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Meet Nicole Kay, an Oncology & Breast Care Nurse, Preceptor and Academic Assistant. Nicole tackles some tough questions in this article and gives great advice to nurses who read on. From a typical day and insight into the role, to dealing with challenging conversations to the psychosocial aspects of nursing and much more.
Introduction
I’m a registered nurse and specialist breast care nurse working in a regional private oncology day unit in Queensland. I live in South East Queensland with my husband Adam, my 9 year old son and our two dogs. In my spare time I make resin jewellery as a creative outlet which keeps me fairly busy.
In a previous life I worked as a childcare educator. I’ve always been drawn to caring roles. I’m surrounded by healthcare workers. My Grandmother was a nurse, my aunt was a nurse, my cousins are carers and nurses, my Dad is even a theatre orderly in the same hospital that I work in. I wanted to be a Nurse like my Grandmother, but when I was applying to uni, my boyfriend’s mother (my now mother in law, who is also a Nurse), was working shift work and I was 18 years old and I thought shift work would seriously hinder my social life haha.
I applied for science instead and finished a Biological Science degree. I loved the science, but that caring was missing. When I finished, a little older and wiser, I realised that I was still really drawn to Nursing and so I applied for Nursing at USQ and started a new degree 6 months later!
What inspired you to work in oncology nursing?
My interest in oncology was first sparked when my Grandmother was diagnosed with cancer and undergoing treatment. A few years later while I was studying Nursing part time, my (now) husband was diagnosed with testicular cancer at age 24. He had surgery and 3 months later at a review with the oncologist, he was diagnosed with metastases in the lungs. We were engaged and had our wedding in-between his second and third cycles of chemotherapy.
Supporting my husband through his diagnosis and treatment, watching the Nurses and oncology team care for him cemented that this is what I wanted to do. If I could help people through this, the way the oncology nurses helped us, it would be worth it.Â
What is oncology nursing?
Oncology nursing is a specialised area, you have to develop not only specialised clinical knowledge but great counselling and psychosocial support skills as well. Developing a good set of skills in active listening and counselling of patients is very desirable in an oncology nurse.
Specialist courses, training and competencies are required to handle and administer cytotoxic medications and need to be updated annually.
Some of the additional competencies I have had to obtain and be reassessed for annually include intravenous cannulation and CVAD management. CVADs are central venous access devices and are used to administer treatments to patients on harsh or long term therapies or when peripheral access is not possible. Careful management of CVADs is needed to ensure no infection is introduced as it can cause sepsis and have serious consequences for the patient.
Infection and sepsis in an oncology patient is an oncological emergency.
Neutropenic sepsis is an emergency that oncology nurses need to know how to assess for and handle it. Patient assessment in general, prior to or after treatment and in the case of an emergency are specialised skills that are developed over time. There are of course guidelines and grading charts to guide you when you first start out in oncology.
Potential sepsis, drug reaction and cytokine storm are the most common emergencies to be knowledgeable of and be prepared for. Our outpatient unit is within a hospital and the management of emergencies is backed by not only the oncologists but the MET call team which means we have great management and recovery from oncological emergencies.
What is a Specialist Breast Care Nurse?
The role of the specialist breast care nurse is to support and coordinate the care of women and men who receive a breast cancer diagnosis from biopsy results through to post-acute treatment and survivorship care.
My days in Breast Care involve organising and attending Multidisciplinary Team Meetings, supporting patients pre-operatively, providing education and guidance, regular contact for support is important throughout a patients treatment so each day includes contact with patients in the ward having treatment or making phone calls and sending emails in between and after treatments. Post-op we provide special post-op bras for the recovery period and fitting these bras before discharge is part of my role. Making referrals to appropriate supportive services, psychosocial agencies and allied health is a large part of the role also.
It is a very supportive and holistic role which is the main reason I love it l. It involves all of the care which you want to give your patients when you are often too time-poor in a busy ward environment.
Over the past 7 and a half years working in Oncology and Breast Care I have become passionate about holistic psychosocial Nursing and caring for the mental health of our oncology patients.
What kind of training do you need to work in these fields?
A Registered Nurse can work in an oncology ward, but depending on state or organisation policy, extra study or competencies are needed to administer chemotherapy and other anti-cancer treatments. This could be a short CPD course, a graduate certificate or a specialised Antineoplastic Drug Administration Course (ADAC).
To be a Breast care nurse you usually have to complete a post-graduate certificate in breast cancer care.
I have completed the ADAC course and have a graduate certificate in breast cancer nursing from the Australian College of Nursing.
Who are the main types of patients you see and what is your involvement in their care?
In our outpatient unit we treat adult (and occasionally older teen) oncology and haematology patients. I work in a regional area and many patients travel from rural areas to have treatment. The most common cancers we treat are colorectal, breast, prostate, melanoma, and blood cancers such as leukaemias, lymphomas and myelomas.
We treat a variety of other solid tumours, cancers and non-malignant blood disorders. We also treat patients with a range of rheumatoid and autoimmune conditions, including multiple sclerosis, through admitting rheumatologists and neurologists as there is often some cross-over of indications with anti-cancer therapies and these conditions.
What are some of the psychosocial issues that arise with your patients?
For oncology patients, having cancer isn’t just a physical disease. The word ‘Cancer’ brings with it certain connotations and baggage. Many patients can develop depression or anxiety as a result of their diagnosis or treatment, even survivorship issues are prevalent with a fear of disease recurrence and survivors guilt being common. For advanced cancer patients, coming to terms with death and fear of death is a major concern.
There can be challenges with physical changes as a result of treatments causing body image concerns, fertility changes and performance endurance in ADL’s and work life being affected. Patients can also have difficulties with role changes in their life, when children have to care for parents, parents with very young children unable to care for them as before, no longer being able to work, be the breadwinner, a successful career person.
Financially, cancer can cause great distress to patients and they may need assistance navigating financial assistance.
There are also cognitive changes with some therapies that cause brain fog & impair concentration and sleep which can be frustrating for patients.
Even though I work in a clinical role in a clinical area, there is so much psychosocial care that is required and as an oncology nurse you learn how to integrate this into your usual clinical care.Â
Communication and difficult conversations
My advice is to get comfortable with death. We as a society do not do death well and we could do better.
Death is a part of life. Learn about palliative care, palliative does not mean dying, it means living as well as possible for as long as possible.
Talking to your patient about terminal illness, palliative care and death can be really difficult but it can also be kind and caring. Listen to your patient and their needs and their fears. Sometimes as a nurse you can make a huge impact on how your patient views their illness and dying.
Advocating for your patient is important also. Sometimes the difficult conversations are not with the patients but with their family members or even another health care professional. A patient may have been having treatment for a long time, have advanced disease, are palliative and want to stop all treatment but other people in the patients life want them to keep going. Advocating for your patient by gently explaining the reality of the situation and the patient’s needs can help everyone to accept the outcome and allow the patient to have some control and peace over their end of life.
What do you love about being an oncology & breast care nurse?
It is extremely rewarding to help people through one of the toughest times in their lives. Helping save a persons life or when that can’t happen, helping someone to have a good life, feeling as well as possible for as long as possible. Helping someone have more time with their family. These things are all incredibly rewarding and it is a privilege to be able to do this.
Most people think working in oncology is depressing. It can be tough at times. But it can be beautiful too. I get to see incredible human strength and spirit and love. Every day.Â
What other areas can oncology nurses work?
Oncology nurses can work in an inpatient oncology ward, outpatient oncology units, outpatient infusion units, in palliative care wards, as a clinical palliative care nurse, prostate care nurse, breast care nurse, cancer care coordination, case management, academia, clinical trials, private oncologists rooms in practice management, haematology wards, radiation therapy units, or in the community. There are so many areas that oncology nurses can branch into.
Why should nurses consider oncology nursing as a career option?
It can be a humbling and beautiful area to work in. Every day at work, I am reminded of how precious life is.
Oncology also has increasingly expanded treatment options. Through fundraising and research, especially in the field of immunotherapies, new treatments are always introduced. It never gets boring, there is always something new to learn.
What advice would you give your younger nurse self?
More general nursing advice than oncology-specific, but LOOK AFTER YOUR BACK! Two back surgeries later and I have realised how very important core strength is in nursing.
What is one thing you’d wish you’d known before starting in this field?
I wish I had a good debriefing and self care practice down pat before working in oncology. It can be difficult to cope with the sad days when you don’t learn to debrief with your team and manage your own self care. Debriefing is a great tool to use in any area of nursing.
What’s next for your career?
I am currently studying clinical education and working casually in academia. I love teaching the students who come through the unit about oncology and introducing them to oncology as a great career option. I have now stepped back from my breast care role at the hospital and am continuing to use those skills in the oncology unit whilst I’m studying.
I am planning to do my Masters in Nursing next, with a focus on health psychology and psychosocial care in oncology.
Resources: Cancer Nurses Society of Australia (CNSA)
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