In 1962, I came to Children's Hospital Boston as a young nurse with a plan to work at the hospital for one year and then return home to Nova Scotia. I'd written a letter to the Nursing Department explaining my limited experience and desire for a job. I received a letter of acceptance with a start date. There was no interview and I completed my application after I arrived. My salary was $82 a week.
I was assigned to Division 35, the cardiology/cardiac surgical unit. My head nurse did not meet me until I had completed a few days of orientation and I worked just a few days with a senior nurse and then was on my own.
There were no intensive care units (ICUs) at Children's when I arrived. We cared for patients who had open heart surgery in the "Pump Room." If patients required a ventilator, they remained in the Recovery Room (now the Pediatric Advanced Care Unit) but nursing staff from Division 35 provided the care. In some cases, patients were so unstable they remained on the OR table while we cared for them. Back then, open heart surgery couldn't be done until the child reached 45 pounds because our heart-lung machine wasn't adapted for babies, so many children died waiting for surgery. Some "blue babies" had palliative procedures done in the hyperbaric chamber, which was located in the basement of the Harvard School of Public Health—now the Wolbach Building. Imagine the challenge of transporting a baby across the garden to the hospital following surgery, sometimes in the dark.
In December of 1964, a very exciting thing occurred. A Cardiac ICU (CICU) was opened on Division 25, the first pediatric ICU in the country. I assisted in transferring the first patient into the unit. A month later, I became Assistant Head Nurse for the night shift. In those days, nurses didn't apply for promotions, but were chosen by nursing leadership. It wasn't unusual to work up to 10 shifts in a row. In addition to a modest raise, this new position gave me every other weekend off—regular staff nurses worked eight-hour shifts and worked two out of three weekends. Providing adequate coverage was the priority, and the nurses' personal lives came second. As nurses, we wore totally white uniforms, white shoes and stockings, and, of course, the cap that represented the school of nursing from which we graduated.
Parents did not stay at the hospital at night unless the child was critically ill, and at 8 p.m., all visitors left. Parents were not encouraged to participate in their child's care, so the staff nurses provided all care, except perhaps an occasional diaper change or bottle feeding. Except at the highest level of nursing administration, nurses were not involved in decision-making of the hospital. Staff nurses did not serve on any hospital-wide committees and annual reviews were done by the supervisors with no peer input. Promotions meant getting farther and farther away from the bedside.
Fourteen years ago, when I was the Nurse Recruiter, I was asked to hire for a part-time position in Patient Relations. A decision had been made that a nurse should fill this opening. However, it seemed that no nurses were interested because no one applied. After a number of weeks, my director came by to ask me if I would consider the position. With much trepidation, I decided to move into this new role while I continued to do nurse recruitment.
After accepting the fact that an angry call was not directed at me personally, and that there are people one simply cannot please, I learned as much as I could about billing and insurance practices. I settled in and found my last job at Children's as challenging and satisfying as caring for critically ill patients. I have enjoyed the more complicated cases and the challenges of situations involving Risk Management and the Office of Legal Counsel. Patient Relations allowed me to use my people skills, clinical knowledge and familiarity with the hospital and its players to address the majority of challenges that came my way. It was a great job for an old nurse!
Since my early days, I have seen so many changes—more than can be mentioned! In addition to the fantastic advances in medical care, we have gone from one small CICU and several small "care rooms" to two large, state-of-the-art ICUs. Parents can visit 24 hours a day and are encouraged to participate in their child's care. RN evaluations are done with peer input. There is a Clinical Ladder that allows nurses to advance but remain involved in direct patient care. Most staff work 12-hour shifts and have two out of three weekends off—not on. Now, nurses wear brightly colored scrubs and there is less formality than in the "old days."
Children's is an amazing place and I am very proud to have worked here for so many years. I have had eight different positions and enjoyed the challenges and satisfaction of them all, whether it's been providing direct care to the patients as a staff nurse or contributing to the care in other ways. I'm leaving feeling very good that I chose to be a nurse.