Tricia Boring

Tricia Boring began working at Mary Washington Hospital in 1989. She first served as a transcriptionist and then in 1995 started as a registered nurse (RN). She has worked in the operating room since 1996 and contributed to the expansion of clinical programs at Mary Washington Hospital, such as the cardiac program and the trauma program.

Tricia Boring was interviewed by Jess Rigelhaupt and Courtney Dickerson on November 12, 2014.

Discursive Table of Contents

00:00:00-00:15:00
Decision to become a nurse—Experiences in nursing school—Advice for new nurses—Working at Mary Washington Hospital—Continuing education—First shift as a nurse—Typical day as an OR nurse—Difficult parts of the job—Completing a bachelor’s in nursing

00:15:00-00:30:00
Changes in nursing—Business aspects of the hospital—Love of working in the OR—Patient interactions—Memories of Mary Washington Hospital, 1989-1995—Changes with the new hospital—Early experiences as an OR nurse—Cardiac service—Expanding surgical procedures at Mary Washington Hospital—Teamwork in the OR

00:30:00-00:40:00
Teamwork in the OR—Changes in the dynamics between nurses and physicians—Trauma program

Transcript

00:00:06
Rigelhaupt:
It’s November 12, 2014. We are in Fredericksburg, Virginia in Mary Washington Hospital. We are doing an oral history interview with Tricia Boring. The first voice you will hear is Courtney Dickerson. She will start off the interview, and I will come in a little bit later. My name is Jess Rigelhaupt. So why don’t you start.

00:00:25
Dickerson:
Could you start off by stating your full name and position at the hospital?

00:00:28
Boring:
My name is Tricia Boring. I am a registered nurse. I perform several duties. My title is Specialty Coordinator. I am a team leader in the operating room. I am also a RN first assistant in the OR as well.

00:00:44
Dickerson:
What made you want to become a nurse?

00:00:48
Boring:
I wanted to be able to help people and to have interaction with people. Years ago, when I went to school thinking I was going to be able to do the things I wanted to do. I quickly realized that wasn’t what medical secretaries were supposed to do. So I applied to nursing school. It forever changed after that.

00:01:05
Dickerson:
Could you tell me more about your education and past work experience?

00:01:12
Boring:
When I came to Mary Washington Hospital back in 1989 I was working as a transcriptionist. I liked what I did, but I wanted to do a little bit more. I was nineteen, kind of young. I have an aunt who is a nurse. She has always been my mentor. She is kind of like a big sister, but really just a guiding person in my life. She said, “Why don’t you try nursing?” I went to Germanna. At the time the only campus they had was out on Route 3 by Locust Grove. I remember what I wore the day I interviewed. It was a really exciting time. I interviewed and it was a very competitive program. They only had so many people in the program and I was accepted. I started in ’92 and I graduated in ’95 from Germanna. After that I worked on the floor for around a year. I wanted to work in the operating room from the get-go. Actually I wanted to be an ER nurse, but I quickly realized that I wasn’t prepared to do that from the start as a new graduate. I worked to make my way to get into the OR. I did an internship back in 1996 and I have been there ever since.

00:02:18
Dickerson:
So when you were in nursing school, how did that prepare you for patient interactions?

00:02:24
Boring:
In nursing school you were very immersed in patient care. The program with Germanna had a lot of classroom work and you also did your clinicals at different organizations within the community, at Fauquier Hospital, Orange County, Culpeper, Mary Washington, and even some Northern Virginia Hospitals and mental health facilities. We did a lot of hands on with patient care.

00:02:48
Dickerson:
With your interactions with new nurses, what advice do you give them?

00:02:51
Boring:
I usually tell the new nurse is that we all start out somewhere. [03:00] Sometimes you are going to find people who forget that they did start out where we all started out together and it is okay to ask questions. It is a good thing to ask questions before you make decisions. As a mentor and as a senior nurse, I am here for the nurses as well. If you need anything, do not hesitate to contact me, call me, or ask questions. It is a little intimidating coming into an environment where a lot of people have been physicians or nurses for a long time. It is easy for many people to forget what it was like to not know a lot of things.

00:03:32
Dickerson:
Why do you like working at Mary Washington Hospital?

00:03:35
Boring:
Why do I like working here? I am from Pennsylvania. I have been here for about twenty-five years. When I moved to Virginia, I started pretty quickly within the organization and I have developed a sense of family. I worked in the radiology department at first. Radiology is very similar to the OR in that a lot people work in that department, but it is a team concept. It is the same thing as the OR. In any given day there are several different people who you work with throughout the whole day. It is kind of like a family. Over the years I have grown in my profession and in my personal growth I have also grown with the family. The hospital has been a great place to work. They are a family and I like it here. It is a great environment. I love taking care of patients. Every day is a new experience, which is the best part. Every day is a new experience, something new and exciting.

00:04:25
Dickerson:
Do you have any interest in moving to another hospital or staying here?

00:04:29
Boring:
I have no interest at this time. I actually am going to school. I graduate next month with my bachelor’s degree. That opens other opportunities, but for right now it is a personal goal for me. I don’t see a need to go anywhere else. I like working in this community hospital. There are other organizations that are interesting. I think the dynamics are similar in a lot of other places. I don’t have an interest right now.

00:04:54
Dickerson:
Where are you going to school?

00:04:55
Boring:
Through VCU, Virginia Commonwealth University.

00:04:59
Dickerson:
What was your first shift like as a nurse?

00:05:00
Boring:
When I first started working as a nurse, I worked eight to twelve hours on the floor. I was a young nurse, about twenty-five. I didn’t have any kids. I tended to be the person who, when they needed help they would call me on the off shifts. They would say, “Hey, would you like to work extra hours?” I was the dependable person. If you needed help I would come in and help in whatever aspect they needed. I was also the nurse who was willing to do other things and try new things. So if they needed someone to float to another floor—if you are on a floor and another floor gets a call out—I would volunteer oftentimes to go to that floor. It would something new and exciting. It would kind of change the environment for the day.

00:05:42
Dickerson:
What other areas were you interested in, at that time, besides the OR?

00:05:44
Boring:
When I first started I started in respiratory-renal. It was also the step down for the ventilator patients and that was interesting. I learned about a lot of those endeavors. I was also interested in cardiac. [06:00] I haven’t dabbled much in the cardiac service, although I have developed skills of the cardiac service in the OR. I am not real adept with the floor nursing as a cardiac nurse.

00:06:09
Dickerson:
Currently, what is a typical day like for you?

00:06:12
Boring:
A typical day? As a team leader, I am competently skilled in many aspects in the OR. I am able to scrub, circulate, and assist. My typical day would be to come in at 6:30 a.m. I usually eat breakfast, to mentally prepare myself. We have a meeting at 7:00 in the morning. We meet with the team, the whole OR staff. We talk about the day’s plans and then you start your patient care at 7:30. We get the patients in the room. I typically assist, or scrub, or circulate. I am with patient care for most of the day. We go to lunch in the middle of the day, typically for about thirty or forty minutes, and you go back to the room until around three o’clock. I also participate in call. We have call for if we have emergencies during the night. As a Level II trauma facility, we always have to have a team available. So I also take call. For example, last night I was on call from 7:00 p.m. to 7:00 am. I came in last night from 7:00 to 8:00 and then I came in around 1:00 a.m. to 3:00 a.m. for patients who were ill and needed emergency surgery.

00:07:16
Dickerson:
On average, how many hours do you think you work per week?

00:07:20
Boring:
Typically it is between forty and forty-five.

00:07:23
Dickerson:
What do you think is the most difficult part of this job?

00:07:27
Boring:
The difficult part about this job, I think, personally is a fine line between commitment to an organization, but also a commitment as a mother and as a family. There are many times when my kids will say, “Don’t answer the phone!” But there is a part of me as a nurse who says, “I can’t. I can’t not answer the phone.” People need me as a nurse. It is a skill that does not come by every day. There are times when we are with family and that’s what I am here for. There are many times that I am committed to the organization. If I am on call, then I am on call. If I am home with my family, I answer the phone calls if they need help. I will provide the help. There is a fine line that you have to marry between the two. There are some days where it is more challenging than others. I think as your kids grow older they will respect and see that level of professionalism to emulate as well.

00:08:21
Dickerson:
So it sounds like it a balancing act.

00:08:24
Boring:
Absolutely.

00:08:25
Dickerson:
What do you think is the most satisfying part of your job?

00:08:27
Boring:
Satisfying? I think it is coming into work every day is a new experience. Knowing that you made a difference in that patient’s life. We take care of patients every day who are sick and you know that their families are scared. I have been in the same situation with my son when he needed surgery. To hand your child over to someone, not knowing for sure that everything is going to be okay. It gives you pride to know that people trust you to do that care for their patient. When you are done the thanks that they have as well.

00:09:00
Dickerson:
What are you most proud of?

00:09:05
Boring:
I think I have become a professional human being. I think that I am a good nurse. I take pride in what I do. I take care of other people, not only patients, but other staff members. It is important that we take care of each other. I tend to be the social person in my department. We like to have lunches and celebrate our successes. I am proud that I try to bring a ray of fresh air and a little bit of laughter and cheer to the OR.

00:09:32
Dickerson:
Working as a nurse, what do you hope to pass down to your children?

00:09:38
Boring:
Dedication, commitment, and hard work. I think when you have those that one of the keys to success is happiness as well. I’m hoping that my children develop the same sense of commitment and dedication.

00:09:51
Dickerson:
Do your children have any interest in going into the medical field?

00:09:54
Boring:
No. My husband and my oldest son literally can’t see blood. They pass out at the site of blood. My son received an allergy injection years ago and passed out. One day he lost his tooth on Christmas morning years ago. He has his tooth and I think “Oh my gosh.” I turn sideways and he fell on the floor. It was kind of funny. But those two won’t [go into the medical field]. My youngest son, I am not sure. I don’t think he will go into health care. I think he will be more into boy stuff. They are still a little young, thirteen and sixteen.

00:10:25
Dickerson:
You mentioned earlier that you had an aunt that was a nurse. What was there anybody else in your family also in the medical field?

00:10:32
Boring:
My sister and my natural mother are both in health care. They work in the laboratory and secretary work within the hospital. But my aunt, she is actually a nurse practitioner.

00:10:44
Dickerson:
I have heard that nursing is a very stressful job. How do you deal with the stress of the job?

00:10:50
Boring:
I think every day is a new opportunity and new experience. Yes life is stressful, but you have to have a balance. I know when coming into work I am doing the best work I can do every day. You just have to know that you can do what you can do. We have guidelines, or practices, or governing counsels that help us make decisions in the OR. Having the trust in those organizations and doing what they recommend. We have peers—we talk with each other and vent sometimes. Sometimes just venting, just like you do with your family. You’ve had a rough day, let me talk about this rough experience and get it over with. I think you have to have perspective and the fine line.

00:11:32
Dickerson:
Could you give an example when it was so stressful that you had to go and vent to someone. Is there a situation like that?

00:11:40
Boring:
In any department, sometimes you have decisions made that you might not necessarily agree with. Sometimes I have learned that you need to develop a skill of thinking about something for a while before venting about it. [12:00] When working in an environment for quite a while you tend to develop theories on how things work. After a while you think you know the theories on how things work and sometimes you don’t necessarily agree with decisions that are made. You have to sit back and give it time to show itself. Things are done for a reason. Sometimes you don’t necessarily agree with a decision, but you have to respect and honor that decision. If you are frustrated and questioning, just go ask, “I don’t understand why this practice change was made?” Get further explanation. I think you have to put it in perspective.

00:12:34
Dickerson:
So it sounds like you like to progress your education constantly.

00:12:36
Boring:
I have been working on my bachelor’s degree for a few years. When I graduated from nursing school in ’95, I thought I would start a family, at that time the clock was ticking. I started a family and then I decided to go back. I thought it would be a lot harder than it was. Once I got into VCU, I thought, “I should have done this ten years ago.” But I didn’t. So yes, every day is a new experience. I think it is a great thing for nurses to continue their education. As we evolve with our health care and the health care act, this also benefits the patients as well.

00:13:12
Dickerson:
Do you have any interest in going past the bachelor’s degree and to graduate school?

00:13:15
Boring:
At this moment in time I am enjoying getting my Bachelor’s degree. It is not necessarily on the table, but it is not off the table. My husband does a lot of business travel—not that that’s an excuse, but there are times as a mother I feel like it is a balance between working and personal life and school as well. Trying to juggle the three things to together I want to make sure my children don’t suffer for that. For right now it is not on the table, but not off the block either.

00:13:45
Dickerson:
Now VCU is in Richmond. How is that commute for you?

00:13:50
Boring:
Actually the only time I had to commute was the first semester. It was one Friday a month and it was very manageable. I just went after work; it was at like 6:00 or 7:00 in the evening. Everything from then on was literally online. It is a new dynamic to my knowledge base, but it was very manageable. You develop a network of using the computer. You become very computer literate. You meet a lot of people online—it is almost like Facebooking, where you message back and forth. But for your class, you kind of talk back and forth, discussing and sharing information about your organization. You learn a lot about what other people are doing, mental health, and different aspects of nursing.

00:14:28
Dickerson:
Now your fellow students, are they in the same stage of life as you? Are they currently nurses still seeking to further their education?

00:14:35
Boring:
Yes, many of them are in the Richmond area.

00:14:38
Dickerson:
Now since you started nursing school, back a couple of years ago, what changes have you seen in the hospital or anything in general nursing wise?

00:14:46
Boring:
As we continue with the Affordable Care Act, we have seen a little tightening of the belt. You have to think smarter, not harder. [15:00] And think about what you are using, not wasting, supplies and materials and that you are more productive in your steps. You are not wasting energy on things that are not really necessary—planning your day and your steps. I have also seen the tier mechanisms for management, senior management and president of the organization. You have seen the dynamics and not only how that changes but how that impacts the organization as whole.

00:15:26
Dickerson:
I have heard a hospital compared to a company. Do you agree with that? Where do you stand?

00:15:32
Boring:
I think every organization is a business. It is a business. We are in the business of taking care of people. You just need to think smarter. The way we provided care yesterday worked, but it was probably not the most efficient or the most effective. Literally, as the Affordable Care Act is implanted we are finding, monthly, things that are working and things that are not. We are working to better that. The community and the organization have really kept up with those changes. Surprisingly, going to school has made me much more aware of the Affordable Care Act and many of the things that we are doing as an organization are in line with what I am doing in the classroom. It is refreshing and encouraging to know that we are line with other places. The people I have met online also said the same things. We are not just doing that here; other people are doing the same thing.

00:16:27
Dickerson:
That’s really interesting. Back to the hospital, is there another area that you are interested in working, besides the OR?

00:16:33
Boring:
Not necessarily. I like what I do. Like I said, I can do all three roles. I love first assisting. I love the human body. The human body is an amazing thing and every day in the OR it is a new experience. Your insides look different than his and my insides. Every day you go into a patient and perform surgery on a patient to help make their life better. It is just phenomenal. I enjoy that aspect of providing care. I don’t know what it is that I like about it. It is just amazing. Like I said, my family can’t stand the sight of blood. It is disappointing because I’m like, “Gosh, it is such a great thing!” I don’t have any interest outside of the OR, no.

00:17:24
Dickerson:
Do you have a lot patient interactions? What are those like?

00:17:29
Boring:
Yes. This morning I went and I met my patient. You get to talk with her. You get a brief history from her, review her chart, and talk about what her issues are that she is here for today. You talk about what is going to happen. You let her know what she is going to expect. Traditionally, then what happens is your anesthesia provider comes right behind you and gives her medicine, so she forgets everything. But sometimes when they wake up they remember, “Oh yeah. She mentioned I am going to do this, this, and this.” [18:00] So there is, in my opinion, what I call a brief interaction. There is enough interaction where I can get what I need to get out from that patient to provide the good care he or she needs in the OR. When they come out, I shift my care to another nurse. The nurse then works on her area of expertise in recovery and the road to wellness and rehab.

00:18:16
Dickerson:
You have these small interactions with them, do you develop bonds or is it, quick I just need this information?

00:18:24
Boring:
I think it is my own bond. It is not often that you meet people in the community that you met here in the hospital, but there are times that you say some names and you say, “Oh, I remember.” It is a bond that we have and share together. When we bring a patient to the OR, we talk with the family. You say, “This is going to happen. I am going to call you in the waiting room and if by chance the phone rings and nobody is there, pick up the phone. This is our only connection I have with you.” It is a bond. When the surgery is over, I call back and say, “The surgery is over. The doctor is going to come out in a few minutes to talk with you. I just want to let you know.” You are sitting out there waiting for hours not knowing about your loved one and not knowing if things are going well or what is going on. There is somewhat of a bond. There is enough to satisfy my need of that patient care.

00:19:14
Dickerson:
On average, what kind of patient do you see?

00:19:17
Boring:
As a team leader, I cover services of urology, GYN, ENT, plastics, and dental. I traditionally see women. But also as a RN first assistant I see everybody and everything: kids, adults, broken bones, spines, and brains. It is a whole dynamic of different people. Mostly it is women on a scheduled day-to-day basis.

00:19:44
Dickerson:
That’s great. That is all my questions. I really appreciate it.

00:19:49
Rigelhaupt:
In the years between when you started here in 1989 and when you finished nursing school in 1995, what we are sitting in emerged. What do you remember about a new Mary Washington Hospital?

00:20:09
Boring:
Absolutely, I remember that. Actually we were talking the other day, back in ’92 when we moved in, ’92-’93. I was in nursing school and we had reached out to the nursing schools, but I also worked here as well. To help have us with the transition I remember that we gave tours. It was kind of funny and ironic: we gave tours around the organization. They gave you a little handbook. We showed people around. This was our new house, come see it. The day, they literally planned everything to the “T.” The ambulances brought everyone from down the hill up the hill. It was a very exciting time in the growth of the organization. When I first started in the late ‘80s, it wasn’t as respected in the community as we have become today. [21:00] I remember telling people, “I work at Mary Washington Hospital.” I was so proud. It was one of my first jobs. It wasn’t always exciting to other people. They would say “Oh.” They didn’t understand until years later, but I think it must have been the people I was speaking with at the time. I think the community has supported the organization as we continued to grow and we have built another organization in Stafford. It has been a great growth.

00:21:30
Rigelhaupt:
Were you actually giving tours in here before they opened?

00:21:32
Boring:
Yes.

00:21:34
Rigelhaupt:
What was it like to be in a big new hospital with no patients?

00:21:38
Boring:
I know. It is kind of cool. It is kind of like when you go to a hotel. You go and walk down all these halls. It was really cool. At the time, they kind of had all the doors opened and you walked through. You showed everybody: “This is where the babies go. This is the cafeteria.” We showed the ORs and they were empty at the time. It was exciting and people really came out. The hospital had welcome parties and gave out refreshments and goodies and stuff. It was exciting, very exciting.

00:22:07
Rigelhaupt:
Did you have a sense that it was going to be a different type of hospital when you started working here after you came out of nursing school?

00:22:19
Boring:
In some aspects, but I guess I really didn’t think about the future and what it would hold. When you looked at the old hospital, I worked over there for a brief period of a couple of years. This was just The Hilton compared to the first hospital, or at least the one down the hill on Fall Hill. I really didn’t think about where we were going. It was just living in the moment. But when you look back at now, you can see other organizations as they grew and monopolized other areas in the state and how they grew as well. I think the community has come to support Mary Washington, as well as Mary Washington returning back to the community.

00:23:04
Rigelhaupt:
Could you describe your first surgery, after you finished your internship? If you remember it. You are done with the internship and you are an OR nurse with your new position, what was it like?

00:23:16
Boring:
It was a long time ago when I first started working. After I finished my internship program I did a lot of general surgeries: patients who had their gallbladder or their appendix taken out. We worked with a couple of physicians who were older gentlemen and were kind of set in their ways. They were a fun group of people to work with, but they had their likes and dislikes as well. When you work in the OR, they tend to tell you that it takes one to two years to really feel comfortable. It does. It takes a while. It is like you go to any new job and you kind of feel scared for a couple days. This was for a couple more months, where you are double-checking, double-checking, and triple checking, to make sure you didn’t miss anything on the list. [24:00] You would ask the doctor, “Is there anything else you would need? What else do you want today?” You did this so you wouldn’t miss something. The dynamics in the OR are you have a relatively small group of people and you work well together. Sometimes if you don’t have what you need, the dynamics are different and it doesn’t work as well and, in my opinion, a little more stressful. You really don’t get to take that deep breath for a couple of months. It was exhilarating and exciting as well. You are growing. The organization is growing as well. It was exciting.

00:24:43
Rigelhaupt:
A few years before you started as an OR nurse cardiac surgery started at Mary Washington. Was it a change, in terms of the level surgical specialty that organization offered? What do you remember about the expansion of surgical procedures after you became an OR nurse?

00:25:02
Boring:
When I came to the OR in the late ‘90s, the team they actually brought in was from close to where I am from in Pennsylvania. It was exciting and we had that little bit of a bond, we are from Pennsylvania kind of thing. I was interested in learning as much as I could about the OR. I learned and I can circulate in a heart room as well. Over the years, I continued to progress in that skill and I filled in when they needed help on the other side. The cardiac service is an exclusive, tight knit group of people because it is a little bit more stressful. You do a little bit more of defined things that you are working in as opposed to more broad areas. It is a great group of people. They work very well together. They communicate well together. When they are working hard, they work hard together. When they relax, they relax together. It has been exciting to watch the ebb and flow of the tide as they have grown. I read the article in the paper, it was very well written, about the physicians who have come and gone, like Dr. Armitage and Dr. Mcmanus in the beginning. We have all laughed together and we have all cried together. It is a big family. It is nice to see that they have the community’s support as well for their successes.

00:26:23
Rigelhaupt:
Are there any other surgical specialties that you can remember following suit in the late ‘90s, or in your first few years, where you scrubbed in or just knew you knew it was happening? That you knew it was a new surgical procedure.

00:26:45
Boring:
Sure. Some of the things that we did over in my lifetime here are bariatric surgery, which has come and gone. We started robotics, probably seven or eight years ago. I have worked very closely with the head of the program. Her name is Wendy. [27:00] We hired her from another organization. She came up to run the robotics program and I have progressed with that as well. It is exciting. It is great for the community. It is good for people in the community who need surgery in that aspect and that they can come to someone here. They can come locally and can recover locally. We have a group of GYN surgeons who come in from Northern Virginia for cancer surgery. They come every week. Women who have gynecologic cancers now can be treated in their own communities. They can still see their families and try to have their lives here. I think it is a great service. It is a win-win for everybody, for the physicians, patients, and the families. We have grown in many areas—urology I do that as well. With GYN we have had the physicians come in. The robotics program is used in both of my services, urology and GYN. Orthopedics has grown tremendously with our joint programs. It is great to see the successes we have had and the community’s support as well. We created the Human Motion Institute and broadened that into other areas for therapy. Pretty much a lot of the services have really grown. When I first came we had ten ORs and now we have fifteen. It is a hot topic: we are fighting for space. It is exciting to see how the program has grown with the community’s support to provide the care we provide every day.

00:28:39
Rigelhaupt:
One of the things that I have heard about the cardiac program and I think you have alluded to it as well, the importance of a team in the OR. It is not necessarily how it is on the floors—

00:28:55
Boring:
Right. It is more individual on the floors. You are a nurse and you are taking care of the patients, yes.

00:29:01
Rigelhaupt:
What are some of the reasons you would point to that would explain this success in team building between the physicians and nurses and the other people that might be in the operating room?

00:29:11
Boring:
In the operating room you have a scrub person and then you have a circulating person. The scrub person passes the instruments. The circulating person, who in my opinion is like the waitress: you make sure that they have everything they need, everybody is doing everything they are supposed to be doing, everything is going the way it is supposed to be going, and that everybody is appropriate. You make sure everybody is going in the right direction. You have the anesthesia and you can’t forget them. They are there to keep the patient pain free and comfortable for the procedure. Then of course there is the surgeon. All the dynamics of all of those people—your scrub, your circulator, anesthesia, and the surgeon, those four people, sometimes five with the assistant—all have to work together. The dynamics of, “If I am not having a good day and I am a little more quiet and reserved.” We all have to bounce back and forth off of each other so that we are providing the care that that patient needs. Yes, some days are better than others. Some people have good days and not so good days. The dynamics of how we all communicate make a difference to the patient. [30:00] We implemented a few years ago what is called a “Time-Out.” All organizations across the country do that. In the beginning it was a little bit challenging. The ultimate goal was to provide safety in patient care. It is one more safety check you will do before that patient goes to sleep and before that surgery to make sure you are doing the right thing. It is a horrible thing for a person to go through a situation where you have done the wrong thing on a patient. With all the other organizations across the country we have implemented that time out. We have struggled through, but got through and persevered. I have realized the need for that time out. Now it has become a commonplace: you wash your hands and dry your hands before you do surgery you and always have a time out before the patient’s procedure. That’s why teamwork needs to work together. If something is not going right, we need to speak to each other: “Hey, I noticed you are a little off. You are not doing the things you normally do.” We need to be able to call each other on our behaviors. That is the dynamic of a team as well so that we are all on the same page performing the right things that we need to do.

00:31:08
Rigelhaupt:
Is that something you could have imagined happening in the 1980s? Part of what I am getting at is the dynamics between physicians and nurses have not always—

00:31:24
Boring:
Correct, I think the dynamics have shifted. One of the aspects in the class I am finishing up, the capstone course, is kind of like the premiere class at the end of your career, at the end of my baccalaureate program. There is a program called “Healthy People 20-20.” It talks about the nurse becoming more of an advocate and provider of patient care. Part of that mechanism is having ten directives that they are recommending, such as nurses should get a baccalaureate degree. The majority of nurses should be a baccalaureate degree, but also advancing the role of the nurse to being more of an independent practitioner. What I am leading to is the nurse’s voice is being heard and respected for the role they provide in patient care. They are no longer subservient to physicians. They no longer say, “Let me get off this chair and you can have my seat.” Years ago, if a doctor walked into a room you would get up and he would take the chair. I never lived that experience, but I understand that was how it was years ago. As you continue to see the role of the nurse evolve you can see that relationship improve. The physicians value input the nurses have in reference to patient care. It is the vital link that the physician has to the patient. Typically in the middle of the night, you call the doctor in the middle of the night because the patient’s vitals have changed. You are that one link between him and that patient. You need to be able to eloquently say, “Something is just not right. This is going and this is going on, but this is going on.” [33:00] I do see how the role has evolved here and across the country in that we have become partners in care as opposed to just a nurse. We are now a partner in that care.

00:33:20
Rigelhaupt:
Organizationally, I am trying to think about your time at Mary Washington Hospital. Is that one of the benefits of more complex surgeries, it requires a team, that you work as a team?

00:33:31
Boring:
Absolutely, I think it complements the successes of surgeries. It definitely can have a detriment to surgery if there isn’t a teamwork component there. But also we have strengths and weaknesses, every one of us. There are times when you need to choose the right person for that patient’s care based on their strengths or their weaknesses, or even sometimes the dynamics of what team works well together and what doesn’t work well together. I definitely see that as a component, yes.

00:34:00
Rigelhaupt:
In terms of surgery one of the most recent programs is trauma, which by definition you can’t fully prepare. Have you been in on any trauma surgeries?

00:34:17
Boring:
Yes, just a few. We have been a Level II trauma center for a few years. There have been multiple patients who I have taken care of over the years that have been memorable. We have taken many patients with gunshot wounds. The dynamics of how you take care of the bullet or the hands. We have taken care of patients just driving down the road and something impales them. That has been memorable: taking care of those people, talking to them, trying to help them cope with what is going on, and giving them the strength to want to survive from those experiences. Then you have a few young people who have been in horrific accidents that, as a mother, you have to take a deep breath and say, “If this was my son.” I had a girlfriend, one of the nurses on the floor—this is a good story. We had a trauma code come in. She went to the ER. That is what you do in the middle of the night when you come in: you go down and see what you can do to help so that when they come into the OR you can help them. So she went down there and the sounds that she heard from this young man, she said “Will forever be in her mind.” She had children as well. She went and held his hand and talked to him. You want to reassure people that they are going to be okay, and sometimes they are not. As a nurse you are there to care for them, but you are also there as a mother and someone who cares for people. It was something that was memorable to her that she shared with a lot of the nurses upstairs. We didn’t bring this patient to the OR for several days, but he made an impact on her life. [36:00] The young man didn’t have any ID on him so they were not able to identify him early on. She was there as his mother, even though she wasn’t his mother. It is something that you step into. You step in to help take care of people as a mother. It was a very touching opportunity for her to share with that patient. Just to help comfort him in his time when they weren’t able to find a family member to help be with him.

00:36:34
Rigelhaupt:
So by the time trauma arrives you had been a nurse for almost a decade. Were there things that you recall as you are building this program that nurses that you worked with or the new physicians who came in, and you told them “We are going to build on these.” What did you build on?

00:37:00
Boring:
One of the components of trauma training that we underwent in the OR before it even came was teaching the preparation. When you have traumas there are certain things that you are going to need. We have a cart of certain supplies, but created thinking mechanism when things come into play. When you have trauma you tend to do everything standardized. You don’t want to do it different ways every time. You want to standardized ways each time so you have the basic information. I can recall the days when the trauma physicians weren’t here. We did not have the trauma center officially, but we were here starting to walk a walk. They came to the OR. We met with teams. We did mock codes and mock traumas. We had instruments brought in for emergencies—traditionally you would see this kind of stuff and that kind of stuff. There was a lot of teaching going on for the staff. The dynamics of who does what were very interesting. We reviewed with many of the staff members so that everybody knew their role. We had a staff in the OR who are called a support team. They are like a CNA and when we have emergency trauma we called them in as well. We have people to help. We need someone to go get the blood, or we need someone to go do this or that, or to hold this or hold that. Though they may not have clinical education their role is just as vital to help us get what we need to take care of that patient. It has been exciting watching evolution of the trauma service as we get to expand and broaden. The physicians do come. We have the trauma team come and bridge that gap several times a year within the OR to continue make sure that the education is there. People come in and they acclimate them to how the trauma program works. Making sure they have the resources on a piece of paper, who to call and what to do. It has been exciting. [39:00] We have watched a few members come and go. But as the program has expanded it has been good thing for the community as well, to be able to offer the care in the community

[End of Interview]

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