Day in the Life of a Peds Onc RN

Ashley Hay, BSN, RN, BSN, RN

The shift begins with assessing the ratios and assigning staff to various roles for the day ahead. Do we have enough nurses to provide exceptional care to each child and their family? Unfortunately (as in many areas of nursing) the answer to this always seems, at first glance, to be a consistent "no". Remaining calm & flexible are some of the best qualities a nurse can posses. We may not be able to spend an hour talking to a family, allaying their fears while simultaneously playing with their sick children, but we can give safe & compassionate care to the best of our ability. With that in mind, we move on and begin our day.

On to equipment checks. Moving briskly through what seems like monotonous tasks - making sure suction works at each bedside, oxygen gauges are in the green, and the code cart/AED are fully functional and ready for use, should we need it. Every once in awhile you stop to realize exactly what it is you are checking - equipment needed to possibly save a young child's life. You shake the thought and keep moving. Time management is crucial and patients begin to arrive.

Assignments usually look better and a bit more straightforward on paper than it can play out in reality - not accounting for anxious parents, uncooperative children, difficult IV starts or life threatening events like drug reactions or codes. A typical assignment might include several patients receiving any of the following: blood products, single/multiple chemotherapy infusions, investigational drugs, biologics, or hydration (many paired with additional antiemetics and/or pain medication).

One area of nursing I didn't account for while in school was all the math I'd be doing on a daily basis. Double checking chemotherapy with another RN requires a considerable amount of concentration and undivided attention, despite all of the hustle happening on the unit around us. Typically most pediatric chemotherapies are based on body surface area. After the BSA is calculated using a formula containing their weight and height, we check the roadmap (a protocol assigned to the child based on their diagnosis, staging, sex, etc) for the drug dosing. We then calculate the mg/m2/day or mg/kg/day. For someone who hated math all throughout school, I've gotten pretty good at it. Mostly because the numbers now mean something to me. One small misstep on the calculator can be a huge mistake when we are dealing with such small numbers.

I frequently feel overstimulated while at work, which really should come as no surprise. Bedside nursing is a barrage to the senses. Hearing a melody of unrelenting beeps: IV pumps, vital sign machines, patient call bells, ringing telephones & pagers. Constant visual assessment: does the IV site look inflamed? How is the child's pallor? Is that a hive? How much time is left before that IV bag goes dry? Smell: Need we go there? Add in dirty diapers to the usual variety of scents that can accompany any hospital unit. You get the idea. Touch: Providing comforting touch to parents or children who need it is an incredible part of my job. Nothing compares to a huge hug from a bald toddler, chubby from massive doses of steroids. Children are quick to forgive. So willing to show some love despite the fact you poked them with a large needle seemingly far too big for their little vein just an hour before. Their displays of affection make my heart swell, every single time.

By the end of a shift most of us are physically tired from walking all day and mentally tired from the palpable stress and frenzy of the unit. Cancer has a funny way of infusing the air with a little more weight somehow. Sometimes shifts end with discussions of fun weekend plans. Sometimes it ends with tears of frustration or sadness - learning of a patient death, poor prognosis or choice to begin home hospice. Being in pediatric oncology, it can sometimes be difficult to practice empathy and compassion without overextending yourself. You can't attend every memorial service, funeral or volunteer event... and that's okay. Self care is crucial in a field like this. It's a constant combination of miracles, grief and human connection. No matter what my career path may be in the distant future, I'll always have extreme pride for being a Peds Onc Nurse.

Day in the Life of a Peds Onc RN

About Ashley Hay, BSN, RN, BSN, RN

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