Professional Practice and Education: Interview With Robert David Rice,  RN, Ph.D., NP

My Specialty

Professional Practice and Education: Interview With Robert David Rice, RN, Ph.D., NP

Keeping nurses current on best practices, clinical techniques and emerging technologies

By Keith Carlson, RN, BSN, CPC, NC-BC
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Robert David Rice, RN, Ph.D., NP  
Director, Professional Practice and Education  
City of Hope, Duarte, Calif.   

How did you enter the nursing profession?

When I came to New York in 1982, the AIDS pandemic was already a part of the fabric of the city. I had completed a liberal arts degree, worked for five years at a large international public relations firm and then worked for five years at a large financial institution.

In the late 1980s, I volunteered with the supportive care program at St. Vincent’s Hospital in New York, which supported people with AIDS and terminal cancer. The program, designed and run by nurses and nuns, involved dedicated nurses, physicians and social workers who provided an extensive orientation to volunteers. The orientation was supplemented by community volunteers and subject matter experts.

The program was unique to me in the sense that the nurses and the volunteers followed the patients in the inpatient setting, at home, in hospice care and until their deaths. In this setting, I learned two equally important lessons about healthcare and the impact of AIDS and cancer care: the absolute importance of the role of family (however defined) in providing patient- and family-centered care and the critical role of the bedside caregivers.

As Virginia Henderson wrote in The Nature of Nursing, “The unique function of the nurses is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge." [Henderson, V.  The Nature of Nursing: A Definition and its Implications for Practice, Research, and Education. New York: Macmillan, 1966.]

This was the first time I had seen the myriad roles of the nurse. The idea was slow to crystallize that I might change career paths and become a nurse. Once I did, I had the good fortune to quickly enroll as a non-matriculated student to take my science prerequisites. Then, I applied for and received a scholarship as part of a tuition abatement/work exchange relationship between Memorial Sloan-Kettering Cancer Center (MSKCC) and Columbia University School of Nursing.

As often happens, when one’s first work practice setting is a good one, that area of nursing specialty becomes home. That is what happened in my first job as a clinical nurse at MSKCC, working on a hematopoietic cell transplant (HCT) unit. MSKCC remained a rewarding home for the more than 20 years.

David Rice City of HopeWhat clinical experiences shaped your early career?

As a novice nurse, I was deeply moved and humbled by providing care to patients with cancer and AIDS. Being able to share with patients and families at a time so vulnerable and fraught with meaning has always been a gift and one of the things that drew me to oncology nursing. Because of the long inpatient stays of patients with hematologic malignancies, the experience of developing intense, interpersonal caring relationships with patients and families profoundly shaped my career.

I think that being older as a “young” nurse, having had a different liberal arts orientation, having worked in different professions and having had the blessing of the volunteer experience at St. Vincent’s all helped to shape me into the clinical nurse I became.

During that time, I pursued my master’s degree and became a nurse practitioner specializing in adult health and oncology. In 1998, I left MSKCC for two years to go to Mt. Sinai Medical Center. There, I worked in the oncology care center, caring for medical oncology and hematology patients. In 2000, though, I returned to MSKCC as a research nurse practitioner.

In my role as research nurse practitioner, for seven years, I worked closely with many very gifted expert transplant nurses, advanced practice nurses and physicians in the ambulatory care setting. There, I was able to see the significant interface between the outpatient and inpatient settings in the care continuum and better appreciate the patient and family personal and social context.

I participated in clinical trials both as an investigator and as a research NP, treating patients with investigational and standard-of-care therapies. I developed expertise in high-dose therapy and autologous stem cell transplant for patients with Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, multiple myeloma and systemic amyloidosis.

During that time, we were expanding our experience with umbilical cord blood transplantation as well. It has been fascinating to learn about this stem cell source and its unique biology. Umbilical cord blood transplant offers a stem cell source that is potentially curative to patients with terminal diseases who would otherwise not have a stem cell source. Access to transplant care also highlights some of the healthcare disparities we face.

How did you transition into professional education?

I loved taking care of patients and families and was very good at it. So, it was a difficult decision to leave direct clinical practice. However, in 2007, I was recruited within the transplant services at MSKCC to become the BMT [blood and marrow transplant] clinical program manager.

Although that was not a direct operational role, I assumed a “virtual” manager role for the transplant program. I was responsible for the clinical care processes of the entire transplant episode as well as regulatory, financial, legal and communications responsibilities.

In 2009, I was recruited for the role of nursing director of quality management. In that role, I quickly appreciated the interconnectedness of evidence-based practice, quality, research, research utilization and education. Research informs practice; quality assures compliance with standards and identifies opportunities to improve; and changes in practice prompt changes in educational strategies and delivery of both care and education for patients and nurses. The evolving field of information technology impacts all of these domains.

When I was recruited to come to City of Hope in 2013 as director of professional practice and education for the Division of Nursing and Patient Care Services, I was delighted to be able to bring all of these domains together again in a different yet similar setting.

We have the goal of recruiting and retaining a highly trained and expert nursing and patient care services staff that can care for and improve quality and safety outcomes. City of Hope is a pioneer in the field of hematopoietic stem cell transplantation, so I was delighted to come here because of my affinity for transplant clinical practice and research. City of Hope has performed more than 12,000 bone marrow and stem cell transplants, with survival rates that are unparalleled.

I am also delighted to come to a center that is renowned for its surgery and medical oncology programs, both of which continue to expand and grow. We are extending our reach into the large geographic areas we serve through a network of practices. It is exciting to offer cross-disciplinary education programs to keep City of Hope nurses current on evidence-based best practices, clinical techniques, standards and emerging technologies unique to their clinical discipline.

I’m honored to participate in local and national conversations about best practices in oncology nursing care through consortia of National Cancer Institute-designated comprehensive cancer centers. We then apply these best practices, revise our policies and procedures and put those practices to work in the interest of our patients and families. We are at the forefront of advancing quality oncology care.

Do you work with the medical team in terms of best practices?

Yes, nursing and medical practices are naturally interrelated and interdependent. As the largest workforce of any facility, nursing is at every table. Any change in practice involves nursing and oftentimes many other disciplines. Nurses must have a voice in all healthcare policy decision-making.

I strongly believe in interprofessional education and multidisciplinary care. A focus on communication is of the utmost importance for all healthcare practitioners. Many patient care errors are directly related to lapses in communication and incomplete or ineffective handovers. We need seamless communication and stakeholder buy-in to ensure the best possible patient care. Expert, timely and accurate communication facilitates that.

How is your work impacted by a technology-dependent environment?

Information technology presents amazing opportunities to improve, standardize, streamline and deliver high-quality care. It allows for consistent data capture, aggregation, analysis and reporting. Technological advances provide for personalized medicine to target an individual patient’s tumors.

We rightfully try to emulate industries that have used standardized work and checklists to reduce error, such as the airline industry. However, unlike airline travel, healthcare is not a linear business. It is a circular series of events with multiple interacting and intersecting participants — patients, families, communities, clinicians, insurers — and unplanned and unforeseen complications.

Still, we must maintain our focus on patient-centered care. Technology must be a tool we use, but it must not be our central focus. We cannot deconstruct our patients into points of data — numeric values, digital images of body parts, diagnoses and codes. We must maintain our holistic approach in nursing with our full attention on the patient and family. We must integrate information technology with nursing practice. Our plan of care must therefore be dynamic and continually adjusted to adapt for all contingencies. It is a human endeavor and so is laden with frailties and subjectivity.

As an educator, how do you approach varying generations’ learning needs?

Much is written about intergenerational relationships, differences and similarities. In nursing, the way each generation communicates and uses technology varies. Logically, younger nurses and healthcare professionals may be more engaged in their own career trajectories while older staff may have more of a personal focus on family and future, eventually leading to retirement.  

Younger generations have more of a sense of work-life balance and stronger boundaries around work. Those differences impact learning needs and styles.

What’s the future of professional practice education?

In vivo training is ideal when it can be used. However, for tactile nursing procedures and tasks, simulation scenarios with hands-on demonstration continue to be a useful method. Peer-to-peer collaboration and education is also valuable. To the extent possible, interprofessional education should be supported and encouraged. Learning together with other disciplines supports teamwork, collaboration, mutual understanding and respect for the role each plays in the healthcare arena.

As clinical ladders evolve, nurses are encouraged to maintain a portfolio of education, activities and accomplishments. This supports continuing education, professional development and leadership skills. One path to the top of a clinical ladder is providing nurses with the opportunity to differentiate beyond clinical expertise — to focus on areas of specialization such as management/ leadership, research, quality and safety, education and others.

Throughout our careers as nurses, formal and informal education challenges us and helps us to be better, consistently improve patient care and continually improve ourselves.

What’s next for you?

Well, I’ve certainly enjoyed where my nursing career has led me. It hasn’t necessarily been a traditional route, but that’s one of the joys of nursing. There are countless paths nurses can take — following our hearts, following our minds and following our joy. A credo of lifelong learning is expected of all nurses and, I would argue, for everyone. There is always opportunity to learn, improve, grow and share.  

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