The University of Chicago Cancer Center at Silver Cross Hospital, New Lenox, IL, is a satellite treatment center providing high-quality, university-based care in a community hospital setting. At the center, adult patients with cancer have access to comprehensive care, including chemotherapy, immunotherapy, radiation therapy, participation in clinical trials, genetic testing and counseling, and survivorship programs.
The Oncology Nurse-APN/PA (TON) spoke with Lisa Senerchia, RN, BSN, OCN, about her roles and responsibilities at the center, some of the challenges and rewards she faces in her day-to-day duties, and how a team-based treatment approach can improve the lives of patients with cancer.
TON: Can you tell us about your responsibilities at the cancer center?
Ms Senerchia: As a clinic nurse at the University of Chicago Cancer Center at Silver Cross Hospital, I work within a multidisciplinary team to consult on each patient with cancer. This team is comprised of many healthcare professionals, including oncologists, nurse practitioners, medical assistants, infusion nurses, radiation nurses, pharmacists, laboratory personnel, and a full support staff. Our center has 3 full-time oncologists on staff, as well as 2 other oncologists who are on site twice a week.
I meet with newly diagnosed patients and educate them about their treatment, which may include chemotherapy and immunotherapy. I discuss the side effects they may experience during their course of therapy, and provide them with important self-care tips they should follow when they are home, such as infection prevention and management, dietary and fluid intake, and when to call the center with concerns. I also go over their treatment schedules.
A large portion of my job is managing disease- and treatment-related symptoms. I let patients know that they can contact me by phone or through our online messaging system if complications arise. If a patient is not doing well, I confer with the oncologist to determine a course of action. Some symptoms may necessitate a nurse assessment in the clinic, new orders from the oncologist, or an emergency department evaluation.
We also offer guidance to appropriate resources. For example, we consult with the social worker who is aware of the patient’s needs, including their emotional and financial needs. Our center has a dietitian on staff and we also work closely with a local cancer support center that offers our patients free services, such as exercise classes, Tibetan bowl therapy, and access to support groups.
TON: We know that your cancer center participates in Kaizens. Can you tell us more about that?
Ms Senerchia: Kaizen is the Japanese word for improvement. One of my job responsibilities is to participate in a daily huddle where we identify performance improvement projects and then we have a Kaizen to work out how those projects can be implemented. An example would be when we changed our care team model. In the past, clinic nurses had responsibilities related to all the oncologists’ practices. We met at a Kaizen to discuss and implement the transition to a new care model in which each physician had his or her own nurse and medical assistant. The process for this Kaizen included representatives from each part of our team—management, researchers, oncologists, nurses, medical assistants, and service representatives. It took approximately 3 days to develop a new model, and on the fourth day, we presented it to representatives from the University of Chicago. The transition involved the whole clinic and was successful because we approached the project as a team.
TON: What is your career trajectory? How did you become an oncology nurse?
Ms Senerchia: I attended St. Xavier University, Chicago, IL, where I majored in nursing. I worked as a Certified Nurse Assistant and participated in an extern program at Christ Hospital in Oaklawn, IL. I fell in love with oncology during my time in college, and I stayed at that hospital after I graduated. I was fortunate to have a long orientation with seasoned expert nurses and great mentoring.
I was drawn to inpatient care, and I worked in that area for 10 years. Back then, most chemotherapies were given on an inpatient basis. I learned a lot about chemotherapy and symptom management, complications, and how to handle emergency situations.
As more and more chemotherapies were able to be given on an outpatient basis, I transitioned to outpatient care and spent another 12 years at the same hospital working with outpatient infusions.
In 2015, I started working at The University of Chicago Cancer Care at Silver Cross Hospital. My job as a clinic nurse brings me full circle with my experience in oncology—from inpatient, to outpatient, to the clinic.
TON: What are some of the challenges related to your job?
Ms Senerchia: I feel that the financial burden for patients is a challenge that we must continue to address. Cost is a significant issue with oral medications used to treat cancer, and patients may have a high copay even with insurance or may not have prescription coverage. We try to help them as best we can to decrease the cost of their medications. The first step is to help patients seek financial assistance from foundations or grants, often with the help of social workers if needed. We appeal to the drug manufacturers. In some cases, patients may meet criteria for financial assistance from these manufacturers, who will then provide medications at a reduced cost or free of charge.
Another challenge is keeping myself emotionally healthy at work so that I can offer the best support to my patients. At my cancer center, we support each other on an informal basis. We try to have a sense of humor. On our lunch breaks, we walk to keep physically fit. Our monthly staff meetings often include workshops on physical fitness, guided imagery, or conflict resolution. This helps us keep our morale high as a team.
TON: What are the greatest rewards related to your job?
Ms Senerchia: I enjoy getting to know my patients. I meet new patients soon after they are diagnosed with cancer and make it a priority to get to know them and their families so that I can build trust and guide them through the cancer journey. I also celebrate good news with patients, such as when they finish a course of treatment or when their scan results are encouraging. Conversely, I am there to offer emotional support to patients when they have setbacks.
Being able to work within a team is another reward. The support system here is great. It is positive and uplifting to be a member of our team.
TON: Can you tell us what you are currently most excited about in the field of oncology?
Ms Senerchia: I am excited about the ongoing research at our center and the fact that we offer clinical trial participation so that patients in the community can receive university-level care.
It is wonderful that treatments are becoming more targeted through genetic and genomic testing. This gives patients more individualized options, and these new therapies can improve outcomes. As a clinic nurse, I am required to learn about new drugs as they become available. Our oncology team teaches us about new treatment options; we read the literature and often attend meetings to learn more about novel agents. I am chemotherapy-, biotherapy-, and oncology-certified through the Oncology Nursing Society.
I am also enthusiastic about the amount of supportive services we can offer our patients. Currently, there is more focus on holistic treatments in oncology. We can refer patients to palliative care earlier in the course of their disease. Patients can also participate in cancer rehabilitation and physical therapy for survivors. Our social worker spends a lot of time counseling our patients and their families. Our approach encompasses the whole patient throughout his or her cancer journey.
TON: If you won the lottery would you continue at your job?
Ms Senerchia: Yes, I would, but maybe on a part-time basis so I could spend more time with my family. Being an oncology nurse is a large part of my identity, so I would find a way to continue working in the field.