This month marks the one year anniversary of Nursing Notes Live! In this month’s episode, Nursing Notes Live takes a look at the world of orthopaedic nursing. This month’s featured “Get to Know Nurse” is Mary Anne Kenyon, Nursing Director for Orthopaedics at Brigham & Women’s Hospital in Boston, Massachusetts. I asked Mary Anne how she became a nurse and arrived at an orthopaedic nursing career.
MP3 Audio Podcast
Jamie: Mary Anne, it’s great to have you as a guest on Nursing Notes Live. We always try to start off these Get-to-Know-Nurse segments with just asking you, what led you to become a nurse to begin with?
Mary Anne: Well, thanks for having me. I had sort of a different path to becoming a nurse. I was at a small all-girls school. This was back in the ‘70s. They really were empowering us to study math and science. It was just really starting to be accepted that women, girls went into engineering and some of the high-tech fields that were just starting. Originally, I wanted to be a civil engineer. I wasn’t even thinking nursing. My father was a civil engineer. I wanted to do that. Through some guidance – through my father and one of the sisters at the school that I was attending – they looked at my aptitude and thought I would be better suited in nursing. So it was something that I came to slowly. I wasn’t really sure that’s where I was going to start. I think my father’s exact words were: “Give it a month. Try it. Just give it a month.” I had to tell you that after the first – even just month of college I was really intrigued. We had a variety of courses – science-based. We had a very beginning nursing course that you just really – I think all you can do was talk to a patient. I had a good feeling about it. I like that it felt comfortable. It felt like I was doing something. Everyday was different. It just sort of grew from there. It grew quietly from there. Years later, I’m very happy that that’s the course I chose. I would never have chosen anything else but it was a quieter start.
Jamie: It’s interesting you talked about the push that helped girls becoming more interested in going into the hard sciences. Yet, traditional female career path, like nursing, is certainly very science-focused. It’s all about the science and science-based care and research-based care. I wonder if that’s just – if people were missing the point there.
Mary Anne: I think we did. I think when I started school – I graduate high school in the late ‘70s – and back then nursing wasn’t a baccalaureate program required at the time. It was still a three-year hospital course. I think from a young girl who was in an all-girl school so we were very empowered. To look at nursing, it might have felt a little soft for me. They were in hospitals. They were not handmaidens but that idea was certainly still out there. I thought I wanted to be more. I wanted to have a voice. So if I was going to make a difference, I want to make a difference. I think when I went to college – and actually the college I went to had a three-year associate degree program – and it was just moving towards all five-year students. The five-year was the baccalaureate. I went into the five-year program and it felt academic based. It felt like it had all those hard sciences. I think we took nine science courses in our first two years and we were taking them alongside the physical therapy students and the pharmacy students. Right out of the gate, you felt that collaboration with the healthcare team or what the healthcare team is going to become. So when I got there, it definitely met my expectations. But when I first started I wasn’t really sure what it was going to look like.
Jamie: Yes. I never met anybody that said nursing school was easy. [Laughter]
Mary Anne: I won’t say that either.
Jamie: I don’t put down anybody’s major in college but I would hold up the rigors of any nursing program, even our Associate’s Degree nursing programs that are out there, are certainly more rigorous than any of the other programs or as rigorous as any other program in their schools.
Mary Anne: Oh, sure. I just wanted to be in the college environment. I didn’t want to start my career right out of high school in nursing hospital-based program probably because it was predominantly women at the time and I was coming from a four-year all-girls school.
Jamie: I completely understand. You needed to get out there into the broader, well, civilian marketplace.
Mary Anne: Exactly.
Jamie: What about orthopedic nursing? Did you start out right out of school as an orthopedic nurse or did you move into that after doing some med-surg or emergency or something else?
Mary Anne: I didn’t. I’ve always been in Boston or predominantly on the East Coast. When I graduated from nursing school, you could not buy a job. It was very similar to the flavor of nursing right now. It was tough to get into a hospital. I graduated from college in June and I started grad school in August because the jobs were not that plentiful. So I went right on and got my Master’s and worked part-time and I worked on a floor. It was very unique. It was ten beds. Five of them were rehab and five of them were dermatology – just a very eclectic group of patients.
Jamie: That’s interesting.
Mary Anne: It was at Yale-New Haven Hospital and it was very eclectic. I loved the rehab end of it. The derm was nice but it offset the hard work that the rehab patients were going through. The derm patients were having tar put on them to soften up the plaques on their skin. I liked the rehab end of it. When I graduated from grad school, I moved back to Boston and applied to the hospital where I currently work, still. The floor that was open at the time was orthopedics. I think I was just open to anything. I was (1) happy to have a job and (2) I had only been working part-time since I graduated from nursing school, again, concentrating on my master’s degree and so wasn’t committed one way or the other and started in ortho. At that time, ortho was even different than my orthopedic unit right now. It was orthopedics with a heavy concentration of rheumatology. I just thought that I think for me I liked the fact that the patients came in not feeling so well. They came in with debilitating arthritis. They stayed for about ten days to fourteen days and when they left, they still weren’t fully mobile. They weren’t independent but they were getting there. They were getting better. I think that’s the part that really attracted me and still attracted to orthopedics. You see an immediate improvement in someone’s life and it’s an improvement that’s going to carry them forward. It’s only going to continue to make their life better. Immediately after surgery when you see them walking, they’re only going to get better. They’re going to lose the walker. They’re going to lose the crutches. They’re going to be independent. They’re going to be back to their life in six weeks. I’m not sure there’s another field that really has that high of an impact on patients.
Jamie: Mobility is so important to who we are. That independent movement of – even being to be able to walk across the room to pick up something you want to have is so central to just being a person and your general health that it is such an impact.
Mary Anne: Absolutely. I think that’s one of the things that we hear from our patients. We do have the luxury of seeing them preoperatively. In a class, we teach them to get them ready for – “Do you really know what you’re signing up for this?” Majority of it is elective surgery – “Do you know what you’re setting yourself up? Do you know what your needs are going to be?” You can make all kinds of provisions before you get here. So you have a smooth transition and less worry when you’re here. One of the things patients frequently say is “I’m so frustrated right now.” Either they’re unable to participate in a sport or an activity that they enjoy. The same thing, if it’s a hip, they can’t bend over the way they could before. They can’t sit for as long as they used to. Just being able to get them back to their lives is so gratifying.
Jamie: I was looking at some of the things about orthopedic nursing recently and one of the terms that really leapt out at me was – not an official medical healthcare term – but “boomeritis.” This aging population coming in with existing sports injury problems and they’re aging. So they got arthritis. They’ve got the normal challenges that go along with an aging population or an aging individual and then they had a very active life up to a certain point and they want to maintain that activity. What do you say to those patients?
Mary Anne: Well, we welcome them here. We’re glad they made this first step. We are seeing exactly what you just said. We are seeing the weekend warriors. We’re seeing the early mid-fortyish population that was very active through college and high school and just wear-and-tear on their joints. We’re seeing older patients who are really so active and vital already and are starting to get limited. That makes them feel old and they don’t want to feel old. They want to stay active and busy. Most of our patients we do encourage them to stay as active as possible before they have their surgery. Then we try to give them the mindset that you’re not sick, unlike some patients who might come to a hospital. You’re not sick. You’re electing to come and make your life better. So don’t get into sick mode. When you’re here, participate in your physical therapy. Get out of bed as much as you can. Participate in your exercises and have that plan for when you go home that you’re going to continue to just get more and more independent.
Jamie: We so often talk about educating our patients as an important part of the nursing process but I think a lot of people often think about that as discharge instructions and there’s really a lot more to it.
Mary Anne: There’s definitely a lot more to it. Our class has been perfected over the last several years. It’s co-taught by a physical therapist, a nurse, and a care coordination nurse. We each have very separate roles but very supportive roles of each other. Our physical therapist will instruct the patients on what they can expect through the [months]. That’s usually a big question for them – “I play golf. When can I go back to golf? I ride a bike. When can I do that?” They want to know that they’re progressing on a normal scale. Our physical therapist is able to set some short-term goals with them and really give them some hopeful encouragement that this is definitely the right thing to do in their lives. They walk them through some exercises. They demonstrate them with the things that they should start doing before they get here. The nurse is able to come in and really talk about her supporting role in pain management and cryotherapy and making sure that the patients are on their baseline medications and their dressing and all those things that will make them feel confident that they can go home independently and help them to participate in their physical therapy to the maximum while they’re here and get close to the independence. Then the care coordination nurse, she’s sort of pulls up the backend and make sure that they know that we’re not just going to let them out the door. That we are going to continue to follow them when they leave. Setting them up with VNA at home and making sure that they have physical therapy support when they leave until they see their surgeon again and sometimes even beyond that. But the class has been great. It’s an opportunity for them to ask questions. As most people in orthopedics know patients who have a knee replacement or hip replacement often have a second joint replacement as well. So in the room when you have a group of patients and their loved ones, their supports in the room, the conversation is so rich they – patients will turn around and talk to the people sitting near them and say, “Oh, this happened the last time I was here.” They’ll give them helpful hints and tell them what to do. It just becomes a very exciting exchange between people and often people linger long after class just having conversations. We’re just going to start looking at – “How do we get our class or a class to everybody?” Because we’re a large academic medical center not all of our patients are from Massachusetts. Some of them are going to choose to have surgery here but they’re not from here so we’re looking at things like podcasts and YouTube videos and what kind of up-to-date brochures we can send them that have the right information so they’re not googling things and making themselves nervous and then making sure that they have human contact. We usually follow up our joint class with – patients have my card and we tell them, “If you have any kind of questions, when you go home, don’t sit at home and worry, call.” People will call. They’ll get home and they’ll start thinking about they heard in class, what they learned, and trying to make complete sense of it so that they’re totally prepared when they get here and they do. We have been able to demonstrate that patients who come to class and participate do so much better and they’re usually out post-op day 2 in the afternoon and they’re going home.
Jamie: I think we’ve over trained our patients to have this expectation that they can’t get their questions answered over the phone and yet there’s such an important aspect of the ability of telenursing – of that ability to answer these questions over the phone from a trained nurse – that really helps alleviate a lot of the patient’s problems and deals with issues before they become a problem. It sounds like you all have really met that challenge head on.
Mary Anne: We tried. I think we have learned over several years – I’ve been doing this about 27 years now – that patients will start to get a level of anxiety if they don’t have their questions answered. Because they’ll just fill in the gap of “You know, I think I heard this” or “My friend who have their joints 35 years ago told me this.” That’s a message we are very clear in class is “Don’t sit at home and worry;” “Don’t google” – googling is fine but – “If you need answers or you have a question, here’s the person – this is a direct line. You’re not going to get put on hold. You’re not going to sort of go in to a queue and no one’s going to answer your question. There’s a live voice on the other end – usually me – and we are here to help.” Nursing is so central. You see your orthopedic patients. They’re going to see a doctor. They’re going to see physical therapist. They’re going to see care coordination. Yet it’s nursing who chose to own this piece of it. I can ask a question to a physical therapist if I have to then I can take that back to that patient and really interpret it in a way that they can understand it. One of our patients, she was having a struggle with – she had a dental problem. She had heard in class that if you have joint surgery you might need to take an antibiotic dose afterwards. She was very confused. She went to her dentist and her dentist said, “Don’t have any dental work done before you have your joint surgery.” We, of course, tell them, “If you have the opportunity, have your dental surgery before you have a new joint replacement just to protect your joint.” She agonized over it. I think she called me every day for a week. I was able to talk her down. “This is okay. Go to the dentist. You’re going to be fine.” When she got here she said, “I want to see your face. I want to make a connection.” It was really great. She was able to express that just knowing that someone was listening to her and sort of holding her hands with the whole thing made her much less anxious and she did fabulous. She had a great experience.
Jamie: That point really shows that distance nursing or telenursing or even answering text questions and things like that are good ways to connect to patients and create that caring nursing relationship even though it is at a distance. It’s clearly evident by the fact that she wanted to meet you because she had formed that relationship.
Mary Anne: Exactly. It’s all good for me too because I invested in this patient and I wanted to – I try to deliver on what I said. She did great. It’s a really good experience.
Jamie: What about for a person considering a move into orthopedic nursing? What would you say to that new nurse that is interested in orthopedics or perhaps an existing nurse who’s thinking of changing career paths?
Mary Anne: For me, orthopedics has been my passion. I started fulltime in that field and I have just never left it. I’m fortunate to have a group of nurses who work with me who have been here through the whole journey with me. In this day and age, everyone wants the glamor – they want the ICU, the want the NICU, they want the emergency room – those areas are so specialized. It’s hard for a new nurse to always break into them. I tend to hire a lot of brand new nurses right out of school. We call them “newly-licensed nurses” (NLN). I would say I probably hire about fifteen a year. Many of them, I have to believe, showed up at my office because it was a job. As I sit and talk to them I really try to tell them about orthopedics and it’s so much more than a job. But taking care of an orthopedic patient is probably one of the best foundations any new nurse could have because the patients (1) they’re not chronically ill, they’re not even acutely ill. So you got a patient who is going to be able to partner with you and go through the journey together – and still better – and know that they’re going to leave here in a better state. The orthopedic surgery itself – surgery is a great place to work. The patients – they have a surgical wound. You’ve got all those post-op things that you have to look for – their vital signs, bleeding, there’s a fair amount of tubes and drains and IVs, pain management – you get a smattering of all that. But what I sometimes think really helps the new nurses, all the orthopedics come with their own co-morbidities. You might parade in ten people who’ve had their total knee and their knees all may look the same but the patient doesn’t look the same. Some have diabetes. Some have heart disease. Some are status post transplants. It’s all that other stuff that you really get to touch on. I think it gives you such a broad picture of what a patient can be, what healthcare is. You interface with just about every surface. We have orthopedic oncology. We have orthopedic patients who come with metabolic issues. We have orthopedic patients who have cardiac or transplant medicine issues. They’re not just hips and knees. They are this total patient who everyone looks different. The nurses that usually come to my unit, they’ll stay three, four years and then they are really ready to transition to just about any other field of nursing there is. They have just an exposure to so much. I think sometimes we lose sight of that. We think of orthopedic surgery – there’s traction and it’s heavy and the patients can’t walk – but it’s so much more than that. I think it’s a great place to start your nursing career.
Jamie: I used to have the impression that orthopedic nursing when I was going to nursing school was like the construction zone of the hospital. If you like tools and – but, really, just doing the research for this even opened my eyes even more. The patients are not just surgical candidates all the time. There are patients that have joint issues that don’t require surgery but do require some thoughtful and critical thinking from a nurse to help them find the solution that may help them manage whatever their issue is.
Mary Anne: Absolutely. I think orthopedics is just an amazing field. The technology and the techniques of this, I started here a long time ago, and our patients came – I think our hips and knees respectively stayed ten and fourteen days. They come with their luggage. They’d come with everything they own because they were staying. Our patients now – same surgeries, same idea of surgery – they’re in and out 48 hours post-op. If you had told me that back in the ‘80s I would have said, “You’re crazy. There’s no way. Their pain can’t even be managed in that short of a time.” I’m very fortunate to work with a fabulous multi-disciplinary group of physicians and physical therapists and nurses and we have been marching into the future with these patients. I think sometimes we have to stand back and say, “It’s amazing! This is an amazing work that these patients are having major surgery on a joint and they’re [up] the day of surgery. They’re walking a day after surgery. They’re on crutches on day two and they’re back to their lives. I just think it’s amazing. It’s almost like bionic. The “Bionic Woman,” I grew up with that TV show. It almost feels like that. You’re rebuilding this people. They’re happy. You can see them. They’re walking on the floor. They’re not dragging IV poles and sitting in johnnies. They’ve got their gym shorts on and their sneakers and they’re tracking around the floor and they’re ready to go. They’re happy. It’s changed their life.
Jamie: It sounds like you’re empowering these patients. That’s such a different way of looking at healthcare. It is really exciting to have talked with you. What’s one of the things that you take away from this as a nurse?
Mary Anne: Well, for me, I’ve done the whole journey. I started here as a staff nurse. I was a clinical educator and have done the director for several years. I think the most exciting thing for me is still the patient contact. I may be pulled away to meetings and things like that but I try to be on the floor for a significant portion of everyday. I try to see every patient every day. I will go back and admit patients. I will teach the pre-op joint class. I think, for me, it’s just staying connected to the – the reason why we do this is staying connected to the patients and their families. I have a little bit of a luxury of being able to sit with the patient’s family and talk to them – “How has this changed you? What are your plans? You got a brand new knee now, what are your plans? What is the first thing you want to do?” It’s really interesting to listen to the patients. We had one woman who said, “I’m going to Italy. I have been wanting to go to Italy forever and my knees bother me and I just didn’t know how I’m going to get there and my friends have been there.” As soon as she got the green light from her surgeon, she was going to fly over to Italy and get to fulfill her dream. I think that the patient contact is what keeps me coming to work every day and the fact that our patients do so well. They do well. You ask them. You engage them in conversation and they say, “I don’t know why I didn’t do this before. I don’t know why I was so nervous.” It’s just amazing.
End of Interview Transcript —
Don’t forget to check out the entire October 2011 issue of Nursing Notes, digging into the world of the orthopaedic nurse. This month’s Nursing Notes newsletter reveals the origins of orthopaedic nursing, injuries that lead to “Boomeritis” and gives a look at the upcoming National League for Nursing’s technology conference. You can read the entire issue online at www.discovernursing.com and don’t forget to catch the other Nursing Notes Live episode this month featuring a panel of orthopaedic nurse leaders and their thoughts on the future of this field of nursing. You’ll find this and other podcast episodes at www.NursingNotesLive.com, the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.