Phyllis Bartley

Phyllis Bartley is a registered nurse (RN). She began working at Mary Washington Hospital in 1964 and retired in 2014. During her fifty-year career, she worked a medical/surgical unit, the emergency department, orthopedics, started the infection control program at Mary Washington Hospital, and concluded her career at the Fredericksburg Ambulatory Surgery Center. Bartley was the first nurse to serve on the Mary Washington Healthcare Board of Trustees.

Phyllis Bartley was interviewed by Jess Rigelhaupt and Abigail Fleming on November 17, 2014.

Discursive Table of Contents

00:00:00-00:15:00
Decision to become a nurse—Nursing school at the University of Virginia—Working at Williamsburg Community Hospital after graduating from nursing school—Working with patients and families—Changes at Mary Washington Hospital—Developing infection control practices at Mary Washington Hospital

00:15:00-00:30:00
Nationwide recognition of the need to prevent hospital-acquired infections—Return to University of Virginia to study epidemiology—Working in infection control when HIV/AIDS emerged—Working as head nurse in orthopedics—Teamwork

00:30:00-00:45:00
Memorable cases from the emergency department—Providing higher-level care and patients infrequently have to be transferred out from Mary Washington Hospital—First shift at Mary Washington Hospital (1964)—Treatment for patients in the emergency department in the 1960s—Hospital units and organization in the 1960s—1979 expansion to hospital on Fall Hill Avenue

00:45:00-01:00:00
Shared rooms at the hospital on Fall Hill Avenue—Infection control and HIV/AIDS crisis in the 1980s—Collaborative work while in infection control and in orthopedics—Working relationship between nurses and physicians in 1964—Emergence of Medicare

01:00:00-01:15:00
Retirement Harry Bach, Hospital Administrator, in 1981—William Jacobs, new hospital CEO in 1981—Memories of the first discussions of a new hospital—Nursing consultation about patient rooms and equipment in the new hospital—Excitement for private rooms and increased storage space at the new hospital

01:15:00-01:30:00
Beginning at Fredericksburg Ambulatory Surgery Center (FASC), first on Princess Anne Street—FASC’s move to the hospital campus—Cardiac surgery and surgical sub-specialties emerge after the new hospital opened—Increased specialization and additional education among nurses—Mary Washington Hospital receives Magnet status in 2009—Mary Washington Hospital had desegregated by 1964—Stafford Hospital

01:30:00-01:38:00
Primary care and public health—Moss Free Clinic—Summing up a fifty-year career at Mary Washington Hospital

Transcript

00:00:05
Rigelhaupt:
It is November 17, 2014 and we are in Fredericksburg, Virginia, at the Fredericksburg Ambulatory Surgery Center doing an oral history interview with Phyllis Bartley. The first interviewer will be Abigail Fleming and she’ll begin. I will come in a little bit later asking questions and my name is Jess Rigelhaupt. Abigail, I’ll let you get started.

00:00:29
Fleming:
Good morning. So I have a lot of questions about change at the hospital, specifically what you’ve seen. But first we’re going to start out with when and where you were born?

00:00:41
Bartley:
I was born in Charlottesville, University of Virginia Hospital.

00:00:47
Fleming:
How did you decide you really wanted to be a nurse?

00:00:51
Bartley:
I always had the feeling that I wanted to take care of something, even animals, when I was growing up. But I just had that feeling that nursing was what I wanted to do and of course, years ago, the main two occupations for women were teaching and nursing. It wasn’t like you had all the opportunities that you have today. Once I worked in a doctor’s office when I was a teenager during the summer, I knew that nursing was for me.

00:01:23
Fleming:
You never considered becoming a veterinarian or that just wasn’t—

00:01:25
Bartley:
Never considered anything but nursing.

00:01:31
Fleming:
Where did you attend school?

00:01:33
Bartley:
Orange County high school and then I went to the University of Virginia.

00:01:38
Fleming:
Went into their nursing program?

00:01:39
Bartley:
I went into the nursing program at University of Virginia. At that time it was called the diploma program and you went three years, thirty-six months. Had a couple weeks off in the summer, but it was a work program where you were studying and working at the hospital at the same time. When I look back now, I realize that was a fabulous program.

00:02:00
Fleming:
So you did your clinical experiences at the same time—

00:02:04
Bartley:
I did not have to go anywhere. I stayed at the University of Virginia the entire time. We didn’t have to do any outside clinicals.

00:02:15
Fleming:
Did you originally have a specialty in nursing? Did they have that?

00:02:20
Bartley:
You basically decide what you want. I know when I was a senior, I did my senior experience in an early intensive care unit, which really was one of the first intensive care units. When you get out, from the experience you had in nurses’ training, you get a feel for what you really like the best. Sometimes that leads you to find that job in what you felt you liked the best and were best at when you were in training.

00:02:55
Fleming:
Did you like working with children or adults?

00:02:58
Bartley:
I preferred adults. [03:00] I think children tugged at my heart too much. I remember my first death experience with a child on pediatrics. That was very traumatic, which it is for most nurses. So I centered on adults.

00:03:16
Fleming:
They’re easier to handle and—

00:03:21
Bartley:
They’re more predictable.

00:03:26
Fleming:
Did you work anywhere before Mary Washington Hospital or did you immediately start at Mary Washington?

00:03:33
Bartley:
No. I worked in Williamsburg, at a community hospital in Williamsburg for a good while. That is where my husband and I—I married after training and that is where my husband and I were stationed at that time. I traveled to Williamsburg Community Hospital. That was interesting because at that time it was a small hospital. My first job there I worked in labor and delivery, but when the bell rang for the emergency room, if you were not delivering a baby, you had to run down and see what the need was in the emergency room. Needless to say, after about a year I found, “I don’t think I want to do this anymore.”

00:04:15
Fleming:
That is a little intense.

00:04:16
Bartley:
There was some interesting—and I was working 3:00 to 11:00. It was some interesting evenings.

00:04:23
Fleming:
Well you said you didn’t really like the switching back and forth constantly, but did you like working in labor and delivery?

00:04:30
Bartley:
It was okay. It’s kind of like feast or famine. You had nobody or you had everybody delivering at the same time. Once I resigned from there, I did work in a doctor’s office in a small community where we were living. That gave me the feel of impacting patients’ lives more than just the medical care. You could see the total person and their needs in a small community. You got to meet all of their family because he was the only doctor in the community. That was a wonderful, enriching experience and it gave me the feel that taking care of the patient is just part of the job. You still have a commitment to the families too.

00:05:17
Fleming:
Do you feel that way working here?

00:05:18
Bartley:
I do. I’ve always felt that way. I think families, close friends, or anyone who is close to a patient is a real asset, most of the time. You need to incorporate them into the care of the patient as much as possible. Now it’s important because we start discharge planning when we first see the patient. When you’re getting the patient in the hospital or we’re interviewing the patient here to be set up for surgery, you actually start your discharge planning then. That does incorporate the family, friends, or neighbors right away.

00:05:55
Fleming:
Can you explain to me what discharge planning is?

00:05:57
Bartley:
That’s how you’re going to take care of yourself when you leave the hospital or the surgery center and what your needs are—physical needs, equipment needs. [06:00] Who is going to be with you and how are you going to cope with this illness or surgery after you leave our institution. That’s vitally important and that prevents a lot of readmissions too.

00:06:23
Fleming:
You said most of the time the family is an asset. Can you tell me about times when you need them to just kind of be away?

00:06:32
Bartley:
Two things can happen. One, families can interfere trying to decide what the care should be—if mama’s getting enough of this, or not enough of that, or the cure. Sometimes you have families that are fractured themselves. They haven’t seen each other for years. They haven’t spoken to each other for years and all of a sudden and someone in the family is critically ill and they come together physically, but they are not emotionally knit together to be the asset that they should be to the one who is ill. Sometimes you can have negative influences by families too. But you have to deal with that too.

00:07:22
Fleming:
So you kind of have to act as a go between?

00:07:25
Bartley:
You do.

00:07:28
Fleming:
In certain cases—

00:07:30
Bartley:
You do.

00:07:31
Fleming:
Do you feel like that’s part of your job or do you feel like it’s just something you have to do?

00:07:34
Bartley:
The patient is always your primary concern. The patient is always your primary concern. With the surrounding family members, friends, or whoever is the significant caregiver, you have to make sure that it’s a stable situation for the family before they leave your institution. It’s very important. Now it’s nice because we have home health and the home health nurses go out and they can do follow up for many reasons. That’s been one big asset to health care, home health.

00:08:12
Fleming:
Have you seen a lot of hospital change—you said there is been home health and that has been a change that came around. But over the years that you’ve been here, have you seen any major changes as you moved from department to department?

00:08:27
Bartley:
I have. When I first came to Mary Washington I worked in the emergency room, which was really small at that time. We used to transfer all of our critically ill patients to Richmond—some to Northern Virginia, but mainly to Richmond. We got the name of “The First-Aid Station in Fredericksburg.” That’s what they called us. We would bandage them up and send them to Richmond. That has dramatically changed over the years. We rarely have to send anyone out from Mary Washington anymore because we provide the services that the community needs, and that has been a goal of the board of directors of the hospital over the years. [09:00] As this community has grown in population—which it has tremendously has in the last twenty-five, thirty years—the needs of the medical community have increased too. This corporation [Mary Washington Healthcare] has kept up with that and really is ahead of the game in many avenues of health care now. We don’t have to send our patients to other hospitals. It’s a rarity that we send somebody out anymore. The health care system has grown with the community by demand, but also by the foresight of people who have been leading this organization.

00:09:52
Fleming:
You said when you went into your ER work, you said it was very small when you started out—

00:09:58
Bartley:
Yes.

0009:59
Fleming:
So can you tell me some of things you did as a nurse in the ER?

00:10:04
Bartley:
It’s just like any ER nurse. Years ago we started with just a few rescue squads, now of course every county has a mammoth amount of EMS people. But a lot of people were just brought in, in cars. They didn’t call for the rescue squads like they do now. Whenever the bell rang at the door in the emergency room, you never knew what was behind that door. We didn’t have the volume that you have today because the community was smaller. The emergency room population when I first started working in the emergency room was much smaller. That was a nice experience for me as I started my family. I had small children. My first experience in the emergency room was working evenings on the weekends, which management loved. I mean, who wants to work evenings in the emergency room, anytime? That was a time for me when I could be with my children during the week and work in the emergency room on the weekends, the evening shift. Even today, nursing affords a nurse the opportunity to do many, many things. It used to be you just worked in a doctor’s office or you worked at the hospital. Today there are so many avenues that a nurse can go into.

00:11:28
Fleming:
You were able to do—spend time with your children during the day and then you would just come in on the weekends at night to work?

00:11:34
Bartley:
Yes. That was good. That was very good. It was the right thing for me to do, you know.

00:11:42
Fleming:
And your husband, you talked about him earlier you said he’s also—he’s a doctor, or he’s a nurse?

00:11:47
Bartley:
No, no, no. When I was married my husband was a Virginia State Trooper. We moved and that’s how we got to Fredericksburg. Then he left the Virginia State Police and went into building materials here, working in building materials and selling building materials, which he did for the rest of his career. [12:00] He could sell ice to an Eskimo in the wintertime. [laughter]

00:12:10
Fleming:
So he was definitely a good salesman?

00:12:13
Bartley:
He was. Sold himself to me.

00:12:18
Fleming:
What were some of the best—or I don’t know if best is the right term. Do you have any stories about the ER that were particularly—

00:12:30
Bartley:
I think the ER was just one avenue that I worked in. Basically when I left there, I also continued to work evenings and I worked on the med-surg floors. I went out on the floors and worked with direct patient care, which was good and I really enjoyed that for many years. I floated back and forth through the emergency room many times when staffing needs were there and I always enjoyed being there. I worked there for a good while off and on, but I would go back to the med-surg floors. Then one of the most interesting things that I’ve done was when the Joint Commission said that we have to have an infection control program here in the hospital, and that was a nationwide thing. They approached me about going back to UVA—which is my love, the University of Virginia—and getting an education in epidemiology and starting an infection control program for the hospital. That meant setting up a lot of policies and procedures to prevent hospital-acquired infections. After I left the direct nursing care of the patient, I did that [infection control] for nine years and that was very interesting. It was very mentally stimulating and it was something that we had to do to meet Joint Commission requirements. Then I got hooked on it. I liked the microbiology and that part. Then, thank goodness, Dr. Bernstein came: he was our first infectious disease physician. I said, “Okay. Dr. Bernstein, it’s yours. I’m outta here.” Then I went on to be an orthopedic head nurse and I did that for many years. Then I came here to FASC [Fredericksburg Ambulatory Surgery Center] and I’ve been here, I guess fifteen years. I got to do a lot of different things in nursing. That’s the beauty of nursing. There are many opportunities if you look for them. This corporation affords a lot of variety for nurses because it is such a big corporation now.

00:14:35
Fleming:
Can you tell me how many different, it’s probably a lot as you said, but how many different kind of departments they have for nurses?

00:14:42
Bartley:
I can’t tell you exactly, I don’t know. I really don’t know, but there are different things. I know we have nurses who work in our research department. There are so many different things you can do. I just don’t know the number of departments. [15:00]

00:15:01
Fleming:
Going back to your infection control, it sounded really interesting when I heard that you had worked in. So you were trying to contain hospital infections?

00:15:12
Bartley:
Prevent.

00:15:12
Fleming:
Prevent hospital infections. Can you tell me why they decided to start that? I mean, I know hospital infections are not—

00:15:22
Bartley:
No.

00:15:23
Fleming:
A good thing to have, but about when did they start this?

00:15:27
Bartley:
I think the nation realized, with all the statistics that are done by so many people, that patients were acquiring infections in the hospital and of course that was bringing on mortality and morbidity in the patients. The Joint Commission on accreditation said, “We need to look at this. We need to look at what is causing these infections and we need to come up with avenues of prevention.” That was when every hospital in America was required—it wasn’t optional. If you wanted to pass Joint Commission review—and that has a lot to do with your revenue recapture too—you had to provide a program that looked at what are we doing that could put the patient in jeopardy for picking up bacteria and infections while they are here. That came from simple things, like if a patient had surgery the norm is to turn, cough, and deep breathe every two hours to prevent pneumonia. Are you really doing that? Are you really, as nurses, turning and coughing? Simple things, but it can prevent the patient from getting hospital acquired pneumonia, being on massive antibiotics, and staying a week longer. Wound infections, urinary tract infections, all kinds. Then when we got to advanced technologies where we had catheters and IV lines coming out of so many ports on the patient. Then that became a real issue because they were into the patient’s bloodstream and major organs and that could really be dangerous. So it became even more critical as health care and nursing care became much more defined for the patient. Now every hospital has to have an infection control program.

00:17:32
Fleming:
Can you tell me how you controlled some of these infections before you had the major technology?

00:17:38
Bartley:
The program was where you would look at risk factors, and as the nurse doing infection control, we had categories that we knew were problems for patients, like pneumonia and wound infections. [18:00] You had a monitoring program, where actually an infection control nurse was making rounds on patients, patients’ charting, and procedures that we did to patients. But always the number one thing that you emphasized was hand washing. It seems so simple, but that has not changed. That hasn’t changed in a hospital. That hasn’t changed at home when you’re taking care of children who are sick, as a mother. If you’re in a grocery store working, anywhere, and the flu season coming on now—hand washing is still the most stable part of an infection control program in a hospital or anywhere to prevent transfer of bacteria and viruses. You really push and you had to come up with clever ideas, posters and all kinds of things. I think it was so simple that if you said, “We just want you to wash your hands a lot. We’re going to give you the product you need to wash your hands and that’s how important we think it is.” It was so simple that you had a hard time selling it to begin with. Now I don’t think we have a hard time selling hand washing anymore. Now we have, when you go anywhere, you will see hand-wash dispensers and you’ll see the wipes as you go into the grocery stores. You can pick a wipe up and wipe off the handle of the cart you’re going to use. You see a lot of products that are there readily to health care but also to the general public too for hand washing.

00:19:38
Fleming:
So they sent you back to the University of Virginia to study—

00:19:42
Bartley:
Epidemiology.

00:19:43
Fleming:
Epidemiology. So when you came back to Mary Washington, you were the one to set up the program. So you helped pick the staff?

00:19:54
Bartley:
We had a committee.

00:19:55
Fleming:
What exactly did you do as you came back here from—

00:19:57
Bartley:
First of all we established an infection control committee chaired by a physician and physicians from each of the major departments. We had other people from housekeeping and talked about how important a clean environment is. Our committee was made up of people that had input into the cleanliness and everything that goes into an infection control program. My job as an infection control nurse was to work with the chairman to set up policies and procedures on appropriate things to do when you were inserting IV lines and all kinds of different things for the patient, but also for the environment, for housekeeping, and for the products we used to clean. It’s important to know which products are best to eradicate bacteria and viruses. At the time I was infection control coordinator, AIDS sprung up in America, a real challenge. As physicians and nurses on the infection control committee, we got very active and set up a program. [21:00] We actually went out into the community and did classes for clubs, schools, and churches, wherever people would invite us to come in to explain what AIDS was and how it was transmitted, as to what we knew then. What we knew to begin with was minimal, compared to what came out and what we’ve known since it started. That was a real challenge for me and for the committee at the time, when AIDS became really on the forefront of America at one time. We dealt with simple things, just like scabies and head lice. You know you can have an outbreak of scabies in a hospital and the staff gets it and so do the patients. That’s a disease where you get a little mite under your skin and you just scratch and scratch and scratch. Simple things like that, there had to be control measures for that and we treated things like tuberculosis, which you don’t see today thank goodness. We treated things that we don’t have to take care of today. It was very interesting. It was very mentally stimulating. Even though we were dictated, as health care in America, that we must do this, it basically just changed for the patient the risk of getting a hospital acquired infection, which was the real goal.

00:22:31
Fleming:
So you said a physician came and took over later?

00:22:34
Bartley:
Yes.

00:22:34
Fleming:
But you had physicians on the board?

00:22:37
Bartley:
We had physicians on infection control committee all times from all the different services.

00:22:44
Fleming:
But nobody came in?

00:22:45
Bartley:
We didn’t have infectious disease specialist until Dr. Bernstein came, which was a blessing.

00:22:52
Fleming:
And then you said “Okay.”

00:22:53
Bartley:
“See ya!”

00:22:54
Fleming:
Is that when you went into orthopedics?

00:22:57
Bartley:
Yes. I was the head nurse in orthopedics for several years.

00:23:01
Fleming:
Can you tell me what you did as the head nurse?

00:23:03
Bartley:
Oh my. You ran a thirty-bed unit with a nursing staff. The head nurse is a manager, a manager over personnel, but also manager of the patient care. You stepped into that role to give the best care you could to the patients so that they had the best outcomes from their surgery. You also wanted to keep your staff educated, so that they knew how to give the best care, prevent complications, and so that the patients the length of stay would become shorter and shorter because they got the care they needed to get in and out of the hospital. Also at that time, it seemed really important to me because orthopedics involved so many broken bones and replacements. [24:00] We were just getting into replacements, all the replacement joints, and had a very active cooperation with the physical therapy department. We started our physical therapy the day after surgery, which was kind of unheard of then. Many patients stayed in the hospital forever before you did much. You let them get well before you did things. It became the norm that patients would start their physical therapy as soon as possible. It prevented a lot of complications by not keeping them in the bed. Also, it got them up and around and out of the hospital and to home, really where they healed faster than just staying in the hospital. I really enjoyed being the head nurse. I really enjoyed overseeing the patient care to make sure it was the best that we could give. I enjoyed making sure my staff had the equipment and the training that they needed to be the best they could be. One of the most rewarding things we did on that unit—we had a housekeeper and you could tell she just had a love for people. When she was in the room she was always talking to the patients and their families. She just had the personality that we said, “She just has too much on the ball to remain in housekeeping.” We talked to her about going into nursing and she had a family, two small children. We worked with Germanna and Jane Ingalls and we got her some foundation money. We as a staff took up money and paid for her books and she went back to school and she became a nurse. That was one of the most rewarding things we did as a group. That’s been done many times, but today she is still practicing nursing.

00:26:03
Fleming:
Is she here?

00:26:04
Bartley:
No. She moved, she moved to another state so she could be with her parents and help care for her elderly parents.

00:26:13
Fleming:
So you really felt you worked as a team a lot?

00:26:16
Bartley:
We did work as a team. When you don’t work as a medical team, you personally lose something because you don’t feel that camaraderie and you don’t feel that support. You don’t feel that reward of when I come to work today, I know my team is going to be there. We all have personal lives. Things happen outside of your hospital, or your health care institution, your doctors’ office, or wherever you work. Health care can be very emotionally and physically draining. Having team members there and that are there so that you work together to get the rewards of, “We gave the best care we could and the patient got well and went home.” [27:00] Also my team is there for me as a person, so that I can be stronger even though I have a lot of things going on outside of my institution. I saw—and I still do and I really see it here at FASC—that the nurses and the other staff, support staff, are always here for each other if you have things going on in your personal life that you share. The team will rally around you and be there for you.

00:27:41
Fleming:
And they understand you because they’re going through the same—?

00:27:44
Bartley:
Health care, not just nursing, but health care is very demanding. It’s very demanding emotionally and it’s very demanding physically. I think when I was the head nurse in orthopedics I realized how demanding orthopedics, the department of orthopedics was because of the amount of physical care and lifting my staff had to do. One of the things we did there was we increased our support staff, our CNAs. We had more people to help the RNs and LPNs. That really became a team effort and we finally got an orderly just assigned to that floor only, not random in the hospital. He was awesome. He was there for us and he knew he didn’t have to go anywhere else when he got called. The patients got up and around and in their chairs and up to their walkers a lot quicker because we had support staff for the nursing staff.

00:28:50
Fleming:
I noticed you guys take a lot of walks, whenever I’m driving over here, so you have time for your exercise and kind of, to de-stress maybe?

00:29:00
Bartley:
That’s your choice. When the weather permits, I walk the campus every day during my lunchtime. People have gotten used to seeing me and they knock on the windows and whatever. One person said to me, “I’ll know when you retire because I won’t see you walking anymore.” Then I have to figure out a food I can eat while I’m walking, peanut butter and jelly sandwich or something. For me, I really like exercise and I like to stay healthy. [30:00] I choose to walk my thirty minutes around the campus and when I come back in, I generally feel refreshed, mentally. Pulling that hill, “Doctor’s Hill” as they call it, the hospital hill—its pretty good exercise when you start down by CVS and come all the way up to the roundabout. That’s your choice, but a lot of people do walk and that just depends on if you can get out and do it.

00:30:06
Fleming:
You’re talking about how it’s very emotionally demanding on you. Do you want to talk about any stories that were just very tense situations or you had a hard time dealing with?

00:30:20
Bartley:
I guess I go back to the emergency room with trauma. I think two things stick in my mind. One, we had a child, a young child that was severely injured by a riding lawnmower. That child did live. We had to transfer that child out of course because at that time we couldn’t provide trauma care, which we do provide now. I’ll always remember that. I also remember a lot of people that had no one. They were brought to the hospital by rescue squad and no one ever showed up to support them—no family members, no friends, no one. If you were in the emergency room and the rescue squad brought them, and then no one came to get them. That became a real issue and it was very heart wrenching to see. Sometimes by their own choice, people had become hermits and they didn’t have people around them by their choice. But other times there were just people that we had and we couldn’t send them back home because they didn’t have anybody to come for them. We always worked it out. We had a wonderful gentleman who owned a cab company here and we called him and pleaded. He would always, if they were stable, he would always take them home for us. You get involved with patients, particularly today when you see a lot of cancer patients and the cancer patients are younger and younger. Some of that is because of the disease entity, but also some of it is because of our diagnostic skills today. We are just picking up a lot of our cancers a lot sooner than we would have. But you see two things: you see people that the disease is devastating and they are gone in no time. [33:00] Then you see people that encourage you because they’re such fighters for the disease and it just thrills me to know that patients today do not have to leave Fredericksburg to get the top-of-the-line care for cancer today. It’s all right here in our community. No more travelling to Richmond and Northern Virginia. All of our brain cancers we treat here with the highest of technology in radiation. This community and this health care community are just fabulous today, but that has been a growing process, as I said. The community has grown. Then the board of directors and the hospital saw that this community’s avenues for care have grown too. If you leave here for better care—it’s a small, small niche that you’ll need to go somewhere else. But also sometimes it’s just your choice, second opinions or whatever and that’s fine and that’s wonderful. We are so blessed to be close to Northern Virginia, Richmond, and Charlottesville. If you want to go for second opinions or other things, we are close enough that you can do that from your personal home. We are blessed in Fredericksburg to be so surrounded by medical entities that can be adjunct to the care we give here.

00:34:00
Rigelhaupt:
So going back a few years, can you walk me through your first shift in the ER when you started at Mary Washington Hospital?

00:34:08
Bartley:
I have a good memory, but I don’t think I can remember that. I remember that we had a four-bed unit and I just talked to one of the people that I worked with there not too long ago. She and I were recalling how we were so thrilled because we got an electric coffee pot in the emergency room, which then was just a big thing. We did have a four-bed unit. It was really small. The lab was right next door to the emergency room. If you wanted a lab tech, you just knocked on the wall and she would come over and draw the blood and so forth. We didn’t do all the invasive things that we do in the emergency room now. As I worked longer in the emergency room, we did more and more. When we first started out, unbelievably, we did not have doctors staffing the emergency room. Then the board of directors decided we would use the Corpsmen from Quantico. They wanted to make extra money. The corpsmen from Quantico came and they worked with us then. [36:00] Before I actually left and started working my 3:00 to 11:00 stint, the emergency room started staffing with a core of doctors that were hired by the hospital just to work the emergency room. Several of those doctors I still see. They still live in the Fredericksburg area, but they have retired. I do see them every once in a while and say, “Do you remember when we worked in the emergency room years ago?” That was a real blessing when the emergency room first became staffed with just ER doctors. Of course now we have tremendous care in the emergency room and staffing of doctors. One of the things that too has happened is when you worked in the hospital after five o’clock, everybody went home it seemed like. Doctors, years ago when I worked on the floors, made rounds. The surgeons particularly and the medical doctors made rounds in the morning and then they would go to their office and then made rounds after being in their offices. Then after the office practices became so demanding, you could see them cutting back on their hours. One of the things you have now is hospitalists. You have doctors, not just in the emergency room, but in the hospital at all times to take care of patients when the private physician can’t get there. That’s a real plus from years ago. In the emergency room years ago when we’d be there and we didn’t have a doctor, the charge nurse in that emergency room, when the patient came in, did the assessment. Then you had to call the doctor—and we didn’t have cellphones and beepers and stuff then. I remember when the doctors first got pagers and we didn’t have to call them on the phone at home and say, “Get in here.” We could actually page them and that was a big deal then. The pager and the coffee pot were the big deal. [laughter]

00:37:33
Rigelhaupt:
What were some of the specializations the physicians had as they began working at the ER, the staffed positions that you described?

00:37:41
Bartley:
First of all, when we got the first group of physicians that came, they treated everything. Then when they felt they needed a specialist—like they needed a pediatrician—they would call that doctor to come in. If we had somebody come in from trauma, they would do what they could do then they would call the surgeon in. The ER physicians assessed and did everything they could, but then if they needed a specialist, they themselves would call that doctor to come in, and they always came.

00:38:19
Rigelhaupt:
Could you talk about a normal—not that there is a normal—but a patient flow if someone came in through the ER and needed to be admitted, in the second half of the 1960s. They come in, they get treated, they go—where do they go? [39:00]

00:39:06
Bartley:
They went to their room. Basically, you would come into the emergency room and you would be treated. If you needed surgery then we would call the people on call for the operating room and they would come in and set up the operating room. Then you call the surgeon and the surgeon would come to the emergency room, assess the patient and then we would take the patient right to the operating room. If you had a medical issue, a heart attack or pneumonia or something like that, it was the same thing. Like every hospital we had admitting office. If you deemed that the patient needed to be admitted to the hospital, then you call the admitting office and you got admitted. If they had a family member there, you just sent them around to the admissions office and gave them all the information. Then a nurse and an orderly would take them to the room assigned to the patient.

00:40:00
Rigelhaupt:
How were the different floors or units organized when you started, maybe through the second half of the 1960s?

00:40:07
Bartley:
They were organized like they are today, by specialty. You had a medical unit, you had a surgical unit, you had an OB/GYN unit, and you had a pediatric unit. It was by specialization then just like it is now. It was always specialized by floors. The pediatric unit at that time was very small. But then as I said, as the population in Fredericksburg grew, they kept adding on to the old hospital down on Fall Hill. It got addition after addition after addition and those units got bigger and bigger and bigger as the population grew. The population of this area grew due to proximity of Washington D.C. and people traveling. People live here, but work there. This population just exploded in no time and the health care had to do that. They had no choice. If you wanted to provide for the people here, then we had to get bigger and bigger. We had more and more additions and then we got the “hospital up on the hill” as we called it and where we are now. We call it “the campus” now.

00:41:16
Rigelhaupt:
I know there was a big addition in 1979, to Fall Hill. Do you remember how the physical space changed in between 1964 and ’79?

00:41:26
Bartley:
We added two whole wings and we enlarged the emergency room tremendously. I guess triple its size and that was wonderful. By then the community was bigger and we had lots more rescue squads. The emergency room population was getting bigger and bigger and bigger. At that time we just needed more beds because we had more patients. We served a fairly large area, which we still do. [42:00] With the Stafford Hospital and Potomac Hospital we’re not quite the biggest area that we used to be. At one time we were serving such a huge population that we had to have just more beds. I can remember many, many days of having patients in the halls because we did not have any room. You would put a patient in the hall and you get portable privacy curtains to go around them. It was the best we could do and that just happened over and over and over again until the expansion. You just couldn’t continue to put patients in the hall and give them the care they deserve. But you couldn’t send them home, so you had no choice. We did the best we could and we provided for the patient. Then the next day, invariably, somebody would be discharged and that patient would get moved from the hall into a room. It’s hard to believe, but we did do that.

00:42:58
Rigelhaupt:
Did they expansion in 1979 alleviate some of the space crunch?

00:43:02
Bartley:
It did. It really did. That was a blessing because the community was growing tremendously. The patient population was growing tremendously and we got to the point where we didn’t have patients in the hall anymore and we did some unique things. We had alcoves, elevator alcoves—we put patients in the elevator alcoves. Thank goodness they were right across from the nurses station so you could watch them closely. Those patients probably got the best care because we were just kind of petrified that they were out in the hall or in the elevator alcove, but we didn’t have to do that after we had the great expansion. We had plenty of beds then.

00:43:48
Rigelhaupt:
And the beds in the Fall Hill facility, the rooms were not private rooms?

00:43:51
Bartley:
No, they were not. We had several private rooms and we had rooms that had negative pressure for isolation patients. We had those private rooms. We tried to keep those free for when we had an infectious disease need. If we didn’t have an infectious disease need, we would put a patient in there. Most of the time patients would request a private room. It was a personal thing. They didn’t want to be in a room with somebody else or whatever, but there were very few private rooms compared to the semi-private rooms and we had wards. We had five-bed wards. You had privacy curtains where you could enclose each bed, but you did have big rooms with five patients in those rooms.

00:44:37
Rigelhaupt:
What were some of the challenges of working with wards and shared rooms?

00:44:42
Bartley:
One thing, if you were assigned to the five-bed room, it was pretty good really because you had all your patients right there. You didn’t walk yourself to death going from one room to the other. That was another thing that was important. I know that when I was a head nurse, you had to think about the quality of care each patient needed. We set up a numerical system from one to five. [45:00] One being negligible care because maybe the patient was better and they were going home that day. Then five was a patient that had come from the operating room at three o’clock in the morning. You did not want a nurse to have all patients who were fives. You tried to distribute the patient load so the nurses had even work. Then you would walk them to death sometimes because they would have patients all up and down the halls. But you had to, basically. It was better for the patient to get the best care than for the nurse. We put on a lot of miles in our lifetime. I know I have.

00:45:53
Rigelhaupt:
Were there any benefits to having as you described a few of the nurse with all five patients together? Were there other benefits of having shared rooms?

00:46:05
Bartley:
I don’t know if it was a benefit or not. Sometimes I’m sure patients thought it was an invasion of their privacy not to have stable walls, even in their pain or expression of their pain. The personal care you gave them even though you had the curtains—I don’t think they felt the privacy that they deserved. It was a norm in all hospitals then. It wasn’t just Mary Wash. It was big institutions. When I trained at UVA, we had wards with fifteen to twenty patients on a ward. They were huge. I thought it was wonderful when I came to Fredericksburg and we just had semi-private and five-bed wards after training in this hospital where they had these huge wards. An advantage for the nurse was she could keep a closer eye on her patients. If she was taking care of one, she could actually physically see or be near the other. I think that was probably the best advantage. The patients really benefited when we went to semi-private rooms. Now that we’re in all private rooms here, that is a great advantage for two reasons: one the patient has that sense of privacy and two the family can stay. My husband recently just had surgery and I spent the night with him and it was a real security blanket for him and also for me. There are times when you have to limit the number of people that can stay. [48:00] And you have so much equipment today that private rooms are almost necessary due to all the equipment you have on patients.

00:48:11
Rigelhaupt:
I want to just try and get the chronology straight. So you start here in 1964, of course, and how many years were you in the ER?

00:48:18
Bartley:
Well, I did a couple stints in the ER. I started out in the ER and I worked there several years and then I went to the med-surg floors. Then I went back to the emergency room, when they expanded the emergency room. In the expansion they needed more nurses. I said, “I’ll go back because I like the emergency room.” I went back to the new emergency room and worked there. Then they asked me to infection control. I did infection control for nine years and then I was a head nurse for six years.

00:48:53
Rigelhaupt:
What year—do you remember about what year you began in infection control?

00:48:56
Bartley:
No. I should have looked it up, but I don’t remember the years.

00:49:01
Rigelhaupt:
But it was before—

00:49:02
Bartley:
Dr. Bernstein could tell you because I did nine years before he came.

00:49:08
Rigelhaupt:
But it was before AIDS had emerged?

00:49:10
Bartley:
Yes. Infection control—AIDS emerged after. The infection control program was started to prevent what we call nosocomial infections, hospital acquired infections. It was not begun because of AIDS, but AIDS surfaced during my tenure in infection control. In a way it was a blessing that the nation was beginning to look at control measures for infectious diseases because then we were better equipped to take care of the AIDS patients. I am sure all hospitals, as ours did, had an AIDS patient that you didn’t know about until it became in the forefront of this is the virus that was going around. This was why these people were so sick. We were better equipped at that time because we had already started doing measures to prevent the spread of infectious diseases. When AIDS came along, the basics were already started.

00:49:56
Rigelhaupt:
For the general public, AIDS was scary—

00:49:58
Bartley:
Petrifying.

00:50:00
Rigelhaupt:
And certainly I imagine in a hospital setting, you have more knowledge than the general public about the disease process. What do you remember about how you in infection control and the hospital began learning about AIDS?

00:50:16
Bartley:
First, it came from CDC and then through your state health department. After, basically it was diagnosed on an epidemiology standpoint and you could actually diagnose it. One of the things I actually think we went out as teams, a couple people from the infection control committee and I would go out as teams and we would present programs. We had a slide program. We were desperate in this area to educate the public because there was panic out there. Everybody was just like, “What is this?” “How do I get it?” Perfect question at every seminar was, “Is it okay to sit on a commode seat? Can I touch a doorknob?” [51:00] These were things that the public was panicked about. I know because I went to one seminar and I’ll never forget it. It was a seminar of all men in a basically physical job. They really had pretty strenuous work, they came in contact with the public a lot, and they felt that anybody diagnosed with AIDS should be put on a desert island. That was their way of how we’re going to control and AIDS. That was the hysteria that was going on at that time and we as a health care institution felt that the only thing we could do, other than take care of the patients when they came to us, was to educate the public as fast as we could. A lot of that literature came from the CDC and the state health department.

00:51:49
Rigelhaupt:
Was there any fear within the hospital or the nursing or medical staff, with the first recognized AIDS patients in the hospital?

00:51:56
Bartley:
I think so because we didn’t know everything then that we know now about transmission. Just like with hepatitis, it was the same thing. If you got a needle stick or if you got a blood splash, you were petrified that you were going to come down with AIDS or hepatitis because sometimes it was simultaneous in these patients. Then we got to the stereotyping in America of the person who comes down with AIDS and we had a lot of problems of dealing with, “This is a patient who has a disease.” We’re treating a patient with the disease, not the lifestyle. That was a real issue.

00:52:52
Rigelhaupt:
From what you described in terms of working in infection control it was a committee?

00:52:54
Bartley:
Yes.

00:52:55
Rigelhaupt:
A team.

00:52:56
Bartley:
Yes.

00:53:00
Rigelhaupt:
Were there things you learned about the importance of team building and collaboration that you used when you became head nurse in orthopedics after infection control?

00:53:08
Bartley:
You learned you were not an island. I don’t care what level of management you are in—whether it’s health care, whether it’s sports, whatever it is—the team effort is what gets the best results. You have to develop a culture: that team is what you expect and that comes from the top down. When you start with team at your top, the administrative staff and your board work as a team, it filters right on down. Families have to work as a team. Life is a team. There are people who work as islands and they miss a lot in life, but sometimes that’s what they choose to do. [54:00] Life is a team effort, whether it’s in a family or in health care. That is when you get the best results: when everyone pulls together and you learn from each other. No one knows it all. I know some people will say to me, “Well, Phyllis, how do you know that?” And I say, “Well, it wasn’t in a book. It’s just from life and somebody shared this with me. And then I’m sharing it with you because this is what really works.” I did learn a lot. We developed our program in infection control as a team, as a committee, and by working together. It expanded and expanded as the need came. Then when I went on to be a head nurse, I found that my rewards as a head nurse were built on how the staff felt about the care they were giving. I was determined to give them every tool they needed to give the patient the best care because then they felt rewarded and the care just got better and better and better. I was just so proud of the care we gave and the staff themselves. It was a team effort and they were pretty critical of each other too. We have pretty high standards. They would kind of patrol each other because it was a team and you didn’t want the team to falter in any way.

00:55:36
Rigelhaupt:
Thinking back to when you began, you know, 1964, what were the working relationships like between physicians and nurses?

00:55:46
Bartley:
We were such a small, core group. The staff for nursing and the physicians was small. Basically, we knew everybody. I remember when a new doctor would come—I remember the first true orthopedic surgeon that came. Came right from the military, and came right to Mary Wash to start the Orthopedic Service for Fredericksburg. He was just greatly embraced by the general surgeons because the general surgeons were having to do the orthopedic care. What I saw over the years, every time a specialty has entered into this health care system, they have been welcomed with opened arms because it allows people to really specialize. It has been a blessing for this community. The more specialties we have and the better care we can give, the less people have to go out of town for care. We did see that grow. I saw the first intensive care open up, a two-bed unit, the first surgical intensive care unit, and then a surgical step-down unit. We started tiering our patient care, which was wonderful. We grew as the demand came—this institution has grown as the demand came. I am very proud of this institution and what they’ve done. [57:00]

00:57:05
Rigelhaupt:
So staying—and I’m going to talk about the big growth that has happened in the last twenty-plus years in just a minute—but one of the changes that happened for the nation about the time you started here or the year after was the passage of Medicare.

00:57:20
Bartley:
Yes.

00:57:23
Rigelhaupt:
How did the federal government becoming involved in health care in a new and very different way shape health care delivery for those first few years that Medicare existed?

00:57:33
Bartley:
I think two things happened. One, it lifted the financial burden from the patient. There were many patients—we’re a pretty rural area, back in ’64. We didn’t have—it wasn’t the city of Fredericksburg, it was the town of Fredericksburg. The rural area greatly encompassed our patient population. We didn’t have all these people working in D.C., making the big salaries. Money was not as fluid as it is today. I think Medicare lifted the burden from a population that needed that tremendously. I think it gave the patient population the sense that “I am entitled.” That’s not a good word in today’s society, but “I’m entitled to health care, no matter what my age is.” Rather than “When I grow older, I just curl up in a corner and die.” I think we saw the beginnings of “These are the things you do to help you live a healthy, long life.” There is care and insurance for you as you become older.

00:58:53
Rigelhaupt:
But were there—I guess was there an increase in patient census, more, I mean particularly senior citizens—

00:58:59
Bartley:
Yes.

00:59:00
Rigelhaupt:
—who Medicare most affected, the only people that it really did. Were there were more patients who otherwise you wouldn’t have seen in the hospital that you could began seeing

00:59:12
Bartley:
I guess as a young nurse, I wasn’t so attuned to the financial then. I can’t really address on statistical basis if that really happened because then I wasn’t thinking about the finances. It’s just like today and I know people find it hard to believe: nurses don’t think about how the patients are paying for bills or who’s paying for them. Most of the time you could ask a nurse “Does that patient have insurance? Are they Medicaid? Medicare? Are they self-pay?” [The nurse would say,] “I don’t know.” It’s not a thing that nurses are concerned about as a first line caregiver. So I guess as a young nurse then, I didn’t think about what Medicare was doing to the population increase in care. [01:00:00] And I think that’s true today. We are faced with asking the patients more about their finances now because that becomes part of discharge planning: “Who’s going to take care of you? Do you have long-term care? What insurance do you have?” Discharge planners will come and do that for nurses now, from the discharge-planning department. We are more involved in the financial now than we ever have been before.

01:00:38
Rigelhaupt:
My question was not so much about the financial, it’s just that did you see something different? I mean it was more how did Medicare affect the hospital?

01:00:47
Bartley:
I really don’t remember. Honestly, I don’t. I can’t say from A to B what happened because I don’t really remember that; I really don’t. I can tell you a couple things that are not related to care at all. In one of the first shifts I worked in a surgical unit, it was an eighteen-bed surgical unit and this was in the late ‘60s. We didn’t have any TVs in the hospital. There was no television in the hospitals at one time. We actually had to get permission for a patient to bring in a little table radio, to listen to the radio. They put antennas up on the old Fall Hill hospital for some reason. I don’t know why the big antennas were there. But anyhow we had a patient who had been in a motorcycle accident and fractured both legs and then you stayed in traction for six to eight weeks. It was physical traction to pull the bones back together rather than doing surgery. This patient was going to be with us on this unit for eight weeks. His family went out and bought one of the first little small televisions. We hooked it up, plugged it into the wall, and of course all you got was snow. 3:00 to 11:00—after five o’clock it was pretty calm and a lot of people went home. We didn’t have a lot of people in the hospital from administration. One of the gentlemen from engineering said, “You know I can go up on the roof and I can drop a cable wire down to this room and we can bring the cable in and hook it up to the TV and see if it’ll work.” This was all terribly illegal, but I’m still here. He went on the roof, dropped the cable down, and it was swinging outside the window. I leaned out the window as far as I could and got a broom or something and pulled that cable in. [01:03:00] Unbeknownst to me, Mr. Bach, who was the administrator of the hospital then, had his office was right down on the first floor. He happened to see the commotion outside, looked out the window, and there’s one of his nurses leaning out the window in her white uniform because we wore white then. Anyhow, we hooked up the TV and it did work. I had a call to Mr. Bach’s office next day: “Ms. Bartley I don’t want to ever see you do that again.” But I didn’t get fired. [laughter] There were things, and now that’s team. That was a real team and the TV did work and he got three stations. There were basically a lot of those things. A lot of those stories that a lot of people can tell you and things that you wouldn’t dare think of doing today.

01:03:50
Rigelhaupt:
Well speaking of Mr. Bach, what do you remember about his retirement and the transition to Mr. Jacobs as the CEO?

01:03:58
Bartley:
I think it was the fact that Mr. Bach had been at the hospital for so long and a lot of us thought, “How can we ever run without Mr. Bach?” Anybody who’s in a position for a long time and done a good job, you think you can’t. We loved Mr. Bach and he was very people oriented. We all came to realize after several years of Bill Jacobs being the CEO that he was on a fast mode and was going to take us to places we had never been before. He was really aggressive. His prior employment had prepared him to bring us to where we needed to be much faster and he really started the progression of this medical community, not just the hospital. He was a blessing.

01:04:53
Rigelhaupt:
Are there ways you can think back—the way the nursing program was supported? That maybe there were more educational opportunities or that when Mr. Jacobs was here in his first few years that he supported the growth of the nurses in the nursing program?

01:05:10
Bartley:
We did. We started the Department of Education, which was for in-house education and was wonderful. It served many avenues and then we started a co-op program in Germanna. That also was just wonderful because it met our needs for nurses. Then we had the students working in the hospital and then once they had worked in the hospital, we were able to retain a lot of those. They continued their careers with us rather than going somewhere else. Those two things: the department of education and working with Germanna for the nursing program were wonderful.

01:05:52
Rigelhaupt:
You talked about the growth with Mr. Jacobs. [01:06:00] One of the things that happened while he was here was the development of this campus and the new hospital. Not so much when it was officially announced, but weren’t there discussions, water-cooler talk, from internal to the staff about the hospital? Do you remember about those first conversations about there might be a new hospital up on this hill?

01:06:20
Bartley:
I think some of it was, “We don’t need that.” I think you heard it in the community: “We really don’t need a new hospital.” I think sometimes the public was so attuned to going out of town for health care. It was a way of life to go to Richmond. Then it became a way of life to go to Northern Virginia. The public here was just attuned to, “If you really want care, you have to leave Fredericksburg.” I think it was a culture. People didn’t expect to get top quality care in Fredericksburg and Bill Jacobs didn’t see it that way at all. That we could provide what a growing population needed right here and we were beginning to get more and more specialists in on our medical staff. They needed more space, more equipment, and they needed to start new programs. It moved to the point that it became a necessity. You wanted to provide what the community needed. I think Mr. Jacobs and the board were very forthright in saying, “We want to be the medical community here, not in Northern Virginia or Richmond.” It was a hard sell to people who were used to travelling to Richmond and Washington for care. I don’t think they trusted that the little hospital could do that. They really stepped out to say, “We have got to grow.” I think that was driven by the population growth. I really do.

01:08:07
Rigelhaupt:
Were there any challenges to selling it to the nursing staff or medical staff?

01:08:12
Bartley:
I think we all felt, “How will we ever staff a hospital that big?” If you were a nurse and you worked sometimes when you were very short—people got sick, called in, and then you didn’t have enough staff—you kind of remember the nights and days that you worked and pushed and took extra patients or stayed an extra shift because we didn’t have enough staffing. Every hospital has those problems. I mean that happens today. I think we thought, “How will we ever have enough nurses to staff a hospital that big?” But we do and we did. And then we’ve grown to be a Magnet status hospital for nursing.

01:08:55
Rigelhaupt:
And I’m going to come back and ask you about the Magnet status. [01:09:00] Do you remember having any input in how the rooms would be designed or how—the workspace being a nurse at the new hospital?

01:09:08
Bartley:
I was a head nurse then at the Fall Hill Hospital. Barbara Kane and I got sent by private jet out to Indiana to look at equipment. We did. I remember that explicitly. She and I were flown out and wined and dined, although neither one of us drank. Anyway, we were wined and dined to pick out equipment: beds, new Hill Rom beds, and ward equipment. That was one of the first things I remember. Then they would bring equipment in, bring in things, and nurses were involved in some of the things that were brought into the new hospital. We had some input into special things: how units should be set up. Barbara was really instrumental at that time, which was great. The head nurse group worked a lot at that time. We would have head nurse meetings for nothing but discussing the needs and had to look forward to what the needs would be ten years down the road. It was very challenging and we did on site visits at other hospitals that were much bigger than we were so we would get some ideas of what our needs would be.

01:10:32
Rigelhaupt:
What were some of the things that you were most excited about, that you thought would be some of the best parts of the new rooms and going into the new space both for nurses and how they worked and also patient care?

01:10:47
Bartley:
I think we were, in a way, excited about it being private rooms. We thought that was really great for the patient and the families. I think the fact of having storage room: you can’t imagine how much equipment we used to have sitting out in the halls because we didn’t have anywhere to put it. As the equipment amassed and the equipment got more technical, we just had more and more equipment. In the Fall Hill Hospital we had nowhere to put it. We had it at the end of halls, down the halls, or everywhere. The hospital really worked on having more equipment so that we had a safer environment. Now we have computers sitting out in the halls everywhere so we’re back to where we were before. [laughter] That seemed like a simple thing and nobody would understand it unless you worked with it because you had beds in the halls because you didn’t have any rooms and then you had all this equipment in the halls. [01:12:00] It was not a safe environment to be working around the equipment, around the patients, and in the halls. We knew when we got to the new hospital we would have free halls and we would have a place to put equipment. We wouldn’t have patients in the halls and the physical environment was really going to be a boon to health care and for everybody, including housekeeping. It made it so much easier for housekeeping to do their jobs in the new hospital. Each patient had a bathroom. That’s really important. You could get them up and say, “We’re going in your room, in your bathroom and take your shower.” You didn’t have to take them down the hall in the wheelchair to the communal showers and bathtubs and all.

01:12:49
Rigelhaupt:
Do you remember the last time you did a walkthrough at the new facility, probably right before it was going be open? What was it like to walk through this brand new hospital that didn’t have any patients in it yet, and knew that it was coming?

01:13:05
Bartley:
We did. All hospital employees had the opportunity to do tours before we moved in that one weekend. It just seemed cavernous. It was humongous. It just seemed like we’ll never find our way around. It was overwhelming, it really was. But once we moved the patients in and moved the equipment in, then it warmed up, filled up, and things were different. The tours we were allowed to do before we moved in, it just seemed huge and it did seem that way.

01:13:52
Rigelhaupt:
Were you involved with the move-in day?

01:13:55
Bartley:
I was not involved with move-in day. I had just moved here to FASC when they moved in September. I did not physically move into the new hospital. I had just come here. We were down on Princess Anne Street at the time.

01:14:13
Rigelhaupt:
When did FASC [knock on the door, door opening] move—when did FASC move to this campus?

01:14:24
Bartley:
Patty can tell you that, maybe. [Door opening] It’s been like, I guess, fifteen, sixteen years ago at least. We moved from Princess Anne Street up here. We felt the same way about this building when we came up: “Oh my goodness. It was so many doors.” We felt, “We’ll never find our way around.” It was huge compared to the unit we had down on Princess Anne. But it has served the needs.

01:14:55
Rigelhaupt:
Did the new space here create the opportunity to do different procedures? [01:15:00] What were some of the new things you could do because you had this new space on the hospital campus?

01:15:09
Bartley:
We had more operating rooms so we could do surgery on more patients. Because at the time we could see the surgeon, the outpatient surgeon was just tremendous. All over the United States and that was driven a lot by insurance: “We won’t pay for this to be done in a hospital.” You can’t stay overnight. We won’t pay for that.” A lot of the patient population was drifting more and more to outpatient surgery. Again, that was a great decision made by this corporation. We got to have a bigger facility because this is the way health care is going. If we want to stay in the market for this, which is same-day surgery, we have to have a bigger building and more operating rooms. More and more, even today, more and more things are being done. Sicker and sicker patients are being done because we have better equipment, better anesthesia oversight, and we can do patients that years ago would have been done in the hospital. Even though they are not as stable medically, we can still do them in outpatient surgery because we’re educated and can do that.

01:16:24
Rigelhaupt:
Part of the story of Mary Washington is that the new facility opened up the possibilities of surgical sub-specialties. What are some of the clinical practices, the milestones you would point to after the first few years after the new hospital opened that began this part of the medical practices offered at Mary Washington and in the community?

01:16:46
Bartley:
The biggest one I think of is cardiac surgery. Everybody had to go out of town for cardiac surgery and they opened up the cardiac surgery. That’s the biggest thing I can think about. Then we have all this joint replacement—now we do all the joint replacements that you used to have to go somewhere else to do. We have neo-natal intensive care unit—babies are delivered here that weigh a pound and a half. They stay here and thrive and do well. Just so many things. We have specialty medical intensive care units. If you are just really compromised, medically, you can stay here rather than be transferred out. As I said, we transfer very little anymore. I think the biggest thing I saw happen was the cardiac surgery program that started here right after because we had to have the operating rooms for that. Those rooms are huge. You have got to have all that space to get all that equipment in. You had to have a cardiac step-down unit to take care of these patients and all that equipment. That was a big program that started.

01:18:00
Rigelhaupt:
Another part of specialization is that its not just physicians and surgeons and their specialty and surgical sub-specialties, but that nurses and other staff members on the team become more specialized. Did you see that happening in other places, other than cardiac surgery? Was that a model that began to be emulated in other units within the hospital?

01:18:29
Bartley:
I think when we got the department of education, it encouraged nurses to get more education. The hospital supported your education financially and there was a commitment from them through scholarships and so forth. Many, many nurses went back: the LPNs went back to become RNs, RNs went on to be BSNs and Masters, and a couple of them have gotten their doctorates now. The other thing is we got into certification. That was a national thing, not a local thing: where you could be certified in a specialty. You could study, take your test, and if you wanted to specialize, you had a certification. We started clinical ladders, which meant that nurses could work their way up to management. You studied, you took the test, you learn what you needed to do and you inspect. You worked your way up and that was a great deal of encouragement for nurses to continue education. You were offered the opportunity to go to national meetings with funding from the hospital for that. So many, many nurses got to go all over the United States and still do for things that you can’t do here. Of course, now we do a lot of Internet. You don’t have to travel as much anymore to meetings as we did before. It was a big encouragement for nursing and other departments too, to continue education, to be the top of your skill level, and to give you advancement. If you wanted to work hard, you could work your way all the way up to management if you wanted to. Barbara Kane is a perfect example of that. She was afforded that opportunity and took advantage of it.

01:20:21
Rigelhaupt:
One of the things you mentioned that Mr. Jacobs did, the CEO would support nurses and nurses’ education. So this is a question about Mr. Rankin and the transition from Mr. Jacobs to Mr. Rankin. Was it a similar level of support and are there other things you would point to that Mr. Rankin has done to facilitate the growth of the organization?

01:20:43
Bartley:
I think he just picked up and went right on with the ball game. They are not really any different. You are still afforded all those opportunities, even in the financial crisis health care is in now—and we all know it is throughout the United States. You still have an opportunity to get an education. [01:21:00] The foundation has a tremendous amount of money they can give for scholarships if you want to go back to Germanna or somewhere else. That is still continuing on. You just have to avail yourself of the opportunities that this corporation has. You have to seek it for yourself. If you want it, it is there for you, advancement in education. That hasn’t changed at all.

01:21:29
Rigelhaupt:
One of the milestones you mentioned earlier, Magnet status in 2009. Could you describe—were you involved in building up to Magnet?

01:21:40
Bartley:
I was.

01:21:41
Rigelhaupt:
The application?

01:21:43
Bartley:
I was not involved. Now our manager here was involved, but I, as a nurse here, was not directly involved in the magnet. We were well aware of what was going on. We were well aware of what we needed to do here, as a nursing unit here to support that Magnet application for the entire organization. We had to meet our standards and prove and do all the things that we had to do here. It is a great boon when you are Magnet status. There is quite a lot involved in it. It’s also commitment to say, “We want to be the best for our community.” It proves a commitment to your community. Even though they may not realize it, we’ve worked hard to be the best nurses we can be.

01:22:31
Rigelhaupt:
Were you in the atrium when the phone call came about Magnet?

01:22:34
Bartley:
No, I wasn’t.

01:22:36
Rigelhaupt:
But how did you find out that magnet had been achieved?

01:22:39
Bartley:
It just went all over. That whole day it went all over the system. Of course it came through your emails, but it spread like wildfire. It did. We had no doubts we weren’t going to meet it anyhow.

01:22:52
Rigelhaupt:
What did it mean to you to have it stamped, and it was delivered and you had officially won Magnet status?

01:22:57
Bartley:
It said we had reached a goal. We had reached a goal. You strive to be the best and we had reached that goal. The other thing it says, though, is that we care in this community about our patients and the care we give. We want to be the best. We just want to be the best we can and this is just another way of doing that.

01:23:23
Rigelhaupt:
I want to jump back in time to when you started in 1964 because it was an era of profound change.
In this part of the country, particularly around public facilities, hospitals included, in terms of race and access. Had Mary Washington desegregated when you started here? Or was that something that you witnessed?

01:23:48
Bartley:
We had. We had desegregated. When I was at UVA up until ’61, we did have segregated units up there. We actually had segregated by skin color. We also had segregation by sex. [01:24:00] We had a men’s unit and a women’s unit. When I came to Mary Wash, we did not have that. It was integrated units then. It had already taken place when I came here in ’64.

01:24:13
Rigelhaupt:
Was it relatively recent had you heard anything?

01:24:15
Bartley:
It had just occurred. It hadn’t been long.

01:24:19
Rigelhaupt:
Was it controversial within the hospital, or—were people still talking about it or at least recognized that this is the way it’s going to be from going forward?

01:24:26
Bartley:
I did not see it as a divisive action at all. And I still say it is because we were a rural hospital. We didn’t have the stigma of Chicago, New York, San Francisco. The people here were a small community. I don’t think skin color was as big a divisive force at that time here because it was such a small town and a small rural community. So the impact might have been less than it might have been in a big, urban area. I don’t remember it causing problems. I do remember several times, people saying to me, “I do not want to be in that room with a black person.” I do remember that happening and we did make changes. I remember that happening, but it was the exception rather than the rule.

01:25:29
Rigelhaupt:
So there were some issues with patients?

01:25:31
Bartley:
Yes. Right.

01:25:32
Rigelhaupt:
Not as much with nurses and the medical staff. Were there more nurses working in different units? The segregation that you said before was—I mean Xavier Richardson, now the vice president of the foundation, describes being born in a colored ward. I guess that’s what it was called just a few years before.

01:25:52
Bartley:
Yes, that’s true.

01:25:56
Rigelhaupt:
But probably the staff then was also, was segregated by race. Had that changed? Were there more RNs, nurses working all around?

01:26:11
Bartley:
I don’t remember so much. Some of the best friends I have today were African Americans. The lady that taught me so much, an LPN in the emergency room was an African American. I don’t remember in nursing, us being divided by skin color. It may have happened, but I don’t ever remember it being an issue with me. I think back of the people that I worked with and I do think that most of your RNs were not African American at that time. I did not have any African Americans in my class at UVA. [01:27:00]

01:27:04
Rigelhaupt:
So you saw a difference in terms of the hospital staff here, than you saw at UVA. In terms of the floors, in terms of patients?

01:27:16
Bartley:
I did. It was much more pronounced at UVA. But that changed. That changed radically and in no time after I left there.

01:27:28
Rigelhaupt:
What do you remember about the—excuse me I’ll take a turn to cough—the development of Stafford Hospital, the second hospital within the health care system and how that was talked about among nurses?

01:27:44
Bartley:
All I remember, basically, is when it came out that MediCorp was thinking about another hospital up in Stafford. I think what we would remember are times when we were full again. You know with flu season in the winter, there came times at the new hospital when we did not have any new beds. We were back in a situation where we were again. We had developed a unit in the emergency department where you would retain patients down there and hold them because you did not have a bed. It seemed the logical thing to do. “Here we go again.” We’re in this situation again, where we’re running out of beds and so it seemed plausible that there was another need for a hospital. Of course, Spotsy Regional [HCA Spotsylvania Regional Medical Center] came along about the same time. Now we have three hospitals and hopefully the bed situation is met. But the population still continues to grow. Amazing.

01:28:56
Rigelhaupt:
Your discussion of beds is an indication that hospitals traditionally have done acute care, medical care in acute cases and generally speaking, the history of this country and even not-for-profit community hospitals has not been a focus on public health or primary care. But certainly I’ve heard of this organization being involved in the community benefit and thinking about primary care and trying to provide health care outside the acute setting. What are some of the ways in which you’ve seen the organization try to provide primary care for community benefit?

01:29:36
Bartley:
Years ago when the patients were discharged that was it. They went home. They may go back to the doctor, but there was no follow up really. Then the corporation developed home health, which was just a blessing because there are so many patients that need follow up. There are so many things that needed to be done for patients in the home and that was the best place for the patients. [01:30:00] When I did infection control, what I realized was the sooner we could get the patient out, the incidents of infection control would drop because the longer you stay in an American hospital, the longer you get exposed to germs and more hands. When we had home health, then we could send our patients out sooner because nurses were going in to give the care that could be done. That was just a blessing there. Then there are many other avenues that health care is given by church groups and civic groups. Education is done outside of here by lots of people. The Moss Free Clinic was started, which has delivered a magnitude of care. I think anything that benefits care outside of the hospital, this corporation has supported financially and physically, to bring health care outside of the walls. Of course, we have seminars given all the time for the public to come in and get educated and to voice their opinions too, about what they need and what their needs are too. They’re open to the public and on what they need. Of course you can’t satisfy everybody all the time. There are always going to be unhappy patients. There are always going to be surveys coming back where you didn’t do this and you didn’t do that. But you know you are trained, you’re equipped, and you have the desire to give the best care you can and you just live with the rest.

01:31:47
Rigelhaupt:
What would you most want the public to know about being a fifty-year nurse at Mary Washington that might not be common knowledge?

01:31:58
Bartley:
I guess the main thing is that I feel that I was created to serve. That comes from being a Christian. I am here on this earth to make things better and to be a part of making things better, which is being a part of a health care system. I have been blessed by being able to do so many things in nursing and in this organization and I have been able to be a patient advocate. If we didn’t have patients, none of us would be needed, from Mr. Rankin on down. As long as I remind people, as I do real often, that if it weren’t for the patients, you wouldn’t have your job. You wouldn’t be in the business office. You wouldn’t be in dietary. You wouldn’t be in housekeeping. Not just nursing, but every medical complex has to put the patient first and then you will be a success. I have just enjoyed every day that I have been a nurse. Even though I’ll retire at the end of this year, I’ll still be a volunteer nurse in many avenues in this community. And I think the main thing is I know without a doubt that I was born to be a nurse. Then once I became a Christian, I knew that my gift was to be a nurse, serve mankind, and try in a little way to make things better. The main thing is always to be the patient advocate.

01:33:44
Rigelhaupt:
Thinking about fifty years at Mary Washington, what are some of the things you want the public to know about the organization that might not be common knowledge?

01:34:01
Bartley:
There’s not much that’s not common knowledge anymore. I guess it’s the people behind the scenes that don’t get the accolades. It is a team effort led by people that have vision. I guess that is what I account to Bill Jacobs and Mr. Rankin. I know there are people in the community that have different views on hospital administration, but we’ve had people that had vision. Had we not had top officials and board members who didn’t have a vision of what this community needed, we would not have the medical care that we have in Fredericksburg today. I think we can all agree to disagree on how we reach those goals and that’s just human nature—nobody’s going to agree on everything. There have been big split and there has been dissension here and in the community about health care issues. I think you just have to have a vision. We still have to have a vision. I mean health care and technology is just rampant today. We still have to have a vision of where we are going from here. I never envisioned this hilltop having what we have got today. I could never envision what’s up here. We’ve probably just touched the surface of what going to happen in the next twenty-five years and we still have to have leaders that have vision. You can disagree with us as a community or with the avenues we take, but I hope the community never discounts that vision is what has brought us this far.

01:35:51
Rigelhaupt:
My last question is two questions, but I’ll ask them together. One, is there anything I should’ve asked, but I didn’t? And two, Is there anything you’d like to add? [01:36:00]

01:36:05
Bartley:
It’s not something you didn’t ask. It’s just that over the fifty years I have developed so many friends in the staff, but also in the patients. I will see people out in the community when I’m buying groceries or whatever that say, “Phyllis, I remember when you took care of me.” That is just the warmest feeling. When I’ve been in this community this long, I feel a big part of this community. When I see people now I will say, “You know I can’t remember your name, but I remember we took your gallbladder out.” That is just a blessing to have been here this long. When we moved here, we never intended to be here this long. I think the blessing is I have made so many friends in the people I’ve worked with. I’ve also made so many community friends in the patients that I’ve taken care of. There are many physicians that I just revere and treasure as friends. The medical staff has just been fabulous. At times, nurses and doctors weren’t as close as they should’ve been, as a team. Then we worked on those efforts when we found that. I’ve just been blessed by the friends I’ve made and the patients I’ve taken care of. I really love seeing people in the community and they’ll recognize me and I don’t recognize them. I just don’t fake it anymore. I say, “You have to tell me your name and where I know you from.”

01:38:00
Rigelhaupt:
I think that’s a great place to end. Thank you.

01:38:01
Bartley:
Thank you.
[End of interview]

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