October 22, 2013

Kaiser Permanente early nurse practitioners broaden scope of care

Kaiser Permanente Sacramento staff staged a farewell tribute to the MASH TV series in 1983 by dressing up to resemble its military medical unit characters. Among the players was Marge Geary, bottom row at left. One of the original Sacramento nurse practitioners in the early 1970s, Geary is current nursing leader at South Sacramento Kaiser Permanente. Photo by Richard Gilmore, The Sacramento Bee.

Second of a series

Forty years ago, before advanced nursing positions existed, a group of Kaiser Permanente nurses were cutting their teeth in new fields as specially trained nurse practitioners. In the beginning of this journey, these nurses worked in preventive medicine, well baby care and OB-GYN.

Dorola Haley began work with OB-GYN physician Albert Kahane when Kaiser Permanente first opened in Sacramento in 1965. Around 1970, Dr. Kahane received a Kaiser Foundation Research Institute grant to study the role of the nurse practitioner in OB-GYN practice. At the same time, Haley completed the requirements to become a nurse practitioner, and soon she and Dr. Kahane began to take turns seeing patients.

Dr. Kahane was the first in Sacramento County to propose the then-radical idea of fathers in the delivery room. Haley says there was a lot of resistance to this in the medical community, but he believed it to be beneficial for the family and was proven right.

“They wanted to run Al out of town on a rail,” Haley said. (OB-GYN physician Sidney Sharzer pioneered this in Kaiser Permanente in Southern California.)

Dr. Kahane felt that couples would find another way to be together during childbirth if hospitals didn’t modernize. He had been in the U.S. Air Force for four years in Alaska, where this was established practice.

More time to get to know patients

Marge Geary was one of the first nurse practitioners at Kaiser Permanente in Sacramento. She is the current assistant medical group administrator and director of nursing practice at South Sacramento Kaiser Permanente.

At a recent reunion, several of the early Sacramento NPs talked about how the extra time they spent with patients — a full, uninterrupted 30 minutes — was crucial to the member’s total health. Busy physicians could only rarely devote this much time to a single patient. The NPs’ stories are about striving to reach the ideals of preventive medicine, about getting to know the “whole” patient, and helping him or her to maintain good health.

“We knew our patients’ social history,” said Dianna Costa, an OB-GYN nurse practitioner still working part time for Kaiser Permanente today. “We knew whether the family had a dog, and if they did, who fed the dog. We knew what you (the patient) were eating, and if you exercised. In a 30-minute physical you learn it all. It (preventive care) was huge to us. It was life, not just a physical.”

“If you listen to a patient, really listen, you learn everything you need to know,” remarked Haley. “I’d ask them to tell me what’s going on.  For prenatal patients, I’d talk to them about what’s going to happen in the next month.”

Nurse practitioner pioneers praise mentors

Carl Henriques, MD, medical director of the Sacramento Preventive Medicine program, now deceased, was ruthlessly strict in expecting his students to conduct physical examinations and medical histories perfectly. “You could say he was a tough task-master,” recalled Betty Taisch, one of the pioneer NPs.

Taisch recently attended a lecture by Abraham Verghese, MD, author of “Cutting for Stone,” a current best-selling novel. The Stanford University School of Medicine professor described the importance of caregiver-patient trust and rapport — and of touch. “You walk into a room and someone is sitting there with only a piece of paper covering them, and you ask them the most intimate questions,” noted Taisch.

“You have to quickly develop a bond of trust with this person. You have to understand the simple art of putting your hand on their shoulder. As I was listening to him (Dr. Verghese) describe his bedside manner, I was sitting there so proud because I recalled being taught exactly the same things by Dr. Henriques,” Taisch said.

Marge Geary, a nurse practitioner pioneer and health appraisal manager from 1978-1984, chimed in:  “The way he taught us was systematic, so that we didn’t miss anything.” Dr. Henriques began all of his progress reports on student Marge Geary in 1972 with “This young lady . . .” Today she is both the assistant medical group administrator and director of nursing practice at Kaiser Permanente South Sacramento.

The early NPs have nothing but praise for Millie Kahane as well. They say she helped them reach for a higher level of professionalism through education and training. “She took a broad view of everything,” Geary recalled.

John Mott, MD, physician-in-chief at Sacramento Kaiser Permanente, summed up the experiment:  “(In 1970) the medical climate for NPs was quite different than it is now. The status of the nurse practitioner was not clarified by the California Legislature until 1975.

“Had Dr. Henriques and Mildred Kahane, (BS, MA), slipped, the stature of NPs in California could have been delayed many years. Such are the dangers of living very close to the State Legislature, the Board of Nursing, the Board of Medical Examiners and the Attorney General. . . . (KP) Sacramento membership includes many articulate, highly educated, health-oriented groups . . . who might or might not approve of being examined by a nurse practitioner (rather than a physician).

“Credit should go where credit is due, and Dr. Henriques and Mildred Kahane did a tremendous job pioneering this field.”