charge nurse

ALTHOUGH THE NURSING PROFESSION HAS CHANGED, ONCOLOGY NURSES ARE STILL VERY HANDS-ON AND INVOLVED WITH THEIR PATIENTS ' LIVES.

By Monika Guttman

“Thank you so much,” says the note, “for spending part of your day with my wife.”

The hastily scribbled message on a gift shop birthday card from a grateful husband is several years old, yet it—like the many letters and mementos kept on desks and bookshelves by the 160 nurses at the USC/Norris Comprehensive Cancer Center and Hospital—shows just how important a role USC/Norris nurses play in patient lives.

Nursing may have changed a lot over the past few decades, but one constant remains: Nurses are still very hands-on members of the health-care team. Since the USC/Norris is many things—a place for treatment, a research institution and an education facility—nurses here have many roles. As the following three Norris nursing veterans attest, no matter what their task, at the heart of the work, the patients make the job what it is.

Humor heals:
Pre-surgery nurse Patricia “Trish” Shattler

When Patricia “Trish” Shattler, R.N., was in nursing school in the 1960s, she says, students were reprimanded for spending too much time talking with patients rather than working.

“I always got into trouble,” she recalls, laughing.

Good thing, at least for the 20-plus patients a day Shattler oversees. Because these days it is Shattler’s interacting—her kidding and sense of humor—that “works a world of good with a lot of the patients, who are usually pretty scared. Sometimes you can tease and it puts them at ease and takes the nervousness away,” she says.

Shattler is one of two full-time nurses who work readying preoperative patients for the five surgical suites and preprocedural patients for the gastrointestinal lab at USC/Norris. Her 10-hour-a-day work week includes everything from educating patients one to two days before surgery, informing them about what to expect and answering all their questions, to preparing the patients, assessing them and monitoring their vital signs, starting IVs, and giving preoperative medications before they enter the surgical suite or gastrointestinal lab.

Shattler has been working in the preoperative unit of USC/Norris for 18 years. In fact, she helped start the unit, working out of a cubicle in what was then the Day Hospital, where patients went for chemotherapy.

For Shattler, a nursing career was a natural. “My mother had wanted to be a nurse, but because of life circumstances, she never got the opportunity. I think it was just always what I wanted to do. I’ve never regretted my decision.”

In fact, Nursing turned out to be a bigger part of her life than she ever expected. “I’ve never been able to have children, so I worked full time for 38 years. Back when I started, you didn’t expect to work your whole life, you expected to have children and stay home. Without kids, what would I do at home? So besides my own family, my patients have been my family.”

Shattler began her career in oncology nursing before it was even called oncology, back in the 1970s. “At that time, there was nothing available to treat patients, except a couple of agents including nitrogen mustard, which I think they used in World War I as a poisonous gas. Back then you knew for a fact that everyone in that clinic was going to die.”

It is much better today, she says, because so many patients get well. Working in surgery, she says, is “psychologically easier for me. The patients are starting their journey to wellness, or they’ve gone through the cancer scare already and they’re getting their treatment. Even though as nurses we’re supposed to be empathetic but not too involved, there are patients you become close to.”

She keeps a file of letters from grateful patients, stays in contact with some families who have been through the USC/Norris operating room, and remembers many of the patients by name.

“I’ve been in ambulatory care nursing, in one way or another, for 35 years,” Shattler explains. “I enjoy talking to patients and families and guiding and teaching them so they can care for themselves at home. You must be able to do quality teaching in the short period of time the patients are with you. This is a wonderful place to do just that.”

Clinical trials and jubilations:
Research nurse Claire Hughlett

Some patients referred to the USC/Norris have exhausted their treatment options in the general medical community.

That is where research nurse Claire Hughlett, R.N., C.C.R.C., steps in.

Hughlett works with gastrointestinal and colon cancer specialists such as Heinz-Joseph Lenz, M.D., director of USC/Norris’ gastrointestinal oncology program, placing patients in clinical trials that offer their best hope of recovery or a longer life. “It may be a trial that adds a new drug or something else that might be better for the patient,” she notes. Patients are willing to enroll in the experimental trials because “they trust that the USC physicians will offer them the best treatment.”

After sitting in on the physician’s examination of the patient, it is up to Hughlett to get the patient qualified for the trial. She follows a rigid recipe, called a protocol eligibility, and plugs in all the data for that patient to see if it is a match. ”There’s not a lot of flexibility in a clinical trial. It’s lots of phone work with the patient, tracking down reports, treatment records and tissue samples.”

Once a patient is enrolled, Hughlett has the additional task of making sure the patient gets the exact drugs, and the exact dosages in the exact order. “I have to watch that everything’s done according to the clinical trial guide—that patients get the right lab tests and that vital signs were done. It drives everybody nuts.”

Another of Hughlett’s roles, she says, “is that I’m sort of the doctor-to-patient interpreter. While meeting with the physician, sometimes the patients don’t get all their questions answered, or they’re stressed and they forget what was said. So they’ll ask me, ‘Can you clarify that?’ or ‘What does this mean?’”

Hughlett likes the interaction because “with the personal touch, the patients don’t suffer the ‘guinea pig syndrome.’ They know we care about making this work for them, and we’re doing everything we can for their precise case.”

For Hughlett, who thought she would be a psychologist or a scientist, the research nurse role, she says, is the perfect mix of patient care and science. During her nursing studies 20 years ago at Pasadena City College, “I did my year of floor nursing, which you had to do before they’d let you do anything else, and I found I didn’t care for it. So I started looking for other things.”

She ended up in a doctor’s office, where she administered chemotherapy. She says, “I liked that, probably because it’s more independent. I had found my niche.”

Still, working as a research nurse does not protect Hughlett from the hard truths of cancer patient care. “Some of the patients I see have extensive disease and have usually had multiple treatments, either outside in the community or here,” she notes. “They’ve usually been told by their physician that they’ve had all the standard treatments and there isn’t anything else unless they want to try a research trial. So when they come here, their burden of disease can be severe and they can be in bad shape.”

What she can do, says Hughlett, is offer the patients hope. And that can be powerful, she says, in terms of helping people improve their quality of life or their health.

Like other nurses, Hughlett finds there are patients who become friends, where she gets to know the family over the course of treatment. It is all part of treating the patients as people and not merely research subjects.

“Yes, I like the science—I like plugging things in and making it work,” she acknowledges. “But perhaps the most rewarding aspect of my work is being in there with the patients. Listening to them. Getting to know them as the special humans that they are. They all have so much that they share with you, that it really puts a very personal touch on every trial.”

Celebrating small victories:
Day hospital nurse Mindy Pearson

For Mindy Pearson, R.N., cancer is fought one drip at a time.

Pearson works in the Day Hospital at USC/Norris, where patients relax in oversized reclining chairs for an average of two hours while life-saving chemotherapies and other drugs are administered intravenously. They go home, then return a few days or a week later to tackle their disease with chemotherapy again.

Unlike surgery, which can strike a major blow to the disease all at once, chemotherapy is a slow and often frustrating process. Patients can get sick or tired from treatment, and they may have to delay a chemotherapy session if their white blood cell counts are too low.

So Pearson focuses on the little victories. “Someone’s white count coming back up, or someone’s tumor shrinking, or the fact that someone doesn’t need a blood transfusion—that’s exciting,” she says. “We celebrate, because the small little steps are what lead up to recovery.”

Patients, she admits, often do not understand this at first. “They’re frightened and they have this image that things aren’t going to go the way they want, whereas most of the time they do very well. So when we see the progress the patient’s making, we’re confident they’re going to be OK at the end. We keep telling them: One and one and one keep adding up, and soon you’ll be in remission.”

In fact, much of Pearson’s job is about educating the patients and their families to overcome their preconceived notions of what chemotherapy will be like.

“Cancer treatment has changed so much, especially in the past five to eight years,” she says. “The chemotherapy itself is a lot more refined. The supportive therapies we use—the antinausea medicines, for example—are a lot more effective. And we’re teaching patients how to take better care of themselves at home after treatment. All of these things have changed the whole experience.”

Pearson, who decided to be a nurse when she was six years old, says her own expectations about working in oncology nursing were equally wrong when she entered the field 10 years ago after leaving homecare nursing. “I thought it would be more depressing than it is,” she says. “Although there are patients who are very ill, I think I had an image in my mind like what the public image is—that most patients wouldn’t make it—and yet most of them do.”

As a mother herself—Pearson has two sons, a 20-year-old and a 16-year-old, as well as an 18-year-old daughter—she says the patients who emotionally touch her the most are “female patients who have children. Because they’re struggling to survive, to see their kids grow up and get married. Sometimes when I’m grumbling about my life, I look at these patients and they truly humble me.”

Pearson says she loves the combination of science and human interaction in oncology nursing and wants to stay in the specialty until she retires. “Here at Norris we’re on the cutting edge. We’re involved in clinical trials, which I find very exciting, knowing what’s coming down the pike.”

And the good news, she says, is that things will get better and better for cancer patients. “These days you see lots of victories. And every victory, big or small, is something to be celebrated.”