Exploring the Pediatric Oncology Specialty

Podcast Transcript

Carol Pehotsky (00:00):

I am always fascinated by other nurses' stories and how they ended up in the specialties, where they really found their place. Especially those specialties where I think, whew, there's no way I could have done that. I'm joined today by Meredith Foxx to talk all about the joy she found in pediatric oncology. Hi, and welcome to Nurse Essentials, a Cleveland Clinic Podcast where we discuss all things nursing. From patient care, to advancing your career, to navigating tough on the job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

(00:45):

Welcome back everyone. We've had some episodes already so far that really delved into different specialties within nursing. And with the planning group as we talk about topics, sometimes as that balance of, what is a specialty that, even if people aren't in that specialty, they could learn something from? You know, we, we talked about psychiatric nursing, we know that we need those skills in a variety of settings. We've talked to our home care professionals to really think about, even if I'm not in home care, what can I do to help set that patient for success when they do go home?

(01:15):

And this year we're going to try something new and delve into some specialties, just because we're fascinated, and we have fascinating people to talk to. Way back when, 20 plus years ago, when I was still in nursing school, every time I did a clinical, it's like, "I'm going to be that kind of nurse." And then I went to the next one and thought, "No, I'm going to be that kind of nurse." And the only one I knew I didn't want to be at, at the end of the day, was labor and delivery. Only because, you know, I saw one of the highest of highs, a baby being born and then, my very last clinical day was, fortunate it had a good outcome, but it could have been a devastating outcome from a c-section. And that was my, "Okay, I know what I don't want to do, but I'm open to everything else."

(01:52):

And in my last year or so, in one of my med surg clinicals, a very influential professor of mine, and she pulled me aside one time and she said, "Every week you've had an oncology patient and you've made a real connection with them. I think somebody's trying to tell you something." "Uh, I don't know about that." And so, for me, that direction ended up being care of the oncology patient following surgery. I really didn't feel like I had it in me to do that entirely at such a, a special specialty and calling. I didn't feel like I was really ready for that, but I did find great satisfaction in supporting people through their postoperative journey, when they had had cancer surgery.

(02:26):

And so, I'm delighted to welcome back Meredith Foxx. She's our Executive Chief Nursing Officer for Cleveland Clinic. But what you may not know is that she has a very special specialty, which is pediatric oncology. So, I know people sort of sometimes blanch a little bit when you tell them. (laughs).

Meredith Foxx (02:41):

How do you do that?

Carol Pehotsky (02:42):

It seems so intense. So, tell us a little bit about your... We'll start off with your nursing school journey and sort of w-when it sort of rang with you that this was either pediatrics or oncology or both. What, how did it speak to you?

Meredith Foxx (02:54):

So funny when you were talking about your nursing school experience-

Carol Pehotsky (02:54):

Mm-hmm. Mm-hmm.

Meredith Foxx (02:57):

... I also knew what I didn't want to do.

Carol Pehotsky (02:59):

(laughs). Okay.

Meredith Foxx (03:00):

Which was labor and delivery-

Carol Pehotsky (03:00):

Of course.

Meredith Foxx (03:01):

... and anything around, uh, childbearing women.

Carol Pehotsky (03:04):

Yes. (laughs).

Meredith Foxx (03:05):

And that did not ring true to me. I knew that right out of the gate. I will say that the rest of the rotations, I learned a lot.

Carol Pehotsky (03:12):

Mm-hmm.

Meredith Foxx (03:12):

But I always was gravitating towards pediatrics.

Carol Pehotsky (03:15):

Okay.

Meredith Foxx (03:15):

So, kind of out of the gate, I know I don't want to do labor and delivery-

Carol Pehotsky (03:20):

Maybe not grownups. (laughs).

Meredith Foxx (03:21):

... I know what I would like to do, (laughs), not grownups, but I really, really want to do pediatrics. And then, you know, the oncology piece came over time, when I learned different things about the specialty, caring for the patients across the continuum and the complexity as well.

Carol Pehotsky (03:21):

Mm-hmm.

Meredith Foxx (03:36):

I used to joke and say, "I don't like cardiac, I don't like neuro."

Carol Pehotsky (03:41):

Okay.

Meredith Foxx (03:41):

"I don't like GI."

Carol Pehotsky (03:41):

(laughs). Oftentimes. Yes.

Meredith Foxx (03:41):

But anyone who knows taking care of patients with cancer, you're kind of working with all body systems.

Carol Pehotsky (03:47):

Absolutely. Yeah.

Meredith Foxx (03:47):

And just really started to think about that subspecialty as... And everyone would say, "Oh my God, how-

Carol Pehotsky (03:47):

Right.

Meredith Foxx (03:54):

... how are you going to take care of kids with cancer?" It's pretty rewarding. It's pretty sa-

Carol Pehotsky (03:57):

Okay.

Meredith Foxx (03:57):

... satisfying. And there's so much good that happens every day, that outweighs the bad. Then I also had an experience where I was volunteering during nursing school at a children's rehab facility.

Carol Pehotsky (04:09):

Okay.

Meredith Foxx (04:09):

So, it would, you know, be a kind of post-acute area.

Carol Pehotsky (04:11):

Hmm.

Meredith Foxx (04:11):

And they would always put me with this young gentleman who gave me a run for my money.

Carol Pehotsky (04:17):

Oh, (laughs). How so?

Meredith Foxx (04:18):

You know, I wasn't allowed to do any clinical care, because I was a volunteer.

Carol Pehotsky (04:20):

Sure. Yeah. Mm-hmm.

Meredith Foxx (04:20):

So, I was really there to entertain him, talk to him-

Carol Pehotsky (04:20):

(laughs).

Meredith Foxx (04:23):

... and boy did he keep me on my toes.

Carol Pehotsky (04:25):

Okay. (laughs).

Meredith Foxx (04:26):

And again, you know, because of my role, I really didn't know what, why he was there or what was originally wrong with him.

Carol Pehotsky (04:26):

Sure.

Meredith Foxx (04:33):

And I had my speculations, you know?

Carol Pehotsky (04:33):

Mm-hmm.

Meredith Foxx (04:35):

I was in nursing school, so you're assessing.

Carol Pehotsky (04:36):

Just trying to connect some dots there.

Meredith Foxx (04:38):

Yeah. And I would sit with him and have his meals, we'd watch TV together, we'd do puzzles, we'd color. Sometimes he would just sit there and be angry in his bed and...

Carol Pehotsky (04:46):

Sure.

Meredith Foxx (04:47):

You know, so there were different venues. And at the time, thinking back, I, I was like, "Oh, he must have been in some type of accident where he had burns."

Carol Pehotsky (04:55):

Hmm. Oh boy.

Meredith Foxx (04:55):

Because of the way he was presenting with his skin.

Carol Pehotsky (04:57):

Yeah, yeah.

Meredith Foxx (04:58):

And so, I was like, "Oh, you know, this must be what happened."

Carol Pehotsky (05:00):

Mm-hmm.

Meredith Foxx (05:00):

Again, respected that I wasn't allowed to know. Then fast-forward, I was doing my practicum rotation-

Carol Pehotsky (05:00):

Mm-hmm.

Meredith Foxx (05:06):

... and I decided to do pediatric oncology in-patient-

Carol Pehotsky (05:06):

Okay.

Meredith Foxx (05:09):

... as my senior practicum. So, again, kind of that, "Yes, I want peds. Yes, this is what I, I want. I think I want it. Let's confirm."

Carol Pehotsky (05:17):

(laughs). What a beautiful opportunity.

Meredith Foxx (05:18):

Uh, and it was amazing.

Carol Pehotsky (05:18):

Yeah. Yeah.

Meredith Foxx (05:19):

It was an amazing opportunity. And that young gentleman ended up on-

Carol Pehotsky (05:23):

Hmm.

Meredith Foxx (05:23):

... he was in our unit a lot.

Carol Pehotsky (05:25):

Really? Ugh!

Meredith Foxx (05:25):

And I found out that he had had a bone marrow transplant and that was how his graft versus host disease was presenting.

Carol Pehotsky (05:31):

Oh geez.

Meredith Foxx (05:31):

And so, again-

Carol Pehotsky (05:32):

Did he recognize you?

Meredith Foxx (05:33):

He did. (laughing). Yeah, he did. And he was quite a trooper at the time. He was a pretty funny little, little guy there. But, you know, so then kind of, delving into that, all these different complexities, but really, just taking care of the kids. For those of you that might not be familiar with pediatric cancers, the survival rate's really high for a lot of them.

Carol Pehotsky (05:33):

Mm-hmm.

Meredith Foxx (05:53):

So, a lot of kids survive.

Carol Pehotsky (05:54):

Okay.

Meredith Foxx (05:55):

And so, I forget the statistic, but out there, there, you're probably talking to a lot of different adults who have survived pediatric cancer.

Carol Pehotsky (05:55):

Yeah.

Meredith Foxx (06:00):

Hell, I can name at least five nurses I-

Carol Pehotsky (06:00):

Wow.

Meredith Foxx (06:02):

... have worked with over the years who-

Carol Pehotsky (06:02):

Really?

Meredith Foxx (06:04):

... you know, are pediatric oncology nurses, because they had cancer as a child.

Carol Pehotsky (06:04):

Had cancer? Oh, gosh.

Meredith Foxx (06:07):

And so, wanting to kind of give back-

Carol Pehotsky (06:07):

Yeah.

Meredith Foxx (06:09):

... and have that understanding. And so, that's the good news, right?

Carol Pehotsky (06:09):

Mm-hmm.

Meredith Foxx (06:12):

And so, even that's its own subspecialty-

Carol Pehotsky (06:13):

Sure. Yeah.

Meredith Foxx (06:14):

... trying to manage the, you know, the late effects from that.

Carol Pehotsky (06:17):

Yes.

Meredith Foxx (06:17):

But really, again, that kind of complexity, the continuum, the caring for patients and the whole family, through a lot of ups and downs, can be very isolating for those patients and their family members.

Carol Pehotsky (06:28):

Mm.

Meredith Foxx (06:29):

Particularly, you know, having to learn all the lingo, having to understand all of it, and then trying to explain it to others. So, you know, you do kind of become their family. (laughs).

Carol Pehotsky (06:39):

Yeah.

Meredith Foxx (06:39):

And they're kind of their people. So, I loved my practicum rotation and that was really the specialty that I settled on.

Carol Pehotsky (06:46):

All right. I feel like I encounter a decent number of nursing students or new graduate nurses who, "I want to do pediatrics." And it's a beautiful specialty. There probably isn't a pediatric role for every nurse who wants to be ped. So, for nursing students out there that are sort of leaning that way, what advice might you give them to help them sort of crystallize what is it they're looking for and what if there isn't a ped position available?

Meredith Foxx (07:09):

Well, I think the first thing you have to know is that, while you're, the child or the adolescent or the infant is your patient-

Carol Pehotsky (07:15):

Mm-hmm.

Meredith Foxx (07:15):

... primary patient, the whole family is their patient.

Carol Pehotsky (07:16):

(laughs). Yeah. Yeah.

Meredith Foxx (07:18):

And families come with a lot of different... You're taking care of the whole family.

Carol Pehotsky (07:18):

Mm-hmm. Mm-hmm.

Meredith Foxx (07:21):

And not that you're not taking care of the whole family in other specialties, but-

Carol Pehotsky (07:24):

It's a different dynamic.

Meredith Foxx (07:24):

... it's a different kind of dynamic.

Carol Pehotsky (07:26):

Yeah.

Meredith Foxx (07:26):

They're responsible for decision making. You sometimes become... I'm, I'm not a parent, I don't have my own children, but you sometimes become a parent-

Carol Pehotsky (07:33):

Sure.

Meredith Foxx (07:33):

... in the day to day because you have to, you know, respect boundaries. You have to discipline, you know?

Carol Pehotsky (07:34):

Uff. Right.

Meredith Foxx (07:39):

If parents aren't there or you have to hold true-

Carol Pehotsky (07:39):

Mm-hmm.

Meredith Foxx (07:41):

... to what the expectations are of the family unit. And then, you know, you do get that fun. (laughing).

Carol Pehotsky (07:47):

Sure.

Meredith Foxx (07:47):

Uh, you know, I can remember many a holiday, doing different activities with kids because they were in the hospital and trying to bring what normal kids without a chronic illness or a diagnosis like that outside the hospital. How do you bring what they should be experiencing to the hospital-

Carol Pehotsky (07:47):

Sure.

Meredith Foxx (08:03):

... or to wherever their care setting is?

Carol Pehotsky (08:05):

I can also imagine too, there are probably scenarios where there's quite a bit of ethics involved.

Meredith Foxx (08:05):

Mm-hmm.

Carol Pehotsky (08:09):

In terms of, you know, we have our own opinions of what should be happening. If it's an adult patient, you know, we can have that conversation with them to educate them. But when it's a child and the family, do you have an example of where you really had to work through sticky situations where maybe, what was happening there might not have been aligned with-

Meredith Foxx (08:26):

Oh yes. All the time. All the time.

Carol Pehotsky (08:27):

... (laughs), the medical advice?

Meredith Foxx (08:28):

I mean, I think, a couple things I will say is that, if you go to the reading and you went to like literature and evidence-

Carol Pehotsky (08:34):

Mm-hmm.

Meredith Foxx (08:34):

... and the basics of ethics, there's consent, there's ascent.

Carol Pehotsky (08:37):

Mm-hmm.

Meredith Foxx (08:38):

If you look at some of the ascent literature out there, it says you should be getting children's ascent as young as six or seven.

Carol Pehotsky (08:43):

Oh wow.

Meredith Foxx (08:44):

Right.

Carol Pehotsky (08:44):

Oh wow. Yeah.

Meredith Foxx (08:44):

So those of you that have kids yourself we're thinking about, you know-

Carol Pehotsky (08:45):

(laughs).

Meredith Foxx (08:47):

... them agreeing to the treatment and that's kind of intense, right?

Carol Pehotsky (08:48):

What does that look like? Yeah. How do you get them in a place where they can give ascent? Yeah.

Meredith Foxx (08:51):

And so, do you really understand that? A lot of conversations in the ethics space about full disclosure-

Carol Pehotsky (08:57):

Hmm.

Meredith Foxx (08:57):

... and making sure, and, you know, this goes beyond pediatrics. I mean, thinking about just how we disclose to kids if parents are ill.

Carol Pehotsky (09:02):

Sure. [inaudible 00:09:03].

Meredith Foxx (09:03):

And how do we mana- what language we do, yeah, do we use. I'll never forget, there was a mother who didn't want to tell her son that he was diagnosed with leukemia. He was 16.

Carol Pehotsky (09:11):

Oh, that's tough. Yeah.

Meredith Foxx (09:12):

And she did not want to tell him.

Carol Pehotsky (09:12):

Mm-hmm.

Meredith Foxx (09:15):

And there was a lot of convincing on, I was on the in-patient side, a lot of convincing on the out-patient, because that's how he was coming into the hospital, from the out-patient setting. And it was really tough on all of us because-

Carol Pehotsky (09:26):

Yeah.

Meredith Foxx (09:27):

... we knew he was going to walk over and see all of them, the children without hair.

Carol Pehotsky (09:30):

Right. And why I'm here?

Meredith Foxx (09:31):

So, "Why of all the pe- ... And why am I here?

Carol Pehotsky (09:32):

Yeah. Yeah. Mm-hmm.

Meredith Foxx (09:33):

And so, it was a clue and a cue right away.

Carol Pehotsky (09:35):

Mm-hmm. Mm-hmm.

Meredith Foxx (09:35):

And, you know, so there, that was really hard to manage because-

Carol Pehotsky (09:38):

Yeah.

Meredith Foxx (09:38):

... that's not our expectations-

Carol Pehotsky (09:40):

Sure.

Meredith Foxx (09:40):

... or what we would want to happen.

Carol Pehotsky (09:42):

Right.

Meredith Foxx (09:42):

We would want to tell them ahead of time, we would want to be able to disclose it.

Carol Pehotsky (09:42):

Right.

Meredith Foxx (09:46):

But then that's where you get into the-

Carol Pehotsky (09:47):

The actual respect of parents.

Meredith Foxx (09:48):

... ethical respecting.

Carol Pehotsky (09:48):

Yeah.

Meredith Foxx (09:49):

I have a particular example, a young girl I was taking care of had relapsed multiple times with leukemia. And she was at the end of life at that point.

Carol Pehotsky (09:58):

Mm-hmm.

Meredith Foxx (09:58):

And she was asking a lot of very intense questions, you know?

Carol Pehotsky (10:00):

Sure.

Meredith Foxx (10:01):

All of us as nurses, you know, you can all picture yourself standing in an IV pole and you're talking to your patient as you're checking everything-

Carol Pehotsky (10:08):

Yeah. Hanging the piggyback or what have you, [inaudible 00:10:10]. Yeah. Yeah.

Meredith Foxx (10:09):

... hanging, yeah, hanging the piggyback, checking the pump, making, plugging it in.

Carol Pehotsky (10:11):

(laughs). Yes [inaudible 00:10:12].

Meredith Foxx (10:12):

And, you know, never in a million years did I imagine a 10-year-old was going to ask me if there were ladybugs in heaven. (laughs).

Carol Pehotsky (10:12):

Ooh. Oh.

Meredith Foxx (10:18):

And I was like, "Ah, sure."

Carol Pehotsky (10:19):

Yeah. (laughs).

Meredith Foxx (10:21):

"Oh, is there snow?" "Sure." And, you know-

Carol Pehotsky (10:21):

Oh, boy.

Meredith Foxx (10:23):

... I came out of that room and kind of like gob smacked, like, "Yeah. I just, did I lie to her?"

Carol Pehotsky (10:27):

[inaudible 00:10:27].

Meredith Foxx (10:27):

I mean, no. And then, fortunately the team members around me, it was great to have that support to say-

Carol Pehotsky (10:27):

Yeah.

Meredith Foxx (10:32):

... "No, you didn't lie. Because A-

Carol Pehotsky (10:34):

Right.

Meredith Foxx (10:34):

... we don't really know but, was she comfortable with what you saying? Sure." Because her answer, she wanted to know if there was going to be ladybugs, because it was her favorite-

Carol Pehotsky (10:41):

Aww.

Meredith Foxx (10:41):

... animal and she wanted to know if there was going to be snow, because she had just gotten snow boots. So, she wanted to know if they were both going to be there at the same time. And so, I mean, as she was just coloring away. So, a lot of conversations and a lot of ethics around, you know, when do you have these conversations? What do you disclose?

Carol Pehotsky (10:56):

Sure.

Meredith Foxx (10:56):

And um-

Carol Pehotsky (10:56):

And sort of meeting the kiddo where their energy is.

Meredith Foxx (10:58):

Yes, exactly. And you could have a lot of different conversations and philosophical discussions around-

Carol Pehotsky (10:59):

Sure.

Meredith Foxx (11:04):

... "Was that right or wrong?" She just went on coloring after I answered the question.

Carol Pehotsky (11:08):

It, it was what she needed at the time.

Meredith Foxx (11:09):

Mm-hmm. I think when it comes to parents, the same thing. I had another experience with a young gentleman who had, uh, neuroblastoma, which is not, uh, a very... Even today, some of the long-term survival rates are not great.

Carol Pehotsky (11:22):

Mm-hmm.

Meredith Foxx (11:22):

He had a very advanced disease, but the parents insisted on everything being done.

Carol Pehotsky (11:22):

Mm-hmm.

Meredith Foxx (11:26):

And so, I wanted him to go to the ICU.

Carol Pehotsky (11:28):

Okay.

Meredith Foxx (11:28):

And there was a lot of caregivers who-

Carol Pehotsky (11:30):

Oh.

Meredith Foxx (11:31):

... a lot of-

Carol Pehotsky (11:31):

Struggled with that?

Meredith Foxx (11:32):

... a lot of different nurses and stuff struggled with like, thinking that, you know, you're going to have him go to the ICU and be intubated and all this stuff and, is that quality of life?

Carol Pehotsky (11:41):

Mm-hmm.

Meredith Foxx (11:42):

And I remember the one physician at the time I was working with said, "Let's stop."

Carol Pehotsky (11:45):

Right.

Meredith Foxx (11:46):

"These parents have to know they did everything and-

Carol Pehotsky (11:49):

Yeah. That's what's right for them and their child.

Meredith Foxx (11:50):

... it's okay." Yeah.

Carol Pehotsky (11:51):

Yeah.

Meredith Foxx (11:51):

And so, having those people to kind of ground you as a team, so.

Carol Pehotsky (11:55):

Sure.

Meredith Foxx (11:55):

So, it was very melancholy and sad. Sorry.

Carol Pehotsky (11:57):

No, no.

Meredith Foxx (11:58):

Because there's lots of great stories. I, (laughs)-

Carol Pehotsky (11:59):

Well, yeah. But we'll go there in a second. But first I want to reflect on the fact that, you know, it's always important to have a team, and to be lifting each other up. But I can't even imagine how intense that has to be in a pediatric oncology setting, with those very examples you've given.

Meredith Foxx (12:14):

We would all lift each other up.

Carol Pehotsky (12:15):

Yeah.

Meredith Foxx (12:15):

And I've always seen it in the specialties where I've worked, where I've done clinicals, where any of that. You know, people come together, and they want what's best for the child and family and want to support each other.

Carol Pehotsky (12:25):

Sure.

Meredith Foxx (12:25):

It's human nature. You have commonalities with patients and families.

Carol Pehotsky (12:25):

Mm-hmm.

Meredith Foxx (12:28):

And sometimes people see their own children-

Carol Pehotsky (12:30):

Yeah.

Meredith Foxx (12:31):

... the same age or family members-

Carol Pehotsky (12:32):

Right.

Meredith Foxx (12:32):

... grandkids, nieces, nephews. And so, how do you kind of separate that and, you know, not see yourself in them or think about that? So.

Carol Pehotsky (12:39):

So, you mentioned that pediatric cancers have a very good survival rate-

Meredith Foxx (12:44):

Yes. Yes.

Carol Pehotsky (12:44):

... but unfortunately, there is that darker side, that reality, the melancholy, really for any nurse supporting patients with oncology needs. So how do you manage through that? A-again, the first time I heard that from you, I blanched as well. Pediatric oncology, you know, those really low days, right? The really tough days. How do you support the patients and families? And, and then, what did you do as a nurse to really, keep moving on?

Meredith Foxx (13:08):

Yeah. There's some self-preservation in it.

Carol Pehotsky (13:10):

Yeah.

Meredith Foxx (13:10):

But you also want to support the kids and their families in terms of meeting their goals.

Carol Pehotsky (13:17):

Mm. Sure.

Meredith Foxx (13:17):

It's super important for a kid to get to prom or a kid to-

Carol Pehotsky (13:17):

Hmm.

Meredith Foxx (13:20):

... get to kindergarten graduation or make their first communion and see them have some of those milestones.

Carol Pehotsky (13:27):

The outcome isn't-

Meredith Foxx (13:28):

The outcome is not-

Carol Pehotsky (13:29):

... it's not a cure, it's these other things.

Meredith Foxx (13:31):

Yeah. These are things that they want to do. Or, you know, I have one particular patient I still get Christmas cards from.

Carol Pehotsky (13:35):

Yeah.

Meredith Foxx (13:35):

And he's in his twenties. And there's another patient I took care of, she's a nurse on the first unit I worked on now.

Carol Pehotsky (13:40):

Oh, gosh, that's [inaudible 00:13:41].

Meredith Foxx (13:40):

And he has her own kids. So-

Carol Pehotsky (13:41):

Ooh, yeah.

Meredith Foxx (13:42):

... there are those great stories.

Carol Pehotsky (13:43):

Sure.

Meredith Foxx (13:44):

And there are more great stories than the sad stories.

Carol Pehotsky (13:44):

Okay.

Meredith Foxx (13:47):

So, I think that's what keeps you going. And then, just in terms of, recognizing that there's always new stuff on the horizon, you know?

Carol Pehotsky (13:47):

Mm, sure.

Meredith Foxx (13:54):

You know, I have a great sense of gratitude and myself, you know, when I would think of some of these kids, and maybe that's where I ground myself, is-

Carol Pehotsky (14:02):

Hmm.

Meredith Foxx (14:02):

... I've learned to drive, I went to my senior prom, I graduated high school, I graduated college.

Carol Pehotsky (14:06):

Yes.

Meredith Foxx (14:06):

So, like, all these things I can be grateful for that-

Carol Pehotsky (14:08):

That we have got to do, that not everybody does.

Meredith Foxx (14:09):

Yeah. And, you know, everything's relative. I get it.

Carol Pehotsky (14:09):

Yes. Yes.

Meredith Foxx (14:11):

But, knowing that some of the-

Carol Pehotsky (14:12):

Mm-hmm.

Meredith Foxx (14:13):

... kids and families, I took care of, they weren't going to see some of those milestones.

Carol Pehotsky (14:16):

Right.

Meredith Foxx (14:16):

But many of them have-

Carol Pehotsky (14:18):

Yes.

Meredith Foxx (14:18):

... and it's, they're good stories to tell.

Carol Pehotsky (14:20):

Alright. So, you didn't just stay at the bedside, you then went back to school, and you are advanced practice nurse times two.

Meredith Foxx (14:26):

Yes.

Carol Pehotsky (14:27):

You're a clinical nurse specialist and a nurse practitioner. Tell us about that.

Meredith Foxx (14:30):

So, I always knew I would advance my learning.

Carol Pehotsky (14:34):

Okay.

Meredith Foxx (14:34):

And some type of graduate degree.

Carol Pehotsky (14:35):

Mm-hmm.

Meredith Foxx (14:36):

I can't say at the time I knew which exactly graduate degree it was going to be.

Carol Pehotsky (14:39):

Sure.

Meredith Foxx (14:40):

But that I was going to pursue graduate education. I loved pediatric oncology so much and had a great opportunity to take advantage of an advanced practice nurse program that was both-

Carol Pehotsky (14:48):

Hmm.

Meredith Foxx (14:48):

... a clinical nurse specialist and a nurse practitioner.

Carol Pehotsky (14:50):

Oh wow.

Meredith Foxx (14:51):

So, it's very rare.

Carol Pehotsky (14:52):

Very.

Meredith Foxx (14:53):

And it was rare at the time. And they're even more rare now.

Carol Pehotsky (14:55):

Yeah. (laughs).

Meredith Foxx (14:56):

But I did not base my decision around that because, I wanted to become a nurse practitioner and I wanted-

Carol Pehotsky (14:56):

Hmm.

Meredith Foxx (15:01):

... to work Monday through Friday-

Carol Pehotsky (15:02):

(laughs).

Meredith Foxx (15:03):

... and have an out-patient job.

Carol Pehotsky (15:04):

Right.

Meredith Foxx (15:04):

I based it around the specialty population and-

Carol Pehotsky (15:05):

Hmm.

Meredith Foxx (15:08):

... what I loved about being a pediatric oncology nurse.

Carol Pehotsky (15:11):

And how you could support that. Yeah.

Meredith Foxx (15:12):

And how I could continue to advance in that specialty.

Carol Pehotsky (15:12):

Okay.

Meredith Foxx (15:15):

If I take care of patients and their families and teach new nurses.

Carol Pehotsky (15:19):

Mm-hmm.

Meredith Foxx (15:19):

You will always hear me talk about advanced practice registered nurses.

Carol Pehotsky (15:19):

(laughs).

Meredith Foxx (15:22):

You cannot be advanced if you haven't been a registered nurse. So.

Carol Pehotsky (15:25):

I'm laughing because I've heard that between the two. Yes. (laughs).

Meredith Foxx (15:27):

Yes. And many people have heard it over the years. So, you can't, yeah, you got to be a registered nurse-

Carol Pehotsky (15:30):

Yeah.

Meredith Foxx (15:30):

... before you can become an advanced practice.

Carol Pehotsky (15:30):

Yes.

Meredith Foxx (15:32):

And I truly believe that. I think the other piece that lent itself is that I had the specialty experience as a bedside nurse, to understand how to translate that-

Carol Pehotsky (15:32):

Hmm.

Meredith Foxx (15:43):

... into the advanced practice role.

Carol Pehotsky (15:44):

Okay.

Meredith Foxx (15:44):

And how it changes. So, understanding the diseases and then how I could impact it by furthering my education. You know, I had the opportunity which all of us are still working towards is, you know, how do we take care of central venous lines? (laughs).

Carol Pehotsky (15:56):

Oh gosh. Yeah. (laughs).

Meredith Foxx (15:57):

And, uh, still doing that, that was my project. Thinking about, patient and family education is so important in that specialty.

Carol Pehotsky (16:02):

Hmm. Mm-hmm.

Meredith Foxx (16:02):

I mean, I always say this too, we as nurses had formal education, whether it's an associate's degree, diploma degree-

Carol Pehotsky (16:09):

Right.

Meredith Foxx (16:09):

... a bachelor's, a master's, on how to do some of this stuff. Like, caring for-

Carol Pehotsky (16:13):

Yes. We want-

Meredith Foxx (16:14):

... patients with cancer.

Carol Pehotsky (16:15):

... we want the families to, yeah, "Here we go." (laughs).

Meredith Foxx (16:16):

But now all of a sudden, we're asking the families to do it in five minutes. So, you know? Yeah.

Carol Pehotsky (16:20):

Yeah. Well, that's a great point. Yeah.

Meredith Foxx (16:20):

You know, we we're trained to learn how to take care of a central line in a-

Carol Pehotsky (16:23):

Mm-hmm.

Meredith Foxx (16:23):

... formalized way.

Carol Pehotsky (16:24):

Yep.

Meredith Foxx (16:24):

I'm not sure some of these parents, you know, signed up for that. So, we have to-

Carol Pehotsky (16:28):

Right.

Meredith Foxx (16:28):

... ensure that we can do that as well. But I think I loved being a clinical nurse specialist.

Carol Pehotsky (16:33):

Mm-hmm.

Meredith Foxx (16:33):

I enjoyed being a nurse practitioner, but definitely loved the CNS role in terms of my advanced practice pieces, because of what I could influence and what I could get involved in.

Carol Pehotsky (16:41):

Okay. So, the last time we had you on, you made a statement about, not ever really explaining to patients what a Clinical Nurse Specialist was-

Meredith Foxx (16:41):

Uh-huh.

Carol Pehotsky (16:49):

... and what you did. So, now you have your chance.

Meredith Foxx (16:51):

Yes.

Carol Pehotsky (16:51):

So, if, if you were to say to our audience, especially the difference between having both roles.

Meredith Foxx (16:56):

Mm-hmm.

Carol Pehotsky (16:56):

The difference between the nurse practitioner and CNS and, and why you gravitated towards that CNS.

Meredith Foxx (17:00):

Mm-hmm. A little background. A Clinical Nurse Specialist is a less known advanced practice nursing role. There's four, as we know, CRNAs, the nurse anesthetist, nurse midwives, nurse practitioner probably being the most well-known. And then this clinical nurse specialist that, in many states in the U.S. it is recognized as advanced practice. And so that is a good thing. It is a little bit of a different role because it kind of goes around the spheres of influence and you have three spheres, uh, the patient sphere, the nurse sphere, and then the system sphere. And anybody that you find out is a Clinical Nurse Specialist, will talk about all the different work they're doing at the point of patient care-

Carol Pehotsky (17:36):

Yes.

Meredith Foxx (17:36):

... teaching nurses, helping nurses with competencies, and then, thinking about how they can impact organizationally wise.

Carol Pehotsky (17:41):

Right.

Meredith Foxx (17:42):

Say, with product supply choices-

Carol Pehotsky (17:44):

Hm. Mm-hmm.

Meredith Foxx (17:44):

... or a practice change or even more globally research-

Carol Pehotsky (17:47):

Research. Yeah. Yeah. Mm-hmm.

Meredith Foxx (17:48):

... education. So, it's really fundamentally going beyond kind of, per se, direct patient care. And so, in the nurse practitioner space, it is primarily direct patient care.

Carol Pehotsky (17:59):

Right.

Meredith Foxx (17:59):

So, you're managing-

Carol Pehotsky (18:00):

Mm-hmm. Mm-hmm.

Meredith Foxx (18:00):

... true patient care from, kind of start to finish or the aspects of that care. I think some nurse practitioners also would argue that you can do that other work as well.

Carol Pehotsky (18:01):

Sure.

Meredith Foxx (18:09):

But the main kind of focus of your role-

Carol Pehotsky (18:11):

Right.

Meredith Foxx (18:11):

... is direct patient care.

Carol Pehotsky (18:13):

Yep.

Meredith Foxx (18:13):

I think the beauty of a clinical nurse specialist is you can do both.

Carol Pehotsky (18:16):

You can do both. Excellent. We're getting close on time again. So, to really wrap up your clinical journey then, somebody's listening going, "Wow, I want to do all of those things." (laughing). Or, one of those things. That nurse that maybe is, thinking about changing specialties or that new grad, any advice you'd give them in terms of, narrowing down to at least, "Where do I want to start in terms of a specialty?"

Meredith Foxx (18:38):

What brought you excitement in your nursing school program?

Carol Pehotsky (18:41):

Hmm. Mm-hmm.

Meredith Foxx (18:42):

So, would you get really excited learning about the brain?

Carol Pehotsky (18:45):

Sure.

Meredith Foxx (18:45):

Are you really excited learning about the heart? Were you more about the holistic head to toe? Are you more technical? Is it really about knowledge in the family unit? So, I think you would really have to think about what excited you and what did you not want to close the textbook in reading about possibly, is an easy-

Carol Pehotsky (18:45):

(laughing). Sure.

Meredith Foxx (19:01):

... easy way to say it. And I think the other piece is exploring what the different options are. And it's okay to think about wanting to shadow and-

Carol Pehotsky (19:09):

Yeah.

Meredith Foxx (19:10):

... look at different, as a nursing student-

Carol Pehotsky (19:12):

Mm-hmm.

Meredith Foxx (19:12):

... uh, your clinical rotations. If you're not feeling jazzed about something, ask to-

Carol Pehotsky (19:13):

Right.

Meredith Foxx (19:16):

... go to explore other places or other areas. There are so many specialties and so many things out there. And I love when I talk to nurses who found their kind of-

Carol Pehotsky (19:24):

Yes.

Meredith Foxx (19:24):

... excitement or jam-

Carol Pehotsky (19:25):

Yes.

Meredith Foxx (19:25):

... in a particular specialty. Especially when it's not something I was ever excited about.

Carol Pehotsky (19:29):

Sure.

Meredith Foxx (19:29):

Because I'm thankful that there's people that want to do A and B, C, D. And-

Carol Pehotsky (19:33):

We need all types of nurses. (laughs).

Meredith Foxx (19:34):

We need everybody. Exactly.

Carol Pehotsky (19:35):

Yes.

Meredith Foxx (19:35):

Mm-hmm.

Carol Pehotsky (19:36):

Well, and there's no expiration data on shadowing. You don't have to only shadow when you're a nursing student, you can shadow any time.

Meredith Foxx (19:43):

Mm-hmm. And, you know, with the exploration of the nursing profession in healthcare, we're trying different things.

Carol Pehotsky (19:48):

Yeah.

Meredith Foxx (19:48):

We're looking at hybrid roles.

Carol Pehotsky (19:49):

Mm-hmm.

Meredith Foxx (19:49):

We're looking at dynamic career pathing.

Carol Pehotsky (19:49):

Yes.

Meredith Foxx (19:52):

We're looking at ways to explore different ways to work to really allow for all nurses to feel professionally fulfilled-

Carol Pehotsky (19:59):

Yeah.

Meredith Foxx (19:59):

... and meet their needs. I will give you one more example. When I was a pediatric oncology nurse, I was in the inpatient setting, and they needed somebody to help out in the outpatient setting.

Carol Pehotsky (20:09):

Hmm. Mm-hmm.

Meredith Foxx (20:09):

As a temporary because of some maternity leaves or something.

Carol Pehotsky (20:13):

Yeah. (laughs).

Meredith Foxx (20:13):

And I, again-

Carol Pehotsky (20:13):

Mm-hmm. Yeah.

Meredith Foxx (20:14):

... said yes and volunteered, what a great experience to see the other side of where our patients were cared for.

Carol Pehotsky (20:14):

Oh, yeah.

Meredith Foxx (20:20):

And just to understand, to be able to even share that with the inpatients.

Carol Pehotsky (20:24):

Mm-hmm.

Meredith Foxx (20:24):

What's it, it's going to be like, when you go to the outpatient clinic.

Carol Pehotsky (20:26):

Yeah.

Meredith Foxx (20:26):

And just to understand the flows there and appreciate the same specialty, but in a different care setting.

Carol Pehotsky (20:31):

Very cool. Very helpful to our listeners, I'm sure. So, here we are at the end, unbelievably. So, a couple questions to help our audience keep getting to know you.

Meredith Foxx (20:31):

Sure.

Carol Pehotsky (20:40):

I love asking you these questions. What are your hidden talents?

Meredith Foxx (20:43):

Uh, well-

Carol Pehotsky (20:44):

(laughs).

Meredith Foxx (20:44):

... my hidden talent, I was an avid dancer, ballet, tap, and jazz-

Carol Pehotsky (20:50):

(laughs).

Meredith Foxx (20:50):

... when I was a kid, so I could pull off a shuffle ball change, in tap dancing.

Carol Pehotsky (20:54):

(laughs).

Meredith Foxx (20:55):

Like the best of them. Gosh, I don't know any other hi-hidden talents. My husband would say I remember too many things, and, uh-

Carol Pehotsky (21:01):

(laughs).

Meredith Foxx (21:01):

... numbers, letters.

Carol Pehotsky (21:01):

Classic husband. (laughs).

Meredith Foxx (21:04):

Yes. He's like, "How do you remember all that?"

Carol Pehotsky (21:06):

And you can remember your dance moves. So.

Meredith Foxx (21:07):

Yes, exactly.

Carol Pehotsky (21:08):

There you go. Thank you for joining me today.

Meredith Foxx (21:10):

Thanks Carol.

Carol Pehotsky (21:14):

As always, thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

(21:48):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.