Advice for new Ped-Hemonc Nurse

Pediatric Critical Care Columnist · Sep 8, 2018

You've chosen a challenging area to start out in, but one that's incredibly rewarding. You'll learn a lot while you're on orientation about the meat and potatoes of your job, but the most important things can't really be taught.

How do you treat a child with cancer? Like any other child... because they ARE still children. They'll want to play when they feel okay, and they'll want to be left alone when they're feeling cruddy. They'll sometimes need to be cajoled into cooperating, other times they'll be so accommodating you'll think you're in the wrong room. They quickly become used to the routine of their treatment and know what makes them feel better. They also "grow up" a lot faster than healthy kids, and will want to protect their parents when they realize they're probably dying, even when they're very young.

Parents of children with cancer are probably the most informed parents out there. They're given a lot of information from the beginning and are considered integral members of the care team - because they ARE. They're taught the patho of their child's cancer, the treatment protocols, side effects and how to cope with them, infection control as well as the ins and outs of your facility. Don't be surprised when a mom can tell you before you've even looked at the lab report that their child's white count is low, or their platelets are low... or that they've relapsed. They'll insist on knowing the lab values, often telling you what the numbers mean in the context of their child's disease, and they'll insist to be kept in the loop about EVERYTHING. But don't ever think that because they're strong and put together that they don't need support and validation. They're doing what they have to do for their child, but they're still "just" parents. Never assume they want to be the bad guy or that they have to be the one to do most things with or for their child. Ask. Give them an out. Sometimes they need permission to look after themselves. My usual phraseology relates to making good choices for their child, which they can't really do unless they're looking after their own needs.

Remember to take your own pulse first. Make sure you're looking after your own mental health needs, because looking after children who are at risk of dying at almost any time takes a toll on us as the second circle of caregivers. Figure out how you're going to manage your emotions and who you're comfortable venting to. There will be days when you want to scream out loud over the unfairness of these children's illnesses, and I guarantee you're going to have days when you cry. That's the human thing. As long as you're not the loudest crier in the room, it's all good. At the same time, you'll need to have some sensitivity for your coworkers, whose load is no different from yours. Kids with cancer have long and frequent admissions and eventually most of the nurses on the unit will have been part of their team. They might not be the nurse of record when a child dies, but the odds are, they've had a relationship with the child and the family. Support each other. You're all in the same boat.

Piano-CelloRN · Sep 8, 2018

Thank you for your writing this to me. A lot of people that I talk to about this keep asking me why I want to be working in a very depressing field, and sometime those comments get into my head. However, I keep telling myself that becoming a pediatric oncology nurse is the reason why I want to be a nurse, and here I am, starting my career in this field next month. I acknowledge that it will be a challenge, but also very rewarding.

Thank you again.

KelRN215, BSN, RN · Sep 9, 2018

Thank you for your writing this to me. A lot of people that I talk to about this keep asking me why I want to be working in a very depressing field, and sometime those comments get into my head. However, I keep telling myself that becoming a pediatric oncology nurse is the reason why I want to be a nurse, and here I am, starting my career in this field next month. I acknowledge that it will be a challenge, but also very rewarding.
Thank you again.

Most kids with cancer survive nowadays. There are some diagnoses that have terrible prognoses (like DIPG- 100% terminal) but for ALL, the most common pediatric cancer, survival is 85% or higher. For those of us who work in the field, it's not as depressing as unfamiliar people believe. If you really let yourself think about it, yes it is 100% horrible that these children have to endure this horrible disease and the equally horrible treatment in many cases but kids are incredibly resilient. In some ways, teenagers are the hardest to deal with because they know that what they're going through is not normal. The 2 year old doesn't- he may think that everyone gets a port. I knew a family whose middle child was diagnosed with hepatoblastoma when their youngest was only a few days old. That child asked his Mom when he was old enough to talk when he was getting his port, like his big brother, because he assumed it was something that everyone got.

I have had more than one school aged child who expressed that they knew they were dying long before anything had been disclosed to them. My favorite patient ever was a 9 year old with glioblastoma. She told several staff members that she knew she was dying (she was right) and not to tell her parents that she knew. She was trying to protect them.

Some of the really hard cases I've dealt with over the years were the kids who died from secondary cancers, which were the result of their treatment. I have seen a survivor of ALL who died of a brain tumor, which MDs believe was caused by the cranial radiation he had when he relapsed, a survivor of medulloblastoma who died of osteosarcoma to the skull, which his MDs also believed was caused from radiation, a survivor of high risk neuroblastoma who developed osteosarcoma of the pelvis, again from her radiation, and a survivor of multiply relapsed AML who underwent multiple stem cell transplants and developed heart and kidney failure by her early 20s d/t the toxicity of her treatment. Actually at my last job, I saw several young adult survivors of pediatric cancer who had heart failure from doxorubicin.

DiscGolfNurse, BSN · Feb 23, 2019

Such great advice already on this thread. Taking care of yourself if highly important. On my unit we have lost 3 kiddos within the last 3 months all from different cancers and they all sting the same. Dealing with loss is always difficult but with children, personally, its s different kind of difficult because of the innocence and the time that they are robbed of.

As far as everyone asking you why you chose that field, be honest and quite frankly their opinion doesn't matter. Working on peds heme/onc is 90% of the time the most fun you will ever have at work. I laugh more at this job than I have at any other unit I've been on. Theres a lovely article written about peds heme/onc by a nurse called "the happy floor". Look it up and read it. So accurate.

Treat them like kids, play with them, empathize with their parents, and have fun and learn a lot. You will bond with their parents and the kiddos themselves and thats okay. They spend so much time with you during some of the most vulnerable moments of their life so you become important to each other.

Enjoy! Its equally rewarding and heartbreaking but it will be the biggest blessing of your life!

ShadowNurse · Feb 24, 2019

I second what everyone else has said, though I am not oncology/hematology. I see more chronically ill kids. People call my job depressing and I really don't see it that way. Kids with any diagnosis don't have time to be sick. They live life, period.