UP FRONT
Advanced Practice Perspectives
In this column, we will hear from an increasingly represented and crucial
component of hematology/oncology care: advanced practice professionals/
advanced practitioners. In this edition, Amy Goodrich, RN, BSN, MSN,
CRNP-AC, gives us an inside look into the daily life of a hematology/oncology
advanced practice professional and how she balances all of her responsibilities.
A Day in the Life of a
Hem/Onc APP
“What do you do in a typical day?” is a
question I am often asked by everyone
from nurses who aspire to further their
careers in nursing, to patients and physicians. My reply: There is no such thing as
a typical day; I never know what I’m going
to walk into.
I have a hybrid clinical and administrative role. On the clinical side, I meet
with patients in the outpatient department for routine and urgent visits; on the
research side, I am heavily involved with
our cancer center’s research operations;
and, on the administrative side, I help
plan changes to our clinical systems, such
as recent changes to the electronic medical record in the institution.
How do I balance these responsibilities? That’s a very good question. I juggle
as much as I can at any given time. Unfortunately, though, I do require sleep.
A Day in the Life
6:00 a.m.: My day starts as I sneak out
of the house before anyone else is up.
My husband is self-employed and works
from home, so he takes over getting our
children (ages 10 and 12) off to school.
6:45 a.m.: I am one of the first to arrive
at the cancer center. It’s the most peaceful part of my day. As I sip my morning
coffee, I try to carve out time for each of
my responsibilities throughout the day
– clinical, administrative, and research
– and hope to find little pockets of time
to work on other things on my to-do list
such as returning patient calls, reviewing labs, reading protocols, completing
patient notes, and preparing for the day’s
scheduled patient visits. Finding time inbetween patients and meetings is the best
way to check these items off of my list.
8:00 a.m.: I hit the ground running, be
it with patients, with meetings, or with
other management/administrative responsibilities. Many of the patients I see in
my outpatient-based clinical practice are
enrolled in research studies. Seeing these
patients requires a slightly different skill
set from other advanced practice practitioner (APP) positions. Knowledge of the
investigative protocol, side effects of the
study medications, and necessary study
procedures is critical. I am constantly
switching hats to work with research
nurses, tackle research compliance issues,
and complete documentation for patients,
with extra attention to detail for those
participating in clinical trials.
For all of my patients, I function as
their provider (diagnosing acute conditions, managing side effects, and ordering
tests); for research patients, I function as
an active research team member (ensuring
the study patients take their medications
as directed, assessing toxicities, ensuring
proper dosing and other protocol compliance, and altering my schedule to guarantee research-mandated timelines are met).
I see patients on two campuses; on
our main campus, I try to be done seeing
patients by 3:00 p.m. and when I see patients at a satellite location, I typically only
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ASH Clinical News
see patients in the morning before their
scheduled treatments. On days when I am
not in clinic, I’m attending meetings all
over campus.
In my administrative role, I am the
go-to person when there are workflow or
process changes in our clinical systems – a
frequent occurrence. As both a provider
and researcher, I’m thinking about how
these changes in workflow will affect our
study patients, or the workflow of the research nurses.
Right now, we are in the middle of
implementing a new EMR system. Anyone who has lived through this process
understands the ever-shifting sands of
workflows to accommodate the switch.
My goal is to make sure that all of the individual pieces that affect quality research
(the way labs or medications are ordered,
appointments are scheduled, the flow of
drug orders through the pharmacy, and
who checks in the patients) are being
carefully thought out and accounted for
while these clinical changes are happening. That entails some mediating on my
part – ensuring that communication is
flowing smoothly between APPs, nurses,
physicians, and other clinical personnel.
I am also involved in the planning
of new procedures and systems, so each
day includes a bit of education from my
administrative role. I make sure that our
research teams know how to use our electronic resources to help them with their
work. Finding time to address administrative issues, squeezing in meetings, and
dealing with unscheduled patient needs
can be a challenge, but I find a way to
make it all work.
3:00 p.m.: I head back to my office, just
in time to field a few urgent phone calls,
respond to emails, take a bite of lunch,
and catch my breath.
4:00 p.m.: Now comes the worst part
of the day, right before I’m planning to
head home: Looking at all of the items
that I haven’t crossed off the day’s to-do
list. That’s when I take a deep breath and
ask myself, “What are my priorities for
the next 15 minutes? What needs my at-
tention at this second, and what can wait
until tomorrow?” It may not be pretty, but
in the end, it all gets done.
6:00 p.m.: There are two parts of my
day that I look forward to the most: first,
is working with patients and hoping they
are happy with their care regardless of
their prognosis or their outcome; second,
is pulling into my driveway, having a day
of work behind me, and looking forward
to time with my family, which most evenings, includes kids activities, sports, etc.
I am also very involved with my children’s
activities, which I absolutely love. I am
typically the “team Mom” and scorekeeper, a current Girl Scout Leader and former
Cub Scout Den Leader, and a Sunday
School teacher at our church.
I make a very concerted effort to separate work, research, writing, and home.
It’s easier said than done, obviously, but
I like to think of my commute home as
my “transition zone,” when I switch gears
to focus on my family and our evening.
Then, once everybody is settled down for
the night or while I am on the sidelines at
various practices during the week, I start
“phase 2” of my work – catching up on
patient documentation or conducting research for my academic writing activities
or taking care of things on my to-do list
that I can accomplish remotely. There are
evenings where I just need to unplug and
relax, so as an avid reader, I always have a
good book to dive into.
I’m also thinking about the challenges
that the next day at the cancer center will
bring. Because, of course, even when you
think the day is over, it’s not over.
Luckily, I enjoy the hectic life of a hematologist/oncologist APP. I get satisfaction out of being productive, both at work
and home. Personally, I don’t think I know
how to relax, which is probably how I pull
off the balancing act. ●
Amy Goodrich, RN, BSN, MSN, CRNP-AC,
is nurse practitioner in hematologic malignancies and research associate at Johns
Hopkins School of Medicine and The Sidney
Kimmel Comprehensive Cancer Center at
Johns Hopkins in Baltimore, Maryland.
September 2015