Archive for March, 2011

Iron nurse Dorothea Daniels had a soft spot for nursing students

posted on March 21, 2011

Daniels at right, Lisker second from right, 1950 Permanente Foundation Nursing School capping ceremony in Oakland, California. Note Daniels' Phillips Beth Israel cap.

By Ginny McPartland
Heritage writer 

Read almost anything about Permanente Foundation School of Nursing’s first long-term leader Dorothea Daniels, and a caricature of a stern, tough-shelled, by-the-book and proper nurse comes to mind. Daniels, a product of New York, rattled her students, nurses and many physicians with her exacting demand for perfection in all things related to patient care and protocol.

She made the nurses work and study hard in restrictive conditions and she didn’t hesitate to correct a physician who displeased her. “She came from a different cut of cloth,” wrote John Smillie, MD, in his history of the Permanente Medical Group. “She regarded herself, and I think quite properly, as a peer of any of the doctors she was dealing with.” 

Migrating to California from New York City after the war ended in 1945, Daniels brought to Permanente her solid education (a doctorate in education from New York University) and experience running a nursing school in that city. From 1936 to 1945, Daniels was the director of the Phillips Beth Israel Hospital School of Nursing. 

Daniels imposed strict rules for student lifestyle

Not unlike other nursing schools of the time, Phillips stressed the students’ need to conform to strict standards of behavior, dress and health habits. House mothers hovered over the students to make sure they didn’t misbehave. “Nurses were not permitted to marry while in training, and subsequent marriage was grounds for instant dismissal,” according to the school’s current Web site. 

At Phillips, nursing students worked six days a week and curfews were rigorously enforced. Pupil nurses were disciplined if they stayed out all night. “Dress inspections took place in the dining room, and students were weighed once a week to make sure they did not ‘get too heavy’ since there was a professional necessity for nurses to ‘look well.’ 

Kaiser Foundation School of Nursing in an old hotel building on Piedmont Avenue near the Oakland hospital, 1948 to 1976

“Hospital director Daniels insisted on student nurses who looked healthy and fit, believing that if students were overweight, they could not work hard and take care of patients,” the school historians reported. “There was concern (during the 1930s) that nurses did not get enough exercise and recreation…’” 

Daniels gets support for her view of fitness in a textbook for orienting student nurses in the 1930s: “Curative medicine gives place to preventive medicine, so must (the nurse) be prepared to understand and apply intelligently the principles of prevention…“The nurse of the future must exemplify health, and teach it. Humanity is ready to cast off sickness.” 

Encouraging nurses to spend leisure time wisely

In 1940, Daniels embarked on a study to assess Phillips students’ leisure time activities, including physical activities. “What Ninety Girls Like to Do in Their Free Time,” authored by Daniels, was published in the National League of Nursing Education publication. A softer side of Daniels emerges in her discussion of the study results. 

“These young women (19 to 24 years for age) have developed abilities of discernment and judgment in their avocations as they develop in the school. While they are learning to assume increased responsibility, they seem to be learning how to spend their leisure time more wisely,” she wrote. She said many subscribed to a professional nursing journal, and “The most thorough inspection of the nurses’ quarters never reveals magazines of the ‘true story’ category.” 

The survey results conclude that the younger girls are spending an average of six hours a week on exercise and the older girls 7.3 hours. “Within a short walking distance there is a tennis court, a swimming pool, a roller skating rink and bicycle-riding areas. “Little equipment is necessary. Sport dresses are the only necessary paraphernalia for hiking, bicycle riding, and roller skating…these types of exercise are easy to learn and give one a sense of well-being and feeling of grace,” Daniels wrote. 

Once the anonymous surveys were compiled, Daniels returned them to the students and asked them to send them back with identification so she could: “aid in fulfilling the wishes stated on the papers. We found it possible to send some students to their first legitimate play; and some 25 were sent to concerts. Our physical education director was instructed to work out her program to include activities for which there were expressed preferences.” 

Bringing her ideals to California

Permanente Foundation Nursing School graduation 1951. Dorothea Daniels at far left, Clair Lisker, third from right.

When Daniels came to California, Permanente Foundation hired her as director of nursing in the Oakland hospital. That position grew in 1948 to include the job of director of the nursing school established in 1948. As expected, Daniels incorporated into the school policies many of the ideas she had adopted in New York. 

The first Permanente School of Nursing student handbook, developed in 1948, prescribed the dos and don’ts for students to get along well at the school. “Your ability as a nurse is reflected in the way you keep your room…Students must be in their own room at 10 p.m., and all lights will be out at 10:30 p.m…Guests may be entertained only in the living room between 8 a.m. and 10 p.m. (Exceptions were made if a mother came to visit.) 

“Pre-clinical students will be in the residence at 8 p.m. each day, Monday through Thursday, unless otherwise specified by the director of nurses…Your window shades will be kept drawn at night when the lights are on…Every student is expected to be adequately clothed when going through the halls…Students are expected to be tidy and well groomed at all times…The conduct of the student nurse on and off duty must be such as will not reflect discredit on herself, her chosen profession, nor her school.” 

In a 1961 nursing school report, a revised philosophy of the school was detailed. Revisiting the fitness theme, one stated role of a successful nurse was: “A teacher of healthful living.” A decade later, the Kaiser Foundation Nursing School brochure stated under Personal Qualifications required for admission: “General appearance is one of the considerations in the selection of students. Applicants must weigh within normal limits of the range established for height and structure.” 

Daniels helped students pursue bachelor’s degree

Daniels, at left, as a hospital administrator. Daniels was the first woman to serve as a hospital administrator in the Kaiser Permanente health plan.

Daniels left the school in 1953 to become administrator of the Los Angeles Permanente Foundation Hospital, making her the health plan’s first woman hospital administrator. She later returned to Northern California to take over as administrator at San Francisco Medical Center. Clair Lisker was one of Daniels’ early students who rose within KP hospital nursing administration. In a 2002 oral history, Lisker credits Daniels with “paving the way for all of us. She was in San Francisco, and she was at Sunset in Los Angeles, two major facilities. 

“She was a tremendously powerful woman, intellectually. I don’t ever remember seeing her sit down,” said Lisker. Daniels encouraged her best students to earn a bachelor’s degree in addition to an RN degree, believing that a well-rounded education would ensure a promising future. Lisker was one of those students. 

“Dorothea was encouraging me to go and enroll in Holy Names College in Oakland, which was then down by the lake (Merritt) where the Kaiser building is now,” recalled Lisker. “She wanted me to get the basics, like English 1A and 1B, and whatever else I needed, philosophy…I basically said: ‘I can’t afford it…she said ‘well, what I’ll do is I’ll pay your fee, and I will get reimbursed. I’ll take $5 out of your allowance (stipend) every month.’ ” Lisker remembers $5 being deducted from her stipend once but doesn’t believe Daniels ever claimed the rest of the $30 advanced ($10 per course unit). 

Kind, generous and impeccably dressed

“She was very kind and generous to those student nurses, and for a good student she would find scholarship money for that young lady to go on to get a degree, so (the student) would become a leader in nursing,” Smillie recalled. Avram Yedidia, a health plan leadership pioneer, said of Daniels: “Her dedication to patient care was as unblemished as her uniform, which miraculously never wrinkled.” 

“She wore these white starched uniforms with a little pointy hat with a black band, and a little pleated organdy cap on her head,” Lisker recalled, noting the cap was from the Phillips Beth Israel school. Daniels’ penchant for a proper nurse’s uniform was no doubt formed in her early years in New York. While she was at Phillips, student nurses were required to adhere to strict dress standards. 

The Phillips Web site: “Students wore black stockings, long sleeves, bibs, aprons, ankle length blue-check dresses, tight cuffs and a bishop’s collar. During the senior year, what was black became white: socks, stockings and dresses became the uniform of the professional nurse. Students wore no caps until the senior year.” 

To make sure they got the uniform right, the administration consulted etiquette expert Emily Post on the proper attire for student nurses on an outing. “Hats and gloves were de rigueur on field trips,” Phillips historians reported. 

The memory of Dorothea Daniels, who passed away in 1968, will always be of a woman to be reckoned with. Lisker summed it up: “Dorothea’s (attitude) was: ‘I’m in control. I’m in charge’…But she also had her other (tender) side, which she didn’t display very often…She loved her dog. She brought (Snuffy) to work every day, and the dog slept in a drawer in her desk…She was a wonderful lady, but she was a character.”

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19th century Fabiola ladies championed health care for all

posted on March 6, 2011

Fabiola Hospital in its heyday

By Laura Thomas
Heritage correspondent   

Kaiser Permanente Oakland stands today on one of the busiest intersections in the city, destined to bustle even more with the new medical center rising in place of the MacArthur-Broadway indoor mall.   

What many may not realize is that the groundwork for the Kaiser Permanente complex was laid – both literally and figuratively – in Oakland’s early years by a group of high society women of the Fabiola Association.   

In 1887, it was at that same corner, then New Broadway and Moss Avenue, on 2 ½ acres of land covered with oak, eucalyptus and locust trees donated by Anthony Chabot, that the Oakland Homeopathic Hospital and Dispensary constructed a splendid turreted Victorian building. They named it the Fabiola Hospital after a wealthy woman who built a public hospital in 4th century Rome.   

It looked more like a railroad baron’s mansion than what we might think of as a medical building, but it was in line with what those 19th century matrons thought was best for sick people – an environment that was home-like and comforting.   

Privileged women strive for underprivileged

Bucolic setting of original Fabiola hospital

The group had been organized by Kate Kirkham 10 years before. She witnessed a carriage accident and was horrified to learn the victims would be taken 10 miles to a San Leandro hospital, the nearest hospital at the time. She collected $50 donations from 18 women of her circle – local water developer Chabot was a friend of hers – and opened the group’s first facility on Market Street.   

They formed the Fabiola Association to support their work, which focused on providing medical care to anyone who needed it. In its early years, the association members were proponents of homeopathic care.   

Once the hospital went up, the association members established a nursing school that accepted men (an oddity at the time), a diet kitchen, and a visiting nurse service. They began a program of expansion that didn’t abate until the Great Depression hit in the 1930s.   

Fabiola grew to meet community needs

Interior of maternity cottage late 19th century

Fabiola’s expansion was much like the evolution of the modern-day Kaiser Permanente’s complex. Before 1900, Fabiola annexed a Queen Anne-style cottage to the main building for the nurses’ quarters, and then added a facility for children and a maternity “cottage.” Over the following 20-plus years, the hospital spread across Broadway with the takeover of a Red Cross facility and the building of a graceful Spanish-style nursing home designed by Julia Morgan.   

A new surgical building went up in 1907 along Moss Avenue and Howe Street. The final spate came in 1923, accompanying a building boom across the city, when the Fabiola ladies built another nurses residence at 3797 Piedmont Ave., with a tennis court.   

The year ended with the completion of a modern 50-bed maternity hospital at the corner of Moss Avenue and Broadway appointed with, according to the Oakland Tribune, “antique walnut, rich rugs and cretonne hangings.”   

The much-touted maternity building, you may realize, became home to the first Kaiser Permanente hospital in 1942. But there’s more to this story.   

Both Kirkham and Kaiser dreamed of better access to care

The Kaiser Foundation Health Plan’s mission is built upon the work of earlier generations that saw providing adequate health care as a duty of the society. And people of means often took it on as their personal mission. Henry Kaiser was inspired to set up the Kaiser health plan by his mother’s untimely death, much as Kate Kirkham was prompted by the suffering she witnessed in the accident.   

In the progressive era, women across the country started hospitals and clinics for women, children and the poor. The Fabiola Association was part of the trend. Members insisted in their by-laws that the hospital be managed by women and that the staff doctor always be a woman.   

Fabiola maternity hospital circa 1924

They were privileged women with feminist instincts who financed their work by staging endless parties, teas, rummage sales and a big horse racing event that were covered in detail – down to the gowns each woman wore – in the Oakland papers. Reading between the lines of the Tribune, Herald and Post-Enquirer provides an insight into the social mores and strict sense of personal duty of a century ago.   

Society ladies took care of working nurses

The Fabiola women were fiercely devoted to the welfare of the nurses. In 1902, they were encouraged by the board president to take turns sending their carriages out “at 8 o’clock in the morning to take the night nurses out for an hour or two driving in the quieter parts of our suburbs” to help them relax before going to bed.   

There were power struggles among the ladies who served on the Fabiola board and at least one strike by nurses which necessitated the matrons’ heading over to the hospital to hoist the bed trays up from the kitchen. They were also taken to task by local ministers who berated them for raising money through gambling, with the Fabiola Derby Day at the Oakland Trotting Park.   

Again, owing to their social status, such criticism didn’t stop them. “Oakland’s most exclusive dames are members of Fabiola and they are indignant over Rev. Baker’s strictures,” reported the Tribune in June 1904.   

Each year, the Fabiola Association issued their service statistics. In 1900, they saw 871 patients of which 619 were hospitalized. Of those, only 131 paid the full hospital charges, the rest paid nothing or just what they could afford. By 1930, the hospital saw 4,753 patients, of which 517 received free care.   

Unfortunately, the good works wrought by the Fabiola ladies soon came to a crashing halt. Hard times reduced paying customers and donations dried up. The hospital closed in October 1932. The Tribune’s headline was “Fabiola Ends Experiment in Feminism” and editorialized that the regret felt by Oaklanders for its loss “was akin to grief.”   

Original architectural beauties demolished

Early the following year, the glorious original hospital – a building that would qualify for landmark status had it survived – as well as the children’s annex, nurses home, and the surgical building were all razed. The new maternity hospital was saved in hopes the operation could be resurrected.   

Instead, the Fabiola Association turned over all its assets to Samuel Merritt Hospital in 1940 with the stipulation that it be used for those unable to afford hospital care, and the women went to work for another decade to aid that effort. The real estate, including the hospital, was estimated at a $75,000 value.   

Fabiola maternity hospital renovated and reopened as the first Permanente Foundation Hospital circa 1942

The hospital was considered still quite modern with its reinforced concrete construction, and Henry Kaiser and Dr. Sidney Garfield were quite pleased to find it in 1942 when they were running out of room to treat shipyard workers at the Richmond Field Hospital. They paid $333,000 for the land and renovations and reopened it in August.   

The Fabiola building served as the core of the original Kaiser Permanente complex during the war and early days of the public health plan. Many additions and renovations on the site characterized Oakland’s flagship facility’s growth over the past 65 years.   

At one time, the Fabiola was painted pink, Henry Kaiser’s favorite color, and in its last iteration was encased in aluminum, one of Kaiser Industries’ main industrial products. The 1923-built, four-story building was torn down in 2005 as part of the Oakland Medical Center rebuild project currently under way.   

Kaiser Permanente carries on Fabiola’s original mission

Few Oaklanders remember the old hospital now, though scores were born in the homey maternity cottage, including my father in 1920. The new Fabiola building on Howe Street is the last reminder of that “institution of real Christian socialism” – as defined by its president Mrs. J.P.H. (Catherine) Dunn at its closing – that was the original Fabiola.   

If in later years Henry Kaiser was accused of being a “socialist” for putting forth a prepaid, group health plan, he stands shoulder to shoulder with Kate Kirkham and her successors in realizing his shared humanity with those in need but without means.   

One hundred and thirteen years separate the pastoral beauty that surrounded the 19th century Fabiola Hospital from the current scene: pavement, numerous traffic signals and striped crosswalks that knit together Kaiser Permanente’s modern complex. But the legacy of thoughtful health care and community benefit is what abides.

For more about Kaiser Permanente’s community benefit programs, go to http://tinyurl.com/4fcswsh

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