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LR: What drew you to home care?

 

ML: When I went to apply to my school of nursing, I indicated I wanted to be a public health nurse and I was told that no one comes to nursing school wanting to be a public health nurse first.

 

But I said I read The House on Henry Street, and that's when I wanted to be a public health nurse, because it encompassed public health nursing with social work and teaching. At that time I had had 2 years of college at Hunter I had a really hard time deciding among teaching, social work, and nursing, and felt that public health nursing combined all three.

 

LR: You were kind of on the cutting edge?

 

ML: Yes, they didn't really like that idea.

 

LR: So what did you do? Did you stand your ground?

 

ML: Well, of course. When I graduated from the Presbyterian School of Nursing, in those days, you had to give a 6-month commitment, but during the 6 months I was completing the application process with VNS. At that time, applying to VNS was considered a privilege. It was like entering an Ivy League college, you had to have references from your Minster, and your college credits had to be good. So I stayed on at Presbyterian the 6 months and left to join VNSNY.

 

LR: What year are we talking about?

 

ML: 1952. I came on March 17th, 1952.

 

JC: You have been here for 50 years?

 

ML: Well, you see my husband was a musician and we traveled. He was with the Dallas Symphony and the St. Louis Symphony for a period of time, so I had to travel with him. In those days there was no per diem nursing. I would have to resign each time, but they would let me come back for the summer or longer because the Philharmonic season didn't start until the late fall. For a brief period of about 6 months I worked with Nassau County Department of Health. Two years were in an official agency. I did that because they used to tell you, "If you want to be a good public health nurse you have to work in an official agency" [a New York state or New York city health department].

 

LR: And this was a purposeful strategy to become a well-rounded public health nurse?

 

ML: Yes, to be the best. Then in '59 I got a U.S. Public Health Service Grant to work on my masters, which I did at Teachers College. They gave you a stipend, paid for your tuition, and you committed 2 years to working in a community health setting, that was the pay back. In those days we were called public health nurses; the title community nurse is relatively new. But even then we had to be certified by the state of New York, so you submitted your credentials, and I had a little card that I was a Certified Public Health Nurse.

 

LR: Someone told me that public health nurses do government work?

 

ML: Well, technically that is sort of what it means. But years ago, when you worked for VNS, you needed to be classified as a public health nurse. Years ago the classification was real. There was a pay difference.

 

If you were a public health nurse you had a little card the state gave to you after you submitted your qualifications. If they made you supervisor you got another card that showed that you were certified to be a supervisor of the state.

 

LR: It wasn't the difference in the BSN vs. the non-BSN, at that point?

 

ML: You had to meet certain requirements in addition to the BSN. It meant a difference in terms of VNS-a different classification.

 

JC: When you had the two different classifications early on, did your job responsibilities actually differ based on the classifications?

 

ML: They tried to let the public health nurses be the senior advisors. We would then orient new nurses, one-on-one, in the field.

 

LR: Like a mentoring role?

 

ML: Yes, it was a role the public health nurse carried out. She was a senior advisor, and had training for it at the VNS.

 

LR: When you joined VNS, what regions were we? How big was VNS?

 

ML: About 15 district offices, I was on the lower east side.

 

LR: I remember hearing about all these. It was incredible that we were so decentralized.

 

ML: That's the only way we should have ever been, because you are close to the community. The big difference, looking at the lower east side then and now, is there were not a lot of high-rises. Most of the tenements were five to six stories high, without elevators. I worked on Third Street to Avenue A to D and everyone knew me in the community.

 

It still was very much like Lillian Wald's period because you'd walk down the block and people would wave to you from the tenement windows. Now a lot the tenements are down and the large high-rises are up.

 

LR: What are your more vivid memories of your early days as a visiting nurse?

 

ML: I had come as a relatively new nurse and I was fulfilling a life-long wish. It was everything I hoped to be. I really didn't learn about nursing until I started to work with patients. I have a picture that VNS took of one of my first patients who needed to have daily insulin. I had really never done diabetic teaching; I had to learn so much myself so that I could then teach other patients.

 

The other very vivid memory is the last years of the polio epidemic. Sister Kenny was a physical therapist and a nurse who introduced what was then a controversial treatment for polio patients. We had many children on the lower east side with polio. Where before, doctors would exercise them and stretch them and cause them great pain.

 

Sister Kenny introduced hot packs to relax the muscles and put the patient through normal range of motion. The results were positive and there was less pain. They were very long visits and you were working with children, it was whole new thing for me. A brand new world was expanded to professional practice.

 

LR: Was VNSNY piloting this new regimen or were we one of many trying this?

 

ML: No, we never piloted anything, we just did things. We just crashed into them. You also have to realize that, when I entered into the field, in the 1950s, the only nurse service that VNS provided was nursing. We did not have home health aides. We just signed a contract with the physical therapy association (The Association for Crippled Children, which was on 23rd and 1st Avenue) and we had one physical therapist/consultant in each office, who would set up the treatment plan and would come out to supervise the nurse carrying out rehabilitation nursing.

 

Then VNS kept that model until the late 60s or 70s when we provided direct service with physical therapists who worked on a contractual basis. We would have one PT in each office, and sometimes in more than one office to "set up a nursing rehabilitation plan" and help you follow it.

 

LR: How long was your average visit then?

 

ML: First of all there were different treatment modalities. There were a lot of cardiac patients to get injections to remove fluid; they had congestive heart failure. I sometimes saw 17 people in a day, but only because the travel was vertical. I could go into a building and have several patients on different floors. Giving an injection was 15-20 minutes.

 

But toward the end of the day I had to do total care to patients who were completely bed bound. I would have to do rehabilitation nursing; those visits were 30 minutes to 1 hour long. You had to do all that, or you had to work with a family member.

 

LR: I was curious about the diabetes, because I have diabetes and my mother had to boil the syringe parts and put them together.

 

ML: That is what we did on the weekends. The diabetics would boil their equipment, leave it in the water with the cover over for the pot for the nurse.

 

Also, we would rip sheets and teach patients who couldn't afford to purchase dressings to wrap them in packages and bake them in the ovens. The world has now become disposable.

 

LR: What motivated you to move from direct care to management.

 

ML: I just felt ready to do it as a field supervisor. From that I was still working part time, and then after that I became an assistant supervisor.

 

I always enjoyed working with staff and patients and established clinics, some of which are still in operation today in Queens.

 

LR: What do you consider your most significant contribution to VNS?

 

ML: I've always been forward thinking and I'm able to forecast what needs to be done. I may not always be listened to, but I have a pulse on what the agency should be doing and I've been a mentor to so many people throughout the city in different agencies that I'm most proud of that.

 

LR: Those are two important roles. What other significant changes have you seen during your career?

 

ML: The complex care being given at home. We really moved from providing basic, essential treatment to dressings, injections, to much more sophisticated treatment modalities: IV care, the complex case management with wound care. There are supports we have now that we didn't have back then; although, at that time we relied more on outside community agencies to do more of the social follow through. Now it seems that there are fewer community-based agencies that have charitable money.

 

LR: It was very important that you were a mentor to many different people. Do you think new nurses are in danger of losing sight of their patients in making a commitment to nursing?

 

ML: I think that our new nurses are occupied with all the things that they have to do for regulatory compliance: the things they have to do to make the computer work, that they are so focused on that it is so hard to crowd in the patient time. If you look at a map of time spent with the patient now and the amount of time you spend on paperwork, there's a radical difference.

 

LR: What do you gain from the students?

 

ML: Oh, they keep me young, they keep me on my toes. I feel like I am their age.

 

LR: As a new nurse, did you envision your career taking the path it has both in terms of what you're doing and the longevity?

 

ML: Not really. I just knew I was doing what I wanted to do and liked to do and I wanted to continue doing it. I was married. I thought I was going to have a big family, but that didn't happen. I had only one son, so I was always delighted to have my career.

 

LR: What is the single most valuable lesson or word of advice you can offer to new nurses?

 

ML: They should never lose sight of the patient.

 

FIGURE

  
Figure. Marilyn Liot... - Click to enlarge in new windowFigure. Marilyn Liota (far right) with two nursing colleagues, circa 1950s.

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Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.