About Julianna Paradisi, RN, OCN

Julianna Paradisi, RN, OCN, finds inspiration where science, humanity, and art converge, creating compelling images as both a writer and a painter. She is the author of https://jparadisirn.com/, and also blogs frequently for http://www.theonc.org/ and https://ajnoffthecharts.com/, the blog of the American Journal of Nursing (AJN).

The Afterlife of Trauma, Near and Far

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog.

Mixed media illustration by Julianna Paradisi Mixed media illustration by Julianna Paradisi

The alarm clock rang noisily. I wasn’t ready to surrender the cozy cocoon of my bed and venture into the emotional turbulence of this particular day: The 14th anniversary of 9/11.

The week leading up to it was rough. My stepfather had quadruple coronary bypass surgery in another city. Although it was successful, and his children were there to help and support my mother, I’ve felt guilty for not being there myself, because I’m the nurse in the family, and I feel responsible for every medical problem that arises for the ones I love—even if I’m not really needed.

Besides this, at work we’re in one of those cycles where every patient gets bad news: The cancer has invaded the borders of another organ, or the patient is incredibly young for the diagnosis that’s been received. Six months into my career as an oncology nurse navigator, I realize the emotional toll from secondary trauma is often more related to a previous job as a pediatric intensive care nurse than that of my more recent position as an oncology infusion nurse.

Because of all this, I decided to minimize my media exposure to the trauma of 9/11 this year. I stayed off of Facebook, and instead of watching the morning news I listened to Lyle Lovett croon the delightfully […]

2016-11-21T13:01:58-05:00September 28th, 2015|career, narratives, Nursing, nursing perspective, Patients|2 Comments
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Measuring a Nurse’s Career Through BLS

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog.

ParadisiBLSCertificationCardI was a child when I first heard the term CPR. My father, a volunteer fire captain in our community, had newly certified that day at drill. From the head of our dinner table he proclaimed, “It’s a terrible thing to have to do, but everyone should know how.”

He was right.

It feels as though I’ve known basic life support (BLS; sometimes still referred to as CPR) all my life, but I believe I was 16 years old when I first took a provider course, long before I knew I’d become a nurse.

Since then, as a former pediatric intensive care nurse, I have performed a lot of CPR, and a related professional compliment received during a pediatric resuscitation rests bittersweetly in my heart.

It was one of those codes that begins in the ED, and transfers into the PICU because survival is unlikely. The cause was cardiac. As I did compressions, and my colleague, a respiratory therapist, hand-ventilated the child, blood gases were drawn. The attending cardiologist looked over the results, and told us, “It’s too bad a perfect blood gas isn’t enough to save a life. The two of you are performing superb CPR.”

He was right. It wasn’t enough.

That was nearly 20 years ago. Basic life support recertification is required every two years. Now […]

2016-11-21T13:02:08-05:00August 19th, 2015|career, Nursing, nursing perspective|1 Comment
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An Oncology Nurse’s Heart: Helping Dying Patients Find Their Own Paths Home

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog.

Heart Break = Heartache graphite, charcoal, water color, adhesive strip by julianna paradisi Heart Break = Heartache
graphite, charcoal, watercolor, adhesive strip, by julianna paradisi

The disadvantage of building a nursing career in oncology is that a fair number of patients die. Despite great advances in treatment, not every patient can be saved. Oncology care providers struggle to balance maintaining hope with telling patients the truth.

Sometimes, telling the truth causes anger, and patients criticize providers for “giving up on me.” In a health care climate that measures a provider’s performance in positive customer satisfaction surveys, paradoxes abound for those working in oncology.

Providers may also be criticized for delivering care that is futile. “Don’t chemo a patient to death” and “A cancer patient should not die in an ICU” are common mantras of merit.

Maybe because I live in Oregon, a state with a Death with Dignity law, or maybe it’s the pioneer spirit of Oregonians, but I don’t meet a lot of patients choosing futile care to prolong the inevitable. In fact, many patients I meet dictate how much treatment they will accept. They grieve when they learn they have incurable cancer, and most choose palliative treatment […]

2016-11-21T13:02:13-05:00July 24th, 2015|career, Nursing, nursing perspective, patient engagement, Patients|3 Comments
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Soul-Satisfied, but Heartbroken: The ‘Soft’ Skills of Oncology Nurse Navigators

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration below is part of a series on mountains as barriers that she is working on.

Untitled oil stick & charcoal on paper by Julianna Paradisi Untitled oil stick & charcoal on paper by Julianna Paradisi

When I introduce myself to nurses as an oncology nurse navigator, they often respond, “Oh, that’s great,” staring blankly. Sometimes, in the midst of patient care, they say, “Yeah, that’s great, but I’m really busy. Come back later.”

Nurses caring for patients are really busy—so busy that this is one of the reasons the relatively new specialty of nurse navigators exists. Another reason is that oncology care is increasingly complex, and mostly occurs in the outpatient setting where vulnerable patients must fend for themselves.

Patient navigation was founded in 1990 by Harold P. Freeman at Harlem Hospital Center to improve outcomes for poverty-stricken African-American women presenting with stage III and IV breast cancer. Freeman declared, “The core function of patient navigation is the elimination of barriers to timely care across all segments of the healthcare continuum.”

In 2010, the Affordable Care Act (ACA) mandated patient navigation for oncology by 2015. No […]

2016-11-21T13:02:21-05:00June 22nd, 2015|career, Nursing, nursing perspective, Patients|0 Comments
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The Borders of Loss: An Early First in One Nurse’s Career

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration below is hers.

Peds Ward (2008), charcoal, graphite, flash, and acrylic. By Julianna Paradisi Peds Ward (2008)/charcoal, graphite, flash, and acrylic/by Julianna Paradisi

Working in oncology, the topic of whether it’s crossing a boundary for nurses to attend the funeral of their patients comes up. Sometimes, however, we’re carried across that boundary by our heartstrings. The first patient funeral I attended was that of my first patient.

During Jack’s short life, he was the first assignment of many a new nurse on the pediatric unit where I was hired as a newly graduated nurse. He had lived in the hospital his entire life.

Jack was nearly ten months old when we met. Born with a congenital illness requiring multiple surgeries, he failed to thrive. A nasogastric tube snaked through his nose into his stomach so he could conserve the calories burned eating from a bottle or spoon. As Jack’s nurse, I mastered the skill of nasogastric tube feedings.

Most parents bond with their chronically ill babies, but it takes a big commitment on their part. Babies like Jack do not look like the pictures of healthy babies in magazines. They are cloistered in an isolette and connected […]

2016-11-21T13:02:33-05:00May 8th, 2015|career, narratives, Nursing, nursing perspective, Patients|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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