One of the first cardiac nurses in Minnesota, Karen Stombaugh began her career in the late 1960s. She remembers her first job in the intensive care unit (ICU) as nerve-wracking. Among her patients were adults who underwent open-heart surgeries that had become broadly successful only a few years prior. Karen made an impact in the U.S. by educating other nurses, and she also made her mark outside the country, on mission trips to Africa with Children’s HeartLink’s founder and cardiac surgeon Dr. Joe Kiser. Children’s HeartLink is a non-governmental organization (NGO) based in Minneapolis that improves access to pediatric cardiac services in low- and middle-income countries.
When Karen entered the Swedish Hospital in Minneapolis in 1969, nursing was considered a female occupation, and most doctors were men. The nurse-physician relationship was hierarchical, with decision making top-down and non-collaborative.
“Nurses expressed their opinions gingerly. It was better to just give hints. We were not encouraged to think critically or independently. Assessments such as listening to heart and lung sounds were considered a physician’s territory. Orders were not questioned, and this was not necessarily in the patient’s best interest.”
There were no critical care orientation classes for nursing staff. Nurses had to learn on the job. Nurses wore white uniforms, nursing caps and white lace oxford shoes–no scrubs or colors. There were no computers.
“We relied on the Kardex, a large folded card within a portable metal file that gave instructions for care and orders for patients. Instructions were written in pencil, then continuously erased and updated. There were no intravenous (IV) pumps. Nurses used their second-hand wristwatches to time intravenous drip rates. These were controlled by clamps on the IV tubing. If the needle in the patient’s vein moved, the medication could drip too fast, causing serious reactions.”
Gradually, physicians came to accept that nurses were uniquely in tune with patients because they were by the patient’s bedside during the most critical moments, day and night.
“We switched to a nursing care delivery system where the bedside nurse was responsible for administering all aspects of the patient’s nursing care. This personalized the patient’s care. Nurses started communicating and rounding with the physician on their assigned patients. This was a difficult change to make, and we faced resistance at first from both nurses and physicians.”
Nurses’ salaries, however, were low and benefits were almost nonexistent.
“Things improved after the 6-week city-wide nursing strike in 1984,” says Karen. This was one of the largest nurses’ strikes in the Twin Cities. Karen’s focus and eagerness to learn led her to a position as head nurse of the ICU/Cardiac Care Unit and later of the coronary unit at Abbott-Northwestern Hospital in Minneapolis.
“It was very important to me that the nurses become competent and confident in new cardiac technologies and clinical bedside assessments.”
Karen was also concerned that patients were not receiving information about their condition and medication instructions before they were discharged.
“I stayed after my shifts to give this information to patients and families. Word got out. Physicians were surprised at the knowledge of their patents. The doctors decided the hospital needed a patient educator position and offered the job to me. This became one of the first patient education programs in the Twin Cities.”
In the mid-1990s, Karen joined a Children’s HeartLink’s volunteer medical team going to Kenya, led by cardiac surgeon Dr. Joe Kiser. Karen’s role was nursing education. On her first trip to Nairobi Heart Clinic and Hospital, three children were operated on. On the subsequent trip, six surgeries were done. Those included the first pediatric double valve surgery in Kenya, the first repair of Tetralogy of Fallot, and the first two coronary artery bypass surgeries.
“There was fear of failure, fear of the unknown, the sleep deprivation that came with travel, and the stress of last-minute preparations. There was a fine line between ‘doing with’ and ‘doing for.’ Equipment, blood products, IV fluids and medications were all different enough that one had to be innovative and fall back on basic principles. Supplies were limited, and I learned quickly to conserve and not be wasteful.”
The main thing Karen would like to tell nurses in underserved parts of the world is “thank you”: “Thank you for being a good student and achieving your nursing degree in spite of the challenges you faced. Thank you for having the courage, inner strength, and dedication to continue. Thank you for taking on the additional challenges presented by the novel COVID-19.”