In honor of Oncology Nursing Month in May, Oncology Data Advisor is celebrating the stories of these essential members of the cancer care team. For this interview, editorial board member Maria Badillo, MSN, RN, OCN®, CCRP, speaks with Doyle Bosque, RN, Director of Nursing Research Programs at MD Anderson Cancer Center. Mr. Bosque explains the role that he plays in the oversight of clinical trials and shares the exciting opportunities that a career in research nursing can offer.
Maria Badillo, MSN, RN, OCN®, CCRP: Hi Doyle, good afternoon. Before we start our conversation, I would like to introduce you to the group. Doyle is currently serving as our Director of Nursing Research Programs. He has been a nurse for over 27 years. Out of the 27, for 17 years he's been working in the nursing research arena. He's responsible for assisting in the oversight and direction of the research professional community which manages the clinical trials here at MD Anderson and is responsible for ensuring compliance and patient safety.
Doyle is a very strong advocate within MD Anderson for the clinical trial research professional role and discovering new approaches and practices in advancing the research community into the future. He's in charge of bringing together the research community and the frontline staff through collaboration and education to ensure clinical trial compliance, delivering excellent care to patients on clinical trials, and preserving patient safety.
Doyle, as a director of our research community at MD Anderson, can you tell us more of your role in the research community?
Doyle Bosque, RN: My charge as Director of Nursing in the Clinical Research Program is to the research community together with the frontline staff to ensure that both sides understand what it takes to provide patient care and for those patients who are accrued on our studies. It is important that both sides understand how that patient care is delivered. The research community needs to understand that when they have a clinical trial and it has requirements that we need to discuss with the frontline staff, is it a realistic expectation for the frontline staff to implement these requirements? Sometimes it may not be realistic. For example, we may want to monitor vital signs every five minutes for an hour. Well, that's just not realistic for the frontline staff to do because of all the other requirements for patients they have.
My job is to make sure that both sides understand if a clinical trial can realistically be implemented. If it can, but it needs to be tweaked with those requirements, can we come together and decide what is a realistic and valid way to implement those requirements? That requires education, that requires collaboration, and that requires both sides understanding the role that each have within the institution. It takes all of us to provide those clinical trials and make sure that they are completed in order to provide new therapies for patients all over the world.
Ms. Badillo: Thank you, Doyle. One of the initiatives of you and your team are the research protocol fact sheets. I would like you to maybe give us an explanation of the role of the research nurse and the role of the clinical nurse in giving the chemotherapy in the bedside or outpatient. What are the roles of these types of nurses?
Mr. Bosque: The research protocol fact sheets actually came about from the request of the frontline staff, because there was some confusion about all the protocols. On a routine basis every year, MD Anderson has 5,000 new protocols that come out; it became a little bit unrealistic for the frontline staff. As an example, a frontline staff member may have 10 patients a day, sharing with another nurse, and those 10 patients may be on 10 different protocols. So, they would have to know the requirements of 10 different protocols. If you look at the actual protocol, each one may be 200 or 300 pages long. The expectation and the burden placed on them was really heavy.
They requested if we could come up with something from the research community to help them provide patient care at the bedside and also adhere to the protocol requirements. What we did was we went back, we had a meeting, we made a committee, and we took their recommendations. What the nurses wanted was a quick reference guide, one page only, that would help them provide care at the bedside. This one page needed to be accessible 24/7 to anybody, because these patients can show up on the weekends and at night, and it needed to have contact information for who they could reach out and ask if there were questions.
We created a one-page protocol fact sheet, which is just a quick reference guide for each individual study that included the contact list, objectives of the study, drugs that were being administered, and special requirements. This is not a treatment plan; these are just special nuances of the trial that the frontline staff need to know, as well as potential side effects if there are any that they should be aware of. We got their approval; they liked the one-page fact sheet. We then had to put it in the electronic medical record, because that was the only way that they would be able to access it. We created a platform with a link to our medical record, called Epic, that the protocol fact sheet would flow into every time a patient was placed on a protocol.
That fact sheet would be associated with that patient in their medical record. The nurse and the physician could go into that patient's record, pull up that fact sheet, and have it right there. They could actually print it out, carry it with them, and give it to the next nurse who was coming in on the later shift. It was very mobile and very easily accessible. We also have a process; every protocol that's submitted must have one of these protocol fact sheets before it is activated. You cannot activate a new protocol without this fact sheet. That's to ensure that we have taken every effort to help the frontline staff provide care for our patients who are on these clinical trials.
Ms. Badillo: Yes. As one of the research nurses, my team creates these fact sheets. It's truly very helpful for our colleagues in the infusion area. It's a very quick guide for them to use if they have questions about the type of treatment they're infusing to patients.
Let me switch gears here, Doyle. As I mentioned earlier, you've been in the research arena for 17 years. I've actually been in research for 14 years, and I still feel like every single day is a new day, and it's very interesting. It's a new type of nursing. For our listeners who are new nurses or graduate nurses, is this something in nursing that they can look forward to?
Mr. Bosque: I think that one of the best things about the nursing profession is its diversity. There are so many opportunities for nurses to engage in other elements of the medical profession, because nursing is not just simply taking blood pressures and starting IVs anymore. There are so many opportunities within the nursing profession to expand your knowledge, and research is one of those areas. I started out in the operating room as an OR nurse, but as an OR nurse, you only get to see the patient 20 minutes before the surgery and then 20 minutes after the surgery, and then you never see that patient again. While I loved being in the OR, I missed the continuum of taking care of a patient and seeing their outcomes as they moved along their journey, and research nursing provides that.
Research nursing provides you the opportunity to not only know your patients, bond with those patients, and be along with them on that journey, but it also allows you to be their support mechanism. It allows you to be a part of their family and go along with them on that journey. Once our patients here at MD Anderson hear the word "cancer," everything stops. They no longer hear anything that you're saying to them. That's where the research nurse plays an important role in ensuring that not only the patient, but their family as well, receive the support and the resources they need to alleviate those stresses that come. They don't need to worry about making sure their schedule is right—that's our job. They don't need to make sure they know how to get from one place to another—that's our job.
Being a research nurse not only allows you to provide the direct patient care that's part of nursing, but it also allows you to be involved in the scientific part of it. You may be part of a study that is trying to determine if this new therapy is better for potentially curing cancer or at least making it stable and replace the old standard of care. That's how we keep learning, by instituting these new therapies so that we can make cancer a thing of the past. Research nursing, to me, is one of the most exciting disciplines there is. You get to have direct patient care, but you also get to be a part of the scientific piece of it where you see how these drugs work. You are part of ensuring that the side effects are noted and that there are treatments for them and that the patient is taken care of.
I think that it's a very exciting field. It's always changing. There are always new therapies coming out that we're learning about. Here at MD Anderson, when we say we're making cancer history, when we institute a protocol for the first time and we give it to that patient with a new therapy, we are making cancer history because it's the first time in the world that it's ever been administered. I've always encouraged nurses to look at research and to consider it in their professional career ladder as something that gives you a little bit of everything: direct patient care and the scientific part of making patient care through evidence-based practice even more improved.
Ms. Badillo: That's correct. Well, thank you so much, Doyle, for your time and your very insightful information. Definitely for me, working in research for all these years, I feel like I have not learned everything yet. Every time that you get a new treatment, it's a new thing to learn, and it's nonstop learning. This is one area of nursing that is very, very exciting. You get to be a part of not only giving the treatment, but learning the disease and learning the drug, as well. Thank you so much, Doyle, for your time, and happy Nurses Week.
Mr. Bosque: Happy Nurses Week. Thank you very much.
About Ms. Badillo and Mr. Bosque
Maria Badillo, MSN, RN, OCN®, CCRP, is the Research Nurse Manager in the Lymphoma/Myeloma Department at The University of Texas MD Anderson Cancer Center. As a clinical trial manager, she develops research programs, manages protocol design and implementation, and coordinates patient participation in phase 1, 2, and 3 clinical trials. Ms. Badillo has been a speaker at several conferences, including the Oncology Nursing Society Congress and the Academy of Oncology Nurse and Patient Navigators Conference. Her research focuses on the development of novel therapeutics for patients with hematologic malignancies and the management of treatment-related adverse events.
Doyle Bosque, RN, is the Director of Nursing Research Programs at The University of Texas MD Anderson Cancer Center. He has been a nurse for 27 years and has spent 17 years working in the research nursing community. Mr. Bosque plays in integral role in the oversight and direction of the team which manages MD Anderson's clinical trials. In addition, he collaborates with frontline staff to ensure patient safety and compliance through innovative methods such as the development and implementation of trial protocol fact sheets.
Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor.