Notes from a nurse on the stem cell transplant unit

Stem cell transplant nurse with patient
Colleen caring for a child on 6W

I have worked at Boston Children’s Hospital for the last 10 years, the first two as a co-op and the last eight as a staff nurse — all on 6W. I just love this floor. We’re a small, 14-bed unit that provides longer-term care for children undergoing bone marrow transplants. We see different types of leukemia and other cancer and blood disorders such as neuroblastoma, aplastic anemia and myelodysplastic syndrome. We also see other genetic, metabolic and hematologic diagnoses like CVID, Wiskott-Aldrich syndrome, SCID, adrenoleukodystrophy and sickle cell disease, some of which we treat with gene therapy.

Knowing that there’s always something new unfolding here and a new horizon that people are trying to reach keeps me optimistic and excited to come to work.

I work up to four 12-hour shifts per week, usually with two patients per shift, depending on acuity. Kids are here for an average of four to six weeks, so we get to know them and their families really well and we also get to know their treatments and side effects just as well.

“The longer I’m here, the broader the scope of treatments we at Boston Children’s/Dana Farber Cancer and Blood Disorders Center offer children​. Knowing that there’s always something new unfolding here and a new horizon that people are trying to reach keeps me optimistic and excited to come to work. A lot of things that happen at Boston Children’s are firsts in the world of medicine and science.

Over the years at Boston Children’s, I’ve sought out opportunities to learn and have always had the support of my nurse manager, Barb Cuccovia. She’s always been in my corner, routing for me and for all of our staff to pursue paths of education and professional advancement. Today, as a Level II nurse, I’m in more of a leadership role. I precept nursing students and new nurses and am finishing up a Master’s in Nursing Education. Looking back, teaching was always where I thought my career would go.

A few important things I’ve learned along the way:

Bond with the child and the family

Your job is to focus on the child you’re caring for, but in pediatrics, we care for the whole family. When parents see that their child is comfortable with you, they relax. And when a child knows their parents trust you, they trust you. Building a relationship with both the child and the parent makes the process a little easier and less scary for everyone.

Respect the family dynamic

Every definition of “family” is different and every family’s situation is different. A parent can’t always be at the child’s bedside. It’s important to give families peace of mind when they’re away by ensuring them that their sick child is in the best hands and at the best hospital. For a parent who has to work, it can be a huge comfort to hear, “I’m here all day and I’m going to make sure your child is well taken care of … and we’re going to have fun playing Mario Kart, too.”

Be honest

The lives of these families are like one giant question mark; they never know what the next day is going to bring. They have a lot of what-if questions. There are no easy answers, but I try to be honest with them and not sugar-coat things. I prepare them for what could happen and at the same time I encourage them by saying: “Nothing that is happening today is scaring me. What I’m seeing right now is par for the course.”

Stay calm

You might see a vital sign you don’t like very much, but patients and families — especially after they’ve gotten to know you a bit — can read the emotion on your face. Use your experience and training to respond the way you see fit and climb the chain of command you need to. And always project calm — no matter what.

In nursing school, someone told me that my job as a nurse is to be gatekeeper. That is so true on this floor. I give children medicine, change dressings, manage visitors, tutors, PT, OT, psych-soc, specialists and so much more. But I am also their protector. It’s my job to change direction if I know they need a break. It’s my job to hold their hand, read their face and give their feelings a voice.

Learn about the Stem Cell Transplant Center at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.