Alfred Spivack taught nurses to do a number of jobs generally restricted to doctors in the early days of Stanford’s coronary care unit, and also helped to developed new technology for cardiac care.
May 15, 2015 - By Sara Wykes
In 1966, Stanford Hospital joined the handful of hospitals worldwide with a dedicated nursing unit for coronary care. That specialized unit, with only four patient beds, was advanced for its time — and so, too, was what followed for the nurses who worked there.
“Nurses then couldn’t start IVs,” said Joan Fair, PhD, RN, MSN, NP, one of the unit’s original nurses and now a cardiovascular researcher and fellow of the American Heart Association. “And I was trained to stand up when a doctor entered the room.” Alfred Spivack, MD, the unit’s founding director, wasn’t a fan of that kind of thinking.
He taught its first head nurse, Bonnie Goddard Burnham, and the nurses in the unit to do a number of jobs generally restricted to doctors in those days, such as reading electrocardiograms. He also taught them a technique he pioneered to monitor heart failure: It required threading a catheter from the arm to the major vein leading into the heart to measure oxygen and blood pressure — another type of procedure considered outside the bounds of a nurse’s duties then.
“Some doctors were totally against nurses doing these kinds of things,” Fair said. “It also took time for some doctors to accept our opinions about how their patients were doing, or if we saw a problem and called them and asked them to take a different line of treatment.”
The coronary care unit is now approaching its 50th anniversary. In April, Spivack, now a professor emeritus of medicine at Stanford, and many of the nurses who worked in the unit over the decades were honored at a special dinner. The occasion was the official announcement of a major gift from Spivack to honor the nurses who pioneered the unit’s specialized critical care for cardiac patients. The gift will fund the nursing station when the unit is relocated to the new adult hospital, where it will be called the heart acute care unit. The new hospital is slated to open in 2018.
In 1959, Spivack arrived at Stanford as a research fellow in cardiology. Selling the idea of a dedicated coronary care unit at what was then the Palo Alto-Stanford Hospital was not easy.
Some couldn’t see the teaching benefit, and others thought the emerging technology of electronic monitoring for heart rhythm, for example, was gimmicky, Spivack said. “They thought it had no viable future,” he said.
Bedside defibrillators were just becoming available, but few clinicians or nurses had been trained to use them. “When we started the unit, because we had no faculty and no students, our nurses were the ones who accepted the challenge,” he said.
Spivack, Fair said, was “tireless in making us experts. He really believed we could do these things, and that made us believe we could, too.” Spivack urged her to go to her first American Heart Association research conference, and her time there inspired her to start doing research. In 1977, she joined the Stanford Prevention Research Center as a research investigator. In 1996, she earned a PhD in nursing. Her dissertation was on the interaction between negative emotional states and multifactor coronary risk reduction.
When Fair went to graduate school in 1974 to earn a master’s degree in nursing and nurse practitioner status, Joan Mersch, MSN, became the unit’s nurse coordinator. (She retired in 2006.) Spivack also taught Mersch to do certain procedures mainly done by physicians, and she trained other nurses to do them. She said she’s confident that she and her fellow nurses were able to make crucial interventions because of this training. “When you know how to read electrocardiograms, recognize lethal cardiac rhythms, perform resuscitation and defibrillation — it saves patient lives,” Mersch said. “You understand what needs to be done, and you can take action.”
The dinner was attended by almost two dozen of those former nurses, who over the years have co-authored hundreds of published research papers. Several have earned master’s and doctoral degrees — more evidence of the influence of Spivack, Fair said. “He instilled in us a curiosity about research and included us in early research investigations conducted in the CCU,” she said, referring to the coronary care unit. “That became an important element in the careers of many CCU nurses.”
Advocate for technology
In addition to empowering nurses, Spivack recognized that cardiac care needed better tools. He designed new technology, including a bed-based computerized torso called the Arrhythmia Trainer to train nurses on using defibrillators. He developed that device with the help of Hewlett-Packard co-founder Bill Hewlett, Spivack said, whom he cold-called.
He instilled in us a curiosity about research and included us in early research investigations conducted in the CCU.
Some of the monitoring techniques in the early days of the unit were primitive compared to what now exists, but they were the groundwork “from which we came forward,” Spivack said during remarks he gave at the celebration dinner, “and it would not have been possible without these nurses.”
He paused and, addressing the nurses, added, “I thank you very much for what you’ve done for Stanford and what you’ve done for me.”
“He saw that the future of cardiology was headed toward an environment where patients would be intensely monitored in a high-surveillance nursing unit, where the sickest of patients could get the best care,” said Randall Vagelos, MD, professor of medicine at Stanford and director of the adult hospital’s coronary care unit. Testing and adopting new electronic monitoring meant there was a lot of data coming in “and he understood that that data wouldn’t do any good unless you had someone there to make sense of it.”
It would be a setting, Vagelos added, “where you weren’t going to have to guess whether someone was getting sicker, and he understood that all of this was going to depend on nurses. There were clearly not enough doctors to create that kind of surveillance.”
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