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Training and Teamwork Help Researchers and Heal Patients
Imagine if you will... one tiny, miniscule ant trying desperately to fight a huge army. Now take that heroic, smart, clever ant and somehow exponentially grow it and put it back on the battlegrounds, this time with a whole battalion, furiously ready to fight once again.
Although it sounds like one of the newest video games to hit the market, this is actually a simplification of an innovative cancer treatment, one that is skillfully supported by nurses on the 2 East Surgical Immunotherapy Unit.
The procedure, called tumor infiltrating lymphocytes, or TIL, involves a surgical procedure where a tumor is removed from the body, chopped up and scoured for cells that are attempting to fight the tumor.
“Just like that one ant that was trying to fight an army, we take the immune cells in the growing cancer that were trying to fight the tumor and grow them in the lab,” said Tye Mullikin, clinical nurse on the unit. “Once we reintroduce them into the patient’s body, they will immediately return to the tumor, still fighting, but this time much stronger.”
Simplicity, even in the way that treatments are explained, is the key on the unit, which houses adult cancer patients mainly dealing with melanoma, kidney cancer, lung cancer, colon cancer and sarcoma. Since 60 percent of the patients on the unit have melanoma (the fastest rising cancer in the U.S.), the nurses are specially trained to deal with the disease and more specifically, the treatments and their side effects. Another state-of-the-art treatment on the unit involves administering an experimental vaccine that targets tumors.
Once the patient is immunized, a conventional cancer treatment called IL-2 is given. IL-2, which is FDA-approved for melanoma patients, mediates the growth of lymphocytes, which are one type of white blood cell. It’s the unique environment of the NIH that weds conventional treatments and experimental treatments to help combat diseases, which is just the reason that many patients come here.
“IL-2 is available in my hometown, but one of the many reasons that I chose to come here is that back home the hospitals may do IL-2 treatments about once a week, but here they do between three and ten a day,” said a Columbus, Ohio, melanoma patient. “My belief is that experience means a lot in whatever you are doing, and that is clear because the nurses here are very specialized and extremely experienced.”
Training, as with all nursing units here, is an integral part of the 2 East Surgical Immunotherapy Unit.
“Our scope is crossing over between medical and surgical oncology and the variances in our protocols are very wide, so there is a lot of information that our staff needs to know,” said Paula Muehlbauer, clinical nurse specialist on the unit. “Many of the protocols that we support have lots of new ideas, and since we have seen an increase in the last few years in the number of protocols, the protocol managers and high-caliber nursing staff have done an excellent job getting up and running and getting the information to the patients.”
One specialized training that helps support nurses, the Cancer Nurse Internship Program, brings nurses from across the country to the Clinical Center for an intensive 6-month session.
Initiated in 1985, this program uses classroom and bedside teaching to train nurses in the intricacies of the field of oncology.
“Some of the treatments that we administer, such as the IL-2 protocol, are very nurse-dependent and our] nurses are able to manage side effects and get our patients through the protocols because they know what to do and when to do it,” said Mullikin. “This program provides specialized training to a cadre of nurses, many of whom stay on after completing the program.”
Those who do not, according to Mullikin are better prepared for the field, no matter which organization they end up in. Mullikin, herself a graduate of the first class of the Cancer Nurse Internship Program, extends her abilities outside the NIH walls by training nurses from other hospitals on how to administer IL-2.
Supporting the training of community nurses, furthers the NIH’s ability to conduct extramural research.
“When we learn to be experts on something, we should train others on it,” said Mullikin. “IL-2 is something that many people on the outside are afraid to give and its use is not real prominent, but if they come here and train, they might not be as intimidated by the drug.”
“Masters-prepared nurses at the bedside add yet another element to the care that we can give here,” said Mullikin, who herself has a master’s in nurse education and is a strong proponent of nurses pursuing advanced degrees. “Their knowledge and skills are passed on to less experienced nurses right there at the bedside, during regular and off-hours, including weekends.”
The unit also takes a team approach to primary nursing, which according to staff members has made a world of difference.
“Here at NIH we have time to understand why we are doing what we are doing, and often at community hospitals some nurses become task-oriented because of time constraints,” said Mullikin. “As a result, the nurses here are an integral part of the research protocols, and are treated as such.”
According to Crystal Cook, a clinical nurse on the unit who travels to the Clinical Center from West Virginia, it was that valued role of nurses that made her decide to come here after serving as a temporary nurse at an area facility.
“Here nurses are treated as peers rather than subordinates,” said Cook. “They treat you like you have input and your opinion is relevant, and it’s viewed as something that can make or break a protocol.”
But it’s not just fellow nurses that see the collaboration and team approach, the patients see it also. “The nurses on this unit are great with patients and they really show concern,” said a lung cancer patient, undergoing her third surgery here.
“I’ve found that nurses here work together really well and are not afraid to ask questions or ask for help if they need it.” In fact, according to Mullikin, by asking questions the patients as well\ as the organization benefit.
“There is no such thing as a dumb question,” said Mullikin. “By asking questions, nurses help to improve our standards of practice. Their question could relate to something that we have taken for granted for years, as a result we will be able to work toward improving our policies or practices.”
So as new and innovative cancer treatments are developed daily, so too is the knowledge-base of the nurses on the 2 East Surgical Immunotherapy Unit. Viewed as experts in their field, the nurses support themselves, each other, and the patients who come from across the world in a valiant effort to advance the knowledge of cancer.
“The protocols we undertake often involve treatments never done before and the nurses here always meet this challenge with flexibility, innovation and enthusiasm and often make suggestions and changes that greatly improve our experimental efforts,” said Dr. Steven Rosenberg, chief of the NCI Surgery Branch. “The nurses on 2E and 2J [Surgical Intensive Care Unit] are the best patient-care nurses I have ever worked with. They really make a difference!”
—by LaTonya Kittles