Learning in the Face of Adversity: Nurse Residency and COVID-19

September 04, 2020

Today’s new normal has changed everything at home, from what we wear to how we teach our children—and in the oncology nursing workplace, from new precautions to the rise of telehealth. It’s also affected nurse residency programs, but one institution has thrived as it adjusted.

Dana-Farber Cancer Institute’s (DFCI) infusion nurse and research nurse residency programs train newly licensed nurses (NLNs) for one year in oncology nursing specialty areas. To respond rapidly to manage the acute challenges of the unfolding pandemic, each resident was deployed to a new rotation within their respective residency programs. The NLNs shared the following stories about their residency experience during a pandemic. 

Outpatient Investigational Drug Shipping

By Rylee Keis, BSN, RN, and Nikita Patel, BSN, RN

As NLNs, we were unsure of our role in an evolving environment when we were redeployed to the investigational drug supply (IDS) shipping project that sent oral investigational medications to patients in clinical trials. The COVID-19 pandemic forced us to grow comfortable with discomfort, which was both a challenge and opportunity. We learned how the pharmacy is integrated with the disease groups and how each disease group had a different workflow. We became more self-reliant in identifying patients’ dosing needs and effectively educating our patients. When our research nurse mentor, Jennifer Hedglin, BSN, RN, took a day off, we ran the IDS workflow successfully and felt confident responding to study drug shipment queries. This experience left us more trusting of our preceptors, more assured in our teamwork, and excited for more experiences.

Multiple Myeloma Clinical Research Management

By Lauren Ritterband, BSN, RN, and Anna Barrell, BSN, RN

The 43 patients enrolled in the primary multiple myeloma maintenance trial we coordinated were quickly transitioned from monthly in-clinic visits to telehealth visits with the study drugs shipped to their homes. For weeks, each day brought new questions and concerns as patients and staff adjusted to the workflows and the answers were constantly evolving. Although we were overwhelmed by the prospect of managing patients independently for the first time, the care coordination and telephone triage skills we developed significantly improved our nursing confidence. 

As patients shared fears about living with cancer during a pandemic, we reassured them that their team was constantly evaluating how to provide the best care for them. During telehealth calls, we assessed their physical condition, encouraged self-care, and provided emotional support. With more independent and flexible scheduling, we had more time to learn our patients’ passions, fears, and hopes, fostering our own self-growth, situational awareness, and advocacy skills.

Patient Screening Center

By Cindy Quijada, BSN, RN, and Keysha Miralda, BSN, RN

We were responsible for educating and enforcing frequently changing DFCI policies regarding limiting visitors and personal protective equipment for patients entering the facility. The COVID-19 screening processes and procedures evolved as the symptom questions became more specific and DFCI developed and implemented screening software. The rapid changes made our patients frustrated, stressed, and unable to manage their emotions. Over time, we developed skills to better manage varying emotions and learned to incorporate real-time de-escalation techniques. Our patients were reacting with fear, which was a rational response for a population at higher risk from COVID-19 infection. When the mind is panicked, higher executive functions like logical reasoning are out of reach. We recognized misplaced anger and met emotional patients from a place of empathy with techniques like active listening, validation, and empowerment.

Resiliency Beyond a Pandemic

Resiliency is the ability to cope despite facing substantial adversity. When feeling stressed, we intentionally grounded ourselves and regrouped so we could provide the best care for our patients. We incorporated several self-care methods, including moral support, reframing maladaptive thoughts, exercise, self-reflection, and prayer.

Often, our colleagues would ask how we felt about our redeployments. Although we missed our original roles, we realized that our feelings were rooted in needing to let go of the expectations we had for our first year of nursing. Acknowledging that was the first hurdle in moving forward. We recognized our growth and focused on our blessings, including unexpected learning opportunities, stable nursing jobs, and the support of a professional residency program.

Finding your voice as an NLN is difficult. It requires fighting self-doubt that comes so naturally at this stage of our careers. But when placed at the frontlines during a global pandemic, finding your voice and maintaining a sense of resiliency is vital.

The nursing role requires ongoing patient education, flexibility, and compassionate care in a world where health care is evolving rapidly. Amid the pandemic, we are reminded that we cannot control everything, but we can commit to our oath and mission as nurses to care for each other and our society by instilling positivity, encouraging others, and leading transformation in the ways we promote health and well-being.

The authors acknowledge with gratitude the DFCI Department of Nursing and Patient Care Services and the University of Massachusetts/Boston College of Nursing and Health Sciences for providing them with this learning opportunity at the start of their nursing careers.

Copyright © 2020 by the Oncology Nursing Society. User has permission to print one copy for personal or unit-based educational use. Contact pubpermissions@ons.org for quantity reprints or permission to adapt, excerpt, post online, or reuse ONS Voice content for any other purpose.