Nursing and Patient Care

Nurses are important members of a patient's care team. For children being treated for cancer, nurses perform a number of critical functions. Nurses often serve as a patient and family’s first line of contact in and out of the hospital. An inpatient nurse acts as a primary care provider during a hospital stay. Outpatient nurses assist the physician with gathering information and providing care to the patient. 

Responsibilities

Nurses lead the caring process and tend to patients’ daily needs. This includes:

• Checking vital signs
• Feeding the patient
• Preparing patients for treatment or surgery
• Administering chemotherapy and other medicine
• Performing assessments and physical exams
• Drawing blood or other fluids for laboratory tests
• Administering blood products as part of a transfusion or to replace lost blood
• Providing hygiene care

Nurses play a critical role in educating families, including information about:

• Cancer diagnosis – what the disease is, prognosis, and recommended course of treatment
• Medication and treatment – how often they will be administered and any side effects
• Care at home - how families should care for a scar, clean and dress wounds, identify signs of infection, and provide nutrition.

Depending on the diagnosis, treatment and treatment facility, certain nurses may also assist physicians in the hospital by:

• Planning care regimens
• Writing prescriptions
• Prescribing treatment

Nurses complete different levels of training. The more responsibility and specialization a position requires, the more training the nurse will receive.

Nursing teams

Typically, there are a number of nurses on a child’s care team who perform different but often interrelated functions. This allows teams to provide complex and multifaceted services.

The size of a patient’s nursing care team will likely vary over the course of treatment and depends on how much care is needed. This includes factors such as:

• Whether the child has recently had surgery 
• How many medications are being administered
• How recent the diagnosis is
• How advanced the disease is

Families may wish to write down a list of their child’s nurses including:

• Name 
• Appearance 
• Responsibilities 
• How often and what time they usually check in on the patient 

Nurses usually work in shifts — usually between 8 and 12 hours at a time — and will communicate with one another and share information to ensure a patient’s care is as seamless as possible as they transition from one shift to the next. Nurses are often responsible for caring for multiple patients during a shift; for instance, oncology nurses typically are assigned to care for three patients at a time.

Patients who are undergoing particularly complicated procedures may have a nurse overseeing their care and recovery who only tends to their needs and is not responsible for any other patients. This is also true most of the time for patients in intensive care (ICU) because they are very sick, may be on special machines such as a ventilator, or are receiving medications that require very frequent monitoring and assessments.

Nursing care team: Types of nurses

Nurses perform a variety of important, interrelated functions from giving medicine to answering complex medical questions. Like all health care providers, nurses work collaboratively with other members of the care team. Understanding the roles of different types of nurses may help families better manage care and advocate for their child.

Registered Nurse (RN) — Provides a wide variety of nursing care including monitoring patients, performing assessments, giving medications, overseeing daily needs, and providing patient and family education.

Pediatric Hematology/Oncology Nurse — Provides specialized nursing care to children and teens with cancer or blood disorders, performs assessments, administers chemotherapy and other medications, monitors for side effects, and educates patients and families about diagnosis and treatment.

Nurse Anesthetist (CRNA) — Prepares patients for anesthesia, administers anesthesia medications to keep them pain-free during surgery or other procedures, and actively manages patients during procedures.

Pre-Op Nurse — Provides care and prepares patients for surgery and other procedures.

Operating Room (OR) Nurse — Cares for patients during surgery alongside other surgical team members.

Post-Anesthesia Care Unit (PACU) Nurse — Works with patients after surgery as they recover from anesthesia; also known as Recovery Room Nurse.

Emergency Room (ER) Nurse — Treats patients in a hospital ER and provide care for a variety of conditions due to illness, trauma, or injury.

Intensive Care Unit (ICU) Nurse — Works in the intensive care unit (ICU) and provides complex care to patients with very serious medical conditions. Many ICU nurses work with patients in a certain age bracket, such as children in the pediatric ICU (PICU) or neonatal intensive care unit (NICU).

Home Care Nurse — Offers home-based care to patients and may specialize in different aspects of care such as children with developmental or mobility issues.

Nurse Practitioner (NP) — Works closely with the physician to plan care, perform physical exams, administer tests, and prescribe treatments.

Licensed Practical Nurse (LPN) — Provides daily care activities and skilled nursing tasks for patients at the bedside or in clinics where treatments take place; also known as a Licensed Vocational Nurse (LVN).

Nursing Assistant — Works under the supervision of a Registered Nurse or a Licensed Practical Nurse to provide basic daily care functions.

Nurse Case Manager — Coordinates longer-term care for patients to help manage complex medical needs.

Nurse Supervisor/Nurse Manger — Oversees nursing teams, conducts training, manages administrative tasks, and ensures quality of care for patients.

Oncology Clinical Nurse Specialist (OCNS) — Serves as a clinical expert and consultant for the nursing staff on complex patient issues and focuses on improving efficiency and access to care; Advanced Practice Nurses (APNs) that are certified in oncology.

Communicating with the nursing team

Nurses value open communication with patients and families to provide the best care possible. For families facing pediatric cancer, it can be hard to keep track of questions and information.

• Ask questions. There is no such thing as an unimportant or stupid question when it comes to medical care. Nurses are trained to help patients and families understand information and address concerns. Nurses are experts on procedures, people, and places within their hospitals or clinics.
• Keep a running list of questions. Write down questions when they come to mind. This can reduce anxiety and stress by ensuring that important questions aren’t forgotten over the course of the day. Making a list also allows families to get multiple answers in a single conversation.
• Actively listen and process information. Cancer care involves many details that can be hard to understand or remember. It can help to repeat information back to the nurse or doctor to make sure that communication is clear.