A day in the life of a nurse who works 10-hour shifts in an NYC cancer unit keeping patients comfortable in the midst of a national drug shortage
This is Czarina Cecilio, a registered nurse at the Multiple Myeloma Center at Weill Cornell Medicine in Manhattan. Cecilio has been working there since 2008, starting as a med tech and working her way to become the center's clinical nurse liaison.
At first, Cecilio avoided the job because of "the whole stereotype of if you're Filipino, you must be a nurse," as she told Business Insider. She got her undergraduate degree in anthropology and went into medical research.
She eventually got a spot as a medical technician, an entry-level nurse job. While she enjoyed her work as a med tech, she found herself unable to answer many of her patients' questions regarding treatment. She went to nursing school to get a more thorough medical education.
As clinical nurse liaison, Cecilio performs the traditional duties of a registered nurse, while also helping manage the office, ensure patient medication has arrived, and assisting the clinic's main physician, Dr. Ruben Niesvizky.
Cecilio is the head RN of the practice, and her main responsibilities include educating patients on their therapy regimen and helping them get medication, supervising medical technicians, and keeping the clinic workflow organized.
Her day starts at around 7:30 am, when she drops off her son Ezio at daycare. The daycare has a partnership with the Weill hospital system, so many working parents drop their kids there, too.
Cecilio is typically one of the first to arrive at the office. She uses the extra time to catch up on emails and make sure the medication is confirmed for all the patients.
Cecilio helps administer lifesaving medicine to myeloma patients. Myeloma is a type of cancer that affects cells in bone marrow. Cecilio says while the cancer isn't curable, it's treatable.
Before meeting with patients, Cecilio goes over the patient schedule with Dr. Ruben Niesvizky, an oncologist and the director of the myeloma center, and Stephen Veefkind, an infusion nurse. She meets with them at around 8 am. (Niesvizky is wearing the white coat, Veefkind wears the red scrubs.)
Infusion nurses are a type of RN with a license to inject medicine into myeloma patients with an intravenous line. Injecting medicine into patients can be tricky, especially if their veins are thin. A patient told me sometimes it can take her 20 minutes to get injected.
Cecilio then starts meeting with patients. She brings them to the exam room to take their weight and blood pressure, among other vitals.
Cecilio is sometimes assisted by med techs in the exam room. A med tech is an entry-level nursing assistant position. Responsibilities include making sure patient information is documented on the electronic medical system, and assisting registered nurses.
While Cecilio keeps track of her patients' status, she sometimes still needs reference books to help make sense of some of the conditions and medications.
Cecilio also uses a color-coordinated notebook to keep her patient information organized.
Cecilio says a lot of her job involves "pushing paper" — or coordinating schedules and medicines — along with actually interacting with patients.
Cecilio then meets with her patients to talk about their treatment, along with Niesvizky. Cecilio has close relationships with her patients, including Mary Jane Reilly (pictured).
Reilly was the only patient who consented to being photographed. She has been a regular patient with Cecilio, and the two text each other and talk about their kids.
Reilly and the nurse had been texting earlier in the day to discuss some issues with her treatment. There is a nationwide shortage of the drug that treats myeloma, which has complicated Cecilio's job.
The medicine, intravenous immunoglobulin (IVIG), treats myeloma patients by raising their body's antibodies, or cells that fight infection.
Recently, the production for medicine slowed, causing a nationwide shortage, due to "insufficient production capacity, manufacturing-quality problems and quirks in the reimbursement system for some drugs," according to The Wall Street Journal. Demand for IVIG has also risen due to increased uses for the drug.
Due to the shortage, Cecilio spends more time on the phone with manufacturers and drug providers in an effort to secure the treatment.
After Cecilio and Reilly discuss her medicine, she brings the patient into the treatment room where she gets injected. Reilly says she spends her treatment hours catching up with friends and family, as well as reading.
Because myeloma patients tend to need long-term treatment, Cecilio says a lot of them become friends with each other at the clinic.
One of the main reasons why Cecilio chose to work as a nurse in a myeloma clinic was because of the bond she forms with patients. While ER nurses, for instance, only see people for hours at a time, cancer nurses see their patients during long-term treatment.
Cecilio said losing patients can be hard for her, but she enjoys developing close relationships with their friends and family.
"With myeloma, it's an incurable disease, [but] it's treatable, so that's why we see these patients all the time," Cecilio said. "You get to build a relationship with these patients."
In between seeing patients, Cecilio takes more calls from medicine providers, manages patient schedules, and deals with day-to-day issues around the clinic. Cecilio said the biggest part of her job is making sure Niesvizky's day runs smoothly.
Niesvizky said he and Cecilio have a close bond, as they've known each other since she was a med tech in 2008. Niesvizky said the qualities he looks for in a nurse are organizational skills, a positive attitude, and the ability to remain calm in stressful situations.
Cecilio said the hardest part of her job is making sure everybody's happy. "Not from just a patient's view, but also with the physicians and overall practice — a positive morale," Cecilio said. "Why is that so challenging? Because sometimes patients can be a little bit needy."
To take a break from her job, Cecilio goes to the daycare at 3 pm each day to meet her husband while he picks up Ezio.
Many nursing organizations encourge professionals to take breaks to avoid burnout, one of the biggest problems facing the job right now.
During the day I shadowed her, patients would sometimes interrupt her workday to ask questions, which Cecilio calmly answered. Receptionists, secretaries, and med techs also frequently came up to Cecilio asking questions regarding patients and Niesvizky's schedule.
Cecilio said the best thing about being a nurse is the career flexibility. While an oncologist can't easily become a neurosurgeon, registered nurses can easily hop between specialties by taking a course or two.
In the photo, Cecilio sends blood sample up to another floor via a special delivery tube.
Cecilio said her long-term plan is to become a nurse practitioner. NPs can open their own clinics and administer treatments, but they have less flexibility in switching between specialties than RNs do, Cecilio said.
There are three major types of nurses: licensed practical nurses, registered nurses, and nurse practitioners.
LPNs perform basic caretaking tasks like dressing wounds, taking blood pressure, and bathing patients. LPNs must pass the National Council Licensure Examination for Practical Nurses (NCLEX-RN), and are supervised by RNs. The role only requires a high school degree in most cases, according to NursingLicensure.org.
RNs tend to work in hospitals, and while they can provide care without supervision (unlike LPs), they cannot diagnose patients or prescribe them with medication. RNs must hold at least a bachelor's or associate degree, and pass the NCLEX-RN.
NPs must have a master's degree. NPs can diagnose and prescribe medication, on top of performing the duties of an RN. They typically work in private practices or community health clinics, according to Jacksonville University. They also earn the most money: NPs make over six-figures on average, the Bureau of Labor Statistics finds, while RNs make about $70,000 and LPNs make $46,000 a year.
Cecilio said she currently makes $4,000 a month.
Cecilio's day ends around 6 pm. Her husband, Ralph, had already picked up her son from daycare around 3 pm, so she meets them both at their home in Queens.
Cecilio sometimes catches up on paperwork after clocking out. She has a home office where she responds to emails.
At around 8 pm, Cecilio puts her son to bed, and gets ready to call it a night herself.
"[Nurses] can go in any division: I can go to ER nursing as long as I get my certification," Cecilio said. "I don't have to stay where I am, but I do only because I like the people I work with, I like the patients I interact with."
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