June 2, 2011
Kaiser Permanente nursing excellence: 75 years in the making
The founding principles and vision of nursing started in 1933. and paved the way for high-performing nurse specialties today.
Kaiser Permanente's first nurse, Betty Runyen, at Desert Center in 1933.
The history of nursing at Kaiser Permanente actually begins in 1933 with Betty Runyen, the sole permanent nurse of Sidney R. Garfield, MD, at the Desert Center Hospital near the construction site of the Los Angeles Aqueduct. Runyen, a young nursing graduate from Los Angeles, was just starting out and looking for adventure.
She was well aware of the early 20th century restrictions on her career options. Her mother had told her she could be a secretary, a teacher or a nurse. Nursing sounded the most intriguing. She became bored with her first job helping to birth babies, and sprung at the opportunity to help launch this pioneering hospital in the desert.
In 1933 nurses were not expected, or even allowed, to perform such a task as starting an IV (tube to introduce liquid intravenously). But Garfield, co-founder of Kaiser Permanente with Henry J. Kaiser, was forward thinking. He had taught Runyen how to start an IV, and the skill came in handy one day when she received an emergency call that one of the workers had succumbed to heat exhaustion. Dr. Garfield was not around, so she drove the ambulance to the job site and immediately inserted a saline IV. The patient quickly recovered.
Looking back from 2011, it seems absurd that nurses — usually women — weren’t entrusted with a task that is now considered routine. But this fact is indicative of how far nurses have come in 75 years in America and at Kaiser Permanente. A review of Kaiser Permanente’s history reflects the major strides the nursing community has made, bringing them to a place and time where their skills are as varied and as specialized and expert as physicians.
Kaiser Permanente history reflects national trends
Nursing history is also punctuated with challenges related to the nurse’s evolving role on the medical care team and with major changes in technology, including medical equipment and use of computers to record medical notes.
In the 1960s, 1970s, and 1980s care of patients shifted away from the hospital to outpatient settings. Advances in technology made it possible for surgery patients to spend less time in the hospital, and Medicare reimbursement policy revised in 1983 dictated shorter hospital stays. Despite a growing and aging population, the length of stay national average trended down from 8.5 days in 1968 to 6.4 in 1990 to 4.8 in 2005, according to the Centers for Disease Control.
Wartime Oakland nurses confer with pioneer KP physician Cecil Cutting.
These changes spawned the same day surgery program that allowed patients to have a procedure without staying overnight. The KP home care program was beefed up to provide surgery and hospitalization follow-up. Outpatient chronic condition management — for the benefit of the patient and the health plan — became ever more important to minimize the time patients had to spend in the hospital. Changes in maternity care also led to shorter hospital stays and an emphasis on family-centered perinatal practices.
New nursing specialties emerge
New categories of nursing have popped up throughout the decades. In the 1970s, the nurse practitioner role was developed to perform many of the tasks formerly done by the physicians. For example, the KP multiphasic or annual physical, initiated in the 1950s for the longshoremen’s union and expanded to the general membership, began to be administered by nurse practitioners working under supervision of physicians. Nurse practitioners were also tapped for well baby care and routine pediatrics visits as medical roles morphed during a critical shortage of medical manpower in America.
With Kaiser Permanente’s emphasis on preventive care, its nurses have been called on to create outpatient education programs to help members manage their own health in partnership with their medical care team. Nurses have become specialized in outpatient management of chronic conditions such as heart disease and diabetes, and in providing home and hospice care. Specialized nursing roles have multiplied exponentially over the decades with today’s nurses trained in every aspect of medicine: surgery, intensive care, cardiac care, obstetrics, geriatrics, orthopedics, and the list goes on.
