I believe the HOCU nursing team - as a whole - is deserving of recognition for their consistently heroic everyday teamwork.  

Working previously as a 4E bedside RN for 11 years and now serving as the HOCU Professional Practice Specialist for the past four years, I have intimate knowledge of what it takes to be a nurse on this unit. Our nurses work on a unit filled with stories of both survival victories as well as profound loss. Our nurses care for kids at so many points along their journeys and help these patients and their families navigate the ups and downs of their illnesses. It takes a special team to work together to not only accomplish the level of nursing care that is provided on this unit but to support one another through the waves of success and downturns that occur on 4E.  

The 4E nursing team helps guide patients through all stages of our patients’ disease trajectories. We watch some patients thrive and survive while we watch others decline, face life-threatening conditions, and sadly in some cases, we care for them at the end of life. It takes an incredible amount of emotional and professional strength to care for patients through that rollercoaster.  

Nurses and Patient Care Technicians (PCTs) work together as a team to give a final bath for a patient, nurses walk together to support one another in taking a patient to the morgue, and then return to the unit and work out a way to cover for one another to give each other time to collect themselves enough to care for the other kids that need their attention. In the wake of such a loss, it takes tremendous fortitude to maintain professionalism and boundaries, and then turn around on a dime and put on a good face for other patients and families. We can only do this with the teamwork and support from our colleagues who are the only ones who understand what this entails.

The nursing profession goes far beyond nurturing the emotional needs of our patients and families. Working on this unit requires specialized technical knowledge as well as advanced critical thinking to provide the care required for our patients. We are responsible for complex tasks including transfusions, chemotherapy, and biotherapy infusions, furosemide drips, complicated pain regimens including PCAs and opioid-tolerant doses of narcotics, study drug administration, stem cell infusions, advanced wound care, novel T cell therapy … to name just a small fraction – alongside the complicated assessment and monitoring of these patients.  
 
To get all this work done, 4E nurses work together throughout a shift, witnessing for pump rate checks and opioid dosing, providing double-checks for chemotherapy roadmap reviews, and tending to someone’s patient while the nurse is in another room monitoring his/her other patient’s platelet transfusion, helping each other with port accesses, covering patients for a nurse involved in a rapid response or transfer to the ICU. On any given shift, the group chat on the Zebra phones is persistently buzzing with communication on these needs.  

To help illustrate the above-and-beyond role that our nursing team takes, I share the story of an 8-year-old boy with refractory AML who enrolled in an investigational study drug protocol at Children’s National Hospital last year. To care for this patient, our nurses had to learn about a complex investigational dual affinity re-targeting antibody agent and its Mechanism Of Action and side effects. Nursing responsibilities involved the administration of this 28-day continuous (with daily syringe change) infusion with nanograms/mL dose-escalation, pre-medications, emergency medications as well as specialized monitoring for weight increases, capillary leak, cytokine release syndrome, and infusion reactions.     

Unfortunately, the patient’s disease persisted despite the study drug intervention; he was discharged to home with limited treatment options. Per his request, we threw him a hallway “discharge party”, a celebration given to patients departing from their final chemotherapy treatment or BMT discharge. While a group of staff lined the hallways with pompoms and noisemakers and clapped for him as he walked down the hall, his bedside nurse discretely swooped back into the patient’s room and comforted his mom who could not hold back tears of sadness as she knew the likely outcome for her son whose disease was refractory to all treatment efforts. The patient proceeded down the hall, gleefully soaking up the celebration, protected from the sadness behind him as he walked out with a wide smile.       

To help make his days brighter during his admission, our nursing team regularly fulfilled the patient’s love for receiving mail in the mailboxes that are installed outside of every patient door on the unit. As a result of his experience, the patient shared his interest to become a nurse when he grew up. At his funeral, his family prominently displayed an impressive volume of the artwork and notes our 4E team had placed in the treasured mailbox outside of his door.

On a more positive note, I also share a recent story of our nursing team’s leadership in celebrating the academic achievement of one of our patients. Led by HOCU nurses Morgan Wainwright and Brianna Nolan, a group of nurses collaborated with Social Work, Child Life, and Pet Therapy teams to hold a high school graduation for a 19-year-old patient with Acute Myeloid Leukemia (AML). This patient was diagnosed with AML around the same time as her father had a bone marrow transplant for Multiple Myeloma. Given her prolonged inpatient stays and immunocompromised state, this young woman was unable to attend her high school graduation ceremony.  Recognizing the hardships placed on this patient and her family, our fantastic team planned a ceremony in the Healing Garden and helped coordinate the surprise attendance of her brother who was in residence at his college. Despite a very busy shift, several of our staff, as well as some of her physician and nurse practitioner team members, came together with her family to watch her walk through her Healing Garden ceremony in her cap and gown.  

These represent just two of the countless stories that unfold on 4E every day. These stories only scratch the surface of what takes place here. We all play different roles to help make the shifts go more smoothly for the patients. As I write this nomination a group of staff are singing happy birthday to a neuroblastoma patient while the bedside nurse is conferring with the provider team on whether we will re-start a high-risk immunotherapy infusion that the patient has reacted to in the two previous days and required a Rapid Response Team assessment. I could write a book full of these stories of how the 4E nursing team is consistently juggling many roles and all pitching in to help, all going above and beyond. The expression "blood, sweat, and tears" would not be an exaggerated description of the work that goes on here.  

Nonetheless, it is our entire interdisciplinary team of nurse leaders, bedside nurses, PCTs, Unit Communication Associates, Unit Support Associates, Providers, Pharmacists, Social Workers, Case Managers, Child Life, Dieticians, and Environmental Service who play an integral part in making a difference in the lives of our patients and families.