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 […]

Unbalanced: The Art of Changing Nursing Roles

Bull and Monkey/ graphite, charcoal, acrylic on vellum/by julianna paradisi Bull and Monkey/graphite, charcoal, acrylic on vellum/by julianna paradisi

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

The culture shock experienced by new nurses making the transition from student to professional is well documented. Less well documented is the culture shock seasoned nurses face when changing jobs. Not all nurses are the same. Neither are all nursing jobs.

Working in an unfamiliar setting means being the new guy. You may have been in the top 10 of your nursing class for grades and clinical excellence. Or you may have held a position of leadership in your previous unit. In your new job, you are unknown and unproven.

For nurses changing jobs from high-acuity areas—ICU or bone marrow transplant, say—to an ambulatory clinic, the stress is twofold.

First, there’s a period of grieving the loss of hard-won skills and certifications that are not applicable in the new role.

Then there’s the shock that your skills and experiences did not prepare you for the outpatient setting. Often, the first realization is that high-acuity patients have central lines, so a nurse migrating from such a practice area may not have strong […]

Life Drawing

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

by julianna paradisi - all rights reserved by julianna paradisi – all rights reserved

With one double-gloved hand I pull the unblemished skin of her buttock laterally. Holding a syringe in the other, I pierce the large muscle with a needle, injecting acid-yellow methotrexate deep inside. Its purpose is to deplete the tiny, nonviable embryo inside her of folic acid, preventing its growth, a rupture, and potential harm to the woman.

Usually I administer chemotherapy to stop the life cycle of tumors, not the rapidly dividing cells of an embryo that missed its mark, mistakenly lodged in a fallopian tube instead of finding its way into her uterus where both of them could have been safe. Ectopic, it sacrificed viability, and threatens the life of its host.

Prone on the stretcher after the twin injections, she cries quietly. I hand her a box of tissues. She blows her nose. I try to think of something comforting to say, something that lets her know this is sad for me too. Resources are limited, so the powers that be decided that the safety provided by a chemotherapy-certified nurse outweighs the education, skill, and emotional support provided by an obstetrics nurse. Most likely they’re right, […]

NPR Syndrome

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

calligraphy, 36" x 24," mixed media on vellum, 2007,  by julianna paradisi calligraphy, 36″ x 24,” mixed media on vellum, 2007, by julianna paradisi

Compassion fatigue is a syndrome commonly known to nurses and other professionals involved in patient care. It is the result of constant exposure to traumatic events occurring to others. Its effects on the psyche of nurses are widely studied, recognized as a factor in burnout and self-medication, and sometimes result in nurses leaving the profession.

My clinical practicum as a nursing student, nearly 30 years ago, was in oncology. There I saw patients succumb to cancer. Many were young adults. One left behind a grieving husband, and an infant. It was heartbreaking. I asked my preceptor, a skilled, compassionate, and uncannily jolly nurse, how did she avoid burnout? I did not know about compassion fatigue yet.

She wisely replied, “You need to develop a happy, fulfilling personal life outside of nursing. You have to shut it off when you leave the hospital.” It was good advice.

I took it to heart, and over the years developed a happy, fulfilling personal life. However, turning it off when leaving the […]

Birdcages: An Oncology Nurse on Crucial Information Patients Need About Dying

Julianna Paradisi, who blogs at JParadisi RN and elsewhere, works as an infusion nurse in outpatient oncology. Her art has appeared several times in AJN, and her essay, “The Wisdom of Nursery Rhymes,” was published in the February 2011 issue.

I grew up in a family in which occasional conversations about death occurred at the dinner table. My father openly discussed his own. As a child, this terrified me, but he would say, “It’s a terrible subject, but everyone dies someday.”

by Julianna Paradisi by Julianna Paradisi

I don’t remember how old I was when my father made me promise he’d be cremated and his ashes spread over the ocean upon his death. It feels like I always knew, and this knowledge comforted me when, a few years ago, my siblings and I spread his ashes from a boat over the Pacific Ocean where he used to fish.

Paradoxically, in other contexts my father struggled when it came to telling me about death. Starting when I was around three years old, in the springtime, he would sometimes bring home baby birds that fallen from their nests. He kept an old birdcage for this purpose. He let me name the birds, and I called each of them Jimmy. He taught me to mix small pieces of bread with watered-down milk, and then feed it bit by bit into their disproportionately large mouths with an eyedropper.

This ritual usually lasted two days. On the third morning, […]

2018-03-28T10:34:25-04:00April 10th, 2013|nursing perspective|6 Comments
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