Perioperative Oncology Nursing: Interview with Julie Kang, RN, MSN, City of Hope

My Specialty

Perioperative Oncology Nursing: Interview with Julie Kang, RN, MSN, City of Hope

Seeing cancer patients through treatment and surgical procedures

By Keith Carlson, RN, BSN, CPC, NC-BC
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Please share your nursing career history.

I’ve been a nurse since 2000; my career path began in med-surg, eventually transitioning to telemetry. At a certain point, an opportunity arose to work with a private eye surgeon who was opening his own outpatient opthalmological surgery center. The surgeon needed nurses to run his OR and a few of us were hired.

Prior to opening the center, we observed him performing four or five cataract surgeries in the hospital OR and we were given a one-day in-service in running the new OR ourselves. We learned his preferred methods and techniques for the surgeries that he regularly performed and went about our tasks based on the guidelines set forth by the state.

In the cataract surgical center, we were doing 13 to 15 surgeries per day; the surgeon was very fast and efficient. We eventually developed a broader scope of practice that included some eye-related plastic surgeries. This was a very good experience, but I knew there was more to surgery that I wanted to learn: I wanted to be properly trained as a perioperative nurse.

How did you transition from eye surgery to cancer-related surgery?

Another nurse I knew noticed that City of Hope [COH] was offering a “Periop 101” training course and she suggested that we interview for the program. We were both accepted and it was a great experience. During the excellent training, there were three months of didactic education followed by four months of clinical training. After that, we were both hired as surgical nurses there. At that time, COH needed nurses as they were building a new surgical building with six operating rooms. It was exciting to be a part of the new unit’s launch.

After a decade, what keeps you motivated?

What makes me come back every day is the patient-centered care that we provide. We have the privilege of seeing cancer patients through their treatment, interventional surgeries and in some cases reconstructive surgery. I feel good about what I’m doing for patients. Even though the patient is asleep during the surgery itself, I can still advocate and be there for them during their cancer journey.

What do you love about OR nursing?

Surgery is very exciting; it’s always changing and evolving. There is so much specialized equipment and there are so many procedures, from invasive surgery to minimally invasive techniques. I tend to grasp technical concepts very quickly and am always interested in learning new skills and acquiring new knowledge.

Our surgical unit is heavily focused on robotics and laparoscopic techniques, so there’s always more to learn. Our operating room is “open core,” which means that each nurse must be trained and skilled in assisting with every type of procedure. We must understand it all, as opposed to a “closed core” operating room where each team is focused on one specialized area like liver surgery or cardiac procedures.

Can new grads find employment in perioperative nursing?

As far as I know, we never previously hired new grads because we wanted nurses to have the foundation of at least one year of acute care nursing under their belts. However, since we’re working towards earning Magnet status, we’ve been having trouble recruiting enough experienced bachelor’s-prepared nurses to the surgical unit. We decided to hold the first Periop 101 course since the program that I was accepted into 10 years ago.

At that time, there was a great deal of attrition. The hospital had three separate Periop 101 programs for the OR of which I was a part, but only a small percentage stayed on at COH. The hospital hired 13 nurses for the program and there are only two of us left in the operating room. You see, we’ve found that experienced perioperative nurses can be set in their ways and find it difficult to adapt to our way of doing things. If they come from community hospitals or outpatient facilities, they find the transition very challenging and often don’t work out, especially since they’re not accustomed to the open core model.

In terms of new nurses, the main drawback is that they’re very new to nursing and don’t have the background of critical thinking and prioritization that acute care experience would have given them. On the bright side, they’re not set in their ways and are very easy to train in our methods and procedures.

Are you involved with clinical trials?

We’re also a research center at COH, so we participate in clinical trials and testing. Recently, I worked with a neurosurgeon on a stem cell injection trial. I was there when he first injected stem cells into a patient; news cameras were there for the occasion.

In that process, we injected stem cells to kill a brain tumor, but the patient subsequently passed away. However, another patient who was part of the trial had been diagnosed with metastatic disease and a lesion on the spine. Following the stem cell application, the lesion on the spine was apparently dissolved by the treatment.

Cutting-edge treatments and trials are exciting because there are so many details, guidelines and strict documentation criteria. This type of work is exciting and there’s so much potential to help our patients. At the end of the day, it’s all worth it if patients have improved outcomes.

How has changing technology impacted your work?

When I started in perioperative nursing, we had towers of monitors that had to be wheeled in for every procedure. Now, we have completely mobile monitoring systems that are embedded in each operating room. The transition from analog to digital to HD has also been amazing to witness.

At this time, we’re working with the injection of dyes and a camera that can actually light up the blood vessels that are vascularizing tumors. It’s all very fascinating.

Is it challenging to keep up with all the changes?

Yes. I can’t even count how many pieces of equipment we have, but in an open core unit, every nurse must understand the operation of each piece of technology. We do it each and every day and we continue to learn and adapt.

What advice do you have for nurses interested in this area?

It’s not as rare for new grads to find Periop 101 courses at various facilities, but I met one nurse in an ACLS course who had done Periop 101 and still couldn’t find a position.

Many surgical departments want nurses with at least one year of acute care, but many new grads can’t find those open positions in order to acquire that experience.

I wish there was a formula for nurses who want to find their way into this specialty, but it depends on each individual and their situation; it’s just not cookie-cutter. Connections and networking are important and you have to actively look for what you want and put yourself out there. Having had ACLS, BLS and critical care experience is definitely in your favor. The other pathway is to find a position in ICU, preop or recovery and then transition into the OR.

What are your future career plans?

As of right now, I love what I’m doing; I’m always learning and am happy where I am. I feel like I could stay here for 10 more years and still be just as interested and satisfied.   

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