Putting stock in bonds

Janine Feliciano, who began her nursing career in oncology 14 years ago, remembers when the chemotherapy drug, Taxol, was given to patients in a hospital cardiac unit.

“They’d be hooked to a heart monitor, because doctors were worried about side effects,” she said. “Now we can safely give that drug to outpatients in about three hours.”

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Photos by BARRY WILLIAMS / Special

Clinical specialist Janine Feliciano prepares chemotherapy medication for a patient.

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Clinical specialist Janine Feliciano administers chemotherapy — along with some tender loving care — to patient Thomas New at Kaiser Permanente’s Cumberland Medical Center.

For the past eight years, Feliciano, RN, BSN, OCN, has worked as a clinical specialist for the outpatient infusion center at Kaiser Permanente’s Cumberland Medical Center in Atlanta.

“The advances made in drugs and safer administration methods have made it possible to deliver [chemotherapy and other intravenous therapies] on an outpatient basis,” she said.

Kaiser Permanente has two outpatient infusion centers in Atlanta and is considering opening another one.

“This is a growing niche for nurses and I see more and more positions advertised,” Feliciano said. “Not having to admit patients into the hospital is better for the patients, who would rather be at home, and [it’s] financially better for institutions.”

Besides chemotherapy drugs, infusion centers also give IV antibiotics, and drugs for viruses, pain control, nutritional support and diseases such as rheumatoid arthritis and Crohn’s disease.

“New patients are wide-eyed and anxious. They don’t know what to expect,” Feliciano said. “I tell them that we’re one big happy family, and other patients will tell them that they were scared at first, but not anymore. Our patients provide support for each other.”

At the Cumberland facility, the infusion center is one large room where nurses keep close tabs on clients and watch for adverse reactions. The average therapy takes two to three hours, so patients have time to talk to their nurses and to each other.

“They may not see their doctor that frequently, so they come here with so many questions,” Feliciano said. “I enjoy getting to spend more time with my patients than I did in the hospital and educating them about their diseases, medications and side effects.”

Sometimes patients will come back to visit after treatment just to say ‘hi,’ and to show off their regrown hair, she said. “If I take a day off, I get ‘fussed at’ by my regular patients for not being there.”

Feliciano switched from hospital oncology to infusion therapy so she could work a Monday to Friday schedule, which gives her more time with her son. She discovered, however, that she enjoys the nature of the work.

“It’s hard sometimes,” Feliciano said. “You do all that you can, but know that not all your patients will be cured.

“If you can help them understand the transitions they are going through by offering emotional and spiritual support, then you can help them to a better place. They come here for more than the treatment.”

Experience needed

Infusion-therapy nurses need a solid nursing foundation in medical-surgical practice and must have excellent IV skills, said Patricia Wilson, RN, a nurse in the infusion center at Kaiser Permanente’s Southwood Medical Center in Jonesboro.

With new drugs coming on the market, the learning curve is constant. It helps to have oncology experience, infusion nurse certification (CRNI) and a dose of tender loving care.

A nurse for 25 years, Wilson had worked in hospital med/surge and mother/baby nursing. She didn’t think she could handle treating oncology patients, but working as a hospice intake nurse changed her mind.

She’s been an infusion nurse with Kaiser Permanente for five years.

“I have come home,” Wilson said. “I’ve found my niche and it’s been a blessing. I’m so thankful to have a job that I can put my whole heart into and have my patients feel that I care.”

When patients enter the infusion center, she tells their families they can take a break and go shopping.

“They watch me tuck the patient in with a warm blanket and a pillow, and I tell them, ‘Don’t worry, I’m gonna take good care of your Mama or Daddy. I’m gonna spoil ‘em,’ ” Wilson said.

Human touch

She takes the time to answer questions about the medications and their side effects — and just as much time making friends.

“We try to find a way to make [patients] smile and take their minds off medical things,” she said. “We cut up a lot, and one patient told us she’d rather watch us than the TV.

“I believe that God put me in this place at the right time in my life, because now I have the maturity to understand not only what’s going on with the patient, but with their families.”

Wilson surprised one long-time patient — who had always brought the nurses candy on Valentine’s Day — with a birthday celebration.

“I got a birthday cake and we decorated her chair with balloons and flowers,” Wilson said. “She said it made her day.”

Later, when the patient missed an appointment, Wilson called her home and learned that she had died.

“When that happens, you hurt, you cry a little and then you pull yourself together so that you can be there for the next patient,” she said.