The Exec: Quest for a Cancer-Free World Attracts Nurses to Cancer Nursing

Karmanos Cancer Hospital's mission to lead in cancer care strongly resonates with its nurses, its CNO says.

Karmanos Cancer Hospital in Detroit, the largest provider of cancer care and research in Michigan, has a bit of an edge in recruiting and retaining nurses, says Kathleen "Kay" Carolin, RN, MSA, its chief nursing officer.

Karmanos employs employment strategies typical of most hospitals—sign-on bonuses, competitive salaries, and additional education—but its mission of cancer care seems to resonate strongly in the nurses who work there, Carolin says.

Indeed, as a National Cancer Institute-designated comprehensive cancer center, Karmanos can offer exclusive treatments, as well as clinical trials, multidisciplinary teams of cancer specialists, and cancer prevention programs.

HealthLeaders spoke with Carolin about why nurses gravitate toward its mission of curing cancer and why, as Carolin has said, "Cancer nursing is nursing at its best."

This transcript has been lightly edited for brevity and clarity.

HealthLeaders: How do you apply your organization’s mission of curing cancer when recruiting nurses?

Kay Carolin:  I have always felt lucky that we are so mission-driven because it helps when times are really tough. Our mission is to lead in transformative cancer care, research, and education through courage, commitment, and compassion. The vision is a world free of cancer. Our nursing vision is to provide therapeutic, cost-effective nursing care to persons, families, and communities across the continuum and to be a regional, national, and international leader in oncology nursing, patient care, and education, through courage, commitment, and compassion.

People don’t come into cancer nursing without [an impetus]. When I sit down with brand new grads who are coming in, or with nurses who have been here for a while, people come to cancer nursing for a reason, and I have found that it often has to do with someone that they loved a lot, or something that they saw that was very powerful, and it resonates with them. And they do nursing with that in mind.

We are a comprehensive cancer center and academic medical center, so some of the cool stuff is that you’re participating in research, you're seeing cutting-edge stuff, and you have an opportunity to be part of what's coming next. We're involved with nearly 70% of all new drugs approved in the United States for cancer treatment, and we typically offer those treatments to patients up to a year before they're commercially available, and that is really exciting. So, there's that whole thing of being part of something bigger than yourself.

Getting back to what I was saying earlier, when we talk about being with patients through the continuum, we really mean through the continuum. We do a lot with bone marrow transplants, so we see patients for periods of time as we’re getting them prepped. Then they come in for transplant and they may be here for up to six weeks and we’re with them all the time in these powerful, intimate periods, so you have these relationships, and that's often what keeps you going during tough days, because there's somebody there that you have a commitment to and that you've come to care for.

Kathleen "Kay" Carolin, chief nursing officer, Karamos Cancer Hospital / Photo courtesy of Karamos Cancer Hospital

HL: What is unique about being a nurse in a cancer hospital as compared to an acute-care facility?

Carolin:  When we think about an intensive care unit in an acute-care hospital, the intensity of it can be diffused a little bit because you get varied patients with pneumonia, COPD, vascular surgery, or diabetic ketoacidosis. But the patients we see in our intensive care unit are always cancer patients. There will be cancer patients who are 19 or in their 20s or 30s, or cancer patients who have young kids at home.

That’s a real intensity of care and yet, it’s the opportunity to do the journey with your patients and their families through the continuum of care. To be the person who says, "OK, we've taught you how to take care of this, we taught you what you need to know, but if you get confused or if you get scared, you have my number and I'll talk you through it. I'm here. I'm going to keep you safe."

It’s a different kind of nursing care. I’m not saying it's the panacea and we have it covered on recruitment and retention, but it is easier to speak to it. It’s easier to talk about it, and I'm grateful for it.

HL: What kind of nurses gravitate toward working in a cancer hospital?

Carolin: Most of them have had cancer in their lives, so it means something to them to take care of these patients. It resonates. I can't tell you how often I've had people talk about their grandma that they loved so much.

I’ll tell you a couple of stories. I've got a wonderful nurse who is a childhood leukemia survivor and I remember saying, "How did you have the courage to have gone through this as an 11-year-old with all the fear of that experience and then come back full circle and work with patients needing bone marrow transplants?" That’s incredible courage. It’s facing your fears day in and day out.

I have this amazing nurse who was an attorney and his young wife died of cancer. He had an “Aha” moment and looked at the meaning of his work and his life and went back to school and became a nurse. To watch him provide care just blows you away.

These nurses take such great care of the patients, and they do the journey with them. It's pretty profound to watch them.

HL: You have said, "Cancer nursing is nursing at its best." What do you mean by that?

Carolin: I don’t think any nursing is easy, and I've done a lot of different kinds of nursing. There are a lot of easier ways to make a living than to be a nurse, so if you're a good nurse, you love what you do. But cancer nursing is nursing at its best. I think that is absolutely true.

HL: Can you provide some examples of extraordinary cancer nursing?

Carolin: It just goes on and on. I think of the patient who had been here who didn't have any family and it was her birthday. I saw her primary care nurse come in with her son on her day off with balloons and magazines. I said, "What are you doing here today?" and she said, "It’s my patient’s birthday and she doesn't have anybody, so we've come."

I think of the young man who we knew was going to die probably that day and didn't have any family. And I said to his nurse later, "What are you doing here? I thought your shift was long over," and she said, "Well, I’m just staying. I don’t want him to die alone."

During COVID in the ICU, we had a patient—she was a physician with lots of anxiety—and she was passing. That was when COVID was really bad, and we weren't letting people in, and I had two nurses who tag-teamed it and who never let her be by herself. One of them was always in there with her holding her hand, doing the journey with her.

Those are just some little stories, but they happen every single solitary day. And then there's all the joyful ones, too, all the miracles that you can't even believe. We do so much celebrating, too.