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Honoring Our Nurses Creative Approach To Cancer Care During COVID-19

When the coronavirus (COVID-19) stormed the U.S. in March, its swift spread took most of the country by surprise. Many felt frightened and unprepared, but armed with years of experience in taking on the most complex challenges, our Kimmel Cancer Center nursing team was ready.

Cancer treatments often deplete immune cells, weakening the immune system, so the COVID-19 pandemic placed cancer patients among the most vulnerable to infection.

Within days of the outbreak, Gina Szymanski, M.S., R.N., interim director of nursing and Incident Commander, and MiKaela Olsen, DPN, APRN-CNS, clinical nurse specialist and Operations Chief of the Kimmel Cancer Center’s Covid-19 Command Center, had opened the Curbside Shot Clinic—a drive-up treatment delivery system—for outpatients and a special Urgent Care Bio Clinic for cancer patients infected with the coronavirus.

Patients are able to drive up to the front of the Skip Viragh Outpatient Cancer Building, where they are met by nurses Lori Parker, B.S.N., R.N., and Dania Connor, C.M.A., to have their blood drawn and checked, receive single injections of therapy drugs,  growth factors that stimulate the production of blood cells diminished by cancer treatments, cancer vaccines—every kind of treatment except for chemotherapy IV infusions—without ever leaving their cars.

“Patients were afraid and were canceling appointments for important care,” explains Olsen. “We had to adapt to the circumstances and come up with a way to get them the care they needed while also protecting them from becoming infected with the coronavirus.”

They coordinated with the Kimmel Cancer Center’s information technology team to ensure they had full computer access and capabilities and had a dry run with patient stand-ins to make sure everything was working properly before they opened up to actual patients.

Olsen, a former Army nurse, saw the Curbside Shot Clinic as a type of field hospital. “We require the exact same standards for our drive up clinic as we do for our regular outpatient clinic,” she says.

“It’s in our DNA,” says Szymanski of Kimmel Cancer Center nurses’ rapid response to the unique challenges an infectious virus like COVID-19 presents to cancer patients. “This is the way we think.”

The curbside clinic was so well received by patients, Olsen and Szymanski are looking at expanding it to other Kimmel Cancer Center locations and exploring ways to continue it post-COVID-19. The biggest challenge nurses faced was getting patients and family members to remain in their cars. Many of them were so grateful to the nurses for this ingenious way of getting vital care to them, they wanted to hug the nurses.

“Their visits were streamlined. They didn’t have to pay for parking or arrange for cabs to and from the cancer center, go to different waiting areas or among different floors,” says Olsen of the high patient satisfaction.

To provide care to cancer patients with COVID-19-like symptoms or already diagnosed with the virus, the nursing team quickly converted space in the Weinberg Building into an urgent care biocontainment clinic. The clinic—which is available to patients at all of our Kimmel Cancer Center locations—was uniquely set up to care for patients with infectious diseases, keeping them safe and cared for while preventing the spread of the infection to other patients.

Szymanski drew upon a strong history to get the Bio Clinic up and running in less than three weeks. She built upon the urgent care model already in place in the cancer center aimed at keeping all cancer center patients’ care in the hands of cancer specialists and out of emergency rooms where they are at risk of coming in contact with all sorts of infectious illnesses. She also called upon experience from 1995 when she led a team that safely moved bone marrow transplantation—one of the most complex and intensive cancer therapies and one that used to require a month or more of hospitalization—to largely outpatient therapy. Opening the inpatient/outpatient (IPOP) unit, made it possible for patients to receive much of this intensive treatment as outpatients.

“History is important, and IPOP taught us that we can treat very sick patients as outpatients,” says Szymanski. “We don’t wing it, and we don’t place artificial limits on ourselves.  What we’ve done to help our patients during COVID-19 is a continuation of what we’ve always done. We place the right patient in the right care setting with the right care provider and implement safety principles to take what we’ve traditionally done one way to meet patients where they are now.”

Szymanski and Olsen are quick to credit their top-notch nursing team for the success of the Curbside Shot Clinic and Urgent Care Bio Clinic. “They are the best of the best; the most highly-trained nurses and problem solvers who adapt quickly and respond to every challenge.”

In a typical week, about 400 patients visit the Kimmel Cancer Center. One important service our nurses provide is guidance and education for cancer center patients to show them how to stay safe and monitor for illness and signs of other problems.

“We teach our patients how to protect themselves. They know the risk of the coronavirus and other illnesses, for that matter. They’ve been wearing masks, washing their hands and social distancing long before COVID-19,” says Olsen.

As a result of these ongoing efforts and special services, like the curbside clinic and urgent care clinic, just 26 cancer center patients became infected with the coronavirus—unrelated to their visits to Johns Hopkins—and most importantly, they all recovered.