A day in the life of an Anthony Nolan transplant nurse

Susan Paskar is an Anthony Nolan Clinical Nurse Specialist working at the Newcastle Freeman Hospital. To celebrate World Nurses Day, here she talks to us about her average day, and what working with transplant patients means to her.

It doesn’t matter how early l wake up – mornings are always a bit of a mad dash to get out the door! Luckily, my son goes to a primary school near to the hospital. I drop him off at breakfast club and get to work just in time to change into uniform for 8am, when my day as an Anthony Nolan Nurse Specialist starts.

With an essential mug of coffee in hand, I spend some time at my desk going through emails, as well as checking which transplant patients have been admitted or discharged, and who I’ll be seeing in the out-patient clinic that day.

I attend a number of Bone Marrow Transplant (BMT) team meetings throughout the week. Typically we have a multi-disciplinary team (MDT) meeting, consisting of nurses from the teams on the wards, the medical team (consultants, registrars and junior medics), social workers, dietitians, pharmacists, microbiologists, virologists, physiotherapists, and the palliative care team. Whoever said ‘it takes a village’ was probably talking about caring for transplant patients!

Later in the morning, I take calls from our patients and family members who have questions or concerns. This might lead to me recommending that they come to the hospital to be reviewed by the team, or the solution may be something that I can arrange with their GP or local haematology unit. Some patients live more than two hours from the hospital so it’s important to make sure they get the appropriate care in the right place.

People often call me just to talk through their problems. It’s comforting for patients to be able to speak to an experienced nurse who understands the complexity of the impact that transplant has – both on their health and their social wellbeing – for many years after treatment.

I work full-time looking after patients post-transplant, and the majority of my work deals with those who’ve had their transplants more than 6-12 months ago. Although some people recover relatively quickly, it’s more common that the journey afterwards is somewhat bumpy. Some of the issues mostly commonly faced are fatigue, recurring infections, GvHD and the fear of relapsed disease, and it’s my job to provide support and guidance as much as possible.

We’ve now started a nurse-led, long-term follow-up clinic, where people who need routine after-care can come to have their blood checked and discuss anything that might be troubling them.

On our usual clinic days we see patients who have been discharged from the wards more recently, or who need to be seen by the team more regularly. I help organise prescriptions, transfusions, scans and biopsies, and plan further top-up infusions of donor lymphocytes.

Lunch tends to be an afterthought, and it’s usually a quick bite while I’m back at my desk answering emails and phone messages.

Every week, two or three patients may need extra cells to help improve the amount of donor cells in their bone marrow, known as a Chimerism Level. I arrange for the scientists from the Stem Cell Laboratory to bring some of the cells that we’ve stored from the original transplant and give them to the patient.

My days are busy and usually fly by, so before I know it 5 o’clock has come around and it’s time for a quick change to go and collect my boy from school. He’s usually sweet enough to ask me ‘How was your day, Mummy?’ (although since he’s a clever kid, I suspect this is a move to stop me interrogating him about his school day!)

It’s hard to describe the relationships that we build with our patients. It’s a privilege to get to know a patient, as well as their partners, children and parents. We meet them before transplant, although many of them have already been through several rounds of treatment and chemotherapy. They then go on to be cared for by the BMT team for many years. We witness many aspects of their lives – marriages, births of children and grandchildren, and sadly, deaths. But the ongoing relationship with patients is one of the reasons I love my job.

Oncology and Haematology attracts some very special staff and I feel very lucky to be working with a great team, who care for their patients every bit as diligently and kindly as they would want themselves and their own family members to be treated.

I worked in California for many years in BMT before returning to the UK four years ago; I know that the Newcastle Team provides a world-class service, and I’m pleased to be able to bring my previous BMT experiences back to the NHS to build on our existing work.

At the end of the day I watch a bit of television, with a cup of tea or a well-earned glass of wine (if it’s Friday!) and do my best to unwind. Sometimes my thoughts wander to those patients and families who I’ve seen during the week, and I think about the difficult journey they are on; I wonder how they’re coping.

But nothing beats the feeling of seeing those patients who have overcome turbulent times and come back to the clinic thriving – telling me stories about their families, new jobs, holidays, and the milestones they’ve celebrated. I’m grateful to play a part in their recovery, and I use that knowledge and these moments to encourage future patients through their tough times.

Find out more about the resources Anthony Nolan offer to patients on our website at www.anthonynolan.org/patients-and-families