Penny Vaughan was a 20-something cardiac nurse when her manager, Norma Shepard, called her into her office one day and said, “We’re going to a meeting, and we’re going to start a national organization.” That was 50 years ago. Today, that national organization she helped start is a community of exceptional nurses with over 120,000 members. We talked with Vaughan, who spent much of her nursing career at Vanderbilt Medical Center in Nashville, Tennessee, where she was director of the Critical Care Nursing Program, about those early, formative days of AACN.
How did AACN come about?
In the mid and late ‘60s, coronary care units were being developed across the country, and the nurses working in these units were taking on a role for which we were not prepared.
What do you mean “not prepared”?
We were having to make clinical decisions quickly, because we were dealing with a population of patients whose conditions could change quickly, and we wouldn’t have time to call and consult a physician. So, we were learning as we went, but Mrs. Norma Shepard, who was the manager of my coronary care unit, saw the great need to help educate nurses who were taking on this new role of coronary care nurse. And so we had a conference for cardiac nurses in Nashville and invited nurses to come — all of the speakers were physicians — but the nurses were hungry to increase their knowledge base, so they could knowledgeably and in an expert way take care of these critically ill coronary care patients.
How was the conference?
The response was overwhelming, and it helped Mrs. Shepard and some other senior leaders who were managers of their infant coronary care units realize that the greatest need the nurses had was to learn, and to learn more, and it was both how to manage these patients, but it also was this evolving new role for nurses. There were not many nurses practicing in a more independent, advanced type of way. Nursing anesthetists did, nursing midwives did — but within the hospital this was all new. So, Mrs. Shepard and other nursing leaders saw what these nurses needed to be successful: How we’re going to reduce mortality for cardiac disease is we have to teach them.
What was the nursing environment like at that time?
It was just all new. Technology was new. You would laugh at our monitors and defibrillators we had because [laughs] they were huge, and so today you would go, “Really?” But we had to learn to manage technology, new drug therapy, and every day it was something new. So, in 1968, Mrs. Shepard gathered a group of nursing leaders and had polled and surveyed nurses who attended our first conference.
Overwhelmingly, the nurses said, “Yes, we need an organization to help us.” So the mission and values of AACN really started as helping nurses to know what they’re doing, and, from this, NTI so that they can provide the kind of care that the patients need. And it was always patient-centered, but the patient would only be successfully treated if the nurses had the knowledge base to do that. That was the start of it, and we had I think 140 nurses at the organizational meeting. We organized and elected officers, and then had an annual educational meeting, and it just grew and grew.
What role did you play?
I was the first secretary of AACN. I kept the membership cards in a shoebox. People would send in their membership; then I would make a record of their name and address. Of course, we had no computers, we did not have email; it was all through the U.S. Postal Service. To make a long-distance call? Very expensive. So, we didn’t just pick up a phone and call somebody. It had to be thought out, and we tried to gather information in one setting: “OK, I’ll call you, and we’ll talk about this, this and this.” I would send the checks from the membership to our treasurer — who was in Minnesota — and, again, just back-and-forth mail. And I’m pleased and excited to see that the vision of AACN and the mission have not changed. It’s all about education and excellent patient care, but also providing that arena for the nurse to succeed and to feel the reward of a job well done because I know enough.
How do you think AACN has stayed true to its original intent?
Mentoring nurses is such a powerful activity for an organization to take hold of, and AACN has done that beautifully. I think AACN values its foundation, and you see the growth in numbers; you see the evolution for today’s world. But the mission and vision are taking care of critically ill patients and providing that work environment, so that nurses can successfully do that and feel good about what they’re doing — not to feel that they’re defeated at the end of every shift.
What were AACN’s early days like?
My most powerful memories of the early days were just that Mrs. Shepard said to me one day, “We’re going to a meeting, and we’re going to start a national organization.” OK, so I’m in my 20s, I’m just starting out, I’m newly wed and I’m going, “I don’t even know what this means. How in the world could we” — these nurses in Nashville and others we had made contact with — “start a national organization?”
So, how did you do it?
Mrs. Shepard just had that vision. She made contact with other nurse managers who were working with physicians to open up these coro- nary care units to recruit nurses. So, again, we were blessed to have contacts throughout the United States — nurses doing the exact same thing that we were doing — and they would recruit nurses. As we met with nurses from all over the country, our membership grew. It was just absolutely thrilling and amazing to network with them and to see what they were doing.
How have you seen nursing and AACN change over the past 50 years?
The desire of nurses and the desire of AACN is to take care of patients who are critically ill. So that really hasn’t changed — that desire, that mission, that vision. But nurses today are so smart, and they look at this opportunity in taking care of patients who are critically ill, collaboration with physicians, and they just see the possibilities of how they can make a difference.
How has patient care evolved?
We do things much better now than we did 10 or 20 years ago. We have more evidence. We have more evidence-based medicine in practice. Just having that as a word, a term, a concept that they incorporate in their everyday practice. Because there was a time when that was not so. That we would do this because we have always done this, and as new medicines, new therapies, new procedures would come along, we would have to learn about them. But just because it was a good idea did not mean it was going to help people. So, probably the biggest change is bringing that scientific, clinical evidence of care to the clinical area.
Anything else?
Helping people to live the last of their lives in comfort, in dignity. That death is not always a failure, and if that is the outcome then we need to be prepared to support that patient and that patient’s family. I will never forget when I was working at Vanderbilt, I was working with heart failure patients, and one of my patients was at the end stage of life. And so I asked him one day, “What would be a good day for you today?” He said, “I would like to have an appetite, and I would like to have time with my family.” And so we were offering him a medication that would in fact give him those two things — time with his family and an appetite — but it would not lengthen his life. It would probably shorten it. And so I had the privilege of sitting down with him to tell him, “Here’s what we can do. Here’s what would be good about it, and here’s what would not be so good about it.” It was just so fulfilling to be able to guide him in that decision. So I see that change in nursing too: looking at the whole patient, incorporating the family members into care. That has evolved as nursing care has evolved.
What’s your advice for future critical care nurses?
Go and practice. Take care of patients at the bedside. Examine what it is you know and what you need to know more about. Establish that collegiality with your physician partners. Finally, make sure that you take care of each other.