A Day in the Life of a Hem/Onc APP

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

“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 in-between 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 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 attention 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.

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