In honor of Veteran’s Day, Daily Nurse chatted with Richard Ramos, RN, MS, CNS, PNP, CPON, a pediatric oncology nurse at Stanford Medicine Children’s Health and veteran of the U.S. Army Infantry, about applying his military skills to his role as a nurse leader and devoting his career to pediatric oncology nursing.
Why did you pursue a career in nursing?
When I was younger, the mother of a family whose children I taught swim lessons was a nurse. The seeds were planted by her. While I was looking forward to the adventures my time in the U.S. Army Infantry would bring, when I left the military, I was also left with an abiding desire to continue to do service. In retrospect, it was conversations with this woman about nursing, what nurses do every day, and their important role in healing. It resonated with me.
Before becoming a nurse you served in the Army for four years, leaving as a 1st Lieutenant. Why did you decide to leave the military as an officer and become a nurse?
I was mostly inspired by my dad, an Army officer, and some of my scout leaders who were likewise in the military. They inspired a sense of service and taught me many leadership and outdoor adventure skills that followed me into the Army (e.g., orienteering, rappelling, backpacking, and basic survival). Nursing was a “seed” planted by the mother whose children I taught in Red Cross swimming lessons while I was in college. Some of her stories regarding service and caring for patients “stuck” with me over the years. When I resigned from my commission and reflected on our discussions, it seemed a natural “next step.” Something about it fits nicely.
Was there any experience that made you think, “I want to devote my career to pediatric oncology nursing?”
As I was re-educating and reinventing myself as a nurse, I did one of my clinical rotations at Lucile Packard Children’s Hospital Stanford in 1990. The experience granted me clarity on so many levels. For one thing, I found that the patients, families, and staff were at their best when life had thrown the worst at them. That moved me. Further, it was an easy “banner” under which to fight—caring for kids facing a life-threatening illness.
Do you see similarities (or differences) between serving as a platoon leader and being a nurse leader?
Undoubtedly. You must motivate and inspire the team to achieve a common goal/objective. In many respects, the team dynamics demanded by the military are similar to that of nursing. The most significant difference is communication and how to talk to people, unlike the infantry in the 1980s. What I thought was kind or reasonable in my speech while I was in the military was considered off-putting in different settings. Respect is key. The nursing process is a bit more intricate in its workings. It involves far more cooperation, collaboration, and a far kinder tone of voice than I had grown accustomed to when I served in the military. Even throughout my years as a nurse, I am still learning.
What skills have you seen translate from the military into your line of work as a pediatric oncology nurse?
The military provided me with a profound sense of service. Additionally, the experience showed me how to perform thoughtfully under extreme circumstances. Organization, leadership, critical thinking, responding to situations clearly with a sense of urgency, and risk management are a few examples that the military instilled in me. These skills generalized well in my career as a nurse.
How can bedside nurses use their experiences with hands-on patient care to help effect change on a larger scale than individual health outcomes?
Most nurses have always brought about positive change, specifically in health outcomes—changes that result in healing or extension of life qualitatively, certainly where pediatric oncology is concerned. And that is the change they have been eliciting all the years I have been a nurse.
This is especially evident for nurses who become involved in advanced practice and holistic care (e.g., nurse practitioners, clinical nurse specialists/educators) and/or administrators (e.g., managers, directors, quality improvement/assurance). In my experience, nurses who started at the bedside and learned the intricacies of care at that level develop a 360-degree view regarding clinical practice and how to improve it when stepping into a position that brings about change on a community level (when they move into advanced practice and administrative roles). In that sense, the adage “the hand that rocks the cradle rules the world” applies.
Working with children suffering from pain, discomfort, and fear–and their families–sounds even more demanding than palliative care. (Yet palliative care nurses tend to find their work deeply fulfilling). What is the hardest part of being a pediatric oncology nurse? And what makes it so rewarding?
Disillusionment. I think that’s the hardest part for all involved in caring for a child with cancer, especially when they are a “new diagnosis.” Examples of disillusionment are as follows.
The child. They are uncomfortable in a manner that won’t go away and from which their parents cannot protect them (a scary thing for a kid, I think). For adolescents, it goes a step further in that just when they’ve reached a station in life in which they were supposed to be “bulletproof,” they’re confronted with their mortality.
Parents. They likely had hopes and dreams for their child’s life—it certainly did not involve cancer.
Clinicians, especially young nurses, it’s the disillusionment caring for these kids is much more challenging emotionally, physically, and intellectually than they ever imagined.
The rewards come in inches, bridging the gaps mentioned above by making the patient comfortable. Listening to a parent just long enough to relieve their fears and reflecting that cancer is not always a death sentence. It’s a long fight but one worth the effort. Occasionally, the children who have obtained cures visit the unit. Even the end-of-life aspect of care has its rewards when the family and patient have been adequately prepared. It is peaceful and consoling.
If a nurse is considering specializing in pediatric oncology, what should their first or primary considerations be (for example, are personality or character traits beneficial in your field)?
While resilience is a term that has been a little overused recently, it is appropriate for pediatric oncology. The nurse new to the specialty will see things wonderful and horrible, sometimes during the same shift. They must find an emotionally adaptive way to process the experiences and return to the next shift to do the work skillfully and professionally.
Coupled with the emotional aspects, the budding pediatric oncology nurse should embrace the science of nursing in general and oncology in particular. Where medicine dedicates itself to saving lives, nursing is concerned with keeping people alive. To put it another way, medicine heals, while nursing sustains.
Nursing is the science of creating a therapeutic environment that allows medicine to work. It is sophisticated stuff. It involves surveillance and knowing when to call for help when a patient is in trouble. Nurses should administer the therapies as ordered by medicine and understand what they are and how to administer them safely in concert with the myriad therapies already being administered. In more extreme circumstances, they have to know how to support the patient that has arrested until help arrives. These are all the things I mean by keeping the patient alive.
How are you supporting Spanish-speaking parents in your role as a Group Facilitator at the Latino Parents of Children with Cancer? How are you making a difference in their lives?
I co-facilitate the Latino Parents of Children with Cancer group in partnership with Latinas Contra Cancer and the Leukemia and Lymphoma Society. Once a month, we meet and discuss the challenges and successes of caring for a child with cancer. The parents do most of the work in providing solutions for one another. For instance, the more experienced members will offer suggestions to new ones on navigating hospital systems and what’s in store as treatment unfolds. If clinical questions arise, my colleagues and I are there to explain the process.
On occasion, we advocate on their behalf if clinical or financial needs occur (e.g., attend a care conference and ensure they understand what is happening to their child; help them fill out forms to solicit charitable funds for rent or food). We encourage the kids to come with their parents so they can meet others going through the same thing. It gives them a sense of community and peers who can understand their challenges. Our group is close-knit. Much of the meeting time is social and fun, though it can be serious at other times. Still, we provide a safe and warm space to discuss whatever the families face