Combining research and care
Using a computerized system, infusion nurse Deirdre Callanan, R.N., thoroughly checks medication orders before she administers chemotherapy to a patient.
Debra Moody, R.N., is a nurse-in-charge on one of the inpatient units located on the fifth floor of Brigham and Women's Hospital, Dana-Farber's collaborator in Dana-Farber/Partners CancerCare, along with Massachusetts General Hospital. Her responsibilities include helping other nurses keep pace with new treatments and practices. "Change can be the most challenging aspect of being an oncology nurse, but it can also be the most rewarding," says Moody. "We never stand still because this is a learning facility. It is amazing to see what's coming next."
Most nurses come to DFCI with experience in oncology nursing, but training in Nursing Department sessions and organizations across the country continues throughout their careers. Plans include increasing coaching and mentoring opportunities and providing more support for newly licensed nurses and for those seeking formal certification of their skills.
"Trust is one of the most important aspects of the relationships among patients, physicians, and nurses alike."
— Marie Zano, R.N., OCN
Nurses are also refining practice standards, particularly in patient safety and the administration of powerful chemotherapy drugs. Dana-Farber's physician, nursing, pharmacy, and administrative staffs have been recognized nationally over the past several years for their exemplary work in safe practices. Zano has seen the results of these efforts firsthand.
"We now have a computerized system that I consult every time I prepare to administer chemotherapy," she explains. "I check everything, including the dosage, the time expected to administer the drug, possible side effects, and steps to take if there are any." When patient care and clinical research coincide, infusion nurses must often provide completely new treatments. In that case, says Zano, two nurses and pharmacy staff thoroughly check treatment information and patient-identification badges.
Sally Ryan, R.N., M.S., has personal experience with the competence of oncology nurses in urgent situations. A long-time nurse and manager at St. Elizabeth's Hospital in Boston, Ryan was working for a homehealth agency two years ago when she was diagnosed with an aggressive non-Hodgkin's lymphoma. At Dana-Farber, she serves as a coordinator for One to One: The Cancer Connection, a program that matches newly diagnosed patients and their family members with others facing the same diseases.
During one outpatient session, Ryan experienced a medication reaction. "I remember one of the nurses, in particular, who moved quickly, but was steady and calm," says Ryan. "As she and the other nurses took care of me, I could tell they knew what they were doing. I felt reassured, not panicked."
"We never stand still because this is a learning facility. It is amazing to see what's coming next."
— Debra Moody, R.N.
Institute-wide systems put technology and staff skills to work for safety, says Reid Ponte, but a truly successful program involves much more. "We've learned we must listen to patients. They know so much more about themselves than we do," she states. In addition to applying this philosophy to each patient, the Institute seeks input from adult and pediatric Patient and Family Advisory Councils. By working with clinical staff, patients and family members on the councils help plan and implement policies, services, treatment programs, and design of physical spaces that best serve patients' needs.
Another strategy to support safe practice at the Institute, says Reid Ponte, is creating an atmosphere where staff are encouraged to uncover and speak out about potential safety problems. "Even when you have the best technology and the brightest minds, any system that involves people has potential for error," notes Reid Ponte. "This open-mindedness brings us closer to working relationships in which potential errors are identified and addressed before they become dangerous."
- ext: Critical thinking and continuity
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