Taking Care


The nurse is answering a woman’s question, but she makes sure to look at the boy standing next to her and talk to him as well. “Hey, buddy.” There’s softness in her voice, but she’s not patronizing. This nurse knows what it’s like to be a patient, indeed, to be a child with a serious illness.

“I’d always wanted to do this,” says Megan (Hickey) Barbosa. “I was an oncology patient at 18 months.”

She doesn’t remember that time, of course, but kids who’ve had cancer have follow-up appointments for years. And she well remembers the summer camps she attended with other kids who’d been diagnosed at some point with pediatric cancer and the nurses who volunteered there.

Now she’s a member of the latter group.

Barbosa ‘10 (MSN) is a charge nurse in Hematology/Oncology or “Hem/Onc,” as it’s known. She’s answering phones and keeping tabs on everything that goes on. She’s got a pen tucked into her bun and is triaging and assigning nurses for the day’s chemotherapy infusions and lab work.

“It gets a little crazy around here,” she says. She’s making sure she knows which nurses need help, and which ones can provide that help.

She’s interrupted over and over. This is what it means to be a nurse anywhere. But today at Rady Children’s Hospital San Diego (RCHSD), dozens of USD graduates are making patients’ lives better. Yes, they take vital signs, coordinate care and even administer chemotherapy. But they also provide comfort. They’re passionate about pediatrics, and they’re up to the multi-tasking endemic to working in the state’s largest children’s hospital.

“I don’t think it’s any different than I expected,” Barbosa says. She reflects for a second and adds, “Well, sometimes it’s busier.”

She and another nurse meet at a computer screen to check a patient’s chemotherapy in advance of the procedure. It’s a complicated process that involves not a little math — square roots, many calculations — to determine the patient’s body surface area and the dosage he’s to receive.

RCHSD was the only place Barbosa envisioned ending up, and her “very specific plan” for working there helped her land a rare slot in Hem/Onc as a new graduate. But there is one place she doesn’t seek to work — the procedure room, where children are put under general anesthesia for procedures such as a lumbar puncture. “Having been a patient, that’s a little too close.”

“I’m constantly checking complaints, cleaning beds. There’s nothing I won’t do,” Barbosa says. “I definitely understand what it feels like to be lying in that bed. I try to get to the beeps sooner because of that. The team here is amazing. We’re very tight-knit because of the patients. Everybody jumps in to help.”

Elsewhere in Hem/Onc, Kristina Ost ‘92, ‘93, (MEd) is wearing navy blue scrubs, ready to be one of those jumping in to lend a hand. She’s a manager and attends a lot of meetings as a nurse educator charged with keeping the department nurses’ skills up to date, but the scrubs are a mark of her commitment to always be at the ready to help out bedside.

“I feel like I have the best of both worlds, because I still get to take care of patients, but I also get to be involved on the other side of the spectrum with all of the decisions to be made,” Ost (pictured with patient) says. “Being a resource is the biggest and most important aspect of my job. It’s important to know what goes on at the bedside. It also builds a little bit of respect. I’m not the fastest out there anymore, but I can go take care of a patient. And there are very sick kids here.”

It’s Ost’s job to hire and train the Hem/Onc nurses. She also oversees licensing and supervises the nursing staff in the
hospital’s partnership in the Scripps Proton Center, the only pediatric proton center on the West Coast. “It’s very exciting. It was a huge learning curve for me.”

It’s no surprise that it takes a special kind of person to care for the sickest of children. But over and over, these nurses demonstrate a huge level of commitment to caring for sick kids. There are many heart-wrenching moments, but there are also many rewards.

“I could not be an adult nurse. Pediatrics is a passion, a calling. I just gravitated toward them. Kids are resilient. Even though it’s a sad place, sometimes we also have a lot of fun.” There’s real warmth in Ost’s voice. “We make it the best experience for them, to relieve their suffering. We have an amazing team of nurses here.”

The nurses “advocate hard” for the patients and really work on treating the whole family, she says, including making the most of their time if there is a terminal diagnosis. This all means she’s constantly calling upon her University of San Diego undergrad psychology degree. “I got a great education at USD.”

The university is also helping Children’s Chief Nursing Officer Mary Fagan with her goals for the hospital’s nurses. She’s enrolled in the PhD nursing program and is expecting to graduate in December 2015.

“The real reason I got interested is that we wanted to grow our nursing research program,” Fagan says. “USD has broadened my perspective and helped me really understand the role of the nurse scientist.” She’s finding it to be the best way to connect with other nurse researchers in the community and connect with those researchers who want to help the pediatrics patients.

Rebecca Reynolds ‘07 (MA) appears to have a permanent smile. One-on-one, Reynolds is effusive; her cheer isn’t over-the-top, but it is contagious. Yet in her role as residency program manager for nurses and respiratory therapists, she tells it like it is. Today, she’s moderating as a group of nurse trainees — many in scrubs — get a lesson in patient- and family-centered care, hearing from parents who’ve been through the nightmare of a child’s chronic illness — or worse.

“Every family has a culture,” says Reynolds. “Things get magnified. Some-times families glue together, and sometimes they blow apart. I was not always the nicest nurse. I was an adrenaline-junkie.”

What saved her love of nursing? She was looking for a course change when she entered USD’s Marital Family Therapy Program, but in the end, she says, it made her a kinder, gentler nurse.

“Becoming a therapist really enriched my nursing. Now that I’m a mom as well, I get it on a whole other level,” Reynolds tells her students. “No one is here because they want to be here. So in the stress of these environments and their children’s cases and the not knowing, it often brings out the good, the bad and the ugly in the families we work with.”

It’s the nurse’s job to ask themselves the right questions to get to the bottom of any problems.

“Are (the parents) freaking out because no one took the time to explain to them what was happening?” she asks. “When you push parents to the side, you’re missing the people who know the children best.”

Benjamin Brenners ‘10 (MSN) is a nurse scheduler and coordinator in Hem/Onc who anticipates and balances staffing, but also crunches numbers to make sure quality can be measured and im-proved. His clinical background helps him fit the puzzle pieces — limited rooms, nurses and chemotherapy sessions that may vary from five minutes to eight hours — into a smoothly operating schedule.

He was surprised by his interest in hematology and oncology. “I fell in love right away. I think it was the amount of different things you could do and the variability in what your day could look like, the connection that you could have with the patients.”

And there was this: “I think everyone here seemed like an ace. That was a huge draw.”

Adaptability is key.

“Earlier, I was out there starting an IV for a patient that loves me to start his IV,” Brenners says. “Most of the day, I’mat my desk booking appointments and working on quality metrics and putting together a proposal for industrial engineers on patient volume. It just works for me. I enjoy seeing what the numbers show. I want to see if there’s a better way we can do it.”

Mark Abcede ‘08 is another numbers-driven USD alum at Children’s Hospital. As clinical research manager for cardiology and cardiovascular surgery, he works in a cramped office dominated by a wall of binders containing regulatory information for studies of procedures or devices to improve heart care. (The other notable feature of the office is a large shredder. As everywhere in the hospital, patient privacy is paramount.)

Wearing a crisp, dark blue checked shirt and glasses, Abcede is surrounded by bulletin boards bearing complicateddiagrams of the heart, doctor schedules, regulatory bulletins and the like. Behind him, on a whiteboard, he’s writtenproject statuses and “6 Simple Rules.” Those include: “Smile. It’s not so bad” and “Work harder than everyone else” and, of course, “We are dedicated to the health and well-being of the children in our community.”

“What I like about my job is it’s really rewarding, being able to help our patients each day, just because they’re so innocent.” Abcede says. “I also like that it’s multifaceted, so it’s never the same thing. You’re constantly adapting to various changes. You’re learning about all the newest treatments that are coming out, which is always exciting. We have devices that were nonexistent 10 years ago. It’s helping patients so much, decreasing the amount of stress that patients and their families have to go through because treatments are less invasive now.”

It’s easy to see how not only how these caregivers influence their charges, but also how they themselves are changed by the job. Nurse practitioner Lani Yeh-Nayre ‘07 (BA) is trying not to let that happen, but that doesn’t mean she always leaves her work at the hospital.

A pediatric oncology nurse has to be patient and empathetic, Yeh-Nayre says, while also “not completely losing yourself in the difficult parts of what we do.”

Nayre, who mostly sees patients with brain or spinal cord tumors, enjoys spending time with her own family to nurture her mental health.

“I’m able to keep an eye on what’s going on at work, but still able to separate that when I need to. I mean, don’t get me wrong, I definitely take it home with me plenty of times.” At this, she struggles,
her eyes becoming watery.

“There are times that it still affects you. But we all love what we do. For good or for bad, we get to be very close to our patients’ families. It’s great because when you see them succeed and get through their treatments, we celebrate with them. That part is very rewarding. On the other side of it, even when they don’t do well, of course that’s much more difficult to deal with. But I think for most of us, we look at trying to smooth the journey to soften the blow, as much as we can. Because we create a relationship with our families — oftentimes taking care of them for a year or more — I think we form a bond with our families, so we’re not strangers.”

For two years she worked as a nurse practitioner in primary care, while working in RCHSD on weekends. In 2009, they were looking for nurse practitioners in Hem/Onc. “It’s my dream job. I’m very, very lucky. These jobs are few and far between.”

For Ost, too, this career is very fulfilling.

“It made me realize that a simple life filled with friendships and relationships is the most important thing to me. My life is not based on material things.” She becomes quieter. “You realize that families here are just completely destroyed overnight when there’s a cancer diagnosis — for so many reasons, psychosocial and economic. Whatever we can do to relieve the suffering is really profound to me.”

It can be a struggle, with competing priorities and many administrative tasks to complete, Ost admits. “But I always try to remember that my nurses come first, and the patients come first, and everything else has to wait.”

They may be constantly switching gears. But the thing that’s always there, at the forefront, is working together to make life better for a child who’s very, very sick. — Kelly Knufken