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M A R C H 2 0 1 5 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 7 We continue our explorations of the life and career of Kay McVay, a longtime intensive care unit RN at Kaiser Permanente and pres- ident emeritus of the California Nurses Asso- ciation. In this installment, McVay explains how she differentiates between helpful and harmful technologies introduced into nurs- ing and healthcare, and what implications they have for the profession. You graduated from nursing school in 1955. Can you describe the types of technologies or machines you were using back then? You have to remember how basic things were. It wasn't even until after World War II that nurses started doing blood pressures, stitching, drawing blood, that kind of thing. That was because the medics were doing that out in the battlefield, and when they came back after the war, their practices just continued and expanded to us nurses as well. Everything was manual. For example, we didn't have suctions. We had this thing that looked like a giant hourglass filled with water. It was about 4 feet tall and pretty heavy. And you had to flip it over, and the water rushing down created the vacuum that got you suction. And you had to watch it and flip it over again if you needed more suction. And over and over again if needed. What did a typical hospital room look like? Well, there were usually five patients to a room. And there was, like I said, no suction coming from the walls and no oxygen. You had to strap the big oxygen tank to the bed. You were always either moving the suctions or the oxygen. So what is the first technolo- gy that you remember being introduced into your nursing work? I can always remember when we got the Gomco suction machine. It was a little thing on rollers. We thought it was the best thing since sliced bread because we didn't have to flip over the hourglasses anymore. It was compact and easy to move. We had one on the surgical floor, but it would always go missing. You'd come in the next day, and couldn't find it because the nurses were always taking it to other units. And I remember when they came out with the new cardiac monitors where you didn't have to adjust this air bubble on the equipment just so. You just attached it to the patient and turned it on. That was progress. Big progress. When they put suction, oxygen, and everything else into the wall, that to me was real progress for nurses and for patient care. So it doesn't sound like you are against all kinds of technology. People have accused me of being against technology. I'm not against technology! I loved the idea of having the Gomco. That was progress. What I'm against are technolo- gies or machines that are not assisting you in doing a better job of nursing, but telling you what you can and can't do. I don't think that a computer that is being programmed by techs who don't know a thing about patient care is doing a favor to patients. I have a real thing about people who have never cared for a patient telling me what I should be doing. The software programs, because of what they are asking and prompting nurses, are direct- ing nursing practice. How do you differentiate between tech- nologies that are helpful and those that are harmful to nursing practice? You just have to ask yourself: Is this computer program, software, device, whatever, actually helping me do what I know, as a registered nurse, that I need to be doing to take care of my patient? Is it valuable to me, or wasting my time? Or distracting me from really seeing and listen- ing to my patient? Or actually blocking me from doing something I need to be doing or writing something down that needs to be written? When did you retire from the bedside and what was the state of healthcare technology when you left? I retired from the bedside in 1996, and by that time, it had become very clear that your knowledge and experience as a nurse wasn't going to count for anything if the industry had its way. They brought in computers into the nurses' station a few years before that, but charting on the computer was still optional. I didn't ever chart on the computer because I liked the flowsheet where I could check back to see at a glance what had happened with the patient in a 24-hour period. What is your concern now with healthcare technology? I'm worried that the machines are in charge now, not the nurses. The patient should be the focus, not the machines and what they are saying. I'm worried that nurses think following the computer program and filling out screens is more important than your assessment of that patient. I'm worried that nursing is going to be about assessing the machine instead of assess- ing the patient. And then if nurses don't know what a complete assessment is, how do they know they're not doing it? And where that leads, ultimately, is that they'll decide nurses are not necessary to caring for a patient, and they'll get rid of us entirely. We can't let that happen, so we need to always encourage nurses to think criti- cally about technology and not just accept what- ever they want as the way things should be. "Conversations with Kay" appears in each issue of National Nurse. Through McVay's stories, we docu- ment the origins of the modern staff RN movement as well as the changing practice and culture of nurs- ing and healthcare. Conversations with Kay