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The Registered Nurse

Posted by Ishani Ganguli  February 13, 2012 07:00 AM

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This entry is the third in a series on health professionals who work in the author’s primary care clinic.

As a Registered Nurse (RN), Mary Ann Marshall understands the enormous potential of good multidisciplinary health care and the hazards of hierarchy. It was the promise of collaboration that once drew her away from a career designing buildings and its fruition that has maintained her enthusiasm for nursing. 

In the late 1970s, Mary Ann studied biochemistry at Merrimac College in North Andover, MA, then spent a few years at Saint Vincent Hospital’s chemistry department, testing blood samples and improving drug tests. She didn’t love the job – it offered little of the human interaction that she craved. She was close to leaving health care for architectural design when her friend, a nurse practitioner student, encouraged her to think seriously about nursing. Mary Ann saw an opportunity to apply her biomedical experience in a way that inspired her.
Mary Ann had heard about Joyce Clifford, the nursing administrator of what was then the Beth Israel (BI) Hospital in Boston. Clifford had made her reputation implementing a model of so-called primary nursing in which nurses were accountable for all aspects of their patients’ care and worked side by side with doctors to implement them.

“She was a real independent thinker,” Mary Ann says. “I wanted to follow in those footsteps.” 

So she found a baccalaureate nursing program, at Fitchburg State University, that would allow her to get an internship at BI and bypass the lengthy waiting list to work with Clifford. After graduating with a Bachelor’s of Science in Nursing in 1986, she moved to Boston and took a full time RN position at Beth Israel. 

Registered nurses make up the largest cohort of U.S. health care professionals. In 2008, an estimated 2,596,399 RNs were employed in nursing with an average annual full time salary of $66,973. About 34% of nurses earned a Bachelor’s or graduate degree, while 45% became RNs through an Associate Degree and 20% went through a hospital-based diploma program - a decreasingly popular approach. Most RNs work in hospitals (62% as of 2008) and as staff nurses, though many also have administration, management, or faculty positions. 

Mary Ann spent the next 23 years working as a BI surgical nurse in outpatient clinics, operating theaters, and recovery rooms. Under Clifford’s leadership, her voice as a nurse was heard. “It was a very multidisciplinary approach to medicine. The hierarchy within the system was broken down,” she says. “When we did rounds, it wasn’t just the physician presenting, everyone took a turn.” 

Then the 1996 merger of the BI with Deaconess Hospital brought with it a cultural shift that she calls regressive. Eventually, she found herself looking for an out. She began to hear about patient-centered medical homes and though she wasn’t a primary care nurse, she was intrigued by the model’s similarities to the culture Clifford had promoted. So when she interviewed for the role of registered nurse at the team-based Ambulatory Practice of the Future, “it just clicked.” 

The nursing profession covers a wide range of roles and practice settings - from outpatient clinics and hospitals to schools and homes. This versatility has become particularly relevant as we find that providing care in diverse settings satisfy patient desires and can cut costs and improve health outcomes

In kind, the Bureau of Labor Statistics predicts 22% growth in the employment of registered nurses from 2008-2018 as technology expands care, preventative care becomes more critical, and nurses, and our population at large, approach retirement age. This growth will be particularly pronounced in outpatient clinics (48%) and home health care services (33%) as more health care moves to these settings. 

At APF, Mary Ann’s role mirrors that versatility. She triages phone calls from patients and teaches them how to manage chronic issues from asthma to contraception. She visits clinic patients when they’re hospitalized and checks in on them after they leave to put their medications in order. “I see myself as a liaison between the secretaries and the medical assistants and the providers and the patients,” she says. 

Mary Ann has thought about further training, maybe a master’s degree. But at this stage in her career, the prospect of spending the needed time and money isn’t appealing. And besides, there is plenty to be learned on the job. 

With encouragement from colleagues, Mary Ann now sees patients for urgent care appointments. “I’ll jump in and evaluate patients and take it as far as I can” before running her plan by a doctor or NP. Through a nurse coaching program, she is learning the art of motivational interviewing and partnering with patients for behavioral change. 

For Mary Ann, the appeal of her job is bigger than her nursing degree. “I love nursing, I’m devoted to my patients, but there are other components that interest me. Disease management, the whole health care business model,” she says. And at the end of the day, Mary Ann says that what matters more than her title are the people she works with and a culture of collaboration.
This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

Ishani Ganguli, MD, is a journalist and a second-year resident physician in internal medicine/primary care at Massachusetts General Hospital. She studied biochemistry and Spanish at Harvard College and received her More »

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