Oncology nursing at CHW

The Children's Hospital at Westmead offers opportunities for enthusiastic staff to work as part of a great multi-disciplinary team in paediatric oncology. The oncology unit includes both inpatient and outpatient services, and provides opportunities for nursing staff working in the area to experience both sides of oncology nursing. Camperdown ward is a 17 bed inpatient area, which provides routine oncology care including caring for fever/neutropaenia, chemotherapy administration and specialising in bone marrow and Stem Cell transplantation for both oncological and haematological disorders. We also have up to 25 patients in outlying wards whose care is coordinated by our liaison Clinical Nurse Consultant. The Oncology Treatment Centre (OTC) focuses on outpatient and day treatment care. Paediatric oncology not only challenges staff, but also rewards them with professional and personal fulfilment.

Hi, my name is Robyn and I have worked on Camperdown ward for 13 years. I absolutely love working in Oncology. I started full time and then had a family of my own and went part time. I get great job satisfaction working with Oncology children and their families, knowing I make a difference to their lives, mostly by being here and emotionally supporting them; educating them on the medications /chemotherapy and side effects and on the different diseases and disease processes. I feel privileged to look after incredible and brave children and young people and I am continually learning not only about Oncology but also about bereavement support, ongoing treatments and people.

The nursing staff of the oncology unit are supported by a multidisciplinary team consisting of:

  • Medical
  • Social work
  • Play therapy
  • Occupational therapy
  • Physiotherapy
  • Psychology
  • Dietetics
  • Hospital school
  • Pharmacy
  • Research.

These staff all help provide the best possible care for the patient and their family.

Management and support

The strategic planning of Camperdown ward and the OTC is performed by a Nursing Manager. She is supported in the clinical and leadership roles by 3 Nursing Unit Managers (2 for CW and 1 for OTC) who perform the roles of Nurse Clinical Coordinators. Shifts on Camperdown always have a team leader and rostering is carried out to ensure a good skills mix of staff for all shifts. Support roles that are exist are those of Nurse Educator, Clinical Nurse Educator, Blood and Marrow Transplant coordinator (plans transplants with the family and multi-disciplinary team, and supports acute nursing care in the unit), CNC Oncology Liaison (to support ward and outlying staff in oncology care), Out of hours CNE (mainly at the weekends), CNC Community (works with our patients from discharge planning, outpatient treatment to community and in home care).

Types of nursing environments

Camperdown Ward

A nurse on Camperdown would have the opportunity to be involved in high dependency nursing of children with cancer, including medical and surgical experience i.e. removal of drains and sutures, pre op and post op care, use of oxygen therapy, regular assessment of clinical status / observations- looking for signs of sepsis or fluid overload in the child. Nursing in Camperdown will also offer the opportunity to learn skills specific to paediatric oncology, such as chemotherapy administration, tumour lysis management, understanding disease (cancer) processes, treatment and diagnosis procedures.

I began my nursing career as a new graduate nurse working in paediatric oncology, and in the four years since that time I have gone on to further study in the area. I have recently become a Clinical Nurse Specialist in this area.

I love working within the unit. The patients are sometimes frightened, sometimes apprehensive, usually sick, but always fun to work with. The environment is without a doubt challenging, and sometimes stressful, but this just adds to the camaraderie we have developed within the team. Working under pressure, in situations that are physically and emotionally draining, rapidly binds new team members together; we rely on each other for support in this area. The job might best be described as exhilarating. We are constantly doing new things and trialling new treatments and technologies; we were among the first transplant units in the world to trial a genetically modified stem cell transplant, and are pioneering a new protocol for the treatment of lymphoid leukaemia. The unit benefits from a close association between the areas of oncology and stem cell transplantation.

At the end of each day, when each nurse leaves this ward, we leave knowing that the things we have done have made a difference in the lives of children and families who are facing the toughest times in their lives. That's what makes working here so special.

Blood and marrow transplants on Camperdown Ward

Working in paediatric oncology is a very exciting and stimulating area. As well as looking after newly diagnosed patients and families, patients receiving chemotherapy, nurses on CW are given the opportunity to care for patients receiving a blood or bone marrow transplant for both malignant and non malignant diseases. CHW is one of only four centres in NSW which perform allogenic blood and bone marrow transplantation.

At any given time there are approximately four patients who are working up to, receiving or are post blood and bone marrow transplantation. These patients may have their peripheral blood stem cells collected via apheresis on the ward. This is an advanced nursing skill, which nurses after a length of time on the unit would be given the opportunity of learning and performing. Nursing staff are guided through transplantation by the Stem Cell Transplant Nursing Coordinator, in conjunction with the Nurse Educators and attend a Bone Marrow Transplant Education day after completing their orientation and chemotherapy packages.

Outlying patients

There are often more patients, who need treatment, than there are beds on Camperdown ward. Therefore some of our patients are cared for in other wards of the hospital. Camperdown provides highly experienced nurses who work with the nurses on these wards to help guide the care of these children and young people. The support that the Clinical Nurse Consultant gives constitutes supervision of chemotherapy, education on procedures, liaising with the educators and team leaders on the wards to trouble shoot and offer support and education to families. The role also provides support to the surgical unit and for newly diagnosed patients.

As an Enrolled Nurse working on Camperdown ward for 2 years I have developed new clinical skills and expanded my theoretical knowledge of Oncology Nursing. Camperdown Ward provides a warm, friendly and supportive environment to all nursing staff. It has an excellent preceptor programme. Working here has made me see my potential and now I am completing my Bachelor of Nursing Degree through University of Technology Sydney.

Hi, my name is Sandra and I have worked in Camperdown ward for five months. I came over to Sydney on a one year sabbatical. I normally work in a busy children's day case unit in the Highlands of Scotland. I decided to apply for a sabbatical as I wanted more oncology experience. I have thoroughly enjoyed my time in Camperdown ward and have found the nursing staff very welcoming and supportive.

This sabbatical has given me the opportunity to commence chemotherapy administration which I hope to be able to continue when I return home. It has also given me a greater insight into the management of chemotherapy patients. I also hope to attend the oncology clinic and general day case unit while I am here. I would recommend this very positive experience to anyone.

Oncology Treatment Centre

Usually known as 'clinic', this area of nursing cares for patients during the outpatient phase of their protocols, usually after they have spent time as an inpatient. They often attend clinic for day chemotherapy, CVL dressings, daily antibiotics, platelets, packed cells and education. Often clinic is used as an admission centre and as a triage centre for patients who become unwell whilst at home. Patients will visit the 'fishbowl' where they have bloods taken either from their central line or peripherally. There are 4 permanent clinic nurses and nurses from Camperdown spend up to 3 months working in clinic and fishbowl no a voluntary rotation. The Long term Follow up Clinic operates here too. Patients who have been off treatment for more than 5 years are monitored for any long term side effects of their treatment as they grow and develop.

Clinic is open Monday to Friday 8am till 6 and is a fun and colourful environment to ensure that the repeated experience of ongoing treatment is as 'bright' as possible.

Working in clinic gives you a great opportunity to see patients when they are better, to see how your work and the work of your colleagues in Camperdown had a positive effect. It is also a great opportunity to see and experience a huge range of treatment protocols and to be more experienced in the discharge of patients. The atmosphere in the clinic is so upbeat with wonderful features in the treatment rooms and in the waiting areas to keep the children and young people occupied and happy. I have found it stimulating to negotiate with older patients as to their treatments, their experience of them and the benefits and difficulties in receiving them.

Community care

The Community Clinical Nurse Consultant provides a service to patients and families in their homes and on average the CNC travels 3000km per month. A range of the duties include:

  • administration of chemotherapy in the home
  • central line care
  • intravenous antibiotics
  • education to parents to allow them to perform procedures such as chemotherapy administration in the home
  • education to schools and preschools to support the child or young person returning to school
  • symptom management
  • treatment and support of palliative patients in the home
  • liaison with support services in the community and co-ordination of palliative care
  • bereavement support in liaison with the palliative care team from CHW and Bear Cottage (our children's hospice).

Style of Care

Child life therapy

There is one Child life therapist working in Camperdown ward who works with children 2-17 years of age. Each week priorities have to be made to cater for the varying needs of children who come into the ward. Referrals are taken from the nursing staff and other members of the team. The Child life therapy program works towards minimising the stress and anxiety felt by many children when they have to stay in the hospital. Children's normal development can be delayed due to a serious illness because they are missing out on school and other experiences that are pertinent to a child's global development. Child life therapy can assist with children by providing opportunities to gain a sense of mastery, play, learning, self-expression, family involvement and peer interaction.

Team work with nursing staff:

  • Supporting nurses with distraction equipment/resources (bubbles, videos, games etc, relaxation music) for procedures
  • Making reward charts/systems to help them to encourage children to take medicine and so on 
  • Answering their referrals when they feel a child needs some support Passing on play therapy/child development information for nursing assignments

I encourage nurses to participate in play therapy with the children in Camperdown ward as much as possible. I am also very in interested to form a small committee with nurses interested in medical play and play therapy to work on a few projects together. This includes working on joint journal articles and developing an education program/book for children coming into Camperdown ward (to learn about their time in hospital , their illness, medical procedures, ways to help further with fear and anxiety associated with being in hospital etc).

Dietician

Adequate nutrition is very important to decrease morbidity and mortality in oncology patients.

The role of the dietician who covers Oncology and Bone Marrow Transplantation at CHW includes:

  • Identifying patients at risk of malnutrition or who are already malnourished by conducting individual nutritional assessments
  • Nutritional education and counselling for patients and their families (for issues such as failure to thrive, enteral feeding, nutritional management of oncology treatment side effects such as mucositis, diarrhoea, constipation, steroid induced obesity)
  • Monitoring nutritional rehabilitation and growth
  • Educating staff about nutritional therapy.

The dietician participates in daily ward rounds as a means of liaising with other oncology staff. The dietician and nursing staff work closely together to monitor oral intake, monitor tolerance of nutritional support (oral, enteral or parenteral), perform anthropometric measurements, initiate and grade up enteral nutrition support and review compliance to nutritional therapy.

Social work

There are 5 social workers working in Oncology. We have chosen to work in this area because although it is demanding work, it is also satisfying. We work closely within the multidisciplinary team to provide a complete service and to support one another. Each social worker is 'buddied up' with a staff specialist in Oncology.

All children are linked to a social worker at the time of diagnosis and that social worker is available to assist them throughout their treatment and beyond. Our aim is to minimise the impact of the illness and hospitalisation on the child and family. We offer counselling to individuals and families, and run groups (for example, Soulmates, our support group for bereaved families, and our Siblings Day programs). We advocate on behalf of our families, provide psychosocial education and make referrals to, and liaise with, community services and resources. Social workers attend and contribute to the weekly Multi Disciplinary meeting. We participate in case conferences contributing psychosocial information relevant to case planning or management.

We believe that the multidisciplinary team roles complement each other. Working as a team ensures a high standard of service delivery and also enables mutual support among team members. We appreciate the expertise of nurses and feel that our expertise is acknowledged in return. In working together we can discuss mutual concerns about children or families. As nurses have 24 hour contact with patients and families we appreciate being informed about changes in family circumstances or about specific issues which can be distressing to families. Social workers are available to provide in-service lectures about psychosocial issues and about our work with patients and families.

As part of Oncology Allied health, social workers work together with other Allied Health members. We meet with other Oncology Allied Health staff regularly for case discussion and support.

Psychologists

I am a clinical psychologist working in oncology since 1989. I often receive referrals from nurses in the ward and clinic and we discuss patients/families from time to time. Last year I attended a couple of nursing hand-over meetings at the request of the NM or other senior nurses, to facilitate discussion of deaths on the ward. I think providing non-judgmental support to one another and an opportunity to talk about reactions to patients and families is important. I also did the critical incident training and plan to attend the meetings that are held twice a month to review incident reports. I offer help with anxious and depressed patients and parents, conduct assessments and therapy, (including what I like to call 'therapeutic conversations'). My office is in the clinic and I see people referred as soon as I can. I am facilitating a parent/carer discussion and support group that meets weekly in school term. Nurses remind parents about the meeting and encourage them to attend.

Occupational therapy

Occupational therapy aims to enhance the overall performance of children who are limited by the effects and treatment of cancers and hospitalisation. The therapists review how oncology treatments affect mobility, productivity, play and rest. The therapists aim to help patients adjust and adapt to everyday tasks, including the use of adaptive aids; to review pain management; to develop concentration and other tools to help learning and development; through play to express themselves and their feelings and use relaxation techniques to gain a greater sense of calm and well being.

Integrated clinical services

When the various teams who provide patient care work closely, communicate well, share leadership and respect each other's expertise and contribution, patient care is better. This is why it is important to further integrate our clinical services. The Hospital has embarked upon a project looking at Integrated Clinical Services in our environment and ways we can improve.

Professional Development and Support

Orientation

Every new nurse at our hospital takes part in a general Hospital orientation. They also particpate in a general nurse orientation which, normally takes place the day after the hospital orientation.

Ward orientation

Camperdown Ward offers a structured ward orientation. The first two days you spend on the ward you will be supernumerary. The first day you will spend working with the Clinical Nurse Educator. On this day you will be introduced to some of the nursing skills on the ward such as taking blood from a Central Venous Access Device, giving drugs, giving blood products, giving drugs as well as an introduction to hospital policy and procedures. This day will also include a general overview of how to care for a child with cancer and their family. The second day you will work with your allocated preceptor and observe the care for the children that they are allocated to.

Preceptors and mentors

When you start work on Camperdown Ward you will be allocated a preceptor. The preceptor allocated to you will have been working on the ward for a period of 12 months or more. The preceptor is generally an experienced nurse who is able to assist you to learn the skills required to function as a nurse in Camperdown Ward. You will work with your allocated preceptor for a day in a supernumerary capacity and assist in the care of the children that your preceptor is allocated to care for. You will then work most of the same shifts as your preceptor for the next 4 weeks.

Ward educators

The ward has a number of roles that support and lead education for both staff and families. The Nurse Educator is responsible for the oncology self development including those nurses who care for outlying patients. The NE develops programmes for new staff, graduates and parents and families. They are responsible for reviewing and implementing hospital policies and procedures and alerting staff to them. They run the annual chemotherapy study day, provide the chemotherapy accreditation for staff and give lectures and keep nurses up to date with oncology advances and research. They also manage funding for nurses to attend conferences and carry out study. They are supported by the Clinical Nurse Educator. This role provides a hands on support and review service to the nurses. They provide the ward orientation to all new nurses and provide daily education and learning needs, such as the giving of drugs and chemotherapy. They review all mandatory training such as CPR and fire training and offer support to the families and parents. Both of these roles work 'office hours' and so there is out of hours oncology educator support across the whole hospital by two experienced oncology nurses.

In service sessions

In service sessions are held on the ward on most Mondays, Tuesdays and Fridays for 20-30 minutes. The programme aims to alternate clinical with professional and current issues. Other in service opportunities include the Oncology Planning Meeting, Grand Rounds, and multi disciplinary meetings. Staff debriefing sessions are led by the psychology team.

Target 40

The Target 40 programme is to help us to examine exactly what sort of development activities have been undertaken. It is a minimum requirement that all staff perform at least 40 FTE hours of development each year. This can include in-service, conferences, courses, reading journal articles, attending lectures, mandatory updates, unit workbooks etc. The value of the learning is formally reviewed at appraisal. The ward encourages autonomous learning and has funds available to help with funding courses.

External professional development

Nurses within The Children's Hospital at Westmead are encouraged to continue their professional development. The College of Nursing has a strong link with the hospital and hospital staff are encouraged to attend these courses. The hospital also encourages nurses to attend conference related to specialty areas and nurses are able to obtain funding to attend conferences or attend courses relevant to their work. Nurses working in Camperdown Ward are given the opportunity to complete a Graduate Certificate in Paediatric Oncology which is run through the college of nursing. Nurses are also encouraged to undertake further tertiary study relevant to their area of work.