Nursing Staff Provides Care In a Variety of Treatment Settings
from Practice Update, Summer 2005
Melissa Cushman, RN, with young patient.
By Ellen Severtar, RN and Cindy McConnell, RN
At The Children’s Hospital Center for Cancer and Blood Disorders, the nursing staff plays an integral role in the patient care model. Nursing for this center is split between clinic nursing (outpatient) and inpatient nursing. The nursing staff is comprised of a highly skilled, dynamic and expert team who provide care to hematology, oncology and bone marrow transplant patients throughout the continuum of care. Patient needs range from consults and new diagnosis to relapsed, palliative and long term survivors.
Utilizing a family centered primary care model nurses fill many different roles within the Center for Cancer and Blood Disorders. In the outpatient clinic, each provider is paired with a primary nurse. This nurse is responsible, along with the multidisciplinary team, for the care coordination of the patient and their family. The primary nurses’ role includes not only medical care but school re-entry, central line care and treatment education. Parents or primary care providers who call with questions are able to speak directly to the patient’s primary nurse.
The Infusion Center , located within the outpatient clinic, is open ten hours a day. Blood products, chemotherapy, gammaglobulin, hydration and other supportive measures constitute the majority of infusions. Patients also are cared for as outpatients during total body irradiation prior to bone marrow transplant and brain tumor patients in need of stem cell transplants receive these as outpatients. The Infusion Center provides emergency care during the day for the acutely ill patient and it is not uncommon for patients to be stabilized in the Infusion Center and transferred to the ICU.
The inpatient Hematology/Oncology/Bone Marrow Transplant unit has 22 beds. Sixteen of the beds are primarily used for Hematology and Oncology patients and six beds are designated for bone marrow transplant patients. Patients on the unit include infants, children, adolescents and young adults with a diagnosis of cancer, blood disorders and patients undergoing a bone marrow transplant. The nurses meet highly specific competencies and are specially trained to work with acutely ill chronic and chemotherapy patients, surgical interventions, pain management and palliative care. The inpatient unit also utilizes primary nurse, as well as a multidisciplinary approach. Members of this team include: physicians, nurse practitioner/ physician assistant, social workers, pharmacists, dietician, child-life specialist, chaplain, teacher and case manager.
The newest role for the nursing staff in The Children’s Hospital Center for Cancer and Blood Disorders has been in the development of an anesthesia service for bone marrows and lumbar punctures within the outpatient clinic. The nursing staff is also involved in the coordination of specialty clinics such as the H.O.P.E. clinic for long term survivors of cancer, the orthopedic-oncology program and the multidisciplinary neuro-oncology program.
To continue to grow in their expertise the nursing staff is committed to education and research by taking advantage of a multitude of opportunities including becoming members and associate members of the Children’s Oncology Group (COG). In 2004, the nursing staff from The Children’s Hospital Center for Cancer and Blood Disorders presented four posters at national conferences, spoke at local and national conferences and instituted a monthly on-site educational event. The nurses are invigorated by the continuing improvement not only in the survival rates of their patients, but by the improvements in their quality of life. The longevity and retention of the staff is a testament to their dedication to their chosen specialty of hematology, oncology and bone marrow transplant.
