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Welcome to the interview landing page.
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Interview Profile
Interview Information:
Two sessions: 29 May 2018, 19 June 2018
Total approximate duration: 3 hours
Interviewer: Tacey A. Rosolowski, Ph.D.
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, jjgarza@mdanderson.org
About the Interview Subject:
Joyce Alt (b. 18 June 1940, Alta Vista, Iowa ) came to MD Anderson in 1965 as Head Nurse in the Postoperative Care Unit in the MD Anderson Hospital, rising through the ranks of unit supervisor and assistant director of nursing until 1978, when she was appointed Director of Nursing, a role she served until her retirement in 1996/’96. She was the first woman to serve as a Division head. Ms. Alt assumed leadership of nursing at a time of very significant turnover rates for nurses. She describes the work she undertook on several fronts to develop nursing at MD Anderson to address this significant institutional drain and create a more supportive environment for nurses to develop their careers and provide more effective patient care.
Major Topics Covered:
Personal background and education
Professional experience in the Texas Medical Center prior to MD Anderson roles
Commentary: Renilda Hilkemeyer’s leadership of nursing
Oncology nursing at MD Anderson in the 70s-90s; practices, development of nursing care; strengthening nursing
Support for nursing from executive leadership
About transcription and the transcript
This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it to written standards).
The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].
In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.
The views expressed in this interview are solely the perspective of the interview subject.They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One: 29 May 2018
An Early Commitment to a Career in Nursing
Chapter 01
Nursing Education and Early Professional Life
Chapter 02
Nursing at MD Anderson in the Mid-Sixties
Chapter 03
Observations about Renilda Hilkemeyer and Nursing at MD Anderson
Chapter 04
Director of Nursing and Addressing the Serious Turnover Problem
Chapter 05
An Invention and Advancing Nursing Research
Chapter 06
The First AIDS Unit at MD Anderson
Chapter 07
Interview Session Two: 19 June 2018
Building the Foundation for the Shared Governance System
Chapter 08
Successes in Strengthening Nursing Community and Practice
Chapter 09
Leaving MD Anderson
Chapter 10
The Enterstomal Ostomy Team, Infusion Therapy, and the Oncology Nurse Certification Program
Chapter 11
Final Observations: Houston’s Nursing Leaders, the Offsite Rehab Center, Nursing Conferences, and Working at MD Anderson
Chapter 12
Chapter Summaries
Interview Session One: May 29, 2018 (listen/read)
Chapter 00A
Interview Identifier (listen/read)
Chapter 01
An Early Commitment to a Career in Nursing
Codes
Ms. Alt begins this chapter by sketching her upbringing in a very small town in Iowa where there was a strong sense of community that taught her “a lot about life.” She talks about the limited education when she was growing up, but appreciated her teachers who attempted to make opportunities for their students. She notes that she received a college scholarship from her church (Lutheran). Ms. Alt explains that her town “lived in the shadow of the Mayo Clinic,” and she was always impressed with its history, which inspired her from an early age to go into nursing. She also talks about her experience at Luther College in Decorah, Iowa.
Chapter 02
Nursing Education and Early Professional Life
Codes
Ms. Alt begins by talking about how she came to attend the Allen Memorial Hospital Lutheran School of Nursing in Waterloo, Iowa, then sketches her first jobs: as a charge nurse on the medical surgical unite at Allen Memorial Hospital, and then as Head Nurse for the Medical Surgical Unit at Methodist Hospital in Houston.
Chapter 03
Nursing at MD Anderson in the Mid-Sixties
Codes
Ms. Alt begins this chapter by explaining how she became aware of a job opening at MD Anderson for a Head Nurse in the Perioperative Care Unit. She sketches the work environment for nurses in the 60s, where the MD was the boss in a unit, the head nurse ruled next and nurses followed the chain of command; nurses has no real opportunity for advancement unless they went into management. She observes that nurses may have had good ideas for how to improve workflow or patient care, but there was no culture to support local innovations by individuals not in leadership positions. Next she talks briefly about her work on the Nursing Procedure Committee, which codified all of nursing activities. She recalls that she served as Head Nurse for about three years before advancing to supervisor. As an example of her work, she describes her work with the head of Pharmacy, Roger Anderson. She again observes that the work culture was very resistant to change. After the interviewer observes that Developmental Therapeutics had a reputation for constant innovation, she tells anecdotes about that controversial department.
Chapter 04
Observations about Renilda Hilkemeyer and Nursing at MD Anderson
Codes
In this chapter, Ms. Alt first notes that her own three years as supervisor corresponded to a difficult time for Renilda Hilkemeyer. Ms. Alt discusses Dr. Hilkemeyer’s contributions and the thoughts about her length of service in the role head of nursing. She then talks about how difficult it was to find trained oncology nursing, as the specialty was not treated in depth in nursing schools. She comments on the process by which Dr. Hilkemeyer was removed from her position.
Chapter 05
Director of Nursing and Addressing the Serious Turnover Problem
Codes
Ms. Alt begins this chapter by explaining the “Mason-Dixon line” that separated inpatient from outpatient care at MD Anderson at that time. She then recounts how she stepped into the role of Director of Nursing after the selection committee had interviewed several other external candidates, noting her initial ambivalence about the role.
She then explains how she addressed her primary concern at that time: the 90% turnover rate among nurses. She explains why turnover was so high. She also notes that she was working on a Masters degree at that time, at Texas Woman’s University (MS in Mental Health conferred in 1977), and elected to do her thesis on the turnover problem.
[The recorder is paused]
Next, Ms. Alt discusses her findings and how she put them to work at MD Anderson, noting that institutional directors were very favorably inclined to evidence based action. Lack of promotion opportunities were a key issue for nurses, and Ms. Alt explains the three-option system instituted in clinical, management/education, and research. She notes that this was a large and very costly program to build and maintain, but it was well supported by Dr. LeMaistre and Mr. Gilley. She observes that they also understood that they had to address problems in the payroll system. She worked with IT to develop a computerized payroll system for nursing.
Ms. Alt then reports that at the end of the first year of her service as Director, they institution had reduced turnover to 17%. She notes that Nursing had hired an employee advocate and a mental health counselor. She created a program, “Build Your Own Package,” based on a model she learned from a fire department, that helped with recruitment and retention.
Chapter 06
An Invention and Advancing Nursing Research
Codes
Ms. Alt begins this chapter by talking about what she enjoyed about her role as Director of Nursing. Next she talks her invention of the Patient Manifold (see left), explaining the work she did with the IV Team to develop the device and perfect its use in a clinical setting. She notes that she traveled around the country to teach other institutions about the use of the Manifold to reduce infections [https://patents.google.com/patent/US4447230; https://patentimages.storage.googleapis.com/0d/e2/2a/45c10325eb16a9/US4447230.pdf]
Next she talks about promoting Pat Taylor to Chair for Nursing Research and to sit on the institutional research committee, the first time in MD Anderson’s history (in the early 80s) that a nurse participated in this committee.
Chapter 07
The First AIDS Unit at MD Anderson
Codes
In this chapter, Ms. Alt recalls the period in the 1980s when MD Anderson established its first AIDS clinic, staffed by volunteers. She describes this period as “a nightmare” firstly because of how ill the patients were and secondly because of the prejudiced attitudes were revealed among the faculty and staff. She notes that she was surprised that older faculty were more understanding than younger faculty. She talks about the work of a Dr. Rios, who left MD Anderson to establish a private AIDS clinic.
Interview Session Two: 19 June 18 (listen/read)
Chapter 00B
Interview Identifier (listen/read)
Chapter 08
Building the Foundation for the Shared Governance System
Codes
Ms. Alt begins this chapter on nursing’s shared governance system by recapping the research she conducted for her Master’s these MD Anderson’s serious retention problems with nurses. (She discussed this in session one as well.) Next she explains that when she stepped in as Head of the Division of Nursing, she began to build an environment where clinical staff saw their units as a community in which everyone had a voice. She discusses how the key was to address and build skills in good interpersonal relationships. She talks about the problems of staffing and explains why some physicians did not support her efforts to change the values of the nursing environment.
Next she lists programs she created to support nursing staff: hiring a full-time counselor, an employee advocate, building a recognition program, and establishing a food bank for nursing staff experiencing financial hardship.
Ms. Alt notes that the working conditions for nurses improved after four to five months, resulting in better retention rates. She explains how she also addressed the salary inequities between MD Anderson nurses and temporary nurses, who were paid more. She had support from institution leadership to end the practice of hiring temporary nurses.
Finally, she talks about the career latter program she established and lists challenges, in particular advancing nursing research.
Chapter 09
Successes in Strengthening Nursing Community and Practice
Codes
Ms. Alt begins this chapter by commenting on the reputation of MD Anderson and how this bolstered the successful evolution of the Division of Nursing.
She notes that other departments/divisions were jealous of the fact that she was able to secure so much support for nursing staff. She also notes that the turnover rate went down to fifteen percent, where it stayed. Next, Ms. Alt explains the Medical Technician Program and the context in which the need evolved for special staff to provide drugs safely and comments on the sharp divide between in-patient and out-patient services.
Next, she talks about the “build your own package” program. She notes that all nursing were “graded” according to a transparent system. She talks about vising a fire department to see how they addressed staffing issues and explains why human resources didn’t grasp the specifics of nursing’s work scenarios.
Next she discussed the IV Team, also covered in session one. She notes that Millie Lawson, a key figure on the team, published several articles on the system devised and the lower infection rates achieved.
Chapter 10
Leaving MD Anderson
Codes
In this chapter, Ms. Alt talks about coming to the understanding in the mid-nineties that her position in the institution had shifted and it was time to leave. She notes that she was the first female division head at MD Anderson. She explains that the emphasis of the institution had shifted, with new financial administrators coming in and reorganizing finances to exert an influence on how patient care was practiced. She notes that Dr. Charles LeMaistre was able to support her with an advantageous severance package.
Next, Ms. Alt lists the areas in which she feels she left a lasting mark on the institution: in strengthening the role of the clinical nurse and promoting the idea that self-governance is not a privilege but a responsibility of all.
She notes that she is being interviewed for a film produced by the Texas Nursing Association, then talks about how she began to settle into retirement after her departure from MD Anderson in 1995/96.
Chapter 11
The Enterstomal Ostomy Team, Infusion Therapy, and the Oncology Nurse Certification Program
Codes
In this chapter, Ms. Alt talks about additional projects she took on that made a lasting mark in nursing and the institution. In response to an interviewer comment about fragmentation in nursing currently, Ms. Alt notes that during her tenure, there was no particular fragmentation. She also comments on the growing use and acceptance of physician assistants during that period.
Next, Ms. Alt discusses the evolution of the Enterstomal Ostomy Team, created under Renilda Hilkemeyer [oral history interview]. She explains the context in which the need for this team evolved to provide support and education for patients who needed to manage these appliances. Her goal was to also add an educational component for students learning this dimension of oncology nursing. She notes the close relationships that evolved between the team and patients.
Next, she talks briefly about the Infusion Therapy Team and the IV Teams. She then turns to the development of the credit-bearing Oncology Nurse Certification Program, which was a precursor to the master’s degree in cancer nursing. She notes that the Division of Nursing was the first to have such a program in Houston. She explains that the curriculum focused on nursing care around chemotherapy treatments, side effects, and care of the catheter. Ms. Alt explains that small hospitals across the country could call on her for advice as they set up oncology services.
Chapter 12
Final Observations: Houston’s Nursing Leaders, the Offsite Rehab Center, Nursing Conferences, and Working at MD Anderson
Codes
In this chapter, Ms. Alt talks about her participation in an informal group of nursing leaders from the Texas Medical Center; she notes that they all observed that healthcare organizations were shifting nursing leadership from nurses to administrators. She touches on several initiatives undertaken under her leadership: the offsite rehab center that she staffed with nurses; nursing conferences that helped instill pride in MD Anderson nurses; and the development of the discharge planning team. She talks about the strong culture of communication and leadership that was evolving among nurses. She ends the interview with final comments about her time at MD Anderson.
