Chemotherapy Nursing: Interview with Allison Hoekstra, RN

My Specialty

Chemotherapy Nursing: Interview with Allison Hoekstra, RN

Supporting cancer patients and their families during treatment

By Keith Carlson, RN, BSN
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Tell us a little about your nursing career.  
I began my nursing career working in dermatology, but the job became just that: a job that I didn’t love anymore. I tried numerous times to find a position in an acute care setting, but after being in outpatient dermatology for more than 10 years and not having any acute care experience since nursing school, it was more difficult than I had thought.

I had an interview with the director of telemetry at Anaheim Regional and told her that I needed someone to take a chance on me. She was willing to do that. The transition was difficult, but I knew that this was the right move for my career. Within six months of hire, I received certifications in chemotherapy, basic dysrhythmia interpretation and was ACLS certified. I have now worked in this area at Anaheim Regional for two years and I absolutely love it! Nursing is my passion and having a position that I love makes it so much more than just a job.  

What about your work feeds your spirit and keeps you coming back?

I believe that the main reason I absolutely love nursing is that it feeds my soul. I pray every morning for God to use me to make a difference and to help me nurse with love and understanding. What feeds my spirit is the gratitude of patients and their families, as well as knowing that I do the right thing for my patients — even if I sometimes have to rock the boat.

Statements like “I will never forget you” or the experience of a very frail Hispanic lady kissing my hand and saying, “God bless you, God bless you,” in Spanish are priceless. There is no greater feeling than knowing that I’ve changed the outcome of someone’s life and made a difference in the care they’ve received.

Can you share a story about your work that illustrates what you love about it?

I had a 46-year-old female patient who was very healthy, but had neglected a lump on her chest for over two years. Finally, when she was admitted to the hospital for respiratory distress, she was informed that it was stage IV breast cancer. She was hospitalized for over a month with a chest tube, receiving chemo and daily radiation therapy.

For the three days that she was my patient, she was having a hard time with losing her hair, since it was so long and beautiful. Her mother was flying in from back east to take care of her and the patient didn’t want her mom to be upset when she saw what she [the patient] looked like. I called my sister, who was a cosmetologist before becoming an ER nurse, and she came to the hospital to cut my patient’s hair. My patient just cried and cried that I would do something like that for her. I didn’t think of it as such a big deal, but she said she would never forget me.

How do you process the death and illness that you witness?
I find comfort in the human experience. Any nurse can give bedside care and perform the skills required of them, but I think it takes somebody special to nurse with love. I treat patients the way I would want my loved ones to be treated: I hold their hands, pat their faces, get down to their physical level and talk to them and hug their families. Knowing that my patient died with dignity and received the best possible care brings me great comfort.

Please share with us the challenges of your specialty.
I believe that the challenges we face in my specialty are common in many hospitals that have managed care. Sometimes, it seems that it’s not about what’s best for the patient, but what is best for the HMO. For example, I had a female patient who was diagnosed with stage IV small cell carcinoma lung cancer with metastasis to the adrenal gland. The prognosis was very poor and the patient was given three to six months to live. A hospitalist from a managed care group informed the patient that he had arranged a hospice evaluation and recommended that course of action. I encouraged the patient to speak with her primary physician and have an oncology consult before making an informed decision for herself.

Are there certifications or trainings that are recommended for this specialty?

I have to be certified every two years for chemotherapy administration and ACLS. Courses in telemetry nursing and dysrhythmia interpretation are also required.

Do you belong to any specialty organizations?
I belong to the Oncology Nursing Society (ONS). They keep me updated on changes, educational opportunities, timely articles and new patient care guidelines.  

What would you say to a nurse who might be interested in working in this area?
You deal with life-and-death situations in oncology and chemo, and families and patients need support around many decisions. The dynamics can be complicated. Some nurses aren’t comfortable dealing with death, and you have to have a certain attitude to deal with terminally ill and dying patients. You need to be a positive influence during such a challenging time.

Many nurses are scared of chemo: It’s like a black cloud and has a certain stigma. There are pre-medication guidelines to follow that are very specific and detailed, sometimes including titration. I find it very rewarding to work with these patients and treatments, even though I was also scared at first. It’s not for everyone.

You recently won an award. Can you tell us about it?
In Orange County, there is a huge nonprofit called Community SeniorServ. They help seniors to receive the care and services that are needed after hospitalization. I was nominated for their Senior Care Hero Award in the “Outstanding Nurse – Hospital” category and the board of directors chose me as the recipient. It’s a great honor.

What are your broader career plans?
I want to go back to school for my master’s degree. I love bedside nursing and see myself doing it for most of my nursing career. I may decide to change specialties one day, but right now, I’m happy right where I am. 

Keith Carlson, RN, BSN, has worked as a nurse since 1996 and maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.

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Chemotherapy Hair LossWHY CHEMO CAUSES HAIR LOSS
Chemotherapy works by targeting cells that divide rapidly — a property of cancer cells. Unfortunately, the cells in hair follicles also divide rapidly, causing them to be affected by the treatment. 

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"At the end of four rounds of chemotherapy, [the doctors] expected to see minor changes in the size of the tumors. What they found instead left them flabbergasted. .... The tumors had actually vanished. No one had ever seen such a response. The X-rays, thought to have been mixed up, were sent down for re-examination. The response was real: A metastic, solid cancer had vanished with chemotherapy."
 
— Siddhartha Mukherjee, author of The Emporer of All Maladies: A Biography of Cancer, describing early chemotherapy trials at the National Cancer Institute in Bethesda, Md., in 1956. 

This article is from workingnurse.com.

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