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Pediatric Oncology

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Pediatric Oncology Nurse: Ghislaine Cedeno

Cedeno

Like a number of nurses on the pediatric oncology unit, Cedeno grew up thinking she would become a doctor. “My uncles were doctors,” she says, “and I thought I would become a pediatrician.” She studied health sciences at Gettysburg College, affiliated with the Johns Hopkins University School of Nursing, and soon realized that she was better suited for the nursing track: “I am a very sociable person and decided that I would be happier in a nursing role. I enjoy the interaction with my patients and their families.” 

When thinking about her student practicum, Cedeno was advised by a friend who was a nurse in adult oncology at The Johns Hopkins Hospital. “She thought I would be good at oncology nursing,” and it soon became clear to Cedeno that pediatric oncology was the right field. After graduation, she began working at the Children’s Center on the inpatient unit, and it was all she had hoped: “Every kid inspires me in different ways. A child in the pediatric intensive care unit, to children with a bad diagnosis or a relapse, accepting it and being positive about life.”

She sees pediatric oncology nursing as work, but it’s more than that. “I can be professional and enjoy making my patients laugh!” She remembers one patient who was so miserable he hadn’t smiled for more than two weeks. Cedeno was determined to change that: Dressed in funny attire, she drank apple juice from a (clean) urinal. Finally, he cracked a smile. His mother came to her after, so thankful, as she was concerned they might never see him smile again. “Those little things — seeing the kids change, making their day better — is what brings the rewards. You stray outside your role: These are not things you can check off a list.” 

Cedeno often takes on challenging patients who she feels she can make more of a difference with through this kind of primary nursing care in a hospital setting. “There is a treatment plan, and I see it all the way through, particularly with my primary and team patients. It has helped me reflect on life; the strength the kids have makes me appreciate so much more.” Cedeno loves the relationship she can develop with the family as a whole. “It is like an extended family. The patients and their families ask me about everyday stuff when I first come to work. We know the boundaries but can play within those.”  Cedeno likes long-term care, when her patients aren’t discharged after two days, never to be seen again, as they might be on a surgical unit. “We know who our patients truly are and can see them for who they are when they are hidden behind a bad day.”

As she has become more experienced, Cedeno’s role has changed. She continues to learn something every day. At first, as a nurse gets to know the ropes, the work is “task-y.” Over time, you build relationships with your patients and co-workers. “In the morning, we go to ‘sitting’ rounds with the doctors and other care team members, and we express our concerns. We may point out something that is important but may not have been seen by the rest of the team, or let them know about an issue that needs their attention when they do bedside rounds. We stay in touch with the social worker, physical and occupational therapists, the nutritionist — that can be one of the hardest relationships for the patient who has no appetite and doesn’t want to eat or drink supplements.” Nurses spend time in patients’ room and get to know them well over a period of days, weeks, sometimes even years. “After bedside rounds, when the doctors leave the room, often the patient or family members will say: ‘Oh, by the way…’ It’s easy to forget something, or they feel less comfortable talking to the doctors.”

She enjoys teaching and being a charge nurse. “It challenges you. You learn that you don’t know everything, that all of us need to ask questions and understand the reasons why we do what we do. I have become more critical, more analytical, and noticed that even nurses who are, seemingly, more experienced are really good at asking for help. And we all jump in — that’s how our team works. We are a family.”

Cedeno enjoys the people she works with and appreciates sharing good days and bad. “Outsiders say: ‘How do you do that? It sounds awful.’ But there are two sides to it: It’s rewarding seeing the children struggle and get past it. We are part of their lives, even if the outcome is not good. Maybe then, even more so.” Cedeno and the other nurses often leave notes and pictures they hand-colored for their overnight patients. “Sometimes the kids pretend not to notice — we may hear about their reaction from another nurse. I had a shy patient who, after a while, wrote me notes, pictures and even a poem. I lost a primary patient, and when I went to his funeral, I was amazed to see my colorings were all there. Patients — and parents — save them sometimes.”

Remaining buoyant and fun-loving on an oncology unit takes practice. “At first, you bring it home without even realizing, but you learn to deal with it better. I go home to New Jersey whenever my schedule allows and try to take a vacation every year. I work out, and a group of us is trying out the top 50 restaurants in Baltimore.” The nurses spend time together outside of work and are close. “You know when to say: ‘You’re not yourself. What’s going on?’ The work here is so different that it’s good to have that network.”

Cedeno has returned to her studies to qualify as a nurse practitioner. “Classes are a priority for our nurse manager, Lisa Fratino, when it comes to scheduling our shifts. She encourages open communication.” She also supports the nurses’ participation in working groups and committees that help to keep the team well-informed about current practice. Cedeno is involved in the CLABSI committee, helping to educate patients, families and co-workers on how to maintain a central line, such as a Portacath or Hickman catheter. “We recently introduced special rounds for checking central lines, making sure that we are all adhering to best practice, monitoring the team’s progress and giving feedback.” Another initiative she is pleased with, from the Committee for Service Excellence, is an Above and Beyond box: “We are committed to patient- and family-centered care. This box is for feedback, to let us know when our care has, maybe, hopefully, gone above and beyond.”