Forty years ago she learned to stick a needle in a patient. Now it’s getting right data

The sky hugged the road those January mornings I first made my way to becoming a nurse. Clovis Avenue was a hazardous two-lane corridor bordered by miles of grapevines. A misty, silver air hung low against the white line as I focused my concentration. The Bee Gees were singing “Too Much Heaven” on the car radio. It was 1979. I was a 19-year-old college sophomore with aspirations as heavy as the fog. This was the quickest route between my parents’ home in Selma and my new life.

That semester, I was entering the nursing program at Fresno State. Or should I call it California State University, Fresno? No matter. I had bigger questions. How would I ever get the nerve to give a patient a bed bath or stick them with a needle?

I have to smile at my naiveté. Yes, the mastery of these skills would be essential. What I didn’t yet realize was that learning procedures would be the easy part. Lacing together information and experience into cogent decision-making would be the greater challenge.

I received my registered nursing license in the spring of 1981, months before I graduated from college, which was an option back then. In June of that year, I took my first job on a medical floor of the old Valley Medical Center, a teaching hospital on the corner of Kings Canyon and Cedar Avenues. That same month, the U.S. Center for Disease Control reported its first findings of Pneumocystis pneumonia. Within a month, Kaposi’s Sarcoma was added to the list of rare, opportunistic infections that had begun to pop up around the nation.

I missed this news, too egocentric to see past my daily survival, which included the management of six to 12 very sick patients. But over the coming months, thin, malnourished individuals would arrive; patients who presented with recalcitrant pneumonias or purple splotches on their arms. While the community worried over public drinking fountains, health care professionals feared accidental needle sticks or unexpected splashes of blood. Patients began dying from this mysterious confluence of symptoms. Diagnoses were whispered. By late 1982, we finally had a name: Acquired Immune Deficiency Syndrome (AIDS).

Health care continued to evolve. My career took its own trajectory. I tried different nursing jobs. I obtained an advanced degree. I taught college courses. By the 1990s, I was working as an outpatient clinic nurse in a large, integrated health care system.

The use of a medical coding scheme based on diagnostic related groups (DRGs) was expanding throughout the United States. Private and federal insurance systems used these codes to better track the case mix of patients utilizing hospital resources as well as the quality of care being rendered.

Technological advances now allowed providers to complete moderately complex procedures in the outpatient setting. Cost control became an added incentive. Hospital beds for acute in-patients would always be needed, but the overarching philosophy had shifted: patients should stay out of the hospital if they didn’t need to be there.

There was also the issue of patient safety.

In 1999, the Institute of Medicine released “To Err is Human: Building a Safer Health Care System.” This landmark report underscored the large number of hospital deaths caused by human error. The corollary was that most human error occurred due to process failure, not because individual caregivers were inept or reckless.

By then, I was working as a head nurse and had begun to understand the broader picture. My point of view further solidified when I became the quality manager of a hospital.

Health care can only be delivered safely when individual processes interface effectively to create functional systems.

Today, hospitals all over the nation track voluminous amounts of data — data that drives process improvement and serves as a surrogate for the quality of care that is being delivered.

As a new nurse, I fretted over learning how to insert a catheter into a patient’s urethra. Today, I track the rate of catheter-associated urinary tract infections.

Clovis Avenue is now a four-lane thoroughfare bordered by fields of mandarins and almonds. Kids don’t disco anymore, they floss and they dab.

Forty years is a long time. Things change. But the goal of good health care remains: to help you achieve your best life.

Should your heart stop, it’s advisable that you receive chest compressions at a rate of at least 100 beats per minute. Which happens to be the same tempo the Bee Gees sang “Stayin’ Alive.”