McLean Hospital 115 Mill Street Belmont, MA 02478
When I left my research position with the Alcohol and Drug Center, the federal funding had changed and the six other nurses and I interviewed on units for staff nurse positions. I was lucky enough to work on Codman III, a very psychodynamically oriented unit with many college and young adult aged patients. Many wonderful memories flood my mind when I think of my years there—it was a time of learning about a therapeutic milieu, the importance of boundaries, and nurse-patient relationships. We had an “open door” community where the front door was unlocked at 8 am until 7 pm. The nurses were consistently in touch throughout the shift with their patients. This kind of communication was essential because we had to be aware of any changes in patient vulnerability and safety issues. The open door also meant that nurses and mental health specialists (MHS) needed to check in with each other throughout the shift in a way which uniquely bonded us as a team. Dr. John Gunderson was the psychiatrist in charge and his regular morning community meetings with all staff and patients were wonderful examples of therapeutic group process. Nancy Valentine, my former supervisor, was still a mentor and after two years convinced me to return to school for my BSN. But, boy, did I miss Codman III!
I loved Boston College and the opportunity to take liberal arts courses along with nursing. I focused on psychiatric nursing and had an extended clinical practicum in a quarter-way home which was state sponsored. Spending time in Dorchester and developing long-term relationships with these very seriously mentally ill residents was so satisfying personally.
In 1980, with my new BSN credential, I received a call from the nurse recruiter at McLean who asked if I would apply for a team nurse position in partial hospital (then located in what is now the McLean Imaging Center). I remember meeting with the whole team and getting excited about the role because it would mean I would be working with recently discharged patients as they transitioned out to the community, but also with a fair number of seriously ill patients who needed the consistent stability of an outpatient team and group focused milieu. It reminded me of my clinical placement. I was especially excited about working with a nurse, Karen King, because we hit it off in the interview. It was only after I was hired and started my new job that I realized she was leaving and I took her job! It was a wonderful position. I had anywhere from 30 to 50 patients on my team, all with different schedules and clinical needs. I became very adept at assessing for safety, defusing escalating behavior, hospitalizing patients in an emergency, monitoring medications, and intervening with all aspects of patients’ communities. Unfortunately, financial considerations meant we had to downsize from four teams to one, and eventually, as the last nurse to leave, the unit closed in 1983.
Upham House took me in and once again I found a mentor, Joan Zabarsky, who was fair, intelligent, kind, warm, and wanted the best for both her patients and her nursing staff. Also an “open door” inpatient unit, Upham, under Dr. Phil Levendusky, was exciting and challenging in new ways. It had a major CBT component and contracting philosophy approach. Weekly community meetings focused on goal setting for each patient and individualized written contracts to meet the goals. At follow up groups, patients and staff evaluated the goal attainments and planned new ways to succeed if goals were not met. I loved the focus on relationships with patients, the partnering with patients for safety, and the approach of involving patients in personal responsibility for their lives. The staff worked so well as a team and offered flawless consistency to the patients. But by then Nancy Valentine was back at McLean as the vice president for patient care, and called me to her office to “encourage” me to go to graduate school. Naturally, I listened to her and began a master’s program at Boston College pronto!
After getting my MSN, I accepted a position at BU Medical Center as a clinical nurse specialist (CNS). Having used a couple of McLean references, someone told Marilyn Verhey, about me and Marilyn called to see if I might be interested in a CNS role in Nursing Staff Development at McLean. Working for Marilyn was one of the best decisions I ever made. She was a perfect mentor to a freshly minted CNS—her support and encouragement was boundless and I got very involved very quickly in projects and orientation.
The projects and assignments I had varied over the years. Some were long-term, others not. Orientation was one of those long-term responsibilities and my favorite. I loved engaging with entering nursing staff. Teaching a group that may include experienced psychiatric nurses, new graduates, or nurses from other areas such as medical or surgical backgrounds was always challenging and changing. Orienting MHSs fresh from college, or those with advanced degrees in social work or psychology, along with both former computer techs who might want “more meaningful” work or certified nursing assistants hired to work with the elderly, often felt like conducting a new orchestra, balancing all the players at once! I have known, met with, and mentored so many staff as they have grown professionally and personally. Cleaning out my desk before leaving, I found over fifty letters of recommendation I had written. Some were for nurses who hoped to get advanced degrees, but most were for MHSs applying to nursing schools, many of whom now work at McLean.
When I started, and for many years thereafter, I was the lead nurse of a group studying alternative ways to teach and carry out all aspects of educating nursing staff about de-escalalating and restraining patients. When we finally decided to purchase the crisis prevention intervention (CPI) program, I organized a group of 15 nursing staff to attend a week-long training at McLean with the original founder of the Crisis Prevention Institute. Needless to say, our original group of certified CPI instructors had our work cut out for us! I’m sure it took over ten years (or more) to convert the nursing staff to the basic message and philosophy of de-escalation and prevention. Out with the culture of “toughness” and in with patience, alternatives, and ultimate safety for all. Shortly thereafter, an Employee Assistance Program social worker and I developed and led an ongoing support group for nursing staff who had experienced work related trauma. We also went to unit staff meetings to help staff process traumatic events on the units. The group was held every other week and continued for over 12 years.
Our current framework in nursing (soon to be replaced by Epic) and the notorious “green books” were all based on a nursing consultant that developed the “Marker Model.” Our department spent over two years writing the policy, documentation, and procedure books to conform to this model. We sponsored a “Career Development Program” whereby accepted staff nurses were mentored on a 1:1 basis for a year and worked with our staff on special projects before returning to their original units. One of the main goals was to complete the marker model. I was constantly writing new standards of care, protocols, and procedures. Now you know who to blame for those books! Probably that is why I still like to write new procedures and protocols!
I have spent many years in my role in staff development. When I started, it was a department with five psychiatric CNS nurse educators and one medical NP (Beth O’Neil, now the hospital’s Occupational Health nurse) also in the teaching role. It grew to include several other part-time CNSs and a support staff of four. We were all busy, all the time, because Nancy Valentine and Marilyn Verhey met with us frequently, always brainstorming and creating innovative projects; we also had a budget to match!
In 1986, I had a baby and returned to my position as a part-timer at twenty hours per week, a role I kept until retiring. Sometimes, it’s hard for me to comprehend that I’ve been so engaged and connected with so many people, programs, and projects at McLean while being a part-timer. My long nursing career at McLean never felt diluted by my hours, but rather more intense, as I tended to work every other day. Over time, the budgetary concerns in health care hit McLean hard and as the inpatient hospital downsized so did staff development. Following Marilyn’s move out of state and Nancy taking a position in the VA system, there were many reiterations of our department and roles. We traveled from Higginson House, to Wyman, to South Cottage to the Oaks Building. We reported alternatively to Gail Tsimprea, Linda Damon, or Linda Flaherty, or a combination of all three. Ultimately there were three nurse educators left and we were assigned to units in a decentralized manner. I worked with Jane Ward on East House I and II until I went on medical leave for a year.
Soon after I returned to McLean, Linda Flaherty was appointed the new senior vice president for patient care services and we two remaining part-time staff development CNSs were officially moved under Nursing Administration. I had the good fortune to be mentored in my last years by Linda who I admired for being totally involved in every aspect of both her large nursing staff and patient care. She seems to effortlessly keep track of hundreds of details, concerns, projects, and people. She remains calm, fair, and instructive in crisis situations. She was always available to consult with and advise me which I appreciated. When I wanted to try something new like being associate nurse director on SBII, she encouraged and supported me. Thus, I had one of my best experiences at McLean as I discovered joy in working clinically and administratively with the elderly and the nursing staff. One of the last projects she introduced me to was working with the Patient and Family Advisory Council and the recovery oriented care model which she is passionate about. For all that, I thank her.
My hope is that staff will continue to visit the Nursing Administration office which I often saw as a relaxed, warm, and welcoming place. It can be a safe place to seek out individuals who can answer questions, help process concerns, and offer unmitigated support for the very difficult jobs nurses do every day.