Tamara Jeffries

Transcript

00:00:05
Rigelhaupt:
It is November 14, 2014. We are in Fredericksburg, Virginia at Mary Washington Hospital doing an Oral History interview with Tamara Jeffries. The first interviewers’ voice you will hear is Marie Clifford. I will be the second interviewer and my name is Jess Rigelhaupt. I’m going to turn things over to Marie to get started.

00:00:25
Clifford:
So I thought I would start off with the first question being when and why did you decide to become a nurse?

00:00:32
Jeffries:
I would say probably before I went into middle school. My grandfather was a pastor and we went to nursing homes quite a bit and I just fell in love with the whole nurturing, caring environment, just seeing how the nurses were there for the patient, and how the patients appreciated and basically loved what the nurses did for them. That was my first inkling that I would go into nursing. Both my dad and grandfather worked at the Washington Hospital Health Center, which I guess is now called the Hospital Center. I candy striped there for a summer. Again, just seeing how nurses make such a huge difference in people’s lives and just the nurturing caring personality. That is probably the biggest reason I went into nursing.

00:01:45
Clifford:
That is beautiful. So can you tell me about your first shift as a nurse?

00:01:53
Jeffries:
My first shift as a nurse?

00:01:54
Clifford:
Yes.

00:01:56
Jeffries:
Oh my goodness. My first shift was at the old Mary Washington hospital and I started there June of 1993. I was probably terrified, not that I did not know what I was doing, but just knowing that I was the primary nurse. When you come out of nursing school you have a nurse who you work with. You are not all by yourself—not that I did not have a preceptor at Mary Washington—but still knowing that that was my patient and I had to do all their care and give all their medications. It was also very rewarding and exciting because you are their caregiver and they depend on you giving them the best care. Throughout the night, because I worked evening shift my very first shift, I became more comfortable. I was nervous being the person explaining everything I was doing. [03:00] I think I was confident, but also felt I needed someone behind my back checking on me because I just came from nursing school. I think it was very rewarding and exciting, but nerve-wracking at the same time. If all those things could be at the same time. So it was an exciting experience.

00:03:32
Clifford:
You mentioned education, which degrees do you have?

00:03:35
Jeffries:
I got my bachelor’s in Nursing at George Mason University, which is in Fairfax and then in 2012, I got my master’s from Walden University. Those are the two degrees I have.

00:03:53
Clifford:
Would you say there is more pressure on nurses to go back to school today?

00:04:00
Jeffries:
I think it depends on what kind of nursing you are interested in. That makes a huge difference. I actually went to my school nurse when I was in high school to see what she may have thought whether I should get my ADN, which is an associate’s degree, or my bachelor’s. She at that time said you can do a lot more with a bachelor’s and she highly recommended me to get my bachelor’s degree. But I really think it has a lot to do with what avenue you want to work in. If you work in a doctor’s office you may not feel like you need a bachelor’s degree. I always saw myself as moving more towards a public health interest and in order to do that I needed a bachelor’s degree. Obviously, I am not in public health. I think now in hospital settings because of things like Joint Commission and Magnet and those kinds of things, that we are moving more towards a four year degree, a bachelor’s degree. I think again like in my department you need a bachelor’s degree to work as a full time nurse. More places are requiring a bachelor’s than an ADN. I think as an organization we look to encourage getting four year degrees and furthering your education.

00:05:48
Clifford:
So I heard you stayed at Mary Washington for your whole career as a nurse but you have switched units and changed positions. [06:00] Could you maybe tell us what units you worked in and when?

00:06:07
Jeffries:
I came out of nursing school in 1993 and started in the old Mary Washington Hospital. There I started on a medical floor. We mostly had geriatric patients, detox patients, and some medical patients. From there, in September, we moved to the new Mary Washington and I went to the same floor. It was just 3 North at the time. From there, 3 North had some changes and I transferred to 4 South, which is still 4 South here and is renal and respiratory. So we took care of the respiratory and COPD patients. We had dialysis patients and, we did peridialysis. We had some vent patients, some long term vent patients. In 1998, my husband wanted to go back to school. With two small children we decided that I would start to look for something that was more of a Monday through Friday position and thankfully I had a nurse that worked PRN in the department I work in now: Employee Health or Health and Wellness, which is what we call it here. Luckily they had an opening and I was chosen for that opening. I have been in Health and Wellness since then, but it is more taking care of the associates. My job is I get to be the nurse for almost 4,000 some associates for Mary Washington Healthcare, a big difference between taking care of patients on the floor and being a staff nurse. In 2009, I went through a leadership program and became the manager of the Health and Wellness department and I am still there now.

00:08:00
Clifford:
So you had the ability to move positions, but would you say lately it’s been the same way with other nurses or would you say it is harder for other nurses to change positions?

00:08:12
Jeffries:
Again, I think it depends on what type of nursing you are interested in. There are definitely different types of nursing where you need to be more specialized. If you are going to be a nurse in IS which is Information Systems, then you need to have some type of computer background and education. I think within the organization overall, because we are the department that sees when people transfer and where they transfer, we make sure people are appropriately able to be transferred to different departments. I think as long as you have the skill set, we give opportunities for people to move to different positions and get different experiences. [09:00] But again you have to meet the specifics whether you need your bachelor’s or your master’s. I think because we have a leadership program here, it gives our staff and staff nurses opportunities. If your manager feels you can and if it is something that you would be appropriate for you, then you can go through that leadership program and therefore potentially move into more of a leadership role. I do think we give the opportunities as long as you have the skill set for it.

00:09:45
Clifford:
So as a nurse what challenges do you see or do you face?

00:09:55
Jeffries:
In my own department or in nursing in general?

00:09:57
Clifford:
Whichever way you want to answer it.

00:10:00
Jeffries:
I can answer both ways. I think in nursing in general, the challenges are because of all the changes happening in health care right now. At least in my department we see associates who may be ill or have a health care issues which impairs their ability to work. If you look at health care in general and because of the changes, there have been some more challenges for people getting care, even though its health care for everyone. There are still challenges to that. There are cost prohibited challenges. If you are in that middle area and you need health care and you make a certain amount of money you are still going to be paying more than maybe you can afford. That is one challenge that I see just in health care in general. In my department, in general, I think it is getting our associates healthy. Health care organizations tend to spend more money on health care than other types of businesses, manufacturing businesses and those kinds of places. It’s showing people that being healthy and setting that example for your patients is important. I think as health care providers and even as nurses we tend to take care of others really well, but not take care of ourselves as much. That is one of the challenges we see on our side: showing that if you take good care of yourself you can take better care of your patients.

00:11:55
Clifford:
What advice would you give to aspiring nurses?

00:12:00
Jeffries:
I think first of all it has to be your heart. You have to have the heart for nursing, yet you also need to definitely follow what your interests are. At least in nursing school I encountered quite a few nurses—not in this area, all my clinicals were in Northern Virginia—where you could tell that it was in a family. My mom was a nurse, my grandma was a nurse, or it’s what girls do, it’s what females do, which is totally different now. But I think it is knowing in your heart that you love to take care of people and health is important to you. I don’t know how I want to say this. You have to be selfless if you want to be a nurse because you really are giving of yourself and sometimes that means working on holidays and not being home with your family or working shift work. People who really love nursing and went into it to nurture and take care, it’s natural. Again, since nursing has so many avenues there are so many opportunities in nursing that for me—because my husband wanted to go to school, and there was no way I could work night shift, than I had the opportunity to choose some other place to work and still felt like I was following the path of nursing. I think just being able to follow your heart. And if you’re a little scared of blood like I was—I didn’t like seeing my own blood—sometimes you can overcome that, as long as it’s not your own.

00:14:09
Clifford:
That’s funny. So you mentioned that everyone thinks it is just what women do and that that has changed. Could you maybe expand on how it has changed?

00:14:20
Jeffries:
Obviously, I see a lot more male nurses. It was probably starting to change when I was in nursing school because we had a couple of male nurses that were in school with me. I also think that it is more acceptable now. Maybe it is that parents are more willing to say do what you want? It is in society itself. We can choose a career and there is nothing, hopefully, holding us back as long as it is something you want to do in your life. [15:00] I even have a nephew who is a nurse. I would say that since I have started as a nurse, male nurses have doubled, maybe tripled. We just have a lot more male nurses and it is more acceptable. That is society and I think it makes it more acceptable to do that. Now, some of the elderly patients, especially the female elderly, still say, “Am I really going to have a male nurse?” It may be hard for some of our population to have male nurses, but I think that male nurses bring a lot to our nursing profession.

00:15:50
Clifford:
What other shifts in the image of nursing have you seen, maybe since you started?

00:16:00
Jeffries:
I think we are a lot more autonomous as nurses. You really are making decisions every day that maybe in the past would have been more decisions that a doctor would make. They come up with standards of care, but I think nursing is a lot more autonomous than it was. I think that was beginning to change even before I became a nurse. As I was coming into nursing, and depending on where you work, like in my department, you are very autonomous. We see injured associates, we see ill associates, and a lot of times we have a medical director, but not a doctor on site. Sometimes our autonomy means get that person out of here and get them to the doctor or to the emergency room. I think that we have grown in our relationships with our ancillary departments and medical staff. Nursing is not just taking care of patients. It is a lot more than that. There is budgeting and insurance. There are just so many things, which I probably never even considered when I first came out of nursing school. Now, as I’ve worked through the years and I have gotten my master’s and I have had to sit with the finance people and insurance, you see that there is a lot more to health care and nursing than just being at the bedside and taking care of the patient. I do not think that at the time I probably realized that as a bedside nurse because I was twenty years old and was just trying to do what I needed to do for my patient. [18:00] I was not considering what kind of insurance did they have or who is going to take care of them at home or how they are going to pay for a nursing home, those kind of things that I think now nursing has really embraced. I think Mary Washington Health care has helped us to encompass all those things so we can take better care of our patients.

00:18:20
Clifford:
So I guess my final question is what do you see in your future? In health care or what you maybe want to do? Do you want to stay where you are?

00:18:32
Jeffries:
I mean I would like to retire from Mary Washington Healthcare. They have been so good to me. At the time, when I was in high school and nursing school and I chose to get married, even before I graduated, they had what was called the “Tree of Lights.” They paid for my last two years of college and then I had to work for them for three years. Twenty-two years later here I am. I see myself staying here until I retire whether or not I will be in this department—I mean, I love doing what I do. I think we make a huge difference with our associates. I love the people I work with. It is hard for me to say. I think once I retire from full time and move on to a warmer climate that would be the time when I would want to teach. Right now I am teaching. I am teaching in the evening time, a LPN class. I think that would be something I would like to continue to do because I think preparing others to move into a career in nursing has been rewarding. It’s something I am new at, but I think it’s something I see myself doing once I retire from the position I am in now. Beyond that, who knows?

00:20:10
Rigelhaupt:
So if I could take you back to June of 1993, starting in Mary Washington Hospital, where did 1-East fit within the hospital? Even if you could walk me through parking your car and walking into the unit, where did it physically fit and how did it fit in clinically?

00:20:38
Jeffries:
The old Mary Washington is actually right across the street from where I work now. 1-East—I would say if you talked to people who worked here for many years you would hear 1-East was a hard floor. It was actually on the very lowest floor of the old hospital. [21:00] I would say as a new nurse walking into the unit it was a little intimidating. Again, we had pretty sick patients and we had detox patients, which are always interesting. We had semi-private rooms at the time. It was small compared to what the units look like now here. But I think if I look back, and I do not know if I am answering you correctly. If I look back at the experiences I got from working on 1-East, just in taking care of two patients in a room compared to taking care of one patient in the room and the types of patients, I think I probably got more experience, life experiences, as well as just nursing experiences on that floor. Sometimes you have that feeling of wanting to conquer something really hard. When I choose that floor the comments I got were, “Well, this is a really hard floor. You sure you want your first job to be on that floor?” And I am not sure if I am answering your question correctly. I think it is that excitement of walking on a floor and knowing it’s going to be something different. I am not going to be taking care of the same exact patients. I mean they might be the same patient, but there is always going to be some sort of challenge or something different going on. Does that answer that question correctly? I’m sorry, what was the second part of that question?

00:23:00
Rigelhaupt:
Just where did that fit? If you could describe that unit and the other units you remember at the Fall Hill location.

00:23:56
Jeffries:
It was on the very bottom of the hospital. This seems silly, it was more, compared to when you looked at the oncology unit—and maybe this was because I was new—it felt more secure and more challenging, yet I felt I belonged there. Everybody there always made me feel like I belonged. I did not work on the other floors so I could not tell you how other floors were in that instance. [24:00] For the hospital in general, 1-East was the challenging floor. Not that other floors did not have challenges, but that is what you would hear as a new grad. You would hear “Wow, you work on 1-East.” Now when I moved over here, it totally felt different because it was a brand new building and you had one patient per room. Sometimes it’s a challenge when you have two patients to a room with confidentiality, just care in itself, and with family coming in and out. It felt tighter, closer, more confined spaces and then you had here where it is open and inviting for the patient. The patient probably felt more customer service with having your own room and not having to share and not having to hear someone snoring or up in the middle of the night. I am still not sure if that answered your question.

00:25:21
Rigelhaupt:
Did 1-East speak to your interests in public health?

00:25:30
Jeffries:
Definitely. I would say my love has always been geriatrics and again I think that came from spending time with my grandfather, visiting the elderly, and going to nursing homes. I interviewed for several places when I first came on as a new grad and I chose that floor because of my love for the elderly. Public health being patients in the community who may need care outside the hospital, maybe not hospital care, maybe not nursing home care, but that care in between. Public health. It definitely did remind me of some of the things I saw when I did my public health clinical rotations in college because we do have meals on wheels. Maybe not maternity, because we did do maternity in public health. I did enjoy meals on wheels, visiting patients that were home bound, and daily checking and wound care, and those kinds of public health practices. But also in the job that I do now, public health also has to do with infection control and infectious processes and outbreaks. [27:00] I may not have gone into the position where I am doing home visits and public health, but now I am doing department of health TB testing, follow up on exposures and outbreaks, and those kind of things. I think 1-East did give me a taste of that and helped me move into this position.

00:27:41
Rigelhaupt:
When you started in June of 1993 the facility we are in now is new–twenty plus years old and it is still new–and it had been completely redone. Can you describe your first walk through of the new facility when there were no patients in it and to familiarize yourself with it? What was it like to be in this new building that did not have patients in it?

00:28:08
Jeffries:
It was very exciting. We moved into this building in September of 1993. Prior, all of the staff was able to come over, tour, and look at the unit you were working on. I did get to do that. It was very exciting. When you look at the old layout, with the rooms being right next to each other, the new layout was like “Wow. I will be doing a lot of walking.” That is good for us. Trying to familiarize yourself from a standpoint of time management and where things are. We were still using paper documentation until even after I left, to using different machines and medication dispensing. The nurse’s stations were huge compared to the ones we had at the old Mary Washington. So it was very exciting. I was not involved with the move over, but I think I came in the day after the move over and it was just amazing: the day before everyone was moved over in a certain amount of hours and then the next day when I came in everything was all set. It was like, “Wow, that is magical.” I think it was very exciting as a new grad to be able to have that experience, especially when I went to school in Northern Virginia and did all my clinicals in huge hospitals like Fairfax, Mount Vernon, and Arlington. [30:00] I chose to apply at Mary Washington out of nursing school, which was the smaller one, the old one was a lot smaller. It was exciting to move into this new big facility. It was state of the art. So I felt very lucky to be able to do that.

00:30:31
Rigelhaupt:
Did you sense a change in the nursing program generally speaking because you were working in a new space, that the building had an effect?

00:30:41
Jeffries:
I think nursing care was still great. As with anything new, the excitement gets people all riled up and ready. It was the learning of a new space and appreciating that the patients now had their own rooms and that they were bigger because they did not have two people in them. But I don’t think it changed nursing care. It was a learning curve for nurses moving over to the new hospital. The space difference and the way the units were laid out as compared to what they were there, which was two sides of it and the nursing station in the middle. It is a little bit different here because you are in a big circle. There was an excitement when we first moved over. I think it was exciting for the patients too.

00:31:58
Rigelhaupt:
What are some of the departments that 1-East works with? And part of my thinking is that I imagine some of the patients come through the emergency department and these are not planned. What were some of the departments you worked with when you were on 1-East and 3-North because it sounds like the same unit?

00:32:28
Jeffries:
It was the same unit, just located differently over here. Basically, you work with a lot of the departments. We worked very closely with the emergency department because we would get a lot of the emergency room patients. We worked closely with radiology. We are a medical floor and we had wound care nurses. [33:00] We did work with psychiatric services because we did detox on that floor. Also the OR. It is hard to say specifically because we worked with most departments. You would have endo, you would have the OR, you would have radiology, and cath lab. We were not a surgical floor, but if something was to go in that direction than we would have to work with same day surgery—say if the person was coming from same day, and then for some reason come to our department. Collaboratively the same thing on 3 North: we were all very collaborative when it came to taking care of a patient. Physical therapy—lots of departments. We would even work to the point where nutrition was involved if somebody had a special diet or special request and we would work with them and the dieticians. Taking care of patients is not just nursing, but a multitude of people and departments.

00:34:33
Rigelhaupt:
When you started here it was before hospitalists. What were the relationships between physicians and nurses? Maybe even just focusing on 1-East or 3-North, where you worked when you first started? If you could share thoughts of the general hospital around that time that would be great too, but obviously what you saw firsthand.

00:35:00
Jeffries:
The change to hospitalists is good because you always have someone here admitting the patient and taking care of the patient. I think the difference is when I worked on the floors initially it was the relationship with your primary care physician, which in a lot of the cases would be admitting the patient. Then you would have the specialist who the primary doctor would consult. I have not been a staff nurse since we moved to hospitalists, but from my own family’s thought of having a hospitalist compared to their primary care, it feels different. [36:00] That person has never taken care of me, while my primary care doctor has known me all my life. I think that has definitely been a change. I know now with the nurses on the floor they know the hospitalists because they work with the same ones and there are less of them to work with compared to primary care. That has probably made a difference, but I think in general patients really liked having their primary care doctors come and see them. And we still do have primary doctors that come in to see their patients if they are in the hospital. But the hospitalists are the ones who direct the care and consult other doctors. That has been a change that I personally never had to deal with as a staff nurse. When I was a staff nurse I could see patients liked their primary care doctors seeing them. And when their coverage came in to see them and they think, “They do not know me. How are they going to take care of me?” That has been a change most hospitals I know of are going through and have done it for many years now.

00:37:33
Rigelhaupt:
What were some of the clinical skills that you were most proud of developing the first year or two you were out of nursing school and practicing with other nurses? You learned something about it in nursing school but it is different.

00:37:50
Jeffries:
I was actually lucky to have gone to the nursing school at George Mason because they have the preceptorship program, which means you went for nine weeks and then when you were done with your nine weeks you were taking care of patients yourself, a full load of patients. That did help. After nursing school when I started being a floor nurse I would say some of the skills I appreciated getting as a nurse was starting an IV, putting in a Foley, and dressing changes. Then when I moved to 4-South, which is renal/respiratory, I was able to learn peritoneal dialysis; which a very specific aseptic technique you have to use compared to renal dialysis where they use a dialysis unit. It is different than peritoneal dialysis. So that was one skill. [39:00] An overall assessment of a patient has helped, which is what I do now. And again, we are very autonomous and we have to make the right decisions of whether we should move the patient on to seeing their own doctor or move on to other care, emergency care. That general assessment of the patient and even just listening to their lungs. I mean you did that in nursing school, but you always had someone there behind you saying “Okay. Well, you might have missed this.” It is just learning the skill of assessing your patient in the way that you are able to catch something before it goes the wrong way or when they are not doing as well as you expected to do. For me my favorite part of nursing care was talking to the patient. All that information you learn, especially with an older patient—you learn so many life lessons. When you work night shift, are going in, and someone is not able to sleep at night it is the perfect time to assess them, talk to them, just sit with them to learn more about their life or the way things were fifty years ago. I think that was probably the one thing that was the most impressionable on me: the talking and getting to know your patient.

00:40:42
Rigelhaupt:
Early 1990s you are in nursing school. One of the things from my understanding that is happening nationwide is an emphasis on evidence-based medicine. I can’t say that it was not happening here, but as a smaller community hospital compared to a big academic medical center where it may have happened first or in a school environment. What were some of the things you remember learning in school about evidence-based medicine that you saw being implemented as you started practicing as a nurse at Mary Washington?

00:41:27
Jeffries:
That was a lot of years ago. When I was in nursing school, and actually it was my last year, Fairfax Hospital was already using computer systems to track what medications were given. Whatever came up from the pharmacy would then be documented on the computer. When I came to Mary Washington we were still using paper. [42:00] It had been a couple years since I had been here that we actually moved into that process and obviously even now we moved even farther. Everything is computerized. You are charting with a computer and not paper in those places. That was one thing I saw in nursing school that we eventually moved into doing. The practice was different, not that it was not evidence based. In some hospitals we did certain tests on our patients that were point of care. That means we would do blood sugars at the bedside among others at the bedside, which you did not send to the lab. So that was a little different here. That was the nice thing about going to a school in Northern Virginia: I experienced different hospitals in the way that they did things and when I came here it gives me the opportunity to say, “Hey, this is the way they did it there. Or maybe they were doing it a little more differently here and it was a better process even here.” Truthfully, I cannot think of anything else off the top of my head beside the MARs and the documentation via computers. I am sure there were different processes from place to place. Now we have moved from a small community hospital to a system, to a health care system, which has been rewarding to watch. We did not have cardiac surgery when I started at Mary Washington. We did not have a trauma center when I first started here. As an organization, the leadership and the board of trustees saw we had an opportunity to give services to our community besides what we were doing. I have seen them move toward more than you would expect from a small community hospital to offer. Our advances have made a difference in the area. [45:00]

00:45:02
Rigelhaupt:
Speaking of advances, you mentioned cardiac and trauma. Thinking about your twenty years here, what clinical programs would you point to as important milestones in the organization’s history and markers of that transformation from a community hospital to a regional medical center?

00:45:21
Jeffries:
I would say definitely the cardiac surgery, when Dr. Armitage came and started that up and I think that was in the early 2000s or something. Then moving to trauma and not having to send our patients an hour away has been a huge satisfier in the community. We also have our congestive heart failure unit and we have our diabetes management services who help with monitoring and educating our diabetes patients in the community. The organization gives back so much to the community by holding health fairs and offering services like the Moss Free clinic, which we sponsor. We have the stroke center that does the screenings on our patients for stroke. Our willingness to assist wherever possible. I know we do assist with the Spanish Symposium where we go out and we educate, give vaccines, and we do cholesterol screenings. I think as the years progressed that if an idea is brought to the leadership of this organization and there is a need, then I really feel we address that. We have the cancer center now at Stafford and at Mary Washington. We now have Stafford hospital. I was here for the onboarding of Stafford Hospital in 2009. [48:00] Where there is a need, we try to address that need and be as available to our community as possible so people aren’t having to travel so far for treatment.

00:48:11
Rigelhaupt:
A number of the things you described involve surgical subspecialties, which is part of a nationwide trend of more specialization in medicine. Did that shape the nursing program? Are nurses specializing more and are more team-based around specialty?

00:48:32
Jeffries:
I think we do have more specialty nurses now, just in nursing in general, again because there are so many avenues you can pick within nursing. Like in my specialty, which is occupational health, you can get your occupational health certification. You can get a certification in OR, your critical care certification—there are a lot more nurses who get certified in their specialty area. The organization stands behind their nurses in doing so. In nursing in general, I think, “Wow, I probably could not even think of all the specialties that there are.” We have research nurses now. Compared to when I got out of nursing school, you can specialize in education, IT, and so many different areas. Again, because of society changing and everything being more computer based, we need to have nurses there. We even have nurses in supply chain, where they are the ones looking at all the equipment we are purchasing and seeing what is the best needle and whether it is a safe needle? So I think yes specialization is definitely on the forefront when it comes to what is up and coming in nursing. More places are offering specialized training or certification in those areas.

00:50:34
Rigelhaupt:
What do you see as benefits in having a nurse in IT and informatics compared to a computer science graduates? What do they bring to supply chain and some of these places that we do not typically associate with nursing? What are some of the contributions and perspectives?

00:51:00
Jeffries:
First of all, most of these nurses have been bedside nurses so they know what it takes to take care of a patient. When you look at somebody who has their degree in computer science or informatics, and if they have never been at the bedside taking care of patients, how are they coming up with the best way to chart this? Or what about if I pick, “Yes. The patient has chest pain.” Shouldn’t something else drop down to ask other questions? That is why nursing is so important in something like informatics because you want it to be user friendly, with time management, and taking care of a patient. You want it to be user friendly otherwise you will be spending time at the computer and not with your patient. That is where nursing has a huge role in being in, at least, informatics. In supply chain, these nurses have worked in patient care so when the person who has never taken care of a patients says, “Well, let’s use this needle.” And then the nurse is like, “No. That is not going to work.” I think that is where it has been helpful. I think too, nurses tend to be able to talk to nurses in the way that is helpful and you are more likely to understand when you have a nurse saying, “Okay. This is not going to make sense or it is taking more time than it should. How about this?” I think that is the reason why we are seeing nursing going into so many more areas other than bedside nursing.

00:53:05
Rigelhaupt:
You mentioned technology in terms of being at a computer and not at the bedside. That is one the things with researching changes in nursing, that there is an increase use in technology. Some of the things we read in the history of nursing is there being an increase of tension because of a computer between you and the patient. And since you have worked at the bedside technology has been rapidly increasing in daily use. How would you talk about the tension?

00:53:42
Jeffries:
I cannot personally speak to that because I have not personally had to use the computer like that to document at the bedside. I left before that all came about. As an opinion, with at least the nurse I always needed to be, the patient care came first. [54:00] Spending time with the patient you learn more about what is going on with them then if you are out at the computer or charting. Just sitting in the patient’s room and charting was helpful. Being on the floors and seeing how the computerized machines work, they can roll them into the patient’s room and chart them standing there with the patient. I think there is resistance because it’s a change and with change there is resistance. Learning how to chart that way is not everybody’s niche, everybody is not computer friendly. I think if we make it a more tedious process we are going to miss out on being at the bedside with the patient. Again, you are going to do a better job, at least in my opinion, there at the bedside with the patient. We have to also document. I cannot speak to how others feel about that, but I can tell you what I see on the floors. They are doing it, a lot of them in the rooms, with the computerized charts. Whether or not it is affecting the care that they give, I don’t know. With change there is resistance and we are always going to be changing.

00:56:17
Rigelhaupt:
I want to jump backward in time again to 1993. What do you remember about learning about the values and mission at Mary Washington, maybe when you interviewed or decided to accept the position? What did you learn?

00:56:35
Jeffries:
I think Mary Washington does a great job and even then did a great job. I went through three days of orientation. Basically the mission was to give the best care to everyone in our community. That has not changed. [57:00] We didn’t have all the specifics, like the pillars or the “ICARE” values, but they were expected. We didn’t have the little acronyms to say what we should or shouldn’t do, but I think overall there was an expectation that you would give great care to our patients, be present, available to your patient, and honest. I don’t think any of that has changed but the way we are presenting it now is different.

00:57:58
Rigelhaupt:
Has that been consistent in the terms that the organization has presented it values and mission in the twenty-plus years you have been here?

00:58:08
Jeffries:
I think it has been. I think Mary Washington has been very consistent. It wasn’t spelled out like in “ICARE” Integrity, Compassion—but I think there was always an expectation. Personally, and I cannot speak for every person in this organization, but those that I have worked with have reiterated that there are values for taking care of our patients. Integrity has always been something the organization has stressed to us. I cannot remember if there were any kinds of specifics compared to now. My first year was more of a blur with all the excitement. Over the years we have stood strong on the values of how we take care of our patients and what the expectations are.

00:59:55
Rigelhaupt:
It is clear listening to you and other nurses I had the opportunity to interview that being patient centered is a core sense of being. [01:00:00] It is very clear to me why that would stay consistent over the course of a career, but thinking of over a twenty-plus years that the organization has stayed consistent with its mission and values and how you experience it. At the same time it went from 300 beds to 400 beds, to second hospital, highly specialized programs, and more and more surgical subspecialties. It strikes me that with all of that change there is the potential for losing some or value changes. Why do you think that the values have been able to stay consistent?

01:00:54
Jeffries:
First of all, at least since I have been here, Mr. Rankin has been here and I think he feels very strongly and has really led the organization to that expectation. Even some of the senior leaders in the organization have been here for years and there has been consistency. Marianna Bedway and Eileen Dohmann have been here for a long time. Their dedication to the organization, they really have because of that consistency, brought along that there is that expectation and that our mission, vision, and values have stayed the same and consistent throughout the years. It takes many to run an organization, but I think the leadership is so important because they set the standard. They have to be the ones you look to and say, “Okay. This is not going so well. Can you help me?” I think they always have done that. I have always felt supported when I have gone to my leadership over the years. That is because of consistency in the leadership and when new leaders come on they get mentored by the leadership that is already here. I think that is how we kept that vision and values going throughout the years. It takes a certain personality and heart for health care. [01:03:00] If you have that certain heart than it comes natural: you want to do the best and give the best to your patient, which is the center of what is going on in this organization.

01:03:15
Rigelhaupt:
You just mentioned leadership in terms of administration and nursing leadership, but I also want to reference back to the leadership program. Can you tell me about the leadership program?

01:03:23
Jeffries:
Sure. Basically every year they ask for the leadership to say if they feel anybody could potentially take on a leadership role within the organization. It is called “Pathway to Leadership.” I was one of the first ones to go through, “Pathway to Leadership.” This was done within the organization. It’s a yearlong process that you go through and it teaches you about how the organization runs and teaches you about things that you need to learn when leading others: being an effective leader and where you have your strengths and weaknesses, so you can work on those things. I feel that that was a great program, especially for people looking at advancing in the organization and who have a passion for the organization and want to eventually help others come into the organization that will also have that passion. The program started in 2008 or 2009 and they are still doing it every year. I think that also has a huge impact on the vision and values. We are taking people who want to be leaders in the organization and bringing them along so when they are interviewing and bringing other people into the organization it is consistent.

01:05:27
Rigelhaupt:
Do you recall any particular classes or instructors in the leadership program that were particularly memorable?

01:05:37
Jeffries:
Jo Ellen Armstrong is in Learning and OD here and is a champion when it comes to motivating people. She has been here for many, many years. She really is the face of education, learning, and really giving people the opportunities to advance and the education to do that. [01:06:00] I am trying to think of who else—some of the people are already gone. We had several of our vice-presidents within the organization came to talk to us about finance and human resources. Kathy Wall came in to talk about human resources and hiring the right person and those kinds of things. Then at the very end of our program, Mr. Rankin talked to us and he is very motivational in getting people to want to move forward in their careers. Otherwise all the other learning and OD folks who taught the classes are gone or were outside consultants and I cannot remember their names. Sorry. It has been a long time. It is a very robust program and we have seen quite a few leaders come out of it.

01:07:42
Rigelhaupt:
What are some of the things that you got out of the leadership program that you use frequently or realize you confronted something now as a nurse manager and that you remember, “I can do this.” How have you used it?

01:08:01
Jeffries:
Actually, we did a lot of behavioral interviewing. Since then I have hired a couple of people in my department and that has helped a lot. The hardest part for me, I worked as a staff nurse with my co-workers before I became their manager. At times that could have been difficult because now I was their manager. I think learning to support your staff and having an open door policy to allow them to be as forthcoming as they wish to be. That open door policy really helps create a team where you are addressing things as they come up and not waiting to the point where there are other issues resulting from it. [01:09:00] Being a team player and using the resources within the organization that are available to me or speaking with my HR business partner and going to our Reach program if there is an issue. Using whatever is available to bring your team together and assist where it is needed.

01:09:49
Rigelhaupt:
So thinking about another aspect of leadership. [Interruption and pause for a hospital announcement] Hospitals for most of the twentieth century have been run by an administration or a board, at least in the case of community hospitals, and medical staff and increasingly nurses and nursing leadership, but that is more of a recent phenomenon. So I am asking generally, over the course of your career, and however you want to space it out, but what have you seen as the dynamics between the medical staff, the nurses, the board and administration?

01:11:22
Jeffries:
Truthfully, when I started nursing I did not have the knowledge because I didn’t have much to do with it. At the time, I came to work, did my shift, and I went home. Not that nursing leadership wasn’t out there and we did have a director of nursing, but I think that now we have nurses in positions that helps bring change. [01:12:00] Nursing leaders being available to the nurses because, again, nursing care is a huge part of a patient’s stay here. A nurse spends the majority of the time with the patient. Having nursing in those leadership positions, they can help support the nursing staff with all the changes, with the time they spend with a patient, safety being an issue, and just being that spokesperson on the behalf of the nurses if there is an issue between the medical staff and the nurse. I think now more so than when I was working on the floor, the collaboration between the nurses and the medical staff has improved. We do not deal with physicians as much in my area on a regular basis, which is different from if you were a nurse on the floor and seeing doctors all the time. When you are walking through the hospital and making rounds you see the collaboration and change in the relationship between the doctors and the nurses. They really are a team and I think physicians really do consider the nurses’ opinions and they depend on the nurse to know what is going on. The nurse is the eyes and ears of the patient because the doctor is not always around 24/7 like the nurse is. That is why I think it is so important to have the nursing leadership: they are the ones who bridge the gap between the medical staff and the nursing staff. I think over the years I have seen a huge shift between the doctors and the nurses, their collaboration, and the importance of having the nurse leaders to assist with that. I am part of many committees and just sitting in these committees and seeing how the nurses and doctors relate to one another is a lot different than when I worked on the floors initially. [01:15:00] You didn’t question the doctor. That has come a long way. I would not say every doctor was like that with the staff nurse, but I would definitely say I have seen a change since we put nursing leadership in place.

01:15:29
Rigelhaupt:
Can you think of things that the organization has done to make the collaborations between physicians and nurses part of the culture and support the change you just described?

01:15:43
Jeffries:
Involving the medical staff with the rest of the staff within the organization when it comes to certain meetings, they have to go to together. I think setting the expectation that you communicate and treat one another with respect. I can’t really say because I have not worked on the floors with hospitalists, but I am sure that having the same doctors in and out every day has helped that relationship. And I think society in general, and maybe this is a perception, but it seems to me the younger physicians coming out of medical school are just more—and maybe this is not true—but they feel more approachable. Maybe that is because nursing has said, “Look, we are working as a team here. We are not doing your thing and I do my thing, but that we have to work as a team to give the patient the best care possible.” I do not know if that shift has been because we put nursing into more leadership roles. You have your nurse manager who would talk to the doctor if there was a problem, but now I think that there is more of an expectation that we go and meet together. One of the things we do now that we did not do before I left the floors, is they do rounds with the doctor. That helps with the collaboration and the relationship the nurse and the doctor have. [01:18:00] As an organization we have set the expectation: you are a physician, but you still have to have the same core values, “ICARE” values that our associates have. I think that has been a plus.

01:18:22
Rigelhaupt:
How would you describe the link between your current position in Health and Wellness and what you described earlier as your interests in public health. Since part of what you are doing now is trying to keep 4,000 people healthy? Public health might usually deal with 300 million in the country, but 4,000 is no small number either.

01:19:00
Jeffries:
I would say as a public nurse you are, again considering thousands and thousands of people’s health. We consider Mary Washington a community and our associates create our community. I may not be going out in the community and seeing patients, but we take it seriously if we see that one or more of our associates are coming down with an illness. That is something we want to trend and see if it is something that is happening on the same floor, which is something a public health nurse would be doing. If they had an exposure and they have been on a treatment we want to make sure that they are following a treatment plan and doing what they need to do. Public health departments do a lot of education around disease management and taking your flu shot. Those kinds of things that really mirror what the public health departments does. Just the follow up on exposures. Right now we are in the midst of Ebola and we need to know what that means to the community and to the organization, if you are needing to take care of a patient with Ebola. I think they do mirror a lot. When I interviewed for this position at the time, I felt it may not be working for the public health community, but it was still working for the health of our organization.

01:20:50
Rigelhaupt:
Let me ask about that too. What are some of the ways you see the organization contributing to public health or primary care out in the community? [01:21:00] Which is not necessarily been what acute care hospitals have been interested in—they are acute care centers—but I have heard of this organization being interested in primary care in public health. What are some of the ways you have seen the organization to do that?

01:21:20
Jeffries:
We work very closely with the public health department. As an organization we support the public health arena and I do know that some of our physicians that are actual employees do help in the public health arena. Community wise, it is what we offer to the community and the things we support in the community, like the Moss Free Clinic. We want to make those things available. We do so much charity care each year, which is also helpful to the community. I know the public health department—and I am not sure I am answering the question in how you are asking it. I think this organization supports the public health department if there is something going on in our organization. We are in very close contact with the public health department. They get invited to our emergency preparedness committees and our infection control and safety committees. We want to make sure that if there is something going on in the community that we, as an organization, are aware of it so we can be prepared for it. Other than that I cannot speak to any other specific things we do with the public health department. It’s just the one that I am a part of.

01:23:28
Rigelhaupt:
What would you want the public to know about being a nurse on the floor and being a health and wellness nurse that may not be common knowledge?

01:23:43
Jeffries:
I think it is hard for a patient to realize that a staff nurse is sometimes giving of themselves 24/7. [01:24:00] You are working shift work and you are working weekends and holidays. I think it is heroic for nurses to come to work and sometimes they have their own illnesses and their own things going on at home. I think patients are unaware of that because we do such a great job of taking care of others, and maybe not as much ourselves. When it comes to being a health and wellness nurse, it is definitely harder taking care of the people you work beside. My patient is a coworker. It is a little bit harder than I thought when I first came here. I thought, “Wow, I will not have to give bed baths anymore.” But it is definitely harder to take care of somebody who takes care of others. Again, because you see that they do not always take good care of themselves. I cannot really say as a staff nurse what I would want my patient to know about nursing except for it being a passion, and a passion that your own family may suffer from because you want so desperately to take good care of the patient. I think trying to find a balance between—and I think this is where the organization does a really good job. At least with every person I have ever worked with has tried to remind me as a nurse, “You have to find that family, home and work balance.” Things happen on the floor and in nursing that you cannot control. I think that is hard for a nurse because we have that feeling that we are supposed to fix everything. Sometimes it is very hard when you lose someone or they have that diagnosis that is not a good one. Trying to manage that within yourself and go home to take care of your family, yet trying not to forget about that person you just heard really bad news about and that you have been taking care of for the past week. [01:27:00] Nursing is a very compassionate career and there are times that I think it affects us more times than I think we would like to admit. The things we might see or do to a patient and that ultimate diagnosis or the end of someone’s life. Other than that, I cannot think of anything I would want to say to my patient or have my patient know about nursing. Just that it is a hard job, but we love it.

01:27:52
Rigelhaupt:
What are some of the things that you might point out or would want the public to know about Mary Washington Healthcare that might not be commonly known to the public?

01:28:02
Jeffries:
It is a lot of workings to make two hospitals, a cancer center, and all of the outpatient centers—it is a lot to make all that run smoothly. I think when you see things in the news or read things in the newspaper, just knowing behind all those words there are people who really care and love this community. It encompasses thousands of people trying to take care of people within the community. I think that we work really hard at having the services that people want and need and not an hour or two hours away. Mary Washington Healthcare has always been great to me and has supported me through all of the changes I have done in my life. I think sometimes the organization as a whole, especially if it is in the news or the newspaper it may not have been something we wanted to do or something that people expected us to do, but it was not because we did not care. There are hard decisions right now out there with health care. Things are changing, which makes it hard for organizations not to change and of course people are going to be affected by it. [01:30:00] Mary Washington Healthcare does a great job of making it as painless as possible and supporting the staff as much as possible. I do not know if that is a great answer.

01:30:27
Rigelhaupt:
So the way I like to end, and my last question is actually two questions. The first is, is there anything I should have asked but did not, and the second is if there is anything you want to add?

01:30:41
Jeffries:
That you should have asked but did not? I think I probably would have interjected anyway. Really I think you did a great job asking questions. And to add anything? No, I think I am pretty transparent. I love where I work. I love to take care of people. I chose this career because it was something I felt in my heart. Just how you had asked—we don’t realize that the people in our life make a difference of what we are going to do and in our careers, but we also need to remember that we affect everyone that we touch. As a nurse, if I can change or affect one person it was worth going to school to be a nurse. When you think about it I have touched thousands of lives. I think that is what it is all about.

01:32:05
Rigelhaupt:
That is a nice place to end. Thank you.
[End of interview]