Mary Paradis

Mary Paradis began working as a registered nurse (RN) at Mary Washington Hospital in 1982. She received a bachelor’s of science in nursing (BSN) from George Mason University. She began working in a postsurgical unit and then transitioned to working in the nursery at Mary Washington Hospital. Paradis helped to open the neonatal intensive care unit (NICU) at Mary Washington Hospital and continues to work as a nurse in the NICU.

Mary Paradis was interviewed by Jess Rigelhaupt and Shauna Sanford on November 14, 2014.

Discursive Table of Contents

00:00:00-00:15:00
First day working at Mary Washington Hospital as new RN in 1982—Working in the NICU—Difficult parts of the job as a nurse in the NICU—Media representations of nurses and physicians—Working relationship between nurses and physicians—Decision to become a nurse

00:15:00-00:30:00
Proud of helping with improvements in the NICU—Changes in staffing—Finances of health care—Technology—Gender stereotypes in nursing—Working at Mary Washington in 1982—Decision to begin working in the nursery—Working in the NICU at Fairfax Hospital

00:30:00-00:45:00
Working in the NICU at Fairfax Hospital—Returning to Mary Washington Hospital in 1993 to work in the NICU—Writing policies for the NICU—Planning for the move from the old hospital to the new hospital—Working at the new hospital on the day it opened

00:45:00-01:00:00
Mission and values in 1982—Mission and values in Mary Washington Hospital’s transition into a regional medical center—Evidence-based medicine—Working with physicians in the NICU

01:00:00-01:15:00
Stafford Hospital—Education and involvement with professional organizations—Shared governance—Primary care and public health—Community benefit—Achieving Magnet status for nursing—Nursing is a rewarding career

Transcript

00:00:06
Rigelhaupt:
It is November 14, 2014. We’re in Fredericksburg, Virginia at Mary Washington Hospital doing an oral history interview with Susan Paradis. The first voice you will hear is an interviewer is Shauna Sanford and I’ll be the second interviewer, my name is Jess Rigelhaupt. So, you can start.

00:00:26
Sanford:
Okay. Can you describe your first day working at Mary Washington Hospital?

00:00:30
Paradis:
I was assigned to a post-surgical unit. Being a new RN I guess I was very scared, nervous, and anxious because at that time you were expected to be like a charge nurse within about two weeks. For a unit it was pretty quick. You had to learn on your feet very quickly because a lot of times they only had, I want to say, four RNs maybe on the unit and then the rest were nursing assistants. The nursing assistants did a lot of the hands-on care and RNs did the medicine. RNs were the nurse passing meds around and doing orders and things like that. It’s very different from nowadays, yes.

00:01:24
Sanford:
Was that your first job when you graduated nursing school? Or did you work at a hospital before that?

00:01:29
Paradis:
I worked at several hospitals before I graduated. I worked at Potomac Hospital in central supply area. I learned a lot about processing sterile supplies and then I also worked in a nursing home as a nursing assistant for a summer. I am trying to think if I worked anywhere else. And then I worked at Pizza Hut—nothing about nursing at all at that point.

00:02:01
Sanford:
Why did you want to work at Mary Washington Hospital?

00:02:04
Paradis:
It was close to home and that was probably the main reason. It was close to home. It was kind of a community hospital. I liked the thought of working in the community I lived in.

00:02:20
Sanford:
How long have you been a nurse?

00:02:21
Paradis:
Thirty-two years now. A long time.

00:02:26
Sanford:
And can you walk me through a typical day in your job?

00:02:30
Paradis:
For today? A typical day in the NICU—there are not a lot of typical days. There are different roles that you can play. Take for example, yesterday I was the resuscitation nurse. My role for that is I get called to deliveries, C-sections and vaginal deliveries, and we resuscitate the infants that are born. Take for example yesterday, I attended five C-sections and took care of five different babies. [03:00] Other days you might be assigned to three step down babies where you are just feeding and changing them and things like that. Then other days you can be assigned to a baby on a ventilator doing very critical care. Everyday is different which is nice. I really enjoy it.

00:03:22
Sanford:
What is your favorite part of your job?

00:03:26
Paradis:
I guess working with the families and seeing them get the joy out of their newborn baby, whether premature or not.

00:03:37
Sanford:
How much interaction do you have with families?

00:03:41
Paradis:
Quite a bit. They are there. We learn a lot about their family life and how this is impacting them and how they, you know, respond to their child. We do a lot of talking and a lot of teaching, teaching them how to take care of her premature baby because it is a big difference between a normal new born versus a premature baby.

00:04:11
Sanford:
What was the hardest part of your job?

00:04:16
Paradis:
The hardest part would be the loss of a baby. You know parents have dreams when they’re pregnant and expecting a child. When that all gets crashed, to see them and the sorrow that happens in the loss—I get teary right now talking about it because there have been many families that I’ve helped through that process. The nice thing is that we are there to help them through the process, but at the same time I cry right along with them when they have the loss. That would be the hardest.

00:04:54
Sanford:
How do you handle your emotions when you lose a patient?

00:04:57
Paradis:
I guess just put all your emotions—I wouldn’t say all of them, but most of your emotions—in the back and focus on the family. What their needs are, but I also feel like showing some emotion makes them realize you care and you empathize with them. You just have to take control of your emotions or you’re no help to them. I have seen nurses sometimes—if we’ve had a baby for a long time and that nurse is taking care of the baby for a long time loses that patient. I have stepped in as charge nurse to help them through the process. I can’t help that family. We all work as a team and whoever can do the job at the time does it.

00:05:49
Sanford:
What exactly is a charge nurse?

00:05:51
Paradis:
We call it a charge nurse, but we’ve changed the role to be resource nurse because every nurse in the NICU is an RN and they’re responsible for their own assignment. [06:00] The charge nurse takes care of the flow of the unit. They say who is going to get the next admission, they assign the babies to the nurses, and you take care of any major problems or concerns that occur on that shift.

00:06:23
Sanford:
What differences do you notice between working in a post-surgical unit and working in a NICU?

00:06:29
Paradis:
There are a lot of differences. Post-surgical, you’re working with adults versus premature babies. Post-surgical was more helping adults, comforting them, and getting them through the first day or two. In fact, then for an appendectomy they would stay three days. Now that is an in-and-out surgery. There is big change from the care of adults back then. In the NICU it’s lots of critical thinking and thinking on your feet real fast. Just big differences. I can’t explain. [laughs]

00:07:15
Sanford:
What has been the biggest change you’ve seen throughout your nursing career?

00:07:19
Paradis:
I would say one of the biggest things I see is the difference in the physician and nurse relationship. When I started, we had to wear the white uniform, the cap, and you had to have your cap on. It’s not practical cause you’re getting over beds and losing your hat. When we started nursing, if a physician walked into the room you had to give up your seat. They were in charge and you had to do whatever they asked. There was not a lot of respect from the physicians. Now we’re actually looked at as colleagues. In fact, in the NICU we call the physicians by first name. It’s a big difference and you feel more equal.

00:08:11
Sanford:
Do you think that the media accurately portrays the relationship between nurses and physicians now?

00:08:15
Paradis:
That’s a good question. This whole media thing with the Ebola was quite a challenge because I felt like some of the nurses that got on the news on television didn’t really portray what all nurses are like. But from what I guess, I don’t look at the media as much as I should. I am not sure what is portrayed out there either. I was not involved, but I did kind of hear all the stuff about Ebola and was not happy with what some of the nurses did.

00:09:00
Sanford:
You mentioned the change in how the interaction between physicians and nurses. Has their been a change in the interaction with administration?

00:09:09
Paradis:
Yes there has. When I started, looking back, we had the one—I’m trying to think what her role was called. Director of nursing. She pretty much made the schedule out for all the nurses in the hospital and you worked whatever she assigned you. You could not really request certain days off and you would have to trade with somebody. Whatever she said went. Where now we have shared governance. The nurses that work in each unit have more of a voice. They are involved in the decisions that occur—not all decisions, but a lot of the decisions that occur.

00:10:06
Sanford:
When did you decide to get into nursing?

00:10:09
Paradis:
I actually was studying to be a physical therapist and I did some volunteer work to make sure I enjoyed it. I got into a burn unit at VCU and watching those patients suffer through the whirlpool treatments and everything scared me away from physical therapy. I was like “Oh my gosh.” I knew I wanted to care for people and I felt like nursing was going to work, flexible schedule wise and everything. I already had met my husband and knew I wanted to be a mom as well and thought, “This will work.”

00:10:51
Sanford:
Do you think nursing and being a mother worked well together?

00:10:55
Paradis:
Yes, yes it worked wonderful. I’ve worked all different shifts, part-time, full-time, nights, days, and evenings. I remember with my third child, my husband would work like 6:00 a.m. to 2:00 p.m. and we would meet in the parking lot at like 2:30 p.m. I worked 3:00 p.m. to 11:00 p.m. We didn’t have to have childcare, but it was challenging. [laughs]

00:11:21
Sanford:
When you went to nursing school, where and when did you go?

00:11:24
Paradis:
I actually started at VCU my first year and then to be closer to my husband. I switched to George Mason University. I got a bachelor’s degree at George Mason University.

00:11:38
Shauna:
What did you learn on the job that wasn’t taught to you in nursing school?

00:11:42
Paradis:
A lot of communication skills. When I first started I was very timid and soft spoken and I am a totally different person now with my communication skills and a lot of leadership skills and learning to take action. [12:00] I do remember in nursing school them teaching us about research and how important all aspects of nursing are. But to actually get involved in it as a choice and as a person and I’ve done a lot in the NICU with the clinical practice and to improve the care in the NICU. I did get involved with the research and projects like that.

00:12:34
Sanford:
What has been the biggest change in the NICU that you have been involved in?

00:12:37
Paradis:
There have been a lot of changes. I would say one of the best things that occurred in NICU care was the introduction surfactant that we give to the babies. When I started NICU nursing the viability age was like twenty-eight weeks gestation. Now because of surfactant and other care we give the babies actually, some even as young as twenty-three weeks survive. Over the course of twenty-seven years we have improved five weeks, which is amazing.

00:13:20
Sanford:
Do you feel that you were prepared to start nursing after nursing school?

00:13:24
Paradis:
I did. I did. I mean, I knew I could take care of the patients. It was the whole being in charge of a whole unit as soon as you started that was a little intimidating.

00:13:38
Sanford:
In the past thirty years nursing has become more specialized and a difference in degrees of education. Have you noticed a change in the way nurses interact based off their education level?

00:13:51
Paradis:
I do. I see a big difference between the nurses that get their two-year degree. They’re really focused on mainly the care of the baby. You see the bachelor’s degree nurses get more involved in, I would say, middle management and helping improve processes and things like that. There is a big change.

00:14:17
Sanford:
Can you tell the difference in the education and knowledge when it comes to newer nurses or do you feel that they’re coming out more prepared than they were thirty years ago?

00:14:27
Paradis:
That’s a good question. I would say they are probably are more prepared now. I see them focusing more on what they need to know rather than theory. I know that we had a lot of theory rather than hands on.

00:14:55
Sanford:
What are you most proud of?

00:14:58
Paradis:
That’s a good question. [15:00] I think I am probably most proud of all the processes to have helped improve in the unit. Recently I helped begin a process called the golden hour in the NICU. It’s where we really look at the care of a baby that is less than twenty-eight weeks gestation or if they’re two pounds or less. In that first hour of what we do for them—and we just started it last February—we really have improved the process to get the baby into the NICU quicker. I don’t have my statistics here with me, but by like eight minutes quicker. Eight minutes doesn’t sound like a lot of time, but for little micro-preemie every minute counts to get them in, get them settled, and get them done. It was learning to work with all different disciplines to improve a process. We had pharmacy involved, we had biomedicine, respiratory—I’m trying to think who else worked with us. I can’t remember who else, but we had a lot of people involved and really have improved our care of the little ones.

00:16:30
Sanford:
Do you think you’re appreciated in your job?

00:16:33
Paradis:
I do and I don’t. Recently they had changes—I’m sure you’ve heard, cuts in different areas. I have been middle management, assistant nurse manager. They changed our title to team leader and then they changed it to patient care supervisor and recently we were asked to step down from that position. Now I am a staff nurse and after working that many years in a role that you feel is important, it’s disheartening to realize that they can just say you don’t have to do it anymore. It seems like you are still asked to do the same job even though you don’t have the title or the pay.

00:17:22
Sanford:
Health care has been obviously debated throughout the country. Have you seen it impacting your job specifically or nursing in general?

00:17:31
Paradis:
Yes. The whole change in reimbursement and everything has changed nursing and health care quite a bit. We’ve had to do a lot more with less help. And at the same time, not just the government, but regulations and everything are asking you to do better with less as well. I feel like we’ve really stepped up to the plate and done what we’ve been asked, but then you’re thinking in the back of your mind, “Am I going to be asked to do more? Am I going to be able to do this?” [18:00] This is a lot to take care of and do a good job because that’s what we really want to do: the best we can.

00:18:16
Sanford:
What do you think the hardest part of nursing is?

00:18:21
Paradis:
I would say being able to feel like you’ve done a good job with the resources you have and the time that you have. It’s very challenging to be able to get it all done and make sure you’ve done it correctly because a lot of the times you feel like you’re just running to get it all done and there is not enough time in the day and not enough hands. I always say, “Sometimes I want four hands.” But then they would ask you to do the work of eight hands. [laughs]

00:18:53
Sanford:
Has technology helped with keeping up with the faster pace of health care? With less physical staff or is it about the same?

00:19:02
Paradis:
It’s hard to look back at some things I do know. The monitoring of the infants is really helped a lot and it decreases some of the false alarms and things like that. Something that I feel like has slowed us down a little bit is the electronic charting. I see the benefit of it all being electronic and to be able to keep statistics, but when you’re at a bedside you can’t like chart in the computer. You’re actually writing it down on paper and then putting it in the computer; so it’s double time for that. I see the benefit, but it does increase your workload.

00:19:52
Sanford:
Have you noticed gender stereotypes when it comes to nursing?

00:19:56
Paradis:
Yes, I do. I do. Many people are surprised that men get into it. Even if men are nurses they see them as the ER nurse or the orthopedic nurse. In fact, we have a male nurse in labor and delivery and when he first started some of the nurses themselves were like, “Oh my gosh. A male?” There are male physicians delivering babies. What’s the difference? [laughs] There I do feel like there is a gender bias, but the males make wonderful nurses. I can’t say that there is a difference in the care or anything.

00:20:38
Sanford:
Has there been a change in the gender stereotypes from when you started to now?

00:20:43
Paradis:
Yes. I do feel like more men are getting involved in nursing and I think that’s a great aspect or influence on nursing. I think it’s really good. [21:00]

00:21:06
Rigelhaupt:
Going back to 1982, you start in nursing. Can you tell me about that floor, the typical patients in that unit and how that fit within the hospital at that time?

00:21:21
Paradis:
At the time the hospital was pretty much broken down between a medical floor, the post-surgical floor, they had a cardiac floor, if I’m not mistaken, and they had the maternity ward— I can’t remember if they had many more wards or not. And then they had like a geriatric ward as well. I was really excited to be able to go onto the surgical unit rather than the geriatric floor. That was almost like the dreaded floor to go on—and I love elderly people don’t get me wrong. But it was just a great learning experience because you got to see all different surgeries. Nowadays it’s so specialized you might have an orthopedic floor and a GI floor. I’m trying to think what else there is—cardiac. We had all different surgeries. We would have amputations, appendectomies, and we had gallbladder removals. I can’t think what else, but all different surgeries. It was real varied and you had to have a wide range of knowledge for each surgery.

00:22:43
Rigelhaupt:
At the time there were not hospitalists. What was it like working with physicians in terms of patient treatment? Were you working with community physicians?

00:22:55
Paradis:
Yes, I would say. I have not worked with hospitalists except our neonatologist. It’s hard to compare then and now, but it was much more difficult to contact a physician sometimes. They would write their orders and then expect not to be bothered after that. I do remember one physician. It was Dr. Louis Massad, and I still think of him because the YMCA was named after him. You could contact him day or night without him questioning. He would answer the phone and contact you back. And that’s what you expected of all the physicians, but it didn’t always happen. You’d have to call, call back, and call back until you got what the patient needed.

00:23:53
Rigelhaupt:
What were some of the things you were most proud of developing in terms of clinical skills? You have a knowledge base coming out of nursing school, but I imagine there was a lot of learning on the job. [24:00] What were some of the clinical skills you developed that you were really proud of in the first couple years on the job?

00:24:11
Paradis:
I am trying to think clinically about clinical skills. I guess one of the challenging things as a new nurse would be starting IVs for patients. The first few you did were just such an accomplishment, and the more comfortable you get it actually becomes routine. I’m trying to think what other skills—really just handling the patient load, getting organized, being able to take care of your patients efficiently, and making them happy.

00:24:50
Rigelhaupt:
Did the ratio stay the same? Nurse to patient from the surgical unit.

00:24:56
Paradis:
It did. In fact, they usually had an RN for each side of the unit. It was kind of broken down the middle and then you would have a couple LPNs working under you and the nursing assistants as well. That stayed pretty steady I think the whole time I had worked there. It was only like five years, the first five years of my career.

00:25:19
Rigelhaupt:
And then what was your next step after?

00:25:22
Paradis:
After that there was actually another charge nurse on that unit that I guess I didn’t really trust. She would change how the situation really occurred on the unit when we were working together. It encouraged me to look for a different position. I saw a position in the nursery open and I thought, “Well, I’ll try that.” So I went to work in the nursery in the old hospital and that probably was in 1986, I think.

00:25:57
Rigelhaupt:
What did you see was the strength of the nursing program in the nursery? When you started?

00:26:02
Paradis:
I actually remember her name now. The manager for the nursery, Ruth Martin, had everything very organized. With the organization it was just easy to slip in and you knew your role. You knew what you had to do, when you had to do it, and who you had to do it for. It was very organized and specific, so it was an easy change.

00:26:32
Rigelhaupt:
What were some of the duties that you were in charge of in a typical day when you first started in the nursery?

00:26:37
Paradis:
It is so different from now. All the babies had certain times the babies were fed. I can’t remember the times. It was like 10:00, 2:00, 6:00—so all the babies went out at 10:00 got fed and came back. The babies only stayed with the moms to feed. They didn’t stay in the rooms like they do now. They were shipped out, fed, and came back. [27:00] Our responsibility was to do the vital signs on the babies, change them, get them out to mom, and bring them back. Where nowadays the mom and baby stay as a couple—that’s couplet care. Whatever time the baby starts eating is his schedule. All the babies are on different schedules and it really has changed quite a bit. Then if there was a sicker infant born at the time we had to just stabilize the baby until VCU would come and pick the baby up because we weren’t a NICU at the time. We were just a Level 1 nursery. That’s what actually encouraged me to go to Fairfax hospital. We would have babies born and we would have to breathe for them, hand breathe them with an AMBU bag until VCU came, which could be two to four hours you would be keeping that baby alive. I wasn’t comfortable in that situation and I wanted to learn more. I actually looked at Fairfax hospital and switched to their NICU and that was probably the biggest change of my career. I was there to learn NICU nursing and be proficient at it. Then five years later, I moved my family to Culpeper County and to be closer. I had heard Mary Washington opened a NICU and I came back here. I just learned I love NICU nursing. I love the intensity and the excitement of everyday being different. So it’s very good.

00:28:42
Rigelhaupt:
Could you tell me about your first day at Fairfax hospital and working in a nursery NICU?

00:28:48
Paradis:
I was scared to death. I remember probably, every other day for the first six months, I would be crying all the way home because was nervous and it was quite intense. I didn’t think I was good enough to do the job, but I had a great preceptor at the time. She kept encouraging me and teaching me. I learned so much because they had so many different—how do I want to say—infants with different problems. My knowledge base just grew tremendously.

00:29:28
Rigelhaupt:
What were some of the things that stand out that you learned in the NICU?

00:29:31
Paradis:
I never realized there were so many different things that infants can be born with that are wrong or different syndromes they can have or different defects they can have. I remember one infant who had an omphalocele, where all of their abdominal contents are actually in the cord rather than in their stomach. [30:00] I helped take care of him for like nine months straight. Building that relationship with the family and taking care of him as he improved just was amazing.

00:30:21
Rigelhaupt:
Were there advances that you can think of in terms of NICU care at Fairfax—

00:30:28
Paradis:
Yes, yes.

00:30:30
Rigelhaupt:
— that developed in the five years you were there?

00:30:34
Paradis:
Yes. It’s hard to remember when surfactant started, but I think we started giving surfactant at Fairfax Hospital. Seeing the difference, once infants received the surfactant how well they did was amazing. The team of physicians that were at Inova and the nurse practitioners and everything—their knowledge was just amazing. I tried to soak it all up and ask questions. That’s the point where I saw a difference in the physician-nurse relationship. The physicians really encouraged you to give input to the care and they really respected what you had to say about the infant because the nurses are the ones at the bedside 24/7. They see the subtle changes of the babies and the patients and they know when there is something wrong. You might not be able to tell them what’s wrong, but you can say, “This kid is not right today. Something’s going on.” So a big difference.

00:31:45
Rigelhaupt:
You said something about the unit, the NICU. That the intensity and that the requirement for close twenty-four hour fostered a good relationship, what sounds like a good working relationship between physicians and nurses?

00:31:59
Paradis:
Yes, yes. Just being able to know that when have a real sick infant that has four five drips running or whatever and knowing that you have a physician within a phone call away that can come in and help problem solve and get you what you need for the infant. It’s wonderful. Big change from when started: you had to call physicians and they weren’t there and you couldn’t get ahold of them, to somebody that’s right in the unit that you can get help from.

00:32:39
Rigelhaupt:
So this time at Fairfax was there was a physician on 24/7?

00:32:44
Paradis:
Yes. Yes, in fact they usually had a physician and two nurse practitioners the majority of the time, but their unit is also bigger. When I left there, average census was probably sixty patients just for the NICU, sixty babies. [33:00] Where right now were growing it at Mary Washington and our average census is probably thirteen or fourteen patients. When I started there probably three or four so we’ve grown a lot over the years as well.

00:33:23
Rigelhaupt:
You were gone for five years, you come back to Mary Washington. Did you see changes in the NICU, in the nursery when you came back?

00:33:33
Paradis:
I did, I did. We had a new nurse manager, Sherry Simons who I think she had come from maybe the University of Maryland. She had trained our nursery nurses to become NICU nurses. The nurses had learned a lot of new clinical skills: working with umbilical lines and working with babies on a ventilator. We didn’t have a ventilator when I left and now we had babies on ventilators on CPAP; so there was a big change. The one thing coming back I did notice though was there were no policies written for the NICU. That was one of the things of how I got into management. I raised my hand and said, “I’ll help with policies.” And then I never stopped helping write policies. Most of the policies today were written by me and this manager. It’s neat to see the growth.

00:34:41
Rigelhaupt:
Why was it important to write policies?

00:34:43
Paradis:
Policies help guide the new nurse and they help protect the nurse so they have something that they can refer to and make sure their doing it in the appropriate way. If there is ever a lawsuit one of the first things they look at is, what’s standard practice? What is your policy? If there is not a policy to back you up then you’re in limbo with whether you did it right or not. So they’re very important.

00:35:17
Rigelhaupt:
What were some of the things you remember emphasizing in policies as you began writing them?

00:35:22
Paradis:
A lot of antiseptic technique and making sure everybody does the appropriate steps to decrease infection. I can’t remember when we were running quite a high infection rate. Over the years, by looking at the best practice in different hospitals, now, pretty much our infection rate is like zero percent to .5 percent now. Infection, then safety, and making sure you have the appropriate equipment at the bedside for the patient that you’re taking care of. [36:00] I’m trying to think what else. Safety and then developmental care—not only looking at the critical care of the baby, but you also have to make sure they are developing as a child appropriately. Over the years we’ve had a developmental care committee looking at things you can do to help the baby. What are practices that are trying to mimic the womb as much as you can? We have snugglies and they’re called Dandleroos and you place the baby in it and cocoon them so they stay comfortable and they are not flailing all over the place. It helps them. I’m trying to thing what else. I guess just safe practice is what we concentrated on.

00:36:57
Rigelhaupt:
So this is the early 1990s, am I dating that about right?

00:37:02
Paradis:
When did I come back? It would have been ‘93 I came back and that was at the old hospital. Actually it’s funny, when I was at Fairfax they moved into a new women’s center and I helped them move into the new center. Then I got the position at the old hospital and I helped us move from the old hospital to the new hospital. We did a lot of moving. [Laughs]

00:37:26
Rigelhaupt
What was some of the ideas you learned at Fairfax? In terms you have this new space, a new nursery, what were some of the thing emphasized and the possibilities?

00:37:45
Paradis:
Let me think. I think mainly making the bedsides functional for the families and for nursing so you could have enough room. Looking back, we thought our new NICU was huge. We only had the average census of three or four. Now that we have an average of fourteen or so and this base looks small, but back then it was big. Getting enough room for the equipment, and family, and nursing and having it organized was quite a challenge. Looking at new space now, the move is to have private rooms for NICU babies and their families so they actually have more of a private area to stay with their baby. We’re just one big open room and there’s not a lot of privacy right now. Hopefully in the next couple years in administration will look at either private rooms or pods where at least you will only have an area of three infants and then they would have a little more privacy. [39:00]

00:39:08
Rigelhaupt:
Could you tell me—so you came back just as the new hospital before it opened?

00:39:12
Paradis
Yes.

00:39:14
Rigelhaupt:
It sounds like within six or eight months of it opening?

00:39:16
Paradis
I’m trying to think when we did. Almost a year. I would have to look at a timeline to be sure, but it seems like I was at the old hospital almost a year and then we moved to the new hospital.

00:39:28
Rigelhaupt:
What do you remember about towards the end of the construction process coming over and seeing this empty space what with the equipment ready to go? Could you walk me through the NICU when it was empty?

00:39:45
Paradis
Okay. I was actually very nervous because, as I said, one of the roles of the nurses is the resuscitation role. I was chosen the first day we opened to be that resuscitation nurse and you didn’t know the building, you didn’t know where to go, and you didn’t know where the rooms were. It was quite nerve racking. I went in early that morning and tried to figure out where I was and where we were going. It was also very exciting to start new and fresh and have our fresh start. It seemed like the unit and area were so big. Like I said, now we’re small because we’re a lot busier and have a lot more people to fill the area.

00:40:37
Rigelhaupt:
Of all the things that come in the hospital probably one of the least able to be planned is the delivery.

00:40:45
Paradis:
Yes.

00:40:47
Rigelhaupt:
What do you remember about planning for the move, when people go into labor?

00:40:54
Paradis:
I know, I know. They tried as much as they could to plan. It’s hard to remember because this is twenty some years ago. It’s hard to plan the time frame when you would take the new mom to the new hospital. We also tried to move as few moms as possible in-between their stay, but you did have to have a stopping point. I think when I look back it ran very smoothly. Somebody was watching out for us and it all worked out. I do remember that day where we had squads—I don’t know if some were volunteering. We had a lot and we had squad after squad dropping off the patients that were at the old hospital to the new hospital. It was an exciting day to be there and see the big move to the hospital. [42:00]

00:42:03
Rigelhaupt:
So you were working on moving day?

00:42:04
Paradis:
Yes, I was. It was very exciting.

00:42:09
Rigelhaupt:
Did you start your shift at the old hospital? Or the new one?

00:42:11
Paradis:
No. I think I started at the new hospital. I do think we had almost double coverage that day. We had nurses that were taking care of the patients at the old hospital and then nurses ready to accept the new patients at the new hospital.

00:42:27
Rigelhaupt:
Were there patients from the nursery that had to be transferred from the old to the new?

00:42:32
Paradis:
If I remember right, yes. I don’t think we had many, but we did have a couple that had to be moved. That was an exciting time too. We didn’t really have a transport team or anything like we do now. We used to rely on VCU to pick up the real sick infants. If I remember, I don’t think we had any real sick infants that day—just like grower and feeder babies. It wasn’t a difficult or high tech move. It is very faint, my memory of it. [laughs]

00:43:20
Rigelhaupt:
Now although you worked in the nursery and in the NICU, it sounds like part of your job was also to be in on deliveries.

00:43:30
Paradis:
Yes.

00:43:31
Rigelhaupt:
Do you remember your first delivery that you were apart of in the new hospital?

00:43:35
Paradis:
I’m trying to remember. I can’t even remember if there was a delivery that day. I do remember watching the squad come and being nervous about getting to the right room, but I can’t remember if I went to a delivery or not that day.

00:43:54
Rigelhaupt:
Was there a distinct sense of change in the new facility? That things were going to be different at Mary Washington?

00:44:02
Paradis:
Yes, yes. Just looking at the labor area, I think there were only like five or six labor beds and they were in like a ward, with like a curtain in between. When we moved to here, each person had their private room. There was just a big change in the environment itself. Yes.

00:44:30
Rigelhaupt:
Do you recall the nursing staff having input on how the new labor and delivery and nursery space was going to be designed?

00:44:40
Paradis:
They did. In fact, I was a little confused when we got over here and I was the resuscitation nurse. There were little side rooms, they call them ante rooms for each unit. When I worked at Fairfax they actually used those ante rooms for resuscitation. [45:00] You would resuscitate the baby in there and then bring it to mom. When I came here the idea was just to use the room more for storage, for the baby’s stuff and you didn’t use it to resuscitate the baby. It was a little change and because I wasn’t there from the beginning I’m not sure who was involved with the decisions and everything. But I think L and D [labor and delivery] was probably more involved in the decisions than NICU staff. I think we would have seen it a little differently and used the space differently. [laughs]

00:45:50
Rigelhaupt:
Going back to when you started here in 1982, what do you remember about the values of the hospital and the organization?

00:45:59
Paradis:
It was much more a community hospital. All the nurses knew everybody and knew who was working on what floor. It was just a lot more homey, I want to say. Now we’re so specialized you really probably only know the people in your care center. The hospital is too big to know everybody. It’s a big difference. It’s gone from hometown to almost regional center. That is how I feel. There has been a change.

00:46:38
Rigelhaupt:
Do you see advantages of having gone from a community hospital to, you know, a regional medical center?

00:46:46
Paradis:
Yes. I do sometimes miss a little bit of the hometown-ness. It was just a little more personal, I guess. But at the same time with the hospital being more of a regional center there is a lot more the hospital can offer for their patients, a lot more high tech, specialized care. I think it’s better for the patient, definitely.

00:47:14
Rigelhaupt:
From a working perspective and who you know, with the growth it’s harder to know as many people—do you feel like the organization has maintained the same values and mission as it has grown?

00:47:28
Paradis:
I think so. I still think that we focus on what’s best for the patient. I think a lot of it was the growth of medicine itself and what we concentrated on. From when I started versus what is now happening, I do feel like we still think of the patient first and do what’s best for them.

00:48:00
Rigelhaupt:
Can you think about the first year or so you were back and you’re implementing processes and policies. The early 1990s strikes me as a time when evidence-based medicine is becoming implemented nationwide—

00:48:20
Paradis:
Yes, Yes.

00:48:22
Rigelhaupt:
What were you drawing information from as you developed policies and procedures?

00:48:27
Paradis:
The nice thing is that a lot of it was my experience from Fairfax. Also back then the hospital would pay for you to go to conferences. Sitting and listening to experts and what their big units are doing, I was able to bring all the information back and say, “Hey this is what, you know, they’re doing now.” Unfortunately, the hospital, because of budget cuts and everything, they don’t support sending nurses to conferences as much. It has to be on your own. I still try to go because I love to learn. But I brought it back from Fairfax, from conferences, and even nowadays it’s much easier to get it from the Internet. Looking back at it, there is a California collaborative that I look at a lot and I look at what they focus on. I can’t think of anything else with that.

00:49:41
Rigelhaupt:
But evidence-based medicine undoubtedly was implementing change.

00:49:46
Paradis:
Yes.

00:49:48
Rigelhaupt:
I don’t know if resistance is the right word—but how was it received I guess is the best way—

00:49:53
Paradis:
Resistance is a perfect word. [laughs] I’ve learned through leadership that there’s certain people that will jump on the bandwagon and help provide change very quickly and are open-minded and then there are others. Most change takes almost a whole year for nurses to grasp onto and accept in their practice. So there’s learning to show the benefits of why you’re making the change. That really helps. One of the first simple processes I wanted to change coming from Fairfax to Mary Wash was the nurses learned that when you put a baby in an incubator, they stayed undressed and on skin control until the baby was ready to come out of the bed. Where at Fairfax we would dress the babies, swaddle them up, and put them on air control. [51:00] I would talk to nurses into this is better for the baby. They grow quicker. It took forever to change because they learned it this way and they felt that’s what they were told and that’s what’s best. Where in reality, swaddling the baby is much better for them. That’s just one of the simple changes that we had to make. Another one, which really helped our infection rate, is changing how our nurses used to change our IV fluids. They would use gloves, but they wouldn’t do it sterilely. We had to show them how important changing them sterilely because it’s a lot more work to do it sterilely. Seeing the difference in our infection rate, that was quite a battle as well. They have all embraced it now because they see the benefit, but it took forever to talk them into it. I had a lot of people fussing, complaining, saying, “This is too much work. How are we going to do it?” Now it’s common practice, standard practice. It is a battle and there was a lot of resistance.

00:52:13
Rigelhaupt:
Thinking about maybe like the first five years—nothing specific I am arbitrarily picking, but just a smaller piece of time. What were some of the, along with sterile IVs, what were some of the other things in the first few years after you moved here that became standard practice?

00:52:35
Paradis:
I remember one of the first days I came back from Fairfax: the nurses were just learning to work with umbilical lines and there are stop cocks involved and drawing labs and everything. They didn’t know how to do it without making a big mess of the bed. I had at Fairfax learned a certain way of doing it and it was just neat to see them say, “Show us. We don’t know how to do this.” And now that simple thing is standard practice. In fact, now we have closed system so we don’t even use the process that we used back them. It’s different. I am trying to think of other things we brought back. Just the two things I think are mainly swaddling and changing the umbilical lines, and the sterile technique. The other influence I remember is—it’s not just nursing being resistant, but the physician group we had back then— each physician would have their own way of increasing feedings for the infants. When an infant wouldn’t tolerate feeds you didn’t know, “Was it because each physician would do a twenty-four hour shift and then the next physician would come on and change how they were going to feed the baby?” [54:00] Then the next physician would come on and change it again. We sat down with them in this clinical practice meeting and told them we can’t figure out who is doing what right or wrong because everyone is doing something different. It was a big step to get them on the same page: “Okay we’re going to do this and we’re going to see if this works. If it doesn’t work then we’ll change the process. We’re not going to change day to day of what were going to do.” That was quite a learning opportunity for me to see how to work a group of physicians to be on the same page.

00:54:41
Rigelhaupt:
Was it different working with a physician group, I mean not hospital employees they’re—

00:54:47
Paradis:
They’re contracted.

00:54:48
Rigelhaupt:
I don’t know necessary about the NICU at Fairfax, but I know that they have residents and it is involved as a traditional academic medical center, a teaching hospital, did the NICU at Fairfax have—

00:55:04
Paradis:
We didn’t really have residents or fellows either it was just a specific group and they had been there for a long time. You know each physician had their own style or you know an aspect that they would focus on, but all in all they were a good group. The group here was good too, but they were each doing their own thing and not working together as a group. Over time they actually did start different standards of practices and everything. So it was good.

00:55:39
Rigelhaupt:
And has that continued in the same practice in the nursery and the NICU that it’s a physician group or are there more—

00:55:45
Paradis:
There are some things that they have protocols for and they stick with. I still think that there could be a little more standards of practice that start, you know: if we see this, then we do that. You can track better what works or what doesn’t work if each person is not doing something different. I guess it’s unfortunate, but fortunate that each of our physicians is from a different medical school or different hospitals. They bring a lot of value with different ideas, but at the same time some of those ideas they again use each day differently. I guess with this group the nice thing is that they are on for a whole week. The day shift doctor is the leading physician. So at least for a week the care is the same. But I still feel like there are some things they could have better protocols, or a protocol for.

00:56:50
Rigelhaupt:
Are these traditional pediatricians, neonatologists, what is their medical specialty?

00:56:56
Paradis:
Neonatology. Yes, yes. [57:00] I don’t know how much schooling—it’s a lot. By the time they get their fellowship and their residency and all that done. They’re all neonatologists.

00:57:09
Rigelhaupt:
And even if it wasn’t the same group, had the administration made the decision to bring in a new neonatology group to the area when you came back in 1993.

00:57:20
Paradis:
They actually had the group there and were working when I came. They’ve had them contracted, I can’t remember if it was three years. We switched. It was, “Pediatrix with an x” and with us almost twenty years and now it’s Children’s National Medical Center. They contracted them instead. I’m not sure of their reasonings or things like that.

00:57:53
Rigelhaupt:
Children’s National—I mean a bigger center, I imagine more connected to academic medicine.

00:58:01
Paradis:
Yes, yes.

00:58:03
Rigelhaupt:
Have they brought new evidence-based practices?

00:58:06
Paradis:
Not a lot, which I was kind of surprised by. I thought they would and then we would adopt a lot of the same practices. I think we do do a lot of the same practices already, but I thought we would have more information coming from Children’s to us. We’re really just a satellite working almost independently. Just the last month or so, they were looking at some quality improvements that we can do. I think there are five hospitals now that use Children’s National Medical neonatologists and they’re going to start quality improvements with the whole group. Before that we had just been a satellite, kind of doing our own thing. [laughs]

00:59:07
Rigelhaupt:
In the last few years there’s been another new hospital in the organization, Stafford Hospital.

00:59:15
Paradis:
Yes.

00:59:16
Rigelhaupt:
Were you involved in any of the planning for the nursery at Stafford?

00:59:22
Paradis:
Not a whole lot, because of several things. My nurse manager has been on maternity leave on and off. I’ve kind of filled her shoes while she was gone. I couldn’t be of help too much to Stafford when I was taking care of the unit. But we also have a PRN nurse who is wonderful at organizing and starting new processes. She did a lot of the planning and helping out for Stafford Hospital. Nancy Young, she’s very helpful in starting new processes. [01:00:00] She started our transport team and got all of the evidence-based practice for that. She has actually recently started a cuddler program in the NICU too. We have volunteers come in and hold the babies and the other thing they do is help stock our linen and pretty much anything we ask that is not hands-on clinical.

01:00:35
Rigelhaupt:
How did you continue with your education? You mentioned conferences, have you done it in formal ways as well?

01:00:44
Paradis:
I read almost nonstop. I’m a member of the American Academy of Neonatal Nurses. I’m trying to think it’s the AAN, American Academy of Neonatal Nurses. They have a bi-monthly magazine and I do all the continuing education units of that. I belong to NICU.net and you see blogs, which is neat. Almost whatever problem we have, people out there are asking the same questions. A lot of times you can get the answers from people who are living with the same concerns or issues you are facing. I belong to that. Then I do just a lot of Internet searches to learn and a lot of free continuing education opportunities are out there. I do what I can for free. [laughs]

01:01:56
Rigelhaupt:
Well it sounds like that’s one of the upsides of technology is that, you talked about in terms of electronic charting—

01:02:02
Paradis:
Yes, yes.

01:02:02
Rigelhaupt:
Which might be a downside. But the upside would be that the flow of information?

01:02:10
Paradis:
Yes.

01:02:10
Rigelhaupt:
Are there are things that you have read in your professional association journal, and then thought, “That’s a great idea” That you then brought to your team and talked about with physicians? Any examples that stand out?

01:02:22
Paradis:
I’m trying to think if the idea came from the Internet or I just looked for help through the Internet. One of the other processes that I have helped in our unit is when the babies begin to orally feed, to get them from not knowing how to eat to be able to eat all their bottles. We didn’t have any kind of process to go through that. I found, and I think it was actually at a conference, information. There was a nice talk on it’s called “feeding by cue-based.” [01:03:00] You watch the babies behavior and if they’re ready to eat or not and then you offer it to them. I found a lot of Susan Ludwig’s information on the Internet. I asked our nurse manager if we could use it. I then went back and actually spoke to the author and got her permission to use her information on our electronic charting and everything else. I guess it was a conference and by the Internet that I found information out about that. We have that cue-based feeding besides each of the bedsides so the parents know how we’re going to start feeding their baby and everything.

01:03:47
Rigelhaupt:
Is there a lot of in your unit, and maybe not you in particular, but a sense of contact with senior administration and hospital administration about how your ideas are received or is most of it through nurse managers?

01:04:05
Paradis:
Most of the information flows through the nurse manager. I think there is a little discontent with the ability to talk to upper management. I think they try. The administration tries to reach out, but because they have so many responsibilities I don’t think they have the time either to reach out to all the areas and nursing. I work on the unit everyday and just from the talk the nurses get disgruntled because some of them don’t even know who the CNO is and things like that because she’s so spread thin.

01:04:56
Rigelhaupt:
Part of my question is to think about the way in which hospitals are typically run, you know with the dynamic with the board and administration and the medical staff and increasingly chief nursing officers are in there, but not probably when you started in 1982.

01:05:17
Paradis:
No, no.

01:05:19
Rigelhaupt:
And you know just your impression in the twenty years you’ve been back here, twenty-one, how has that played out? Have they been consistent? Have you seen differences?

01:05:29
Paradis:
I do see a difference in that administration is trying to get more input. They encourage shared governance. We had a clinical ladder where nurses were compensated to be involved in committees, write policies, and orient nurses; you were compensated for that. [01:06:00] Then probably three years ago they did away with this ladder. Many of the nurses that were involved with that are disgruntled because they are not being compensated to go to a committee. Or I mean they get paid for that hour, but they’re not getting paid every day extra to work at a higher level. A lot of the nurses have stepped back and they just do the bedside care and they don’t get involved. I feel like they are hurting themselves somewhat as well because then you don’t have a voice in what occurs. But yet you can kind of see why they’ve been discouraged as well.

01:06:47
Rigelhaupt:
One of the things, in terms of hospital history, is that acute care centers are not always traditionally concerned with primary care or public health. And my question is have you seen the organization trying to deal with health care that is not necessarily the acute form that comes directly to the hospital. And if you think of your experiences through your own unit, but overall if you’ve seen that impression over the last twenty-plus years you’ve been here.

01:07:23
Paradis:
I do see that we try to connect the patients to their primary care before they leave. We make sure the parents have an appointment like a day or two after they leave the hospital so they have that contact right away. We also have a community program called the PEID, Parent Education and Infant Development. It’s a program where the parents actually have to agree to be in the program, but they watch the babies’ development. I’m trying to think if it’s, I don’t know if it’s a nurse or if it’s a therapist like physical therapist that comes actually to their home and evaluates them and then gives a plan on whether the child needs physical therapy, speech therapy, and things like that. There is a connection with our old group of physicians. We actually had a follow up clinic, which was nice. Depending on how little the baby was born, they would come back in a month, then three months, and you could watch their development. I kind of miss that. This group doesn’t do that. We usually refer them to Richmond’s developmental care and there is one at Children’s Hospital too, but the nice thing was when we ran it we got to see the babies grow. [01:09:00] I wouldn’t say we lose contact because many of our long term moms and dads will actually bring the babies back and let us see them and everything. I know from sitting on hospital committees they really try to reach out and make sure the patients have follow up care, fulfill their medical needs, and their health needs. They have a lot of referrals that they offer and give to the patients.

01:09:36
Rigelhaupt:
In these interviews one of the things that I’ve heard about, is community benefit and connections to making sure there are ways that people who don’t generally have access to health care can access them through organizational support and things like the Moss Free Clinic. I think that some of those chronic conditions that bring people in, diabetes, that is obviously more prevalent in an adult population—

01:10:07
Paradis:
Yes, yes, yes.

01:10:09
Rigelhaupt:
—not directly applicable to your specialty, but have you seen ways in which the nursery and labor and delivery and the NICU have worked with some of the community benefit programs?

01:10:22
Paradis:
Some of the programs that, we do have are the WIC program for the moms and the babies. If they qualify for that we get them signed up and in that. I’m trying to think of the other programs that we’ve used. Our case manager, Tanya Couch, is just amazing and she would probably be a good person to talk to about connecting families with community services. You ask her, “What about this?” We get taxi vouchers for moms to visit their babies and we hook them up with community services. I’m trying to think what else. There is a program where they can get free car seats if they can’t afford them. There are just all kinds of community benefits, but many times we just refer to Tanya and she takes care of it.

01:11:37
Rigelhaupt:
Those are largely my questions. What would you most want the public to know about being a NICU nurse that might not be common knowledge?

01:11:52
Paradis:
I’m trying to think. [01:12:00] I guess that it’s quite a challenge to be a NICU nurse, but at the same time very rewarding. To any of the nursing students that follow me, I’m always trying to talk them into being a NICU nurse. I tease and I say, “I want to retire someday and I need somebody to replace me.” [laughs] But I think many times even coming home to my own home, they don’t realize the day you’ve had. You know you’ve just brought three babies back to life that could have not made it before and then you just come home and have to deal with the normal everyday stuff. People forget that nurses—and not just NICU nurses, but all nurses—go through many, life and death situations and then they have to go back and put kids to bed and get ready for their next day of school and all that stuff. It’s quite a challenge.

01:13:02
Rigelhaupt:
What would you most want the public to know about Mary Washington Healthcare that might not be common knowledge?

01:13:08
Paradis:
I feel like we’re an excellent, and I would say almost a regional, center at this point. I feel like the care has greatly improved. We’re much more high-tech and our outcomes are wonderful. I mean, I don’t know if you have talked to anybody about like our stroke program, and our outcomes are wonderful with our stroke patients. There are just a lot of different areas that we really excel. The trauma unit I understand is awesome as well. We just have lots of areas that we’re really doing wonderful at.

01:13:50
Rigelhaupt:
I have one more question.

01:13:51
Paradis:
Sure.

01:13:51
Rigelhaupt:
In 2009 your organization received Magnet status for nurses.

01:13:38
Paradis:
Yes, yes.

01:13:59
Rigelhaupt:
What did that mean to you?

01:14:00
Paradis:
I was very proud of it at the time. Back in—it’s hard to remember. I think back in ‘09, I felt like there was a lot more. I think we still had the clinical ladder and there was a lot more engagement of nurses in committees and everything. I was just very excited because I felt like it was well deserved.

01:14:27
Rigelhaupt:
My last question is actually two questions. Is there anything that I should have asked that I didn’t? And is there anything you would like to add?

01:14:35
Paradis:
I can’t think of anything. I just feel like nursing has been a very rewarding career to be in. It’s very flexible. I just hope and pray that the government can help support the medical care. [01:15:00] And that we don’t lose quality of care and that everyone is allowed access to medical care without it bringing down the whole system. I don’t know eventually if you know a system wide health care would be best or if staying private is better. You know? Who knows? That’s it.

01:15:27
Rigelhaupt:
Thank you.
[End of interview]

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