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Who Is the Oncology Nurse?

Publication: U.S. News & World Report

If you've recently been diagnosed with cancer, you'll soon be meeting a lot of new people. Cancer is a complicated disease, and treatment often entails a care team that includes several specialist doctors, nurses, perhaps a nutritionist, a social worker and other health care professionals who work in concert to treat and hopefully cure the cancer.

One member of the team that you'll likely have a lot of direct contact with is the oncology nurse. This front-line health care provider may wear a number of different hats, and you may work with more than one oncology nurse during your treatment.

Depending on a number of factors, you may encounter several kinds of oncology nurses as they "practice in different settings including acute care hospitals, ambulatory care clinics, private oncologists' offices, radiation therapy facilities, home healthcare agencies and community agencies," write Paula Trahan Rieger and Connie Henke Yarbro in the sixth edition of "Cancer and Medicine," a textbook published by the American Cancer Society.

Oncology nurses work closely with a number of specialists, including surgeons, radiologists and medical oncologists to help deliver care. Some work exclusively with a single doctor and see only a certain type of cancer patient while others work with a range of different doctors and care for patients with all kinds of cancer. Oncology nurses also do everything from monitoring patients after surgery and administering chemotherapy to helping patients access resources they need to ease their journey.

One of the most critical aspects of what an oncology nurse does is to educate patients, says Elena Tobin, an oncology nurse with Texas Oncology–Baylor Charles A. Sammons Cancer Center in Dallas. Tobin works closely with Dr. Joyce O'Shaugnessy, a medical oncologist who treats breast cancer patients, and says that she not only supports the patients, but the doctor, too. Tobin meets with every patient O'Shaughnessy treats to go over all the details of what's going to happen during treatment. "We teach them about chemo and side effects and go through the anti-nausea regimen. We'll go over every little deal of side effects, such as what to do when you have a fever of 105, where to go for chemo classes, where to go for chemo itself, and so on. We talk about everything from the top to the bottom."

In addition, Tobin says "we help hold the patients' hands through the process." This support that the oncology nurse can offer shouldn't be underestimated. "It's emotional for patients to go through it, and so we're there for them. Sometimes we're a punching bag, but we help them through that process," which may involve not just nursing care, but also arranging transportation and connecting patients with financial resources to help make ends meet during a difficult time.

Cindy Werhane, an acute care oncology nurse at Legacy Good Samaritan Medical Center in Portland, Oregon, says that education is a critical component of the oncology nurse's role, because when patients understand what's happening and how to manage problems themselves, "it helps keep the patients from coming back into the hospital. A lot of these side effects that people are experiencing, if you can catch them early enough, they can be managed either in the office or at home, and the patient won't have to be readmitted. So, I think it's important that patients take advantage of that education we offer."

She says absorbing the information as best you can before you start treatment can help make dealing with complications easier if they arise when you're not feeling well. "Once you start to feel sick and once you start receiving chemotherapy, your ability to recall some of that information is muted. If you can let that information just constantly seep in and have family members around you so people can pick up pieces of information, it's easier to recall in those times when you're fatigued and your blood counts are low," and the last thing you feel like doing is thinking about how to handle a problem.

Werhane's role at Good Samaritan is a bit different from Tobin's at Texas Oncology, which shows that oncology nurses fit into the care team in a number of ways depending on the situation, the type of cancer, the facility and even the individual patient. Werhane works as a "floor nurse" on an oncology ward at the hospital and sees patients in an in-patient setting, meaning they're in the hospital rather than in a clinic or an out-patient facility where some patients may receive chemotherapy and other treatments. "My surgical oncology patients come in because they're having a tumor removed or an exploratory procedure to determine if they have cancer. But I also work with medical oncology, so I'm working with patients on symptom management. Some of my patients are end-of-life. They've gone through all their treatment and are progressing into hospice care, so I help them transition there."

In addition, Werhane works with some patients with blood cancers, such as multiple myeloma, lymphoma or leukemia, who are having stem cell transplants. That treatment involves intensive chemotherapy that takes patients to the brink of what their bodies can stand to kill off the cancer and "then we rescue them by giving them their own bone marrow back," she says of these complex procedures. During this type of treatment, patients need a lot of care and support from nurses, and Werhane says that's where the acute oncology nurse comes in to "have eyes on the patient for such an intense period."

In all her patient interactions, Werhane says she acts as an advocate and coordinates with the doctor to make sure patients get the right care. Because she has such close interaction with patients for up to 12 hours at a stretch, sometimes she'll notice that something doesn't seem quite right, even if all the blood work and vital signs indicate nothing is amiss. In those instances, Werhane says she'll call the doctor for an additional check. "I think having patients understand the role nurses play in being their advocate and allowing us to be their voices is really important."

Werhane says she also occasionally notices that some patients aren't doing quite as well as they report; many patients "tend to want to impress the doctors and show them how well they are. Most patients are afraid to let the doctor know that the symptoms or side effects are getting worse, because if they do, the doctor might reduce the [chemotherapy] dose and the patient worries that maybe it's not going to kill the cancer as well as if you stay on schedule."

But she says it's really important to speak up about any changes in how you feel and to communicate as openly as possible with all members of your care team about what you're experiencing. "It's really important to let the doctor know about any issues. It helps them stay on a schedule. Patients should constantly keep the doctors informed of the little side effects so they can get better symptom management and stay on course." And if you find it easier to talk to your oncology nurse about what you're experiencing, he or she can speak with the doctor on your behalf.

Both Tobin and Werhane say sometimes it can be hard to watch people go through the challenge of cancer treatment, but that being an oncology nurse is rewarding work and an important service that they're glad to be able to provide. "Early in my nursing career," Werhane says, "a fellow nurse told me when I was struggling – 'you didn't cause their cancer. It's not your fault that they ended up in the ICU. It had nothing to do with what you did. What you are doing for the patient is you're helping them get through this difficult time more successfully. And you're helping them process and you're helping them along this path.' I always think back to that when I'm struggling with one of my patients who's dying or when somebody is on a difficult pathway. I remember I'm doing the best I can to educate them about what's going to happen so they can make the best choices that make sense to them in their world view."

As Tobin says, "our motto is to be the calm, smiling nurse in that hurricane that's hitting them. Offering some normalcy and a smile – that's the goal of it all."

Read the full story at U.S. News & World Report.

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