’re perception as far as the color of their skin—is it blue or pink? How they’re acting? Are they sweaty? Sometimes its pure intuition—“Something doesn’t feel right.” I can’t even tell you how many of those, “Something doesn’t feel right” that I’ve brought back and it ended up being a heart attack, a very subtle heart attack. Complaints such as, “I just don’t feel good.” I’m tired.” “I’m nauseous.” I’d say perception, intuition, good assessment skills, IV skills, time-management, communication—they are huge. Communication is what saves patients’ lives and having good collaboration between the physician and the nurses and the team is huge. Not everyone is a good communicator. People skills and dealing with people—people are going through really hard times no matter where they are. To be able to comfort, console, and say the right things. [45:00] It’s very dynamic.

00:45:03
Rigelhaupt:
Observation, it sounds like it’s very important in triage. What were some of the techniques, besides intuition, your observation, in terms of asking questions you developed to get the information you needed?

00:45:22
Loyd:
Sure. So someone comes in, “I’m having abdominal pain.” There are a series of questions: “Tell me about the acuity? Is it sharp? Is it dull? Where is it? Does it hurt if you push in or if we push in your belly? When did it start? Any signs and symptoms associated with diarrhea, nausea, or vomiting?” Based on that if its right upper quadrant pain radiates to my shoulder, possibly gall bladder. Trauma. “I fell six feet off a ladder and now my left upper quadrant hurts.” “I’m feeling kind of dizzy” You think its spleen, and possibly they’re bleeding internally. The dizziness—the fall onto their left side. History is huge. When did this start? How did it start? Is there trauma involved? You’re pulling so many different pieces of the puzzle together to come up with a nursing diagnosis to send them in the direction you think they need to be sent in. Or is it simple, is it a simple fracture? He fell like this and there’s no obvious deformity, but there could possibly be a small fracture. “Okay. You’re okay to go to x-ray for now. We don’t need to bring you back in right now.” Lots of questions about how things occurred are very important. Just like trauma, how fast was the vehicle going? How far is the indentation into the side of the car? Did you have a seatbelt on? Were there airbags? There’s a certain set of criteria with trauma and if they meet any piece of those criteria, they’re going to be a trauma. If not so much, then maybe we don’t have to go to the trauma room. Again, everything is based on criteria. Same thing with the paramedics: they do everything based on those kinds of questions as well.

00:47:19
Rigelhaupt:
Thinking about triage in particular, one of the things that certainly probably increased over the time of your career is computerization and technology between you and the patient. Did that have an effect on taking the history, assessment, and doing the medical work you needed to do?

00:47:45
Loyd:
Sure. When I left Loyola we were starting to get computerized, but for the most part it was paper. Then I taught in Stafford County until 2007. [48:00] When I was still in the operating room it was all computerized, but the patient was asleep and that wasn’t an issue. In radiation oncology now, the way the rooms are set up are the computer is over here, the patient’s chair is over here, the table is over here, and the nurse has got her face to the computer. I’m constantly typing like this and I’m always apologizing, “I’m really sorry! A nurse didn’t design this room because we wouldn’t have the computer here and not looking at you.” That’s the first thing, so they know that I’m not being rude. I will say, “That I wish to have my eyes on you, but I need to do my work on the computer.” As far as skills, yes, you’ve got to have those skills coming in. Then it’s just important to be listening because you’re multi-tasking. You’re listening to what they’re saying, you’re watching their facial expressions, and at the same time you’re typing all that information in. It’s a little bit different than just writing things on a piece of paper. The other thing is these systems that are in place now on the computer kind of drive the nurse to sometimes answer questions. When we were on paper, you knew what you had to ask and you were able to write it all down. It’s a little bit different that way, where I feel we’re expected to answer what’s in these standardized forms. Some of it’s okay and some of it’s not okay, but you make it work. Having that eye contact is important and if you don’t have a little computer desk that moves so that you can face the patient, you need to make sure you’re telling them, “Hey, I wish I could be looking at you while we’re doing this interview, but I’ve got to also be on the computer.” I’ll tell you, when I was doing education and training up north from 2008 to 2012: boy, did I learn a lot when I worked with those gamers. You learn lots of different systems, not just Excel. I can’t even think of all the different systems that these guys would do where they are developing these scenarios. There are lines that connect squares and circles. It’s a very creative flow diagram. I actually had this conversation with my husband just a couple days ago. You look back on your experiences and the things you’ve done and it’s such a blessing that I had all that background because of the way things are now and how fast you have to be. You have to be a fast typist and you have to be able to multi-task. Somehow it all comes together.

00:50:40
Rigelhaupt:
So can you tell me about starting in medical education at Washington Hospital Center, and then Georgetown?

00:50:50
Loyd:
Yes. So I told Christian, when I was in the operating room I learned the ropes and did what I needed to do. [51:00] About eight months into it the educator who hired me said, “You know, Mary, one of the real reasons I hired you was because of your education background from Stafford County. And I really need some help training the operating room staff with code blue stuff.” I had all this background from the emergency room, then teaching the nurse-aid students code blue and child care—students and teachers in high school—BLS skills and first aid skills. I was like, “Oh sure. This is great!” I taught different pieces of it. We did some mock drills, but also taught them how to use a defibrillator in different situations. Then I was quickly recruited into the Simulation and Training Center, which was grassroots at that time. It was probably only in place for about a year there. I was happy to come, because I think that’s where my passion really is. OR was great, but I was like, “Wow! This is awesome. An opportunity to work with all these attending physicians to develop this education and training.” There was almost this “sexiness” to it. It wasn’t just being a nurse, but it’s like, “Wow! All my skills can come into play.” So, I was telling you, I worked with a team and we were super successful getting defibrillation times down there. I worked with awesome OB/GYN physicians developing different OB/GYN skills. What was unique about that is having an OR background, an emergency room background, and we developed postpartum hemorrhage scenarios. We did skill-based scenarios where they learned how to do different lathroscopic skills. I knew where to get equipment from and the representatives to talk to: “Hey! I need this equipment. Can you help us out?” It grew and it grew so big. We had a general surgery team doing skill-based things and some scenario based, as well as some emergency room. A lot of it was based on evidence-based medicine. Then learning about those skills, critically thinking about them, and then taking them back to work into the workplace. Nursing got involved and we started doing some things with nursing. You hear a lot about how nurses are being trained in simulation before they come out of school so that their critical thinking skills are enhanced. Remember how I told you guys, when I came out we didn’t that kind of stuff. You’ve got your skills and you took care of a couple patients and “Boom!” you were out learning to think critically on your own. It’s very different now. Now simulations are involved to where they can create these different scenarios and get these nurses to think that way. Patients’ acuity are higher and these nurses have got to come out and they’ve got to be prepared and ready to go. Simulation is exciting and they’re doing awesome things with simulation and medical education, whether you’re at the doctor level or the nurse level. When I get my master’s degree that’s probably what I’ll go back to. [54:00] That’s pretty much the extent of the training that happened there. Then when I went to Georgetown where it was at the medical student level, which is a little bit different. We had the third year medical students rotate through each rotation, whether it is surgery, medicine, OB/GYN, every six weeks. There are didactic programs that we prepared for them: some simulation and then some OSCE stuff, which is a very structured exam and the attending physicians observe what they do. Still, it was very simulation based and, you know, it was fun. Like I said, it’s a very sexy lifestyle. It’s exciting, but it takes over your life because people see what you’re doing. It’s kind of like the attending physicians were coming out the woodwork. It was like the flu. Everyone wanted their hands in this simulated medical education and it was overwhelming. There’s a budget for so many of these staff members and before you know it you’re working sixty, seventy hours a week. You can’t go to school and commute on sixty, seventy hours a week. But it was great and I learned a lot.

00:55:12
Rigelhaupt:
In medical simulation, does it involve a lot of equipment and the use of technology?

00:55:17
Loyd:
It depends on how complicated you wanted to get. When we did the lathroscopic skills for the OB/GYNs, yes. We had number one: a model that came from, let’s say “Limbs and Things Company.” Then we had to get the Stryker towers, which is the tower of all this laparoscopic equipment. You need a light source with of course the cords that go to the instruments. Then if they’re using any kind of special scissors or suture devices, then we have to get those. Where are we going to get all that stuff on a budget? Instrument trays: you want to make it as very realistic as you can so with that comes a mock operating room. You guys can imagine the number of things we had. We didn’t necessarily need a whole body to do it, but we needed that part we were working on. What’s neat is that these companies have these models of all these different things. That’s a pricey example. They have them for demonstrating postpartum hemorrhage and handling it, which is after a lady has a baby sometimes they have complications to where they can actually bleed out and die. They have these little models that go over the belly that bleeds. Physicians put them in their suitcases and take them with them to other countries to do this kind of training. When we did it in the medical simulation lab we had a full body, a high fidelity model, which means that it can do all this nice computer stuff, but we didn’t use her that way. [57:00] We used her that way to show blood pressure and stuff on the monitor, but we had our own big blood bags inside of her and whoever was the nurse would kind of push on the clamp and all this blood would start coming out and we could totally control the flow based on how many medications they were given. So to answer your question, Jess, it could be very complex, very high tech, or very low fidelity. Still, if you can get the same outcomes—it just depended on what are goals were and what objectives we were trying to meet.

00:57:31
Rigelhaupt:
And part of my question was to ask about how technology can both be in between the nurse and patient, but also really enhance the medical care and practice of the nurses and physicians leading up to patient care?

00:57:49
Loyd:
Yeah, do you mean—

00:57:52
Rigelhaupt:
The technology available in training can be wonderful, but can also in practice be something in between.

00:58:00
Loyd:
Absolutely! The goal is to carry those skills into practice and sometimes we did a scenario for the emergency medicine residents. When they’re done with their residency they need to have so many things that they’ve done before they actually move on to be an attending physician. One of the ones was “cracking a chest” in a cardiac arrest. We actually cracked a chest through the sternum and spread the ribs, and you put your hand on the heart and do cardiac massage on the heart. Thank goodness that doesn’t happen in real life very often, right? We actually developed a model. I should say the technicians at, it was called SiTEL, which was a group within the Washington Hospital Center that put together this model and it was great. They learned from it. We had the thoracic surgeon involved and the emergency medicine and trauma people. And again a very simple model, but they learned a lot from it and they were able to say that they did it even though it was simulated. They’ve had that experience. So if it should come up when they’re in rural USA they’ll be able to handle and do what they need to do.

00:59:15
Rigelhaupt:
What was your first experience with Mary Washington, or at Stafford Hospital, either of them?

00:59:22
Loyd:
Stafford Hospital was radiation oncology in June. I started the training at Mary Washington Hospital because that’s where I did my orientation and then eventually moved on to Stafford. That’s the experience. Then before that at Mary Washington a couple years ago I was in Health and Wellness.

00:59:46
Rigelhaupt: Can you tell me about your first day in Health and Wellness, since that came first?

00:59:49
Loyd:
Sure. Health and Wellness was a great place to work. It wasn’t caring for patients; it was caring for associates, whether it be occupational health assessments; or immunizations for hepatitis B or measles, mumps, and rubella. [01:00:00] We did a little bit of workmen’s comp, where still you’re assessing not the patient, but the employee, and in that case the employee is the patient. It was a neat place. I left Mary Washington because I was invited to come back up to Georgetown to take this position, and of course the sexiness of that role pulled me back up there. Which was great, but then again I wasn’t fulfilling my goals of school. After a year there, I’m back here. [laughing]

01:00:39
Rigelhaupt:
Radiation oncology is different, slower probably, than an urban emergency room, what are some of the upsides of nursing in that environment?

01:00:52
Loyd:
I absolutely love it. It’s a great fit because they’re people in great need. I mean everyone is in need to some degree, but I really like taking care of that patient population. There’s a lot of fear and a lot of anxiety that goes along with cancer and treatment. I’m at my best when I’m around people that have fear and anxiety. That actually calms me down. I feel like I’m really able to give the way that I feel. It kind of feeds me to. It’s great. There’s definitely the emergency medicine piece, as we were talking. That’s in there too: having those quick assessment skills. We’ve sent quite a few people to the emergency room that had come in for their treatments and then they’re not doing so good. Those skills are always there. It’s not that I’ve cared less in the other areas I’ve worked in, but it’s just different. There is just a different element of something going on where these are people coming in every day for their radiation treatments, and that in itself is really hard. They’re giving up their work time and their family time. They’re stressed about, “Is this going to make my cancer go away? Don’t tell me I’m going to die. I don’t want to hear that.” It just feels really good to be there for those people every day.

01:02:28
Rigelhaupt:
When you first started in Health and Wellness, did you hear about Mary Washington’s values and its mission? What do you remember hearing about it?

01:02:39
Loyd:
I remember hearing that every day that you come to work you want to do the very best for your patients. They really value their employees. But really it’s the relationship that you have with your patients, that you give one hundred percent every day. It’s very service oriented, very caring. [01:03:00] I really like that about Mary Washington. Like I was telling Christian, I think most hospitals come with a set of their mission, vision, and their values. Being a nurse, again, it’s from within. It kind of goes hand and hand, the nurses’ values with the hospital’s mission and vision. It just happens. It’s a natural thing. I live it every day not because I have to, it’s because that’s who I am and that’s what I want to do.

01:03:34
Rigelhaupt:
It sounds like in terms of your nursing practice you saw a lot of similarities at different institutions, but very different units and specializations. What are some of the things that you see are unique about Mary Washington?

01:03:53
Loyd:
I think that it’s community based. I’ve worked in very few community-based institutions and I really like the sense of smallness and closeness. I’m getting to know the patients in the community. I think the people that I work for are very caring. They want to make sure that we have the resources that we need to do the very best for our patients. The physician that I work with is amazing as far as collaboration goes. If I see something and bring it to his attention—it’s kind of that relationship I was talking about in the ICU where we work super closely together and that communication is so important to make sure the right things happen for the patient. That is there at Stafford Hospital. We do some great things for those patients. I’m very happy. When you leave a wonderful institution like Georgetown, it’s taking a leap of faith and I felt that, that faith was there when I interviewed with Stafford Hospital and it definitely worked out the way I was hoping it would work out.

1:05:09
Rigelhaupt:
Were you surprised to see the kind of culture around collaboration and not only a community hospital, but a very new community hospital?

01:05:21
Loyd:
I was and I’ll tell you why: because my first and only experience in a community hospital was when I got out of nursing school. As I told you, it was different back then. You would call the physician in the middle of the night and you’re waking them up and there’s attitude. Right there there’s that stigma, “Ugh, community hospital.” Then you go to the medical centers and there’s this awesome collaboration and everyone’s working together. I think experience follows you. There was definitely a sense of that coming to Stafford Hospital, but it is absolutely not true, and now we’re how many year past that, twenty-eight years? [01:06:00] Right? Twenty-eight, twenty-nine years since I got out of school and things are very different.

01:06:12
Rigelhaupt:
Do you think, because you also did some orientation at Mary Washington Hospital, that Stafford was able to successfully build on the culture that had been developed at Mary Washington Hospital?

01:06:24
Loyd:
Definitely. Where I worked, Health and Wellness was a little bit different because we had a doctor that was of course over us, but we called her only as needed. It was management, then the nurses below that. We weren’t working with physicians, but as far as the nurses working together it was great. Yes, the collaboration was definitely there even though it wasn’t physicians. The nurses were great.

01:06:54
Rigelhaupt:
You said you trained at Mary Washington Hospital for a few months before starting at Stafford, what were some of the best practices you saw at Mary Washington Hospital in terms of oncology treatment?

01:07:08
Loyd:
Evidence-based practice. The caring nature that those nurses have for their patients. The physics teams. I’ve never worked with teams other than respiratory therapists or physicians. The physics teams. I am working with the radiation oncologists and those dosimetrists to come up with the best treatment plan for the patient. You could kind of see how there are these pockets of collaboration that are happening around the whole plan for the patient. It was a very dynamic approach, a very caring approach, and very efficient.

01:07:53
Rigelhaupt:
When you were starting, did you expect to see as much evidence-based practice at a community hospital? Certainly teaching hospitals and medical centers historically have implemented evidence- based practices, probably faster, the evidence often was developed there?

01:08:13
Loyd:
I don’t think I really knew what to expect walking into that. Being so immersed in evidence-based culture at the medical center, I’m sure I had apprehensions, but you know what? I’m not even sure I knew what those apprehensions were, other than, “Okay, I’m going to a community hospital. Wow! It’s been almost 30 years since I’ve been in a community hospital.” I’m very pleased. I don’t think I expected the degree of the way things are. I’m very happy with what I’ve walked in to. [01:09:00] I’ll tell you something else on that note, too. We have a patient who has a tumor in his chest currently and is exhibiting some symptoms. We’ve had to alter treatment a little bit based on the symptoms, and what’s great about the physician I work with is, you know again at first he presented like it may have been a psychological issue. And then it’s like, “No, this is not physiological. There are some other things going on.” Then there’s conversation around that. This physician will go and do some research to say, “You know, yes. This is the best way to treat this patient.” There’s that constant referral back to “what is the best way to treat?” I really appreciate that because evidence-based medicine eventually leads to patient safety, and it’s a good thing. It makes you feel good. It makes you feel safe where you’re working at. It makes you feel like the patient is getting the very best treatment that he possibly can—it’s a lot of confidence there.

01:10:08
Rigelhaupt:
Part of oncology treatment, even part of emergency room treatment, involves longer-term care. As much as these are acute things at a particular moment when you’ve interacted with patients. Thinking about longer term care, what are some of the ways you’ve seen Mary Washington develop oncology practices that work with and support this specific radiation treatments someone might be coming and getting that you’re working with?

01:10:45
Loyd:
Do you mean for instance, there’s a certain set of symptoms or something that comes up? So that’s a good question. For instance, this is a great example. A quite elderly guy is going through a really tough cancer treatment. We put him on break because he was getting chemo and radiation. He had some shortness of breath. Some symptoms that we thought, “Okay, the blood count is good. Maybe he needs a break.” We got a call from his wife and he’s not doing well. Things are actually getting worse. She’s been asking for help and reaching out. We’re putting support systems in place, but I said, “All right, this is what I’m going to do. We need to get you tapped into your primary care physician.” I met with the physician I worked with. We collaborated on this, called this attending physician, and the nurse gave her the whole history of what’s going on so this primary care physician doesn’t have to start all over again. When this gentleman meets with him, he knows exactly what we’re looking to do. [01:12:00] The wife is also elderly, she feels she can’t do this on her own, and we need to get a home health nurse involved. We need better control of his pain. We need lots of different things, which were identified, to be put in place. It’s that caring. This is all we can do here, but we need to tap you into the resources. I reached out to the cancer navigators to say, “The wife is having an awful lot of stress. She’s really having a hard time dealing with this. Please reach out to her and give her a call.” We can only do so much in this department—it’s a very specialized department. When we see the need that there’s something more—look, in a short amount of time, less than a week, all the resources we’re pushing towards her. Mary Washington is very generous with resources. I reach out to the cancer navigators so much to say, “I need your help with this. I’m worried about this. Or, the patient has verbalized this.” They’re great about tapping our community into wonderful resources. I think that’s probably one of the best examples to give you guys as far as the recognition. It’s listening. It’s really, really listening to the patients in our community and making sure they’re tapped in to the right things. It’s huge. Those resources are out there, just a lot of people don’t know how to tap into those resources, especially the elderly population. They need that guidance and that support. It feels good to be able to do that. Mary Washington is a great community between Stafford Hospital and Mary Washington Hospital as far as having the resources to help.

01:13:57
Rigelhaupt:
I can’t help but wonder and I’m asking a leading question, which I shouldn’t do. But correct me if I’m wrong. Part of what you said is that there’s continuity in your nursing career. I imagine that the radiation treatments available when you started in 1985 were nothing like they are now. And yet as high tech and more specialized, more evidence-based, the practices have become, the ability to even utilize them still involves listening, still involves patient care, and they still have to work together?

01:14:38
Loyd:
Absolutely. And the technology: we just had a staff meeting yesterday and they were talking about history and the old radiation machines. There were these blocks or leaves that would move to direct the radiation, and how now it’s these high tech machines. They’re wonderful, it kind of moves and the different doses of radiation—I don’t know as much about that piece of it. I leave that up to the doctor. [01:15:00] Hearing them talk about the differences in technology, it’s really impressive what’s happening in just probably the last twenty years I’d say. Actually, thirty years. I think my manager has been out of school as long as I have and she was talking about the machine when she came out of school.

01:15:37
Rigelhaupt:
We covered a lot of things. Actually one other question. I know you’ve been back in oncology for a short period of time, but in terms of the cancer navigators tapping people into networks, is that part of the way the organization tries to contribute to primary care? Even to keep people as healthy as possible as they’re going through cancer treatments?

01:16:04
Loyd:
Absolutely! The programs, for instance: if we have a new patient that’s coming into the system freshly diagnosed with cancer, whether they’ve had surgery or chemo or not, when they come to our department we give them a whole education packet. The education packet doesn’t just include information about radiation oncology and how to take care of your skin while you’re going through oncology. It involves integrative medicine. It involves yoga at Stafford Hospital. It involves the noon-time breast cancer support group. It involves the coping support group and the prostate cancer support group for men. There are the resources: the whole mind, body, soul thing which is so important. In nursing theory it’s not just taking care of the physical being or the psychological being: it’s taking care of the person as a whole. You do those things by incorporating support and integrative medicine. The resources are impressive. Even guys, the integrative medicine has the yogis and I’m like, “This isn’t all just yoga. There’s acupuncture. There’s massage. It’s things you might be interested in.” I know there is a stereotype with this kind of stuff in men, but I’m telling you, “Try it out.” You know, so I’ve had men come back and say, “Mary, that was really awesome.” It’s the whole mind, body, soul thing, and I think the resources for the communities are awesome.

01:17:32
Rigelhaupt:
What you describe as integrative medicine, was that part of nursing education while you were in school or anything that hinted at it?

01:17:39
Loyd:
Absolutely not! It was all clinical and going through these rotations. Integrative medicine, I think, is something I’ve learned on my own. It’s me! I crave that kind of stuff. I used to be a runner and now I really appreciate what yoga has to offer. [01:18:00] When I talk to my patients about how these different integrative medicine and yoga and self-help, you know it’s coming from a place. Or when they’re having a lot of stress, when they have to lay down on the table and put their hands above their head, and they’re so afraid of that machine and the first radiation treatment. Obviously we can’t be in there with them, but to say, “Close your eyes and go to that place where you can just relax.” The whole vision, therapy type thing, I think it helps them. It helps them a lot.

01:18:32
Rigelhaupt:
In the simulation work you’ve done and the education work you’ve done, probably not as directly involved, because that was specialized. But did you get a sense that in nursing education now, some of the integrative medicine you’ve described has made it into the curriculum?

01:18:48
Loyd:
No. Not that I’ve seen. It’s all critical thinking skills related to sepsis, or cardiac arrest, or respiratory distress. No integrative medicine. I think to be fair though, that’s something that you learn in nursing theory. I told you guys I got my associates degree thirty years ago. I didn’t learn theory and that was always a big thing when we graduated in the ‘80s: “Well, we’re the hard working nurses. These theory nurses can’t come out and practice like we can.” But now in my first semester here, the last class I had involved nursing theory. I learned so much about nursing theory, and you know what it’s about? Mind, body, spirit. I think they’re getting that education, and the didactic piece of it. I think that’s part of the value that’s communicated with them. This is just a unique place where I work, where there are physical materials and programs to tap people in to. I’m not so sure that is in the floors and stuff like that to give them those resources. But no, not thirty years ago. We didn’t learn that.

01:20:01
Rigelhaupt:
In your short time at Mary Washington, a couple years in Health and Wellness and now almost half a year in radiation oncology, have you heard the organization talk about community benefit? In the sense that for most of the history in the twentieth century acute care hospitals did not particularly focus on primary care or public health, and yet this organization does try to make sure that it provides health care to all people in the community. Is it talked about internally? And what have you learned?

01:20:40
Loyd:
There is an internal and external piece to this. As far as internally goes, I know that—let’s say people that don’t have insurance and they don’t have money for their prescriptions. There are funds where we’ll let the cancer navigator know about, say, a special mouthwash to help with people that are getting head and neck treatments, [01:21:00] Say it costs a hundred dollars, they’ll give them maybe $65, $70 to go to the pharmacy to get the medicine. I hear about fundraising. There is a fundraiser coming up this Saturday to raise money for the cancer center and to add more money to this fund to help patients. That money is going to the fund. I’m trying to think what else, if there’s anything else related in the organization? There was something else that just happened, but I can’t remember what it was. The one coming up is related to cancer. But external, think about a patient who has a type of pelvic cancer. She went to another hospital to start her radiation therapy. She went through the planning where they figure out where they are going to direct the beams. They do little tattoos that are about the size of a pinhead so they know where they are going to line up the beams. She got that far and they said, “$500 please.” She didn’t have a job, didn’t have insurance, and she couldn’t pay. She went back to her physician who said, “You know, try Mary Washington.” Of course she was welcomed in. I’m not sure about the financial situation and how she got help. She’s most likely on a plan. We ask them during the consult, “Why are you here?” “I’m here for a consult for radiation therapy for my pelvis. I was going have to pay $500 up front at this other hospital.” I’m hearing from the patients about how they can come to Mary Washington and get treatment and maybe other hospitals are not taking them because they don’t have the funds. Really guys it’s been what, almost six months that I’ve been here? There are some pretty awesome stories about how Mary Washington helps people in the community.

01:23:11
Rigelhaupt:
What would you most want the public to know about being a nurse that might not be common knowledge?

01:23:19
Loyd:
We really care about people. We really want the best for them. We really listen to what they have to say. But not just listen, we really listen. It’s not just dealing with what the issue is now, but kind of seeing down the road what other resources might be needed to help them through whatever situation it is. We are the most honest, trustworthy, and caring group of people I think that are out there as far as looking at professions. [01:24:00] We hear people’s whole life story and it stays right here. It doesn’t come out of our mouths. We don’t share that with people. We take their stories home and we think about it. We think how we can do better next time. We think about how this is going to help me take care of the next patient. It doesn’t go away. It’s who we are and I think we’re all glad to do it. We’re happy to be here for people. Being a nurse is amazing! I can’t imagine myself being anything else. As I go through it a lot of nurses get burnt out. I think I’m getting more energized from it and the more I go to school the more energized I get from it, but I think it also is moving around. The beauty of nursing is that you can move around and you can get these awesome experiences. If you need a break from one area like the emergency room, there’s the operating room, and there’s education and training. Nursing is lifelong learning. You’re constantly learning, whether I’m in the ER, getting certifications, or I’m fifty-one years old going back to school for my bachelor’s degree—it never stops! You never stop learning. That’s a good thing for the public to know too: we’re not just nurses, but we’re always learning. We’re always bettering ourselves so that we can do well for the public.

01:25:26
Rigelhaupt:
What would you most want the public to know about Mary Washington Healthcare that might not be common knowledge?

01:25:31
Loyd:
They are really here for the community. There are a lot of really talented physicians and nurses who really care. I’ll tell you, patients that have come back to me—because that’s the only knowledge that I really have—who had been admitted and say, “Oh my gosh. I was on 3-West, and it was the best care I’ve ever had. Those nurses really cared about me.” Or, “I had the best care in the emergency room. They did this to me. I’m so glad that they admitted me to the hospital. They were so professional.” The people from the community that come back and tell us they’re really pleased with the care. It’s a group of really caring people. They really want the best for this community.

01:26:15
Rigelhaupt:
My last question is actually two questions: Is there anything that I should have asked that I didn’t, and is there anything that you would like to add?

01:26:24
Loyd:
No, I think we pretty much covered it all. You know when I’ll think about it is when I’m driving home—that’s when it comes. I think you guys did a good job of asking a broad range of questions.

01:26:44
Rigelhaupt:
Thank you.

01:26:45
Loyd:
You’re very welcome.

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