Pediatric Oncology CNS: Interview with Kimberly Johns, RN, MSN, PCNS-BC

My Specialty

Pediatric Oncology CNS: Interview with Kimberly Johns, RN, MSN, PCNS-BC

Educating and consulting with nurses on evidence-based care

By Keith Carlson, RN, BSN, CPC, NC-BC
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Tell us about your career trajectory.

I graduated from nursing school in 2003. I was fortunate to be directly hired into an RN residency program in pediatric hematology oncology. At first, I was nervous about going directly into a specialty as a new grad because I didn’t want to be professionally pigeonholed. In the end, I decided that I loved this patient population. So, I took the opportunity and I’ve happily been here ever since.

After my residency, I worked on the floor as a staff nurse for four years and then transitioned to being the nurse educator for the floor. I was simultaneously earning my MSN; I completed that phase of my education in 2011. It was then that I stepped into the role of clinical nurse specialist. This type of career transition isn’t necessarily that common, but it’s great to have served in so many roles within a department I know so well.

Can you tell us about the CNS role from your perspective?

The scope of the CNS role truly depends on the needs and structure of the unit or facility. There are some clinical nurse specialists who round with the medical and surgical teams as part of their daily practice. My role really boils down to being an expert consultant for patient outcomes. I don’t do direct patient care per se, but when we have complex clinical situations, I sometimes serve as a consultant in order to figure out how to approach a specific dilemma.

I work closely with the bedside nurses in my specialty, taking their suggestions, hearing their feedback and observations and collecting data on challenges they face. We then develop solutions that are either evidence-based or based on best practices that have been shared by similar facilities. If we can’t find literature to support practices that we’d like to consider adopting, we look at what other units or hospitals are doing and try to determine if there’s any consensus or expert opinion on the particular issue we’re exploring.

We adapt these practices for optimal effectiveness on our unit. There’s a great deal of collaboration across institutions, which has helped us as we work to improve care. Loma Linda University Children’s Hospital has great connections with other institutions and there are national and local conferences where we can learn and expand our knowledge. We frequently have opportunities to ask questions and get feedback from others in our specialty area.

Does a CNS do a lot of teaching?

In my clinical practice, I provide a lot of education. The CNS is a type of leadership role: I work closely with the leadership team on planning for departmental changes while focusing on what will help us to improve the patient experience and outcomes. Nurses are an integral part of that process. The leadership team consists of charge nurses, nurse managers, the nurse director, the nurse educator and the patient educator. I’m fortunate to be part of a strong leadership team. Through our collaboration, we’re able to support the unit more effectively.

Do you interact with physicians and surgeons?

I spend more time directly interacting with the nursing staff, but I’ll work on larger collaborative processes and hospital-wide issues with physicians. I may collaborate on direct patient care, but that is strictly on a case-by-case basis.

Can you talk about the emotional aspects of caring for sick children?

The reality is that it’s sad to see sick children. There are times that are really hard for a nurse. However, there’s also so much joy in my specialty. We have kids whom we’ve followed since they were little. We’ve had the privilege of watching them grow up. These children are normal kids in an abnormal situation. Being witness to their lives and their strength is an amazing experience. I feel inspired seeing the fortitude of the kids we work with. Kids who deal with chronic or life-threatening diagnoses have an inner strength that’s incredible to see in people who are so young. It’s an honor to work with them and see their spirit and courage on a daily basis.

How do you support the floor nurses emotionally?

One of the things that’s great about our team is that we support each other emotionally and spiritually through the difficult times. As a nurse, no one but another nurse will understand what it’s like to lose a beloved patient. The colleague next to you can support you like no one else can. One of the reasons I love this specialty is the team. They do an excellent job of understanding where we each come from in facing these challenges. Our shared experiences, both difficult and joyful, strengthen our collective bond.

How has technology impacted your work?

Transitioning to our new EMR was a big learning curve. Overall, electronic documentation has helped us to be more effective and accurate. Data collection has become so much easier with the EMR. It helps us to see how we are actively improving the nature of our practice as well as helping us to identify areas of weakness.

Do bedside technologies get in the way of authentic patient contact?

Technology can get in the way of nurse-patient communication and connection. We obviously have things we need to chart, yet we also may need to spend that extra moment with a patient without looking at the computer. Many nurses do indeed take that moment, sit and talk with the patient and their family and postpone the documentation until later. We have to remind ourselves to pause and be present. That is the heart and soul of nursing.

What’s your level of optimism regarding advances in cancer care for kids?

We’ve made enormous strides in the last 50 to 60 years. In the distant past, we were struggling to cure pediatric cancers. Now, we have truly aggressive cure rates for many conditions — sometimes as high as 80 to 85 percent. Research has really impacted what we do. There is a robust national research group called Children’s Oncology Group that contributes a great deal to our individual and collective long-term success. If each institution has a small number of patients with a particular diagnosis or condition, we can look to the shared national data as we continue to refine our approach. There’s a lot of exciting stuff coming down the road in terms of eradicating or controlling childhood cancers, including gene therapy, biotherapies and stem cell transplants.

What goals do you have for your own professional development?

I’m currently working on my DNP and will finish in 2017. That’s my short-term goal. Once that process is complete, I’ll be able to apply the things I’ve learned about strategies for collaborative practice and application of research to the clinical setting here at Loma Linda University Children’s Hospital. I truly enjoy learning something new and applying it to my current work. Nursing is a lifelong learning process.

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