Caring Headlines - April 20, 2006 - Patient Care Services

Caring
April 20, 2006
H E A D L I N E S
Inside:
Special Issue
Celebrating Oncology Nursing .. 1
Jeanette Ives Erickson ............... 2
• Oncology Nursing
Self-Care .................................... 4
Creating a Healing
Environment ............................ 5
Chemotherapy ........................... 6
Celebrating oncology
nursing at MGH
In 1985, when I began my
career as an oncology nurse,
our patient population on
Baker 5, a 14-bed general
medical-oncology unit, included
any patient receiving chemotherapy
or treatment for cancer.
Today, most of those patients
—by Cynthia Knauss, RN, oncology staff nurse
would be treated in the outpatient
setting. Back then, staff nurses
were responsible for managing the
side-effects of treatment, but as a
rule, they didn’t administer chemotherapy,
transfuse blood, start
IVs, or perform phlebotomy. That
was the responsibility of the house
staff and the IV team. This was
long before the development of
effective antiemetics, longer-acting
analgesics and growth factors,
which have revolutionized cancer
treatment. Patients often required
prolonged hospitalization and
continued on page 15
Chemotherapy Order Set
Coordinator ............................ 7
An Interview ............................... 8
Radiation Oncology Nursing ...... 9
10
Clinical Narratives ................... 10
• Corrina Lee, RN
• Marilyn Gammon, RN
Perspectives ........................... 12
• Outpatient Staff Nurse
• Clinical Nurse Specialist
Oncology Nurse Practitioner ... 14
Cancer Nursing Practice
Committee .......................... 16
What Oncology Nurses
are Saying ........................... 16
17
Fielding the Issues .................. 17
• ED Observation Unit
19
Educational Offerings ............. 19
Oncology staff nurse, Cindy Knauss, RN, with patient, Zwi Kohorn,
and Rabbi, Ben Lanckton, on the Ellison 14 Oncology Unit
MGH Patient Care Services
Working together to shape the future

M
Jeanette Ives Erickson
GH nurses are committed
to providing
innovative, evidence-based,
holistic
patient care.
Sharing that commitment,
oncology nurses
have established a significant
presence at MGH,
developing specialty
practices in inpatient and
outpatient settings, and
pioneering ways to utilize
the skills of advanced
practice nurses. With
their clinical insight and
extensive experience,
oncology nurses play an
important part in developing
cutting-edge therapies
to help make cancer
Number of nurses
Oncology nursing: a
challenging and rewarding
nursing specialty
100
80
60
40
20
0
treatments less stressful,
more comfortable, and
more effective for every
cancer patient. Radiation
oncology, bone marrow
transplants, clinical trials,
chemotherapy administration,
immunotherapy,
and proton beam radiotherapy
are just some of
the areas where oncology
nurses have made major
contributions.
Evidence-based practice
is at the core of oncology
nursing at MGH.
Our thriving nursing
research community is
involved in a number of
studies focusing on issues
such as: central venous
catheter care, therapeutic
touch, fatigue,
low-volume unit chemotherapy
administration,
and benchmarking models
of oncology nursing
practice, to name just a
few. The Oncology Nursing
Practice Committee
was established to help
clarify and resolve issues
related to the nursing
care of cancer patients
(see article on page 16).
Many MGH oncology
nurses are involved in the
professional nursing community
in a variety of
roles and responsibilities.
Connie Dahlin, RN, advanced
practice palliative
Oncology staff nurses working within PCS–2005
(years of service at MGH)
31

Care Concerns
Oncology patient problems:
as indicated by the 2005 Staff
Perceptions Survey
In the last Patient
Care Services
Staff Perceptions
of the Professional
Practice Environment
Survey, nurses were
queried about the number
and nature of patient
—by Elizabeth Johnson, RN, oncology clinical nurse specialist
problems they encounter
in their practice. The top
five common patient
problems encountered by
nurses who responded to
the 2005 survey are summarized
in the table below.
Responses are broken
down into three categories:
all nurses; inpatient
oncology nurses;
and ambulatory oncology
nurses.
Nurses throughout the
institution ranked anxiety
and patient knowledge
deficits among the top
five patient problems.
Preventing and managing
infection were most frequently
seen by inpatient
nurses. Anxiety, end-oflife
issues, and fear were
more frequently encountered
by oncology nurses
in the ambulatory areas,
perhaps related to the
fact that these nurses
typically see patients
soon after they’ve received
news that they
April 20, 2006
have a potentially lifethreatening
illness.
The Common Patient
Problem List was developed
by the Clinical Nurse
Specialist Research Task
Force, coached by Dorothy
Jones, RN, senior
nurse scientist, to help
describe and study nursing
practice at MGH. The
group has used the tool to
implement a national
study of CNS perceptions
of practice.
Top five common patient problems in 2005
All nurses
(inpatient)
oncology nurses
(ambulatory)
oncology nurses
Rank Patient Problem Freq Patient Problem Freq Patient Problem Freq
1 Anxiety 89% Management 95% Anxiety 93%
of Infection
2 Risk for Infection 85% Risk for Infection 94% End-of-Life Issues 88%
3 Management Anxiety 92% Fear 83%
of Infection 84%
4 Wound Patient Knowledge Patient Knowledge
Management 77% Deficit 83% Deficit 83%
5 Patient Knowledge Self Care Deficit 81% Malnutrition 74%
Deficit 77%
Jeanette Ives Erickson
continued from previous page
The comfort of patients
and families, and
the ease and efficiency of
care throughout the continuum
are the primary
considerations of MGH
oncology nurses. While
there are designated areas
for oncology care, patients
with cancer are
seen throughout the institution.
From the Emergency
Department to
Cardiology, from general
medical-surgical units to
Labor & Delivery, nurses
in all areas contribute to
the delivery of knowledgeable,
compassionate
care for patients with
cancer, and their contributions
are invaluable.
I hope the stories and
articles in this issue of
Caring Headlines give
you a sense of the
knowledge, compassion,
and skill that are
the hallmark of our
oncology nursing team.
Update
I’m very pleased to
announce that Scott
Ciesielski, RN, has
accepted the position of
nurse manager for the
Post Anesthesia Care
Unit effective immediately.
MGH welcomes the
Oncology Nursing Society’s
31st annual congress
Page 3

Self-Care
The importance of self-care
for oncology nurses
—by Anne-Marie Barron, RN
As a psychiatric
clinical nurse specialist
in Oncology,
I’m often struck
by the intense demands
of oncology nursing practice
as well as the incredible
rewards. In order to
be most whole and most
present with our patients,
their families, and each
another, one of our priorities
must be us. We
have to consider our own
need for development,
nurture, and support so
we remain vital across
long careers.
Oncology nurses are
exposed to powerful suffering.
They make an
extraordinary difference
in the experience of patients,
often during the
most profound moments
of their lives. It is critically
important to recognize
and honor our contributions,
because the
meaning that comes with
that recognition enables
us to take demanding and
painful journeys with
patients and families
again and again. We bring
comfort, inspire hope,
facilitate coping, and
support life and living.
And when death is inevitable,
we support carefully
considered pain relief,
symptom-control, and a
peaceful death. Our connections
heal.
Providing a caring
environment allows us to
process difficult journeys
and recognize the meaning
of our care. We make
an enormous difference
to one another in our
daily work lives. When
we recognize the profound
gift of our caring,
we mitigate the draining
effects of our demanding
work. When we reflect,
laugh, and cry together,
we connect more deeply
with one another. The
more we process, feel
connected, and experience
the
depth of our
work, the
more we
experience
satisfaction
and meaning
and the less
we become
overwhelmed
and fatigued.
We create
caring environments
by
offering support
and assistance
to
one another
when the
going gets
rough and by
recognizing
the beauty of
the care being
offered. We
more formally
promote a
caring environment
when we
make deliberate opportunities
to reflect together
on the meaning of our
work (nursing rounds,
oncology nursing retreats,
and chaplaincy rounds).
Memorial services honoring
the memory of deceased
patients are powerful
opportunities for
connection and support.
The Ellison 14 and Cox 1
memorial service, coordinated
by Laura Mac-
Staff nurse, Linda Brown, RN, lights candle
at recent patient memorial service
Millan, RN, is held each
fall. Clinicians and staff
from all disciplines who
work with patients on
these units come together
to honor patients who
died during the year.
Staff nurse, Linda
Brown, RN, describes
the service as a chance to
honor the lives of patients
she has cared for,
recognize who they were
and how they lived, and
appreciate that she was
with them during difficult
times. The service
reminds her that she is
touched deeply by her
work and connects her
April 20, 2006
with images of patients
that bring both laughter
and tears. Very important
for Linda, the service
underscores an
awareness that while
death may be a frequent
occurrence in her work,
a patient’s death is never,
never ‘routine.’
The work of nursing
is profound. The work of
nursing is demanding.
When we experience the
deep meaning and powerful
connections in our
caring, we bring wholeness,
harmony, and exhilaration
to our practice.
(photo provided by staff)
Page 4

April 20, 2006
The importance
and benefits of
creating a healing
environment for
oncology patients
have been well documented.
Institutions across the
country are focusing on
healing as renovations
are made and new buildings
are being constructed.
The MGH Cancer
Center is a good example
of a healing environment
with its comforting physical
ambience and many
support programs available
to patients, families,
and staff.
Attention to healing
surroundings is evident
Creating a Healing
Environment
—by Carol Ghiloni, RN; Joanne LaFrancesca, RN; and Katie Mannix, RN
as you tour the new Yawkey
Center for Outpatient
Care and the Cox 1 Infusion
Unit. Clinicians,
support staff, and the
Patient-Family Advisory
Council provided input
on the design of both
facilities. Natural lighting
along the outside
corridors, soothing colors,
and city and river views
provide a warm welcome
to patients and families
as they enter the Infusion
Unit and cancer practice
settings. There’s a sense
of openness that is aesthetically
pleasing. Within
the treatment area itself,
patients and family members
enjoy privacy and
comfort, important factors
in creating a supportive
environment.
An all-season healing
garden on Yawkey 8 gives
patients and family members
a place to relax and
enjoy the beauty of nature
away from the treatment
setting.
Patients and families
also contributed ideas to
the renovation of the Cox
Radiation Oncology waiting
area. A fish tank in
the waiting area and the
inviting arrangement of
furniture create an environment
that is peaceful
and soothing.
Patients are always
looking for ways to bolster
their ability to cope
with the physical and
psychosocial issues associated
with cancer and
treatment. The HOPES
(Helping Our Patients
and Families through
Education and Support)
program was established
in 1998 to help patients
and families cope with
the cancer experience.
The program has grown
to include a variety of
wellness initiatives such
as yoga, qigong, massage,
acupuncture, music therapy,
and the expressive
arts of journaling, poetry,
and collage. A variety of
workshops are available
to help patients learn
more about their treatments
and side-effects,
acquire tips for coping
with symptoms and stress,
and gain support from
others with cancer.
Patients and families
can find information and
support through other avenues
such as the Cancer
Resource Rooms on Yawkey
8 and Cox 1, the Network
for Patients and Families,
the PACT (Parenting
at a Challenging Time)
program, and the Take
Good Care Packs program.
The Images Oncology
Boutique offers a wide
variety of products and
services to help cancer
patients deal with body
image and changes in their
physical appearance.
A complete listing of
support programs and activities
can be found on the
MGH Cancer Center website
at: www.massgeneral.
org/cancer.
Staff nurse, Laura MacMillan, RN (left), and psychiatric oncology clinical
nurse specialist, Anne-Marie Barron, RN, share a moment in the healing garden
on Yawkey 8 with a spectacular view of the river and the city
Page 5

Chemotherapy
An overview of
chemotherapy administration
and considerations
—by Susan Finn, RN, oncology clinical nurse specialist, and Elizabeth Johnson, RN,
oncology clinical nurse specialist
H
ave you ever
wondered why
the word, chemotherapy,
raises so
much anxiety?
Does the association of
chemotherapy with cancer
make it seem like a
treatment of last resort?
Chemotherapy refers
to a classification of drugs
that was originally developed
to treat cancer.
Cancer is a disease of the
DNA that results in the
uncontrolled proliferation
of nonfunctional
cells. Damaged cells can
break off from the original
tumor and travel
through the blood stream
Ellison 14 oncology nurses, Judianne Henderson, RN (left),
and Jennifer Brock, RN, conduct a two-person ID check
before administering chemotherapy to patient, Scott Eagan
(photo provided by staff)
causing secondary tumors
elsewhere in the
body, a process known as
metastasis. Cancer has
been recognized as a
disease of uncontrolled
growth with life-threatening
consequences since
ancient times. Hippocrates
named the disease for
a malignant tumor’s crablike
appearance.
Chemotherapy has
had a major impact on
improving the prognosis
and survival of individuals
with cancer. Its discovery
grew out of an
observation in World War
I that soldiers exposed to
nitrogen mustard, a chemical
warfare agent,
experienced significant
loss of blood and hair
cells. This led to the discovery
that chemicals
that interfere with DNA
replication in cells that
divide and multiply quickly
(such as hair, blood,
and germ cells) could
stop the growth of cancer
cells (which also have a
rapid reproductive rate).
Chemotherapeutic agents
are being used more and
more frequently for the
effective treatment of
conditions unrelated to
cancer, such as autoimmune
diseases.
While chemotherapeutic
agents are powerful
therapeutic tools, they
have harmful side-effects
that make exposure to
them potentially hazardous.
Many chemotherapeutic
agents have a narrow
therapeutic index
(the difference between a
maximally safe dose and
a minimally therapeutic
dose is very small). Therefore,
providers need to
adhere to rigorous prescribing
and handling
guidelines to ensure safe
and effective treatment.
At MGH, there is a
comprehensive, competency-based
plan to prepare
nurses to administer
chemotherapy and care
for patients receiving
these agents. In January,
2005, Patient Care Services
adopted the Oncology
Nursing Society’s
Chemotherapy and Biotherapy
Course as the
first step in the chemotherapy
certification process.
The two-day course
is offered at MGH every
other month with enrollment
through The Knight
Center for Clinical &
Professional Development.
The course focuses
on drug actions and
effects, safe handling,
and symptom management.
After successfully
completing the course,
prospective chemotherapy-certified
nurses pursue
a clinical practicum
under the guidance of a
qualified clinical nurse
specialist or other masters-prepared,
chemotherapy-certified
nurse.
Many patients receive
chemotherapy or biotherapy
during their hospital-
April 20, 2006
ization for oncology and
non-oncology diagnoses.
Every effort is made to
place patients requiring
chemotherapy in areas
where nurses are certified
to provide this care.
But there is a growing
need for chemotherapy
administration on units
where no chemotherapycertified
nurses practice.
Issues associated with
this ‘shortage,’ are becoming
increasingly complex.
To address this challenge,
the Low Volume
Chemotherapy Work
Group was convened in
November, 2005, under
the leadership of Ellen
Fitzgerald, RN, oncology
nurse manager. The group
is developing a set of
guidelines and recommendations
for the safe
and timely administration
of chemotherapy
agents on units where
chemotherapy is rarely
given. Provisional recommendations
include:
• establishing an oncology
nursing consultation
service that will be
available through the
paging system 24 hours
a day to initiate treatment
or answer questions
related to the care
of patients receiving
chemotherapy
• guidelines for staff and
patient education
• establishing effective
communication tools
among clinicians
• documentation standards
• procedures to facilitate
appropriate pre-treatment
processes
• patient preparation
continued on next page
Page 6

April 20, 2006
The role of the chemotherapy
order set coordinator
The development
of the computerbased
Chemotherapy
Order Entry
system (COE) has
been a major contribution
in making chemotherapy
a safer and increasingly
effective treatment
for patients with
cancer. Computerized
chemotherapy order entry
facilitates careful review
of the agents and doses,
forces consideration of
standardized regimens,
eliminates confusion that
can arise from handwritten
orders, and reduces
the processing time
between care planning
—by Karen Lipshires, RN, MGH Cancer Center
and implementation. As a
nurse, I’m able to integrate
important clinical
perspectives into my role
as the chemotherapy order
set coordinator as I
work with nurses, physicians,
and pharmacists to
create and document
chemotherapy order sets.
I have the opportunity to
assist providers as they
enter and edit orders in
COE. In my day-to-day
interactions with staff, I
am a liaison between
clinicians and computer
program developers.
The chemotherapy
order set coordinator role
was created in February,
2000. The position calls
for a nurse with oncology
experience and familiarity
with clinical applications.
I work closely with
staff in the Infusion Unit,
allowing for a comprehensive
understanding of
the unique workflow
related to chemotherapy
administration, but my
role impacts the work of
all clinicians involved
with the use of chemotherapy
agents.
The rapid increase in
the number of oncology
patients receiving treatment
in a comprehensive
cancer center such as
MGH requires providers
MESAC Update
Did you know you can link directly to the
IV Push Policy from the MESAC website?
Click your ‘Start’ button and scroll up to
‘Partners Applications.’ Highlight ‘Clinical
References’ and click MESAC. From the
MESAC website you can link directly to a
variety of resources to help you provide safe
and effective care to your patients. When you
check out the MESAC website, use the
‘Feedback’ option to let us know how we can
make the site more helpful to you.
to be adept with all tools
that support their practice.
More and more, the
care of oncology patients
involves clinical, computer-based
applications.
Many nurses went to
nursing school and began
practicing before electronic
information systems
were widely used in
hospitals. So I provide
education on computer
applications to oncology
clinicians at all levels.
The chemotherapy
order set coordinator role
continues to grow and
evolve. On the horizon is
increased participation in
computer-application
training for nurses and
increased participation in
quality-improvement
processes related to chemotherapy.
Chemotherapy
continued from page 6
Chemotherapy order set coordinator, Karen Lipshires, RN,
in her office on the Yawkey 8 Infusion Unit
A pilot program utilizing
these recommendations
began on March
20, and the findings have
been presented in a number
of key nursing forums.
The guidelines for
chemotherapy administration
on low-volume
units will be disseminated
when they are finalized.
Until then, nurses
caring for patients receiving
chemotherapy agents
on a non-oncology unit
should consult with their
clinical nurse specialist.
For more information
about chemotherapy, call
the Ellison 14 Oncology
Unit at 4-5410.
Page 7

An Interview
An interview with Heidi Jupp,
pediatric oncology nurse
W
Bridget: Is it more than
just a job?
hen Bridget Clancy
was in the 10th
grade, her teacher
asked the class to
interview someone
who had made a difference
in their lives. Bridget
interviewed Heidi
Jupp, RN, her nurse in the
MGH Pediatric Oncology
Clinic on Yawkey 8.
Bridget has generously
agreed to share her
interview with Heidi in
this issue of Caring Headlines.
Bridget: Did you always
want to be a nurse?
Heidi: Yes, pretty much.
My mom is a nurse (retired)
so I grew up with
her taking out sutures
and talking about her job.
She worked with kids
and loved what she did. I
entertained the idea of
becoming an artist, but
didn’t think I could support
myself in that realm.
So the practical aspect of
a job that would provide
financial security was
appealing.
Bridget: Who helped you
decide to be a nurse?
Heidi: My mom and my
older sister. My sister
was already in nursing
school when I was making
college decisions.
Bridget: Did you want to
work with children? Or
did it matter as long as
you were helping others?
Heidi: I always wanted
to work with children. I
started out on an adult
medical-surgical unit to
get some experience. I
did that for about two
years, and then moved to
pediatrics. It’s been twenty-three
years now, and
I’ve always enjoyed working
with kids and families.
Bridget: How do you feel
knowing you help someone
every day?
Heidi: It feels good. But
in that effort to help others,
I also get something
back. I’m constantly learning,
and kids are pretty
terrific teachers. I learn
something every day
about medicine, or myself,
or the world. It’s a
great feeling.
Heidi: Yes. I’m sure
many people define themselves
by the work they
do. I always feel good
about myself when I say,
‘I’m a nurse.’
Bridget: Would this be a
good career choice for
most people, some people,
or only a select few?
Why?
Heidi: That’s a tough
question. It’s hard to
speak for others, but I’d
say for those who are
‘people persons,’ who
don’t mind long days or
odd schedules, who aren’t
easily upset by things
April 20, 2006
like blood or surgery,
who can switch gears
from one situation to the
next and think on the go,
it’s a great job! There are
opportunities to help
people away from the
bedside, too: case management,
nurse manager
or administrator, utilization
review, or research.
It’s a broad field, though
continued on next page
In the Pediatric
Oncology Clinic,
pediatric oncology
nurse, Heidi Jupp,
RN, draws blood
from patient, Bridget
Clancy (below); at
left, she is interviewed
by Clancy for a
class paper.
(Photos by Abram Bekker)
Page 8

Radiation Oncology
Exciting times in radiation
oncology nursing
—by Gail Umphlett, RN, radiation oncology staff nurse
Radiation oncology
nurses provide
clinical care,
education, and
consultation to
patients with a wide variety
of cancer diagnoses.
Radiation therapy is used
to treat certain cancers,
including head and neck,
breast, gynecological
tumors, genito-urinary
tumors, lung, gastrointestinal
tumors, lymphoma,
central-nervous-system
tumors, and sarcomas. At
MGH, radiation oncology
nurses collaborate
closely with physicians
who specialize in treating
specific cancers with
radiation, and with dosimetrists
(dosing experts)
and radiation therapists
who implement the treatment.
Radiation oncology
is a specialty practice,
but radiation oncology
nurses must be knowledgeable
in the nursing
considerations of all cancer
diagnoses as well as
the social, cultural, emotional,
and psychological
impact of a cancer diagnosis.
In radiation oncology,
care focuses on assessing
and managing a patient’s
physical status and responses
to radiation treatments;
emotional status;
cognition; teaching selfcare
strategies to prevent
and manage side effects;
nutrition; and collaborating
with other departments
Radiation oncology nurse, Gail
Umphlett, RN (right), confers with
radiation oncologist, Helen Shih, MD
where patients receive
care. Radiation oncology
nurses educate, assist,
and support patients during
specialized procedures
such as placement of
radiation implants, highdose-rate
brachytherapy,
transrectal ultrasound,
stereotactic radiosurgery
head-frame placement,
and recovery from anesthesia
for pediatric patients.
The world of radiation
therapy has expanded
in recent years. The
availability of proton
beam radiation and other
modalities, such as intensity-modulated
radiation
therapy, ‘gated’ techniques
to ensure precise
exposure of moving tissue
(such as lungs), and
clinical trials involving
radiation therapy attract a
diverse patient population.
Radiation oncology
nurses need to stay abreast
of new developments in
disease-management,
treatment, and technology
April 20, 2006
to deliver knowledgeable,
evidenced-based care.
Caring for cancer patients
receiving radiation
therapy requires nurses to
have a broad knowledge of
oncology, a specialized
knowledge of radiation
therapies, advanced assessment
skills, critical-thinking
skills, and good communication
skills. It’s exciting
to be part of a nursing
specialty that’s growing and
changing, and part of a team
that promotes nursing education
and preparation for
the challenges we face today,
and the challenges still
to come.
Interview
continued from page 8
traditionally people think
of nurses at the bedside.
Bridget: I’ve seen how
busy you are in the clinic.
What are the best
and worst things about
working here?
Heidi: Busy is good.
Slow days make me nuts.
But super busy days,
when I can’t talk to kids
and parents, bug me too.
The best part is seeing
someone who has completed
their cancer treatment
come in to say, ‘Hi.
It’s been seventeen years
since we first met. I’m
graduating college this
spring,” etc. That’s awe-
some! The worst part is
talking to a parent who
has lost their child. I
know I can’t ‘fix’ that.
Sometimes, even when
everything has been done,
and done well, a child’s
illness will prevail. That
can be overwhelming.
However, I will say that I
have never regretted having
the opportunity to
have known those children
and their families.
My job also includes kids
with other types of medical
challenges. Although
it’s not always an easy
time, I see bright futures
for the majority of my
patients.
This year, Bridget applied
to college and asked
Heidi to write a letter
of recommendation for
her. Bridget was accepted
to the college of her
choice.
Page 9

Clinical Narratives
Maintaining nursing
presence during crisis
Corrina Lee is a clinician in the PCS Clinical Recognition Program
My name is Corrina
Lee, and I am a
staff nurse on the
Bigelow 7 GYN-
Oncology Unit.
Mrs. G is a lovely, 58-
year-old woman from out
of state who had been
newly diagnosed with
high-grade, serous ovarian
cancer. She was experiencing
symptoms of
nausea and swelling in
her leg. Mrs. G was a
seasoned real estate broker
who had a wonderful
network of friends, which
was obvious from all the
cards and letters in her
room. Her treatment plan
called for chemotherapy
followed by surgery.
I knew upon entering
Mrs. G’s room that the
emotional impact of the
words, ‘cancer’ and ‘chemotherapy,’
might be
overwhelming to her and
her husband. She was
going through a lot in
addition to being in an
unfamiliar setting. When
I met Mrs. G, I sensed a
positive energy from her
despite her anxiety. When
I went in to speak with
her, I put my hand on her
shoulder and told her I
was sorry she was going
through so much. She
seemed to appreciate the
kindness. I asked if I
could pull a chair up to
chat. She smiled and
anxiously agreed.
We discussed the plan
for the day. Mrs. G was a
strong woman, and she
was trying hard to be
positive. However, I sensed
an uneasy feeling, so I
asked if she was scared.
We talked about her prognosis
and the fear of the
unknown, and I was able
to do some chemotherapy
teaching. Her husband
joined us, and throughout
the day we talked in greater
depth about the goals,
risks, and side-effects of
chemotherapy. Mr. and
Mrs. G had good questions,
including how
their environment would
affect her, and they seemed
eager to learn. Experience
has taught me to
introduce information a
little at a time, choosing
the appropriate opportunity.
We talked about
possible scenarios, what
to expect, and how patients’
responses differ.
Mrs. G was to receive
Taxol, an established
chemotherapy drug, which
has a small but significant
risk of inducing
hypersensitivity. Before
starting the drug, I arranged
Mrs. G’s room in
anticipation of the worstcase
scenario. I asked
one of the residents to
remain on the unit in
case of an allergic reaction.
I started Mrs. G’s
infusion at a very slow
rate since this was her
first experience with
chemo, and she wasn’t
used to taking medications
in general. She knew
her body well, and I asked
her to let me know if
she felt anything unusual.
Unfortunately, I had
to make use of all the
emergency precautions I
had put in place. After
receiving less than a milliliter
of the drug, Mrs. G
had a reaction. It started
differently from others I
had seen. Immediately
after the infusion started,
she said she felt nauseous
and reached for the basin.
Her description of
how she felt was different
from what she had
described before. Nausea
is not typically associated
with Taxol. Nevertheless,
I stopped the infusion
immediately. Her
expression when she
reached for the basin just
didn’t seem right. It was
almost as if she were
confused as to what was
happening inside of her.
As I reached for the oxygen,
typical hypersensitivity
symptoms started
to appear—bright red
facial flushing, shortness
of breath, swelling of her
tongue, lips, and hands,
and acute anxiety. As I
placed the primed oxygen
mask over her nose,
my heart ached for her.
Her sense of panic must
have been intense.
“I’m right here with
you,” I said while calling
a code. “Hang in there.”
The team worked
well together, and Mrs.
G’s condition improved.
Her husband sat on the
bed with her throughout
the crisis, holding her
swollen hand. Clearly, he
was the best medicine,
and we were able to work
around him to do what
we needed to do.
In the middle of all
that was happening, Mr.
G said, “What if we can’t
give her this type of chemo?
What will happen?”
I told him there were
other options, and we
would talk about them
when Mrs. G was more
comfortable. I wanted
them both to feel assured
that they had options.
Information is power,
and in this situation they
might have felt out of
control given what had
just happened. Mrs. G,
her husband, her oncologist,
and I stayed together
as she recovered from her
reaction. Once she had
more anti-inflammatory
medication and epinephrine,
she wanted to give
the Taxol another try. Her
doctor thought we could
resume right away, but I
had some concerns even
though her condition had
clearly stabilized. Her
tongue was still somewhat
swollen, and she
was still having difficulty
speaking clearly.
I asked to speak with
her physician outside the
room and shared my concerns
about the increased
Corrina Lee, RN
staff nurse, Bigelow 7
April 20, 2006
possibility that Mrs. G
could go into full-blown
arrest. Together, we decided
it would be best to
transfer Mrs. G to intensive
care before resuming
the Taxol. Though I
didn’t want her to leave
Bigelow 7, I knew it was
best for her. I explained
the decision to Mr. and
Mrs. G, who were sad to
leave but truly appreciative
of our concern for
Mrs. G’s safety. I assured
them the ICU staff would
take excellent care of her.
Before leaving that
evening, I stopped by the
ICU to check on Mrs. G.
I also wanted to check on
Mr. G, who, I thought,
might have new concerns
given he’d had time to
think about what had
happened. I found him in
the waiting room with
reddened eyes. I gave
him a hug, and we sat
without speaking for a
few minutes. His eyes
spoke volumes. I asked
what he was going to do
that evening, where he
would spend the night,
but mostly I just listened.
I asked the ICU nurse if
continued on page 18
Page 10

April 20, 2006
MMy name is Marilyn
Gammon, and
I work as a triage
nurse in the MGH
Cancer Center’s
Infusion Unit. One of the
many aspects of my role
is helping to facilitate
direct admission to the
hospital for patients who
require more intensive
nursing care than can be
provided on an outpatient
basis. Sometimes, however,
the interventions we
provide in the Infusion
Unit can help prevent a
patient from being hospitalized.
In some cases,
interventions can even
help fulfill a dying wish.
‘Mark’ first came to
the Cancer Center in
September, 2002, seeking
a second opinion for esophageal
cancer that had
originally been diagnosed
in 1995. He had been
evaluated for a lesion
that showed up on a recent
endoscopy, which
proved to be a recurrence
of his cancer. Mark needed
to begin chemotherapy,
and I became his
primary nurse.
What I remember
most about those early
visits was his easy smile,
his twinkling blue eyes,
his Irish brogue, and his
easy-going nature—as
long as you agreed with
him. Mark had a unique
way of pronouncing my
name because of his Irish
brogue. Hearing him say,
‘Marlin’ always brought
a smile to my face.
Fulfilling a dying wish—
whatever it takes
Marilyn Gammon is a clinician in the PCS Clinical Recognition Program
From the start, Mark
was a challenge. He had
an extensive smoking
history and enjoyed ‘a
few beers every day.’ He
continued both habits
despite his diagnosis.
Following instructions
was not his strong suit,
even when reinforced by
his family. On more than
a few occasions, Mark
was admitted for pneumonia,
sepsis, and other
complications because he
refused to call for help at
the first sign of a problem.
He continued chemotherapy,
but took several
holidays to fly home
to his beloved Ireland.
When Mark arrived
for his appointments, he
wouldn’t check in at the
front desk. Instead, he
wandered back to find
me to get his IV fluids
started prior to his chemo.
Then he wandered about
the hospital running his
errands, which included
getting prescriptions
filled, reading the newspaper,
and smoking. Efforts
to encourage him to
quit smoking and drinking
were unsuccessful.
Although he acknowledged
these habits were harmful,
he viewed quitting as
‘next to impossible,’ and
reluctantly, I had to accept
this.
I decided to focus my
attention on instructions
he might follow, such as
ways to improve his nutrition.
It was a huge
milestone to have him
put a scoop of protein
powder in his daily milkshake!
Mark’s cancer progressed,
and in the fall of
2005, he looked thin and
worn. He was also having
significant back pain,
a worrisome development
for progressive
disease. Mark resumed
chemotherapy along with
radiation treatments to
his pelvis. The treatment
team was amazed that it
had been ten years since
he was first diagnosed,
even though he continued
to smoke and drink. We
all began to think Mark
had a leprechaun on his
shoulder watching out
for him. Despite mounting
medical issues, Mark
still arrived in the Infusion
Unit with a wry
smile and a twinkle in his
eye. He would joke about
‘stopping by the pub’ on
his way home from treatment
and try to convince
me that his doctor said it
was alright.
Mark’s condition
declined as the holidays
approached. On December
13th, his nurse practitioner
called to add him
to the schedule for IV
fluids and gave us the
news we had always
dreaded—she thought
Mark was actively dying.
Mark had expressed a
desire for DNR/DNI status
(do not resuscitate).
but there was a twist: he
wanted to die in Ireland.
The question was whether
to admit him to MGH
for end-of-life care or fly
him home to Ireland that
night.
I hadn’t seen Mark in
a few months and was
shocked at his appearance.
He was curled up
in bed with a pained look
on his face and could
barely open his eyes. He
had lost a lot of weight.
His wife and daughter
were by his side and obviously
concerned about
his condition, but they
reiterated his desire to go
home to Ireland. I’m
usually an optimistic
person, but Mark didn’t
look like he’d be able to
survive a 20-minute ride
home, let alone a sixhour
flight to Ireland. I
also knew that meeting
all his needs in a relatively
short time in our clinic
was going to be a challenge.
After receiving IV
fluids, antibiotics, and
blood, Mark began to
perk up. His wife booked
three tickets to Ireland
for that evening, and I
began to feel a bit more
hopeful that he might
make it home. We began
to reminisce about the
many funny times we had
Marilyn Gammon, RN
Yawkey 8 Infusion Unit
shared—like how he’d
wander back to find me
rather than check in, and
how that infuriated the
secretaries.
He said, “Ah, Marlin,
I knew I could count on
you taking care of me...
and you always did.”
By this time, Mark
was actually sitting up
and laughing. He still
looked tired and frail, but
he was starting to get that
twinkle back in his eyes.
Mark was in the Infusion
Unit for about five
hours, and that leprechaun
of his once again
pulled him through. We
all felt confident he’d be
able to make the flight
home to Ireland. His family
acknowledged that
everything we had done
was ‘only a band-aid,’
but they were extremely
grateful that his condition
had improved. I said
good-bye to his wife and
daughter, and then had to
say good-bye to Mark. I
had known him for three
years, and this was going
to be our last and hardest
good-bye. I cradled his
face in my hands and
continued on page 18
Page 11

Perspectives
April 20, 2006
Outpatient
oncology nursing
Oncology nurses in
the Yawkey Infusion
Unit are an important
part of the interdisciplinary
team caring for
cancer patients. We care for
patients from the time of
diagnosis, through a variety
of treatments and interventions,
to transitioning back
to their normal lives or
coping with end-of-life
care. Our practice is everchanging
due to new developments
in research and
education. Being an oncology
infusion nurse is never
boring.
An important component
of oncology care is
educating patients and the
people who will be supporting
them about the
treatment they will undergo
and how to manage symptoms.
We spend a lot of
time with new patients so
they understand exactly
what’s happening here in
the clinic and know what to
expect when they leave.
Staff attend frequent symposiums
to stay up to date
on new information and
treatments. This ensures
that our patients receive the
best information possible
to cope with their plan of
care.
The Yawkey Infusion
Unit practices within the
primary nursing model.
Nurses feel it’s extremely
important for patients to
develop a relationship with
their primary nurse. This
—by Stephanie Walsh, RN, infusion staff nurse
relationship promotes
good communication, and
good communication often
leads to patient information
not previously
discussed
with members of the medical
team. A personal bond
can develop that is rewarding
to both the nurse and
the patient. Many nurses
become close to patients,
their families, and friends.
Strong relationships make
coming in for treatments
less stressful for patients.
Staff nurses have strong
collegial relationships
with other members of the
interdisciplinary team. It’s
important for nurses, physicians,
nutritionists, social
workers, and others to
work together to ensure
that patients get the most
comprehensive treatment
possible. Infusion nurses
often act as moderator
between departments,
helping coordinate care
and facilitate transitions.
We’re an important source
of patient information, and
our opinions are valued in
patient care decision-making.
Infusion nurses are
competent and caring.
Patients depend on us to
provide safe, high-quality
care, education, and support
throughout their journey.
Infusion staff nurse is
a dynamic role that promotes
constant growth and
learning.
M
From staff nurse to CNS: a
decade of change in the MGH
Cancer Center
y name is Mimi
Bartholomay, and
I am one of the
oncology clinical
nurse specialists
for the Yawkey 8 Infusion
Unit in the MGH Cancer
Center. Although this is
my primary area of practice,
I also provide coverage
for Radiation Therapy
and the Proton Bean Radiation
Center. For the past
19 years, the question I’m
asked most by family and
friends is, “How do you
do what you do; isn’t it
depressing working with
cancer patients?”
I inevitably respond
by telling them what any
oncology nurse will tell
you—that the intangible
gifts we get from patients
far outweigh the gifts we
give them. Quite simply, if
you want to make a significant
impact on an individual’s
life, gain perspective
on what really
matters in this world, or
acquire an appreciation
for the strength inherent in
a seemingly small gesture,
become an oncology nurse.
If you want to use all the
skills that brought you
into this profession, oncology
nursing is the place to
be.
Three things attracted
me to oncology nursing.
Nurses are experts in symptom-management,
patientassessment,
and active,
—by Mimi Bartholomay, RN, infusion clinical nurse specialist
compassionate caring. And
oncology patients are one
population that puts that
expertise to the test. By
providing emotional support,
patient education, and
proactive, aggressive symptom-management,
a nurse
can have an extraordinary
impact on a patient’s quality
of life and treatment
outcome. Research consistently
shows that if a person
is able to receive at least
85% of their prescribed
chemotherapy or radiotherapy,
they have better outcomes
and a greater chance
of survival. Nurses are
pivotal in the achievement
of optimal patient outcomes.
Something else that
attracted me to oncology
nursing was the interdependent,
collaborative nature
of the physician-nurse relationship.
Medical oncologists
understand the integral
role oncology nurses
play in both patient-assessment
and management.
Coming from different
perspectives, we learn from
each other when caring for
mutual patients. We may
not always agree on what’s
in a patient’s best interest,
or with the patient himself,
but that freedom to disagree
ensures that patients’
interests are always at the
forefront. Collaborative
practice fosters respect and
autonomy, which are essential
to outpatient practice.
The most important
reason I chose oncology
nursing is the patients
themselves. As an oncology
nurse, you enter an
individual’s life at one of
the most vulnerable times
conceivable. Patients feel
out of control and afraid
when they hear a diagnosis
of cancer. A good nurse
can make a patient’s experience
with illness easier
by finding ways to
instill a sense of control
whenever feasible. Whether
a patient does well or
poorly, an oncology nurse
walks alongside her
throughout the trajectory
of her illness. The nurse is
in a position to help the
patient find meaning in
her illness and address
end-of-life issues in a sensitive
way.
In both the Infusion
Unit and Radiation Therapy,
we practice primary
nursing to enhance continuity
of care and foster the
patient-caregiver relationship.
It’s not unusual for
these relationships to extend
over a period of years,
even decades. When I think
back on my career, it is
marked with moments of
great joy and sadness.
Patient outcomes are not
always what we hope, but
the lessons my patients
have taught me will stay
with me forever.
About a year and a half
Page 12

April 20, 2006
ago, I decided to transition
from staff nurse to clinical
nurse specialist (CNS).
This was a very difficult
decision for me, as my passion
is direct patient care.
But, “the times, they are a
changin’ ” in the field of
oncology. Fifteen years ago,
most chemotherapy was
given on inpatient units. In
the outpatient setting, three
nurses treated 35-40 ambulatory
patients a day; all of
whom were receiving relatively
simple chemotherapy
regimens. Patients would
be seen by their physicians
in one of eight exam rooms,
Infusion staff nurse, Stephanie Walsh, RN (left), consults
with infusion clinical nurse specialist, Mimi Bartholomay, RN
and receive their chemotherapy
on the examination
table. There were three
infusion chairs for longer,
two-hour therapies. Due to
portable infusion-pump
technology, increased use
of venous access devices,
better anti-emetic therapy
and control, and changes in
reimbursement, most chemotherapy
administration
has shifted to the outpatient
venue. Our outpatient infusion
unit has grown to 60
beds, and we treat an average
of 130 patients in one
12-hour day. Patients may
be coming to an ‘ambulatory
clinic,’ but they have
as many needs and are as
debilitated and sick as patients
I cared for as an inpatient
nurse 19 years ago.
In an effort to avoid sending
patients at risk for infection
to the ED, the Infusion
Unit serves as a triage
area to facilitate direct admission
to inpatient oncology
units.
One of the most significant
changes I’ve seen over
the years is how the role of
outpatient oncology nurse
has become increasingly
autonomous. Many of the
chemotherapy and biotherapy
agents administered in
the Infusion Unit have the
potential to cause both
hypersensitivity and anaphylactic
reactions. On
inpatient units, there is
greater access to physicians
and other resources in the
event of an emergency. In
the outpatient setting, it’s
the nurse who usually manages
these reactions independently
with physician
back-up available through
paging. Since research protocols
and standard chemotherapy
regimens are increasingly
complex, nurses
must be adept at multitasking
and prioritizing,
skills that are developed
with years of experience.
All these dramatic
changes have been occurring
in the midst of a national
nursing shortage.
Fifteen years ago, it was
easy to fill vacant positions
in the Infusion Unit with
experienced oncology
nurses. That is not the case
today. Although we still see
experienced oncology
nurses applying for positions,
we are increasingly
relying on younger nurses
with less experience or
experienced nurses with no
oncology background.
Obviously,
these nurses
have different
learning needs.
Fortunately, nursing
leadership at
MGH recognizes
the value of the
CNS role in meeting
these learning
needs.
Over the years, I
recognized that I
was being utilized
as a resource by
less experienced
staff. This triggered
a change in me.
I realized I got as
much satisfaction
from mentoring
newer staff, as I
did from providing
direct patient care.
Having received
my master’s degree
in Oncology
Nursing about two
decades earlier, I
decided it was
time to make a
continued
on page 18
Page 13

Advanced Practice
Reflections of the
first nurse practitioner in the
MGH Cancer Center
Ihave had the privilege
of being a
nurse practitioner
in the Gillette Center
for Women’s Cancers
for the past ten years.
As I was finishing my
master’s degree in preparation
for becoming an
NP, I was presented with
an opportunity to work
with my supervising physician
in Medical Oncology.
At that time, there
were no nurse practitioners
working in oncology
at MGH. The fact that he
had never worked with
—by Nancy Schaeffer, RN, nurse practitioner
an NP, and I had never
been one, added to the
excitement.
My collaborating
physician and I embarked
on a journey, learning
together, and establishing
a model of practice that
has since been embraced
by the oncology community.
At first, his physician
colleagues questioned
the wisdom of
adding an NP to his practice.
Others felt my role
would limit his practice.
He, on the other hand,
believed our model of
care would allow him to
expand his practice and
do even more, which has
been the case.
Early on, I remember
being terrified that I might
miss an important finding
or make a mistake
that would compromise a
patient’s well-being. As
we grew into our new
roles, my confidence
grew, as did my clinical
responsibilities. I now
April 20, 2006
practice with a tremendous
amount of autonomy
that has evolved
naturally over time.
There are approximately
30 nurse practitioners
working in the
Cancer Center today,
compelling evidence
that a care model of
oncologist/nurse practitioner
is beneficial
both to patients and the
institution.
My greatest good
fortune has been caring
for a special population
of patients in my role as
nurse practitioner. It has
enabled me to combine
basic nursing skills with
advanced practice knowledge
in an effort to provide
the best and most
comprehensive care to
our patients.
Nurse practitioner, Nancy Schaeffer, RN (right) conducts
pre-chemotherapy assessment with patient, Lisa Dix
Page 14

April April 20, 2006
20, 2006
Cover Story
continued from front cover
were at high risk for serious
complications.
Pharmaceutical advances
in the 1990s made
it possible for much of
oncology care to take
place in the outpatient
setting. But that didn’t
affect inpatient oncology
census, because MGH
was simultaneously developing
a bone marrow
transplant service, which
opened in May, 1993.
This required nurses to
establish competencies in
chemotherapy administration,
blood transfusion,
febrile neutropenia,
and bone marrow transplant
care. Not only were
nurses becoming more
sophisticated practitioners,
but tools for managing
oncology patients
were rapidly improving
and becoming more readily
available. The days of
emptying buckets of emesis,
administering IM
pain medications every
three hours, and waking
house staff to administer
chemotherapy were well
behind us.
Though hospital
stays were becoming
shorter for many
oncology patients,
the nursing care of
leukemia and transplant
patients was
increasingly complex
and time-consuming.
Whether a
patient was receiving
induction chemotherapy
for newly
diagnosed leukemia
or conditioning
chemotherapy
in preparation for
bone marrow transplantation,
the treatment
course was extremely
rigorous. Treatment essentially
depletes the
bone requiring patients to
be closely monitored and
treated for profound multisystem
complications.
Patients who would have
been transferred to the
intensive care unit years
ago are now cared for on
an oncology unit throughout
their entire hospital
stay despite their level of
acuity.
As bone marrow transplant
and leukemia services
continue to expand,
nurses on Ellison 14 are
becoming increasingly
skilled in caring for these
patients. Approximately
one third of staff nurses
are ONS-certified and
many hold advanced
degrees. Caring for patients
on the inpatient
service has become more
complex over the years,
but supporting patients
and families through
profound uncertainty,
fear, and acute physical
illness remains the same.
Cancer treatment has
seen staggering advances
and in many cases, cure
is now a possibility, but
some patients and families
still face disappointment
and end-of-life decisions
far earlier than
anticipated. Nurses have
always played a central
role in these discussions
and decisions. But over
the years, nurses have
become more visible in
this area. Today nurses
are recognized as advocates
and experts in the
needs of patients and
families dealing with
complex issues related to
palliative care, comfort
care, or continued aggressive
treatment.
Despite the physical
and emotional demands
of working as an oncology
nurse, it has tremendous
rewards. Each day I meet
patients and families facing
life-altering diagnoses
and treatments. I have a
unique opportunity to
support these patients
from a medical and emotional
standpoint, regardless
of the outcome. Whether
patients are cured, go
into remission, or don’t
survive, nurses play a
major role in caring for
patients and families during
these challenging
times.
Staff nurse, Mimi Bartholomay, RN,
with patient on Baker 5 circa 1990
(photo provided by staff)
MGH milestones
of oncology nursing...
• 1970 ---Tumor Clinic established on Vincent 2 for care of
oncology patients. Ieva Brok, RN, appointed nurse
for the clinic
• 1974 ---First proton beam treatment given at the cyclotron
in Harvard Physics Lab. Patient transported via cab
---Platinum introduced as chemo agent but use limited
by severe nausea and vomiting
---Cancer care moves to Cox Building. Clinic subdivided
into medical, surgical, and radiation oncology
---Radiation Oncology opens in Cox Building
• 1978 ---First designated inpatient oncology beds on Baker 5
---Chemotherapy admixed by staff nurses and administered
by house staff
• 1979 ---Risks of handling chemo for clinicians recognized;
personal protective equipment introduced
---Peg Munson, RN, becomes first certified inpatient
chemotherapy nurse
• 1980s---Inpatient oncology unit moves to Phillips House 5
(now Founders House) to accommodate more patients
---Certification established as standard for nurses to
administer chemotherapy
---Heidi Jupp, RN, appointed first pediatric liaison
nurse for oncology
• 1990 ---Oncology care increasingly given in outpatient
setting
• 1991 ---Inpatient oncology unit moves to Ellison 14
• 1993 ---Bone Marrow Transplant program established with
Cathleen Poliquin, RN, first advanced practice nurse
for the program
• 1995 ---Nancy Schaeffer, RN, first oncology nurse practitioner
in Cancer Center
---Cancer Resource Room established
• 1996 ---Blake 2 Infusion Unit opens
• 1997 ---Additional infusion unit opens on Bigelow 12
---HOPES program established to provide support
and resources for cancer patients and families
• 2001 ---Burr Proton Beam Center opens at MGH (second
such center in the world)
---Jill Nelson, RN, first nurse practitioner for inpatient
oncology
• 2002 ---First MGH Oncology Nursing Retreat
---Carol Ghiloni, RN, Oncology Fellowship Program
established
• 2004 ---Cancer Nursing Practice Committee established
• 2005 ---Cancer Center expands to Yawkey 7, 8, and 9
---Bone Marrow/Leukemia Center opens on Cox 1
Page 15

Fielding the Issues
ED Observation Unit
coming this spring
Question: Is it true that an
ED observation unit will be
opening this spring?
Jeanette: Yes. A 14-bed
observation unit is scheduled
to open in May.
Question: Will the unit be
adjacent to the ED?
Jeanette: Although that
would be the ideal location,
the existing ED floor plan
cannot accommodate an
observation unit. The observation
unit will be temporarily
housed on Bigelow
12 until a permanent location
can be identified.
Question: What is the purpose
of an ED observation
unit?
Jeanette: The ED Observation
Unit will provide
continuous observation and
care to ED patients who
need testing or monitoring.
Patients in the ED Observation
Unit might include:
• patients with low-risk
chest pain requiring observation
and further
testing
• patients with kidney
stones requiring hydration
and pain control
• patients requiring observation
and/or diagnostic
testing for asthma, deep
vein thrombosis (DVT),
gastroenteritis or transient
neurological symptoms.
The average anticipated
length of stay for patients in
the observation unit is 14-16
hours; the maximum length
stay will be 23 hours, 59 minutes.
Question: Who will care for
patients in the observation
unit?
Jeanette: ED staff nurses will
care for patients in the observation
unit. MaryFran Hughes,
RN, nurse manager of the
Emergency Department, will
be responsible for the ED
Observation Unit. The unit
will be supported by a clinical
nurse specialist and an operations
coordinator. Nurse
practitioners will cover the
unit 24 hours a day, seven
days a week. Emergency Department
attending physicians
will provide medical coverage.
Question: How do you anticipate
the observation unit will
impact the hospital?
Jeanette: Adding an observation
unit will:
• increase access to care in
the ED
• increase availability of inpatient
beds by providing care
to patients who would have
been admitted from the ED
(an estimated 3,260 patients
per year will no longer require
inpatient beds)
• improve overall efficiency
in the ED
Back issues of
Caring Headlines on-line
Back issues of Caring Headlines are available
on-line at the Patient Care Services website:
http://www.massgeneral.org/pcs/
What MGH oncology nurses
are saying...
April 20, 2006
“Caring for children and adolescents with cancer has taught me so
much about courage, resiliency, and the strength of the human spirit. My
life is richer because of what I’ve learned from them.”
—Kathryn Pazola, RN, Ellison 18
“The spirit, strength, courage, and humanity of cancer patients is what
drew me to oncology nursing, and it’s what will keep me there for a
long time.”
—Emily Patterson, RN, Ellison 14
“Oncology patients have taught me to appreciate the small things in
life. Being compassionate and supportive helps people keep their
identity.”
—Jayne Hill, RN, Cox B
“I love being an oncology nurse because of the relationships I’m able
to make. Patients are more than just ‘patients.’ They touch your heart
and become family.”
—Megan Eldridge, RN, Ellison 14
“As oncology nurses we are incredibly privileged. We’re invited into
patients’ lives when they’re at their most vulnerable, and we’re invited
to share in moments that are incredibly special.”
—Theresa McDonnell, RN, GI Cancer Group
“I transferred to an ambulatory oncology infusion unit 18 months
ago. People ask me, “How can you do that work? It must be so depressing.”
I’ve found it a great joy to be part of a team that’s committed to
the same patient-centered goals. I have the privilege of forming relationships
with patients and their loved ones that evolve into friendships.
I am witness to courage and humor in the face of life’s biggest
challenges. I’ve found I’m able to foster hope, support difficulties, and
celebrate success. I cannot imagine a more rewarding way to focus my
practice.”
—Ed Newbert, RN, Yawkey 8 Infusion
“Oncology patients have taught me the importance of hope... and that
it’s always there no matter how poor the prognosis.”
—Heather Robertson, RN, Ellison 14
“In oncology nursing, we use all our knowledge and skills to care for
patients and families. It’s a big challenge, but patients are such an
inspiration. We learn daily what a difference nurses make in the experience
of patients.”
—Ruth Burrows, RN, Martha Haverly, RN, Bigelow 7
“Oncology nursing is a gift our patients give us. They are wonderful
people to know.”
—Linda Kafkas, RN, Cox 1 Infusion
“Our patients become like our family, and we have the honor of becoming
theirs. You can’t help but get attached. They’re always so glad
to see us, and we love seeing them.”
—Cathy Mackinow, RN, Nancy Kelly, RN, Ellison 12
“I’ve been an oncology nurse for more than 35 years. It has helped me
learn to face issues most people shy away from. It has created so many
opportunities to share intimate moments with patients and their families.”
—Ida Meister, RN, Ellison 12
Page 16

Practice
Cancer Nursing
Practice Committee
—by Susan M. Finn, RN, clinical nurse specialist
Nurses at MGH participate
in a collaborative governance
model in which all
clinicians are empowered
to participate in processes
that promote best practice. Modeled
after Patient Care Services’
Nursing Practice Committee, the
Cancer Nursing Practice Committee
was established in 2004
in response to feedback from
oncology nurses expressing a
desire to localize influence over
cancer nursing practice and improve
communication. The mission
of the Cancer Nursing Practice
Committee is to establish,
communicate, and evaluate standards
that promote safety, comfort,
and successful outcomes
for individuals with an actual or
potential cancer diagnosis.
Under the coaching of a
nurse manager and clinical nurse
specialist, 17 oncology nurses,
representing staff nurses and
advanced practice nurses from
various settings, have been
meeting regularly to discuss
patient-care issues identified by
the colleagues they represent.
The group prioritizes issues and
investigates best practices with
an evidenced-based review of
nursing literature.
Some of the issues addressed
by the group include care of
patients with mucositis and management
of in-dwelling venous
access devices such as Port-a-
Caths and Hickman catheters.
The committee developed tools
April 20, 2006
to identify patients at risk and
evidence-based guidelines for the
care of patients with mucositis
and central venous access devices
across practice settings.
The committee has successfully
completed and implemented
guidelines for the care of patients
at risk for (or with active)
mucositis and created a pocket
guide for measuring the severity
of mucositis. An IRB-approved
study to survey nurses caring
for patients with Port-a-Caths
and Hickman catheters is also in
process.
After meeting for one year,
the group agrees that the goal to
improve communication has
been met, and development of
evidence-based guidelines for
patient care is well under way.
Nurses interested in joining the
Cancer Nursing Practice Committee
should contact Barbara
Cashavelly, RN (4-9440), or
Susan Finn, RN (6-4023).
Cancer Nursing Practice Committee members, Barbara Cashavelly,
RN (back left), Esther O’Dette, RN (seated), and Emily Olson, RN
Published by:
Caring Headlines is published twice each
month by the department of Patient Care
Services at Massachusetts General Hospital.
Publisher
Jeanette Ives Erickson RN, MS,
senior vice president for Patient Care
and chief nurse
Managing Editor
Susan Sabia
Editorial Advisory Board
Chaplaincy
Michael McElhinny, MDiv
Development & Public Affairs Liaison
Victoria Brady
Editorial Support
Marianne Ditomassi, RN, MSN, MBA
Mary Ellin Smith, RN, MS
Materials Management
Edward Raeke
Nutrition & Food Services
Martha Lynch, MS, RD, CNSD
Susan Doyle, MS, RD, LDN
Office of Patient Advocacy
Sally Millar, RN, MBA
Orthotics & Prosthetics
Mark Tlumacki
Patient Care Services, Diversity
Deborah Washington, RN, MSN
Physical Therapy
Occupational Therapy
Michael G. Sullivan, PT, MBA
Police, Security & Outside Services
Joe Crowley
Reading Language Disorders
Carolyn Horn, MEd
Respiratory Care
Ed Burns, RRT
Social Services
Ellen Forman, LICSW
Speech, Language & Swallowing Disorders
Carmen Vega-Barachowitz, MS, SLP
Volunteer, Medical Interpreter, Ambassador
and LVC Retail Services
Pat Rowell
Distribution
Please contact Ursula Hoehl at 726-9057 for
questions related to distribution
Submission of Articles
Written contributions should be
submitted directly to Susan Sabia
as far in advance as possible.
Caring Headlines cannot guarantee the
inclusion of any article.
Articles/ideas should be submitted
by e-mail: ssabia@partners.org
For more information, call: 617-724-1746.
Next Publication Date:
May 4, 2006
Page 17
Please recycle

April 20, 2006
From Staff Nurse to CNS
continued from page 13
change and apply for a
CNS position in the Infusion
Unit. Now that I
have been in the role for
a year, the question I
often get is, “What exactly
is a CNS?” A question
that has plagued clinical
nurse specialists for
years.
The beauty of the
CNS role is that it is
highly flexible to meet
the needs of a specific
specialty area or treatment
venue. All clinical
nurse specialists are master’s-prepared,
advanced
practice nurses with expertise
in a given specialty.
The common thread
that distinguishes the
CNS role is the integration
of research, evidencebased
guidelines, clinical
expertise, patient- and
staff-education, and quality
improvement into
clinical practice. Clinical
nurse specialists help to
trouble-shoot complex
clinical issues and keep
nurses abreast of everchanging
treatment modalities,
technology, and
medications. We mentor
and facilitate professional
development of staff.
We seek ways to improve
care through performance
and practice improvements,
quality and
safety initiatives, and
education and certification
of staff. We encourage
critical thinking and
promote research by participating
in research
studies and incorporating
research into our practice.
There are many wonderful
opportunities in
oncology nursing at
MGH. I never cease to be
amazed at the talent I
see; whether it’s Radiation
Therapy, the Oncology
Unit, the clinical
practices, the outpatient
Bone Marrow Transplant
Unit, or the infusion
units. I feel fortunate to
be part of such a diverse,
dedicated, and patientfocused
staff. And I’m
grateful I’ve had the opportunity
over the past
two decades to participate
in the growth and
development of the MGH
Cancer Center. We have
come a long way in such
a short time, and I know
that nursing opportunities
in the Cancer Center will
only continue to grow.
Narrative (Gammon)
continued from page 11
told him I’d pray for him.
He looked up at me
with twinkling blue eyes
and said, “Marlin, I just
want to get this over
with.”
We all kept our composure
in Mark’s room,
but as soon as we were
out of sight, we started to
cry. It had been a rollercoaster
of a day—emotionally
stressful, trying
so hard to fulfill his dying
wish, all the while
knowing we would never
see him again.
Mark made it to Ireland
and actually lived
longer than we expected.
He lived through the
holidays and passed away
in early January. His family
thoughtfully called us
to let us know that he had
some quality time in Ire-
land, and that he died
peacefully with his entire
family at his side.
When I think back to
that last day when Mark
was in the Infusion Unit,
I am filled with a sense
of pride and accomplishment.
It truly was a team
effort getting Mark home
to Ireland, the culmination
of a long and close
nurse-patient relationship.
We knew of his
strong desire to return
home from his many
chemotherapy visits, and
we had to balance that
desire with the reality of
his physical condition. I
think of Mark and his
family often, and still
smile when I see his twinkling
blue eyes in my mind.
Comments by Jeanette
Ives Erickson, RN, MS,
senior vice president
for Patient Care and
chief nurse
Nurses often need to
make quick decisions
and accomplish a lot in a
short amount of time.
Marilyn’s narrative illustrates
how holistic, family-centered
care and visionary
nursing made a
critical difference in Mark’s
end-of-life care. Hospitalization
might have been
the right course for another
patient in Mark’s condition.
But knowledge of the
patient, prompt, expert
decision-making, and a
desire to fulfill a dying
wish allowed Mark to
return to Ireland and die in
peace despite overwhelming
odds.
Thank you, Marilyn.
Narrative (Corrina Lee)
continued from page 10
the social worker could
stop by to check on them,
given the traumatic day
they’d had.
I was off the next day
and had a chance to decompress.
I called to
check on Mrs. G and
learned she’d had another
reaction with the second
dose of chemo. She
was discharged without
receiving more chemo at
that point and was switched
to a different regimen.
I’m always interested to
know how my patients
are doing; Mrs. G’s oncologist
informed me that
the new regimen seems
to be working and her
CA125 (a tumor marker
for ovarian cancer) has
normalized. Mr. and Mrs.
G are enjoying life back
in their home state and
are in good spirits.
A couple of months
after her allergic reaction,
Mrs. G’s oncologist
told me he’d received an
e-mail from her in which
she said, “I hope when
I’m at MGH again I get
to see that wonderful
nurse whom I credit with
saving my life at the time
of my reaction.” Mrs. G
later wrote me a letter
about her experience and
expressed her appreciation
for all I had done.
Mrs. G’s smile, spirit,
and strength will always
be with me.
Comments by Jeanette
Ives Erickson, RN, MS,
senior vice president
for Patient Care and
chief nurse
One element of expert
nursing is the ability to
think on several levels
simultaneously, especially
during a rapidly
changing situation. Another
is the ability to
advocate for patients
while working collaboratively.
A third is the ability
to convey concern
while functioning in a
highly charged setting.
Corrina exhibited all
three of these qualities as
she cared for Mrs. G. In
addition to addressing
Mrs. G’s intense physical
needs, Corrina was
able to address her and
her husband’s comfort
and emotional needs at
the height of a crisis situation.
Her nursing care
made a difference that
lasted well beyond the
critical event. Mrs. G felt
Corrina’s support long
after her discharge.
Thank-you, Corrina.
Page 18

Educational Offerings April 20, 2006
2006
20, 2006
When/Where Description
Contact Hours
April 28
Caring for Compromised Obstetrical Patients
TBA
8:00am–4:30pm
O’Keeffe Auditorium
May 1
BOATING: Assisting Patients and Families to Navigate Healthcare
TBA
8:30am–10:30pm
Decision-Making
O’Keeffe Auditorium
May 1, 2, 8, 9, 15, 16
Greater Boston ICU Consortium CORE Program
44.8
7:30am–4:30pm
NWH
for completing all six days
May 3
More than Just a Journal Club
1.2
4:00–5:00pm
Sweet Conference Room
May 3
OA/PCA/USA Connections
- - -
1:30–2:30pm
Bigelow 4 Amphitheater
May 4
CPR—American Heart Association BLS Re-Certification
- - -
7:30–11:00am/12:00–3:30pm VBK401
May 4
CVVH Core Program
TBA
8:00am–12:00pm
Training Department, Charles River Plaza
May 5
Advances in Anti-Coagulation
TBA
8:00am–4:15pm
O’Keeffe Auditorium
May 5
On-Line Patient-Education Resources
2.4
8:00–10:00am
FND626
May 10
New Graduate Nurse Development Seminar I
6.0
8:00am–2:00pm
Training Department, Charles River Plaza
(for mentors only)
May 12 and 22
Advanced Cardiac Life Support (ACLS)—Provider Course
- - -
8:00am–5:00pm
Day 1: O’Keeffe Auditorium. Day 2: Thier Conference Room
May 15
Post-Operative Care: the Challenge of the First 24 Hours
TBA
8:00am–4:30pm
Thier Conference Room
May 17
CPR—American Heart Association BLS Re-Certification
- - -
7:30–11:00am/12:00–3:30pm VBK401
May 22
CPR—Age-Specific Mannequin Demonstration of BLS Skills
- - -
8:00am and 12:00pm (Adult) VBK401 (No BLS card given)
10:00am and 2:00pm (Pediatric)
May 23
BLS Certification for Healthcare Providers
- - -
8:00am–2:00pm
VBK601
May 24
Psychological Type & Personal Style: Maximizing Your
8.1
8:00am–4:00pm
Effectiveness
Training Department, Charles River Plaza
May 24
New Graduate Nurse Development Seminar II
5.4 (for mentors only)
8:00am–2:30pm
Training Department, Charles River Plaza
May 25
BLS Certification–Heartsaver
- - -
8:00am–12:00pm
VBK401
May 25
Basic Respiratory Nursing Care
- - -
12:00–3:30pm
Sweet Conference Room
May 25
Nursing Grand Rounds
1.2
1:30–2:30pm
“PICC Your Lines: the Inside Story.” O’Keeffe Auditorium
May 31
Pediatric Advanced Life Support (PALS) Re-Certification Program
- - -
8:00am–12:30pm
Training Department, Charles River Plaza
For detailed information about educational offerings, visit our web calendar at http://pcs.mgh.harvard.edu. To register, call (617)726-3111.
For information about Risk Management Foundation programs, check the Internet at http://www.hrm.harvard.edu.
2006April
Page 19

Oncology Nursing
April 20, 2006
Oncology nurse, Ed Newbert, RN, with patient, Mark
Klauk, in the Yawkey 8 Infusion Unit
Caring
H E A D L I N E S
Send returns only to Bigelow 10
Nursing Office, MGH
55 Fruit Street
Boston, MA 02114-2696
First Class
US Postage Paid
Permit #57416
Boston MA
Page 20