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Pediatric Oncology

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Pediatric Oncology Nurse: Nurse Manager, Lisa Fratino

lisa fratino

Lisa Fratino is the nurse manager for pediatric oncology. Nursing was not her first calling: “I graduated with a psychology degree. Entry-level jobs were scarce without a master’s degree, and I was not yet prepared to advance my education. I knew I wanted to work with children, but the options open to me with that degree did not speak to me.” Fratino worked in dentistry while she considered her options. She volunteered with a medical mission group and provided dental care to the indigent populations in Central America (Costa Rica and Nicaragua.) It was through this experience that she came to realize that she wanted do something in the health care field. “It was my mom who encouraged me to consider nursing. She seemed to know it would suit me.” She studied at the Johns Hopkins University School of Nursing and, during her senior year, came to pediatric oncology for seven weeks to shadow the nurses and learn about the specialty. After that experience, she knew she was interested in nursing patients with chronic illness, in the longevity of care and, after graduation, joined the team as a new pediatric oncology nurse. “I gave myself five years to see if it was for me. I loved it.” 

Five years later, and as a nurse clinician expert III, she moved into nurse management and has been nurse manager for 14 years. “My management style has evolved with time and experience, of course, but for me, the defining moment came months after becoming assistant manager of the unit.” Fratino’s beloved nephew, Vincent, was diagnosed with acute myeloid leukemia. He was 5 years old. “I became highly attuned to the experience of a family of a cancer patient. My sister lived at the Children’s Hospital for six months. She had an infant daughter, still nursing. In those days, because it was respiratory syncytial virus season, and she could not bring her baby to the unit. Back then, children shared a hospital room. I learned firsthand how hard that is on both roommates and on the families, particularly as Vincent became sicker and weaker.” Fratino had to muster all her professional skill and fortitude: “Boundaries were challenging. I had to be sure not to pick and choose my favorite nurses for Vincent’s care, not encourage the doctors to share information with me before they had discussed it with his parents. It was an early and formative lesson, reminding me that I am here to manage the care of all our patients, every one.” 

Fratino shares this story, as it opened her eyes to the importance of family-centered care. Attempting to maintain some semblance of normal family life is very important for children who are admitted for inpatient treatment frequently or for long periods. Visits form siblings, for example, are vital to maintaining healthy relationships between the children and with the parent who may be away from home for long stretches. “Brothers and sisters may visit all year round now. We screen them for symptoms of sickness and ask that the children to stay in the patient’s room during RSV season. But it is important that we regularly test assumptions like a blanket ‘no visiting’ rule, make sure there is science behind it and apply flexibility where we can.” 

Her family’s experience continues to influence Fratino’s approach: “I talk through difficult situations with the nurses. I remind the nurses of the goals of treatment and our commitment to family-centered care. Given my personal insight, I can say to a parent: ‘I do understand what you are going through, at some level.’ I am less reactive, I think, more understanding of the complexities and nuances. There are times when a nurse may not agree with the decision a family has made about the treatment of their child. Sometimes they wonder how a parent can make ‘that decision,’ or ‘when is enough enough?’ I have seen, very close up, that parents make the best decision they can based on the information they have and the cultural traditions that they observe. You cannot always know the drivers of a parent’s decision. You cannot know what you would do until you walk that walk. As nurses, we get to go home at night, close the door and protect our resilience. The parents live with their decisions, and we must support them in every way we can.”

Fratino would not have expected to be touched by pediatric cancer so personally so early on. Her experience helps her navigate the twists and turns of treatment, relapse and recovery, supporting her team of nurses as they carry out their emotionally intense vocation. She understands how important the relationship among the patient, family and professional care team is at every point along their journey. She understands the resilience it takes for a nurse to be able to provide that level of care, leave the room, and provide it for another patient and his family. “Our nurses have to learn how to go from the room of a patient who is newly diagnosed and with a great prognosis to another where the patient is, perhaps, receiving palliative care.” She helps nurses temper their emotions and reactions, maintain each family’s privacy, and that of the nurse herself. 

Sadly, Fratino’s nephew died in 2002 in the pediatric intensive care unit. After a lengthy illness, her mom died a few years later, in 2005. “My mom spent some time in the neurology department here at Hopkins. I had spent a short time there as a student so, again, I had a foot in both camps. Both of these deaths, so close together; what a strange turn of events. But I have to think there is a reason for this exposure. As nurses, we are there at the most intimate of times, times when the patient and family are at their most vulnerable. To bear witness at the end of a patient’s life, to help with that part of the journey, is humbling and a privilege.” 

As a new nurse, Fratino’s mentor, Lynette Fuson, and other long-serving members of the team, remain core to the unit and its ethos. “I grew up as a nurse here. Yes, I am the leader, the supervisor, but these women are my colleagues too. I want to hear the total voice of the nurses, to build consensus.” Fratino meets with the team at a quarterly staff meeting. She encourages a dialogue, an exchange of information. “The nurses do wonderful work, and their peers are very supportive. We work a great deal on team building, and that shows in the group dynamic. If there is an acute event, the nurses are there for each other at work and beyond. And in happy times too. Resilience work is a major success story for this team, and we regularly ask each other: ‘How can you sustain yourself? What do you do to take care of yourself?’” 

Fratino leads by example, ensuring she recharges her own reserves and has the energy and focus she needs for her demanding role. She swims and loves to run. She is working hard to restore a 1950 Cape Cod: “I am bringing it back to life, making it mine.” Fratino surrounds herself with loved ones: “Time spent with my boyfriend, family and friends is incredibly important to me and key in my life. And I love to cook, especially from beautiful Italian cookbooks! It reminds me of my childhood.”