But pediatric nursing also offers opportunities to use cutting-edge data, equipment, and processes that advance her day-to-day nursing practices. Dr. Lewis, who is a member of the Society of Pediatric Nurses’Board of Directors, also finds pediatric nursing provides pathways to pursue her professional interests including pediatric hospital medicine, quality improvement, instructional design, and initiatives that promote diversity, equity, inclusion, and belonging. She shared some of her thoughts about a career in pediatric nursing in time for the annual celebration of Pediatric Nurses Week which runs from October 2 to 6.
Please tell Minority Nurse a bit about yourself. I completed my undergraduate nursing studies at Gardner-Webb University in 2008 and earned my Doctor of Nursing Practice degree at the Medical University of South Carolina in 2015. Additionally, I completed post-graduate studies in pediatric acute care at the University of South Alabama and completed the Advanced Practice Provider fellowship offered by Seattle Children’s Hospital in 2019.
I have over 17 years of nursing experience and hold multiple national certifications in pediatric emergency, critical care, and mental health specialties as well as in nursing didactic and clinical education and vascular access. Personally, I enjoy reading, weightlifting, yin yoga, traveling, and spending time with friends and family.
How did you find your career path to pediatric nursing and what makes it rewarding? I was drawn in by the ethical maxims and caring science of the nursing profession and by the opportunity that it offers to interface with children and their families in a way that makes a positive difference. It is most rewarding to see and know that your actions, as a pediatric nurse, have contributed to the healing of a patient and family. A career in pediatric nursing has also afforded me opportunities to work across the country and overseas; to learn and work with brilliant intra- and interdisciplinary colleagues; to advance professionally; and to grow personally.
You work with a fragile population and their families. What nursing skills do you rely on most heavily? I rely most heavily on my ability to assess patients and families, the process of gathering data using senses. Many of the patients I care for, due to developmental or health-related considerations or other barriers, are unable to communicate using words. Receptivity to and accurate processing of body language, paralanguage, and other signs and symptoms that patients and families consciously or unconsciously share are the foundational of most successful outcomes.
Why is it so essential to have a diverse representation of nurses in pediatric nursing? Person-centered care focuses on the individual within multiple interwoven and complicated contexts. Foundational to person-centered care is respect for diversity, differences, preferences, values, needs, resources, and the determinants of health unique to the individual. Inclusivity and representation are essential to providing person-centered care to increasingly diverse populations, care that requires seeking to understand the totality of the individual’s lived experiences and connections to others.
Diverse representation is the only means by which we can create healthcare systems that empower individuals to make informed decisions about health maintenance and illness and injury prevention behaviors within the context of their own cultures; systems that recognize and value the undeniable influence of culture on the biology, attitudes, beliefs, and practices of patient populations and healthcare delivery alike.
What kinds of technological or medical advances have you seen in your career and what do you expect will develop in the future? As advances in portable and wireless technologies have developed and expanded, so has the provision of home health and telehealth services. These advances have expanded the reach of healthcare providers and services, making some forms of care and treatment more accessible and conducive to improving the quality of life of patients and families. It will be interesting to witness the evolution of artificial intelligence and its application in the detection and diagnosis of disease, as well as its role in information generation and sharing.
What would you like readers to know about pediatric nursing? The nursing profession is facing some longstanding and unprecedented challenges; pediatric nursing is not immune to those challenges. Every challenge, however, presents an opportunity for growth. Child health is the foundation of health and well-being for societies. Pediatric nurses are uniquely poised to lead the charge in reshaping healthcare systems across all care settings and levels of impact.
When nurses think of going into pediatric nursing, they often think of working with a specific age in the wide range of newborn baby to 18-year-old young adult. But what many might not realize is how working with a child also includes working closely with a family as well. In fact, when pediatric nurses think of caring for a patient, they consider the care of the family as part of the whole child, says Shirley Wiggins, PhD, RN, president of the Society of Pediatric Nurses.
As families have evolved to range from the traditional family of a mom and dad with kids, today’s family structure takes on a whole new shape. It can include same gender parents, grandparents as primary caregivers, parents living together or apart, foster parents, aunts, uncles, cousins, and even close friends who comprise the family unit.
So while pediatric nurses tend to the needs of the child, they also remain mindful of the emotions and experiences of the child’s family. “Education is a critical point with families, and it’s what they need,” says Wiggins. But not all families are ready for specific information at the same time. A pediatric nurse’s job includes being able to read a family’s readiness. “What is the capacity of that child and that family both developmentally and at that time,” says Wiggins.
When families have information, they can help support the child even more, and pediatric nurses are there to help them through that process. “You see how powerful the family is in our society,” says Wiggins. “In difficult times, you see how amazing they are. They dig deep.”
Although Wiggins says many pediatric nurses come right from nursing school, there are many who choose the field during a mid-career change. Wiggins says it’s often the call of working with children and in partnership with families that draw nurses in. “Sometimes what drives it is they encounter a family and a child speaks to them,” she says.
Wiggins says no matter where you are coming from in your career, it helps to have an open mind when you think about how you would fit into a pediatric nursing position. “Be open to the that fact that each family is unique,” she says. “Be flexible to just listen.” Families and children often come as one unit, so pediatric nurses see the whole picture.
Of all things pediatric nurses might have in common – the education, experience, and common patient group – what really knits this group together is one thing, says Shirley Wiggins, PhD, RN, president of the Society of Pediatric Nurses.
“I have to say we look at this as our passion where others might see it as a challenge,” she says. “Integrating the care of the child and family is our passion.”
In fact, at a recent meeting Wiggins asked what brought the nurses in attendance to the pediatric nursing field, and many nurses reported that they decided on pediatric nursing fairly early on.
What does it mean to be a pediatric nurse? “The whole emphasis on the Institute of Medicine’s patient centeredness is what pediatric nursing is,” says Wiggins. “It’s what we love to do, and it’s what keeps us there.”
Pediatric nursing works with an age range of patients that encompasses newborn babies all the way to the young adults of 18 years of age, so centering care on the patient means taking in a broad cognitive and physical spectrum. “The approach is developmental and we focus on that child and where they are,” says Wiggins. With all work done within the network of the family, pediatric nurses recognize that patient support comes in all manner of people – from the parents of an infant to the close friends of a teenager.
There are currently more than 180,000 professional registered pediatric nurses providing care, in various settings including home care, ambulatory clinics, schools, public health, colleges of nursing, hospice and palliative care, says Wiggins.
And Wiggins says pediatric nurses, who are often seen as working with the more vulnerable age groups, are amazed at the resilience of children. “There is great strength in children,” she says. Pairing that show of strength with a love of fun and goofiness lends to a very unique workday for most pediatric nurses.
“We all laugh because there are aspects of pediatric nursing that are really fun,” says Wiggins. In the seriousness of the work they are doing, they can’t forget to add the whimsy that kids often love – whether that’s cat’s ears at Halloween or singing familiar songs with the kids.
And a team approach to nursing children is essential, says Wiggins. Teams of medical personnel and child life specialists offer the support the child and the child’s family need. Wiggins says a good pediatric nurse has the same qualities that make any nurse exceptional. “Be the one that asks questions and sees issues and wants to make it better,” she says. “There’s lots of good communication when we work with others and in the Society of Pediatric Nurses we look at evidence-based standards in pediatric nursing with discussion boards and communication that looks at substantiating what we do.”
Wiggins herself said she knew during her nursing student days that this was going to be her direction. Even at the end of a challenging day in clinical, she thought of what she needed to do to be able to do have days like that for the rest of her career. “It didn’t feel like work,” she says. “It was an opportunity.”
And, yes, pediatric nurses are in a field that could make them prone to compassion fatigue because of the heartbreak they encounter routinely. When nurses mention things only another nurse would understand, pediatric nurses share a special bond of caring for ill children, some of whom do not recover. Because of that, there are lots of protections and processes in place for pediatric nurses to help manage the emotional fallout that can happen and to keep them close to other pediatric nurses who have almost all experienced similar joys and sorrows.
Wiggins points to the DAISY Foundation awards, which recognizes outstanding nurses and the “super-human” work they do with patients and families in difficult times. The awards can help acknowledge that nurses struggle with emotions right alongside families and patients they care for.
If pediatric nursing is something that intrigues you, it’s worth looking into getting some first-hand experience to see if it’s a good fit.
Like many nurses, Heather Hightower, MSEd, RN, CPHON, didn’t plan to become a nurse. But they’ve found a career in pediatric hematology/oncology nursing that fulfills their passions for science and for working with an adolescent and young adult population. For today’s celebration of Pediatric Hematology/Oncology Nurses Day, Hightower shared some thoughts on this career path.
Hightower is now the office practice nurse for the Adolescent and Young Adult Program at Memorial Sloan Kettering Cancer Center, and their nursing path started with an undergrad degree in religious studies, a master’s degree in education, and some time as a high school science teacher in New York. Hightower says they realized nursing was a field they were interested in pursuing.
Heather Hightower, MSEd, RN, CPHON
“I love education and teaching students,” they say, and their current role helps a younger population navigate a cancer diagnosis while grappling with essential life questions of “Who am I?” and “What can I be in this world?” The work is Hightower’s sweet spot. “That population needs additional support because they are navigating so many things at the same time, and then they have a cancer diagnosis and everything gets derailed,” they say. As a nurse and an educator, Hightower pulls on all of their experiences and skills each day. “It’s so human and so science-y at the same time,” they say.
From Job Fair to New Specialty
Thinking they’d like to be a midwife or a labor and delivery nurse and playing with the idea of returning to New York, Hightower says a conversation at a job fair unexpectedly led them to Memorial Sloan Kettering Cancer Center. The hospital didn’t have a labor and delivery department, but they did have a women’s health department, and Hightower eventually began working there with gynecology oncology and breast oncology patients as an inpatient bedside nurse. “But I missed working with a kids,” they say.
A mentorship program led them to pediatric oncology and eventually to their current role where they work with adolescents and young adults aged 15 to 39. The Adolescent and Young Adult Program at Memorial Sloan Kettering supports patients from all angles, and Hightower makes personal connections with their patients and with all the other departments they might need. “We consider what are the supports they need,” they say. “They need counseling, social work, vocational and school support, but also nursing that supports health literacy development and supports social development.”
Helping Patients Through the Cancer Journey
For Hightower, the unease and struggle to find a place in a new situation hits home. “I remember what it’s like to be a new kid and try to make new friends,” they say. “So I see them come in and feel this is so foreign to them and they just want to find someone they can connect with so they aren’t doing this alone,” they say. “It’s the same idea, just a different location.”
Within a specialty that is focused on cancer patients but encompasses a wide age range and all different cancers and treatment modalities, Hightower has found nursing support as a member of the Association of Pediatric Hematology/Oncology Nurses (APHON), the professional organization for pediatric hematology/oncology nurses and other pediatric hematology/oncology healthcare professionals. “I can say so many wonderful things [about pediatric hematology/oncology nursing], but at the end of the say it’s really tough,” says Hightower. While nurses celebrate the many successful treatments and healthy patients, they go through real lows as well. “APHON is there to support nurses,” they say and bring together nurses who are driven to advance treatment and quality of life for their patients.
With so many moving pieces to treatment, Hightower says having excellent communication and critical thinking skills is essential. They need to be able to talk with their patients (often either very chatty or very quiet) and help them understand, but also communicate with families and other medical teams. “It’s often saying the same idea in different ways, and it’s a real skill set,” they say because it all has the same goal of supporting the patient and understanding how each step will ensure the best possible care. Hightower must be agile to synthesize all the medical information into words a parent, caregiver, or patient can understand while also working with researchers, labs, and other nurses.
Representation Is Key for Patient Relationships
Hightower is also mindful of how diversity and representation holds a big place in caring for any population, but especially an adolescent and young adult one. “I feel like diversity is my second job,” they say. Hightower says their identities as Black, queer, and nonbinary help inform everything they do with patients.
“It’s important, particularly for patients of color and patients who identify as part of the LGBTQ+ communities, to find someone who can understand them and who can respect them,” Hightower says. “It’s hard to show up as your authentic self, so it’s important for me to show up as a queer person of color and say, ‘I am here and you can be here too. You can be here comfortably and safely. I am here to support you however you show up.'”
Professional Organization Offers Support and Education
Hightower says APHON is an excellent resource for pediatric hematology/oncology nurses. APHON members are dedicated to promoting optimal nursing care for children, adolescents, and young adults with cancer and blood disorders, and their families.
Recent advances in cancer treatment are exciting, says Hightower, particularly in CAR T-cells and in immunotherapy. Members share information and strategies to see what else they can do to integrate into their own practices. Conferences are an excellent opportunity. “It’s bringing minds together around this really important population,” they say, “and figuring out how do we support that nationally.”
Peggy Townsend, MSN, RN, CPON, will never forget treating her first cancer patient–a four-old girl who had just been diagnosed with leukemia.
“The family was very close, and of course this diagnosis devastated them,” she recalls. “I had to be the one to be strong, and they depended on me and trusted me.”
Online Info: Internet Resources for Nurses Interested in Pediatric Oncology • Nurses for a Healthier Tomorrow provides a good overview of careers in oncology nursing at www.nursesource.org/oncology.html. • The Association of Pediatric Oncology Nurses, www.apon.org, provides information on continuing education, best practices, jobs, conferences, publications and more. Formed in 1973 when four pediatric oncology nurses held an impromptu meeting, and incorporated as a not-for-profit organization in 1976, APON is the leading professional association for registered nurses caring for children and adolescents with cancer and blood disorders and their families. The group has approximately 2,000 members worldwide. • The Oncology Nursing Certification Corporation, www.oncc.org, develops, administers and evaluates programs for certification in oncology nursing, including Certified Pediatric Oncology Nurse (CPON).• The Intercultural Cancer Council provides a fact sheet about minority children/adolescents and cancer at http://iccnetwork.org/cancerfacts/.• The Oncology Nursing Society, www.ons.org, offers an online Multicultural Tool Kit that can be used in any oncology nursing setting. (Click on “Clinical Practice” then “Special Populations.”) The kit is designed to help nurses provide culturally sensitive care to ethnically, culturally and socially diverse individuals, families and communities.
Today the former patient is a healthy 17-year-old college student. The teenager and her family still keep in touch with Townsend to say thank you.
Every nurse who specializes in pediatric oncology inevitably is asked: How can you do it? How can you face every day the ordeal of seeing children suffering with cancer? But for these nurses nothing is more rewarding than making a difference in the lives of kids and their families at such a critical time.
“I work here because I see it as helping children overcome some of the worst diseases, and I help parents cope with one of the worst nightmares of their lives,” says Adeline Fredricks, BSN, RN, a pediatric oncology nurse at Children’s Memorial Hospital in Chicago.
Thanks to the tremendous medical advances that have been made in the war against cancer in recent years, today’s pediatric cancer nurses have hope on their side.
“It’s not always a sad story,” says Rita Secola, MSN, RN, CPON, president of the Association of Pediatric Oncology Nurses (APON). “Today we cure probably greater than 60% of children with cancer.” In fact, the cure rate for acute lymphoblastic leukemia, the most common form of cancer in children, now approaches 90%.
“I still get Christmas cards from children I took care of 15 years ago,” adds Secola, who is clinical manager of the inpatient center at Children’s Hospital of Los Angeles.
Melissa Silva, CPNP, a pediatric nurse practitioner at Children’s National Medical Center in Washington, D.C., has a hard time choosing one example of a patient whose recovery inspired her, because there are so many. Pictures of children crowd her desk. “There are so many of them who were at death’s door, and yet somehow, someway, through hope and prayer, they got through it,” she says. “To see them now walk into our clinic is very rewarding.”
“Not the Same Old Nursing”
Pediatric oncology nurses work in a variety of capacities. Clinical nurses provide care at the bedside, deliver blood products, administer chemotherapy and other procedures and provide patient education to kids with cancer and their families. Case manager nurses work with a physician team to coordinate and monitor care throughout the treatment process. Some case management nurses work for insurance companies.
Ada Santa Cruz, RN (left) with a young patient and mom.
Other nurses in pediatric oncology work as clinical educators, providing staff training and making sure newly hired nurses are following treatment protocols. The specialty also needs research nurses who can investigate factors affecting cancer outcomes and conduct clinical trials so that new treatments for childhood cancers can be developed. And there are opportunities to move up into administrative and managerial positions, such as clinical managers.
As a pediatric nurse practitioner, Silva coordinates the care of patients with cancer, especially those with acute lymphoblastic leukemia. She also works on a pediatric palliative care team, a multidisciplinary group that makes recommendations for pain and symptom management and consults on end-of-life issues.
Silva says she always wanted to be a nurse for as long she can remember. She got interested in working with young cancer patients after watching a St. Jude Children’s Research Hospital television special. “That sealed it for me,” she remembers. “It was seeing the courage these children had. Despite having these awful illnesses, these kids were still smiling.”
One of the greatest benefits of working in pediatric oncology is the opportunity to really get to know patients and their families, says Ada Santa Cruz, RN, who decided to pursue a career in cancer nursing after both of her grandmothers were diagnosed with the disease. As a clinical nurse II at Children’s Hospital of Los Angeles, Santa Cruz administers chemotherapy, provides care to alleviate pain, and educates and advocates for patients and families. Her work also entails performing countless small acts of kindness.
“Sometimes it means bringing a parent a box of tissues or bringing a patient a Nintendo game,” she explains.
Santa Cruz, too, finds these young cancer patients inspiring. “You see this different side of life,” she says. “These children are like lions. They have an enormous amount of strength. Despite having chemotherapy and getting stuck with needles, within in an hour they want to run and play. When we have arts and crafts, some kids will look forward to that all morning.”
Another advantage of a career in pediatric oncology is the opportunity to work on the cutting edge, says Secola. In cancer treatment, new drugs are under development all the time. Nurses working in pediatric oncology get to administer the newest treatments available and see for themselves the rewarding results when a child’s condition dramatically improves. “It’s not the same old nursing,” she emphasizes.
Culture, Kids and Cancer Care
As with many other specialty areas of nursing that have been severely affected by the RN shortage, the need for pediatric oncology nurses is acute. Plus, this specialty urgently needs more minority nurses, who play a vital role in helping hospitals meet the needs of children and families from diverse cultures. After all, the last thing the parents of a critically ill child need at this difficult time in their lives is having to deal with linguistic barriers or culturally insensitive care.
“Patients come to [our medical center] from all over the world,” says Silva, who is of Portuguese/Cape Verdean descent. “They often view death and dying differently than we Americans do. We have to respect their families’ religious beliefs and practices.”
Santa Cruz, for instance, recalls a family from Jordan who did not want the staff at her hospital to touch the body after their child had died. Nurses worked closely with the family to get permission to do what they needed to do.
Having a racially and ethnically diverse pediatric oncology nursing staff can also help children and families of color feel more comfortable in an unfamiliar, and perhaps even frightening, hospital setting. Fredricks, who came to the United States from Nigeria when she was 14, has treated some patients at Children’s Memorial who were from Nigeria. When the parents saw her and found that she was able to communicate in their native language, Ibo, “they felt at home,” she says.
Santa Cruz feels that her ability to speak Spanish creates a cultural bond with Spanish-speaking families. But just being able to speak the language isn’t enough, she cautions. Everything must be translated properly to the parents’ level of education. Misunderstandings can develop if medical terms are translated but not explained. For example, a parent might think a “positive” test result is a good thing, when just the opposite is true.
Not Always a Happy Ending
While getting to see children conquer cancer and grow up to lead healthy lives is the most rewarding part of a career in pediatric oncology nursing, there’s no denying that there are also tough times. Sadly, the reality is that not every child is able to win his or her battle with the disease.
Melissa Silva, CPNP
“The most challenging part is when children who have gone through treatment relapse and we lose them,” says Townsend, who is African American.
Silva says occasionally months will go by without any deaths, and then suddenly three or four children will die within the same month. When that happens, she adds, “we all grieve.”
When she’s feeling down, Silva makes a point to drop by the long-term survivors’ clinic, where she can see patients who have been free of cancer for five to 20 years or more. “Some are married now,” she says. “Some who were babies when we cared for them are now in college. That makes me feel better.”
She also gains strength from the camaraderie she shares with other nurse practitioners at her facility. “We have a wonderful group. If we’re having a bad day, I know I can come back here and vent to them.”
At Children’s Hospital of Los Angeles, says Secola, nurses are taught how to cope with these emotional challenges as part of their orientation. They are instructed to develop a plan for how they will take care of themselves and how they will maintain professional boundaries. The nurses get a lot of support from one another, and the staff conducts debriefing sessions after particularly tough cases. Hospital chaplains also provide support, and counseling is available through the employee assistance program if someone needs extra help.
Nurses have to set boundaries for themselves, so they don’t get overinvolved with patients and their families or take on more than they are capable of handling, Secola explains.
Santa Cruz, who has worked in her position for only two years, says setting boundaries is more challenging for new pediatric oncology nurses like herself than it is for veterans. “I’m still learning not to become so attached to patients. I need to be emotionally in tune with what I can take on.”
Fortunately, she adds, her strong religious faith helps her maintain balance in her life. Hobbies, such as running, also help. She recently completed a marathon.
As they become more experienced, nurses eventually learn to deal with the hard losses, says Townsend. “But it never becomes easy. If nurses get to the point where they don’t have to cry, those are the people I worry about.”
There’s no getting around the pain of seeing a young patient die. As Fredricks describes it: “Somewhere in your heart, you know this child is not going to make it. You go home and you cry yourself to sleep. Sometimes you come back [the next day] and the child is gone. But you have to move on. You have to be able to let go and move on so you can help other kids.”
One thing that helps pediatric oncology nurses cope when a child dies is knowing they did their best. Often they helped grant patients’ last wishes to spend their final days at home with family.
Is This Career Right for You?
Registered nurses can work in pediatric oncology right out of nursing school. The once-common belief that nurses should get general experience first before specializing no longer holds true today, Secola says. Hospitals are more than willing to offer specialized training–e.g., in chemotherapy–for new nurses.
Working with pediatric cancer patients isn’t for everybody. “You have to be strong. You have to be compassionate. You have to be caring,” says Fredricks.
Because of the rapidly evolving scientific advances that are transforming cancer care in the 21st century, pediatric oncology nurses must also be flexible. This is a career that requires a lifetime of learning. If you’re a nurse who’s looking for something challenging with constant opportunities for growth, then this specialty is right for you, says Secola. “It’s not [the kind of nursing] where you learn a set of tasks and then it’s always the same.”
Townsend agrees. As education manager for the department of patient care services at Children’s Hospital of Los Angeles, she is responsible for RN staff development. She helps with the eight-day orientations for new nurses and provides support at the bedside to make sure the nurses are performing procedures correctly. “It’s constant learning,” she says. “Things change really quickly and you have to keep up with the standards and practices.”
While the daily pace in pediatric oncology is not as fast as in an emergency room or ICU, nurses must still stay on their toes because patients’ conditions are volatile.
“It takes a lot of advocating and picking up on signs and symptoms,” Santa Cruz explains. “You’re going to be stretched and it’s going to require a lot of patience and sensitivity. You don’t just look at the machines. You look at the patient. You look at the parent.”
Above all, compassion is at the heart of this work. “You may think you’re having a bad day, but you’re not the parent in the room who has just been told their child has cancer,” says Townsend. “You have to turn off [any personal stuff that’s] going on with you.”
And that’s not always easy. But the long-term impact pediatric oncology nurses have on the lives of children and families makes the challenges all worthwhile. As Townsend puts it, “I probably would do this for free if I could.”
