Sunday, June 6, 2010

Sunday's Specialty - Pediatric Hematology/Oncology Nursing

This week’s specialty comes to us from Nurse Teeny over at The Makings of a Nurse. She is technically not working as a Pediatric Hematology/Oncology Nurse (yet) but if you read through her blog you can see how much passion she has for this particular specialty. This passion is exactly why I asked her to share with us on this, and I am so glad she did! After you finish reading about this specialty, head on over to her blog to check her out!

Pediatric Hematology/Oncology Nursing

I may have no business writing this post, seeing as how I was in Peds Hem/Onc for a total of 168 a capstone nursing student...

But oh how I loved it! And now that I am a working RN in Critical Care, oh how I miss it!

And I will be back. :-)

Pediatric hematology/oncology nursing is working with kiddos who have blood disorders and cancer. It can be on an inpatient or outpatient basis. Your patients will range in age from infant to young adult (if they were diagnosed as kids, they'll often be followed by their pediatric doc into young adulthood for consistency). You will see a lot of hair loss, a lot of skin issues, a lot of nausea and vomiting. You will become an expert at central line management, blood and platelet transfusions, bone marrow transplants, and nutrition management. You will become allies with parents and family members, many of whom will become like extra staff members on the floor. They will have tips for getting that medication down the hatch (and will often be comfortable giving it themselves), they will know when their child is having a medication reaction before any symptoms appear and they will know normal lab values better than you in a matter of weeks (what's normal for these kids is NOT normal for the rest of the world).

If this is a specialty you are considering, I would highly recommend trying to get some exposure to it in nursing school to 1) Make sure it's for you and 2) Get it on your resume. It IS possible to get a job in peds hem/onc as a new grad but probably only if you do your senior capstone rotation in this area (or at least in either pediatrics or oncology). In the current job market, however, the pickings are slim. You will likely have to start somewhere else, then move over once you have your "1-2 years of acute care experience" (I really grew to hate that phrase).

Once you have worked in inpatient hem/onc, you can also move into outpatient care. Most hospital cancer centers have clinics where kiddos can come and get chemo or transfusions on an outpatient basis. They'll also need periodic checkups. In addition, since a lot of kids are immunosuppressed, usually doctors arrange for them to be admitted as inpatients through the clinic rather than the hospital ER if they have a fever or aren't feeling well.

The beautiful and poignant thing about peds hem/onc is that you get to witness just how resilient kids really are. I had patients in the middle of chemo who were riding their tricycles down the hallways and doing art projects in the craft room. They may feel like crap, but they'll be damned if that's going to keep them from going to the school room and making a potato battery. Even the ones who were dying wanted to "just be kids" for as long as they could. When one of my patients found out I'd be graduating in about two months, she told me she'd come back to the floor and bring me a graduation present. I was pretty sure that she wasn't going to make it to my graduation day but the fact that she was thinking of someone else in that moment was touching.

When I talk about the kind of nurse I want to be, many people scrunch up their noses and purse their lips and ask the age-old question: "Why?" Why would you want to work with sick kids? Why watch kids suffer and die? Isn't it draining?

No, it's not draining. It's sad on some days. It's fun on others. We have birthday parties and cupcakes and we wear silly hats and costumes. We celebrate the victories and cry when we lose a friend. We listen when the parents need to vent, and hold babies when mom needs to take a shower or get off the floor to grab a cup of a coffee and some fresh air. We acknowledge that it's just not right that anyone should be going through what these little ones go through.

But they go through it anyway, right or not. And we're there for them through it all. And I love it.

And yes, I will most definitely be back. :-)

For more information about peds hem/onc nursing, here are some helpful sites:
Association of Pediatric Hematology/Oncology Nurses (APHON) (
Certified Pediatric Hematology Oncology Nurse Exam Information (

Thanks again Nurse Teeny, for sharing your passion for this specialty with us! I wish you luck and hope that you find yourself doing what you really want to do soon!


  1. Hats off to you, Nurse Teeny! It is the only area I couldn't work. :(
    Just reading a friend's journal on the heartbreaking road they have travelled with their daughter who is going through what you describe is enough to make me cry:

  2. I love what's you doing here! I have a deep interest in neuroscience and have been looking forward to working with neuro patients once I start nursing school in August, but I love hearing the discussions of various specialties. I know there will be so much to experience in NS and like the heads-up from these posts. :)

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