Lillian Walsh, Class of 1969
“It’s been 45 years, and it seems like 5,” said Walsh in a recent interview with Oncology Nursing News. After graduating from nursing school in 1969, she launched her career as a dialysis nurse, a specialty she was drawn to because the prognosis for patients with kidney disease was grim, and dialysis was available only to a fortunate few.
Dialysis nursing became somewhat of a calling, and she went on to work in that setting for 20 years—most of them at her alma mater, Holy Name Hospital (now Medical Center) in Teaneck, New Jersey—and was later tapped to be nurse manager of the dialysis unit at Newark Beth Israel Medical Center, also in New Jersey.
Yet after several years in a managerial role marked by buyouts and practice consolidation, Walsh became increasingly frustrated with the role’s statistical focus and looked to make a change.
“I decided I’m taking off my high heels and my stockings and putting on my scrubs. I’m going to be a nurse again, like I had always wanted to be.”
After refreshing her clinical skills in dialysis units at New Jersey area hospitals, she sought out a new specialty but knew that it had to be one which would allow her to continue to care for patients on a more sustained basis, just as she had done when practicing in the dialysis setting.
“You’ll never find me in an OR, an ER, or someplace where patients come and go. I like the relationships I develop with people by caring for them over time. That’s the kind of nursing I like—the one-on-one getting to know people.”
With such an outlook, it’s not surprising Walsh chose oncology, and she now works as a chemotherapy and biotherapy infusion nurse with Regional Cancer Care Associates (RCCA) at their East Brunswick, New Jersey, infusion center, one of 26 RCCA facilities located throughout the state.
In this role, where her practice is not limited to anticancer therapies but also includes other infusion-based therapies, such as iron therapy and treatments for multiple sclerosis, she said, “Every day I feel blessed to be there, because I get much more from the patients than I give, spending time with the heroes sitting in the chairs in front of me.”
A New Landscape for Cancer CareIn the 9 years that Walsh has worked in oncology, she has been heartened by the great progress achieved through the discovery of new medications and drug combinations that are improving patient outcomes. She also has been struck by the huge increase in oral anticancer agents which pose new challenges for the oncology nurse.
“Thankfully,” she said, “most patients who have cancer are older,” but that also means they may be more likely to miss doses due to forgetfulness or not feeling well.
“We have more control when they come to us. When they’re out there on their own, it’s a little bit scary, but the convenience is there.”
When patients seek her advice about managing multiple medications at home, Walsh advocates relatively simple, yet sensible, strategies such as organizing them each week into a light-colored AM pill box in the kitchen and a darker-colored PM pill box on the nightstand.
The Caregiver ConnectionThe veteran nurse knows firsthand the complexities and challenges of caring for family members with acute or chronic disease, including her late husband who lived with chronic lymphocytic leukemia and heart disease for 10 years. She also cared for her mother, who had both Alzheimer’s and Parkinson’s disease, and her father, who had colon cancer.
“It doesn’t matter if you’re a nurse, and sometimes it’s even harder, because people expect you to know everything and do everything. Sometimes, as a nurse caregiver, you just want to be a caregiver, not be expected to know it all, and have others tell you what to do now and then.”
Walsh agrees with the growing realization among the oncology community of how important it is for the caregiver to serve as the patient’s advocate, but with this, comes the need to provide these family members with support. She said that she and her colleagues often look to the spouse of the patient as a gauge of how the patient is really faring, as the caregiver’s demeanor can provide real insight into the patient’s status.
For example, “When you ask a man how he is feeling, he is likely to say he is fine. Then you turn your head and look at his wife. You watch her eyes for facial cues, you see that she didn’t put any makeup on, she doesn’t look good either, and that tells you that things really aren’t going that well at home.”
Knowledge FirstDemographic trends pointing to growing numbers of older patients and survivors, along with therapies that allow many individuals to live much longer with the disease, means more patients will need cancer-related care, and practitioners will require the knowledge base to provide it. In fact, given these trends, experts agree that all nurses would benefit from some oncology training. When asked what advice she would give to someone new to oncology nursing practice, Walsh said that becoming well versed in the science is paramount.
“I would say what I said to myself. I know what kind of nurse I am (or for a new nurse, the kind of nurse he or she would like to be), but the focus really needs to be on the knowledge base, especially for those going into oncology. I had no knowledge base in oncology, even though I had a great nursing background and years and years of experience.”
“I had to build that knowledge base,” she continued.
“I made myself a binder for information from my chemotherapy and biotherapy course and other materials I downloaded. You need to really understand the disease processes of cancer, the drugs and their side effects, and what teaching you will have to give the patient.”
Feeling comfortable with the didactic aspects of cancer treatment means that, “When you approach the patient, which you already know how to do—or are learning how to do—at least you have the knowledge, and the patient doesn’t perceive you as someone who is stumbling.”
“Of course, it’s okay to say, ‘I’m not quite sure about that; I’ll have to ask the doctor,’” she stressed, “but you do it in a way that demonstrates you have confidence,” which will help to put the patient at ease.
“If you have your knowledge and your ducks in a row, you’ll able to approach that patient with compassion and knowledge, and you’ve got it made.”