At diagnosis, if your family is not initially referred to a specific hospital, or if there are several excellent pediatric hospitals in the area to choose from, you may be able to choose where you would like your child to be treated. Parents can obtain a free referral to an accredited center from the National Cancer Institute (800) 422-6237 or:

(626) 447-0064

https://childrensoncologygroup.org/index.php/locations

In recent years, the way health care has been planned and delivered to children has transformed. It is now based on the concept of family-centered care, which fosters healthy relationships among healthcare providers, parents, and children. At most children’s hospitals, a family-centered team is assigned to each family with a newly diagnosed child. This team—composed of physicians, nurses, child life specialists, psychologists, social workers, physical and occupational therapists, and others—strives to ensure that the emotional, social, and developmental needs of every member of the family are addressed, in addition to the medical care of the child. The core concepts of family-centered care are respect, dignity, information sharing, participation, and collaboration. Members of your child’s team will be there to answer questions, provide emotional support, and recognize that you are the expert about your child.

The doctors

At large children’s hospitals, there are doctors at all levels of training, from first-year medical students to experienced professors of medicine. It is often hard to sort them all out in the early days after diagnosis. This section describes each type of doctor you might meet at a training hospital.

A medical student is a college graduate who is attending medical school. Medical students often wear white coats, but they do not have MD after the name on their name tags. They are not doctors.

An intern (also called a first-year resident) is a graduate of medical school who is in the first year of postgraduate training. Interns are doctors who are just beginning their clinical training.

A resident is a graduate of medical school in the second or third year of postgraduate training. Most residents at pediatric hospitals will be pediatricians when they complete their residencies. Residents are temporary: they rotate into different services (e.g., cardiology, neurology, oncology) every 4 weeks.

A fellow is a doctor pursuing postresidency study in a particular specialty. Most fellows you encounter will be specializing in pediatric oncology. Not all teaching hospitals have fellowship programs.

Attending doctors (or simply, attendings) are highly trained doctors hired by the hospital to provide and oversee medical care and to train interns, residents, and fellows. Many of them also teach at a medical school.

Consulting doctors are doctors from other services who are brought in to provide advice or treatment to a child in the oncology unit. The attending may ask for consults with other specialists, who may appear in your child’s hospital room unexpectedly. If questions arise about who these doctors are and what role they play, you should ask the fellow or attending assigned to your child or any member of your family-centered team.

Each child in a teaching hospital is assigned an attending, who is responsible for that child’s care. This doctor should be “board certified” or have equivalent medical credentials. This means the doctor has taken rigorous written and oral tests given by a board of examiners in his or her specialty and meets a high standard of competence. You can call the American Board of Medical Specialties at (866) ASK-ABMS (275-2267) or visit www.certificationmatters.org/is-your-doctor-board-certified.aspx to find out whether your child’s attending is board certified.

If your family is insured by a health maintenance organization (HMO), or an insurance company that maintains a list of preferred hospitals, you probably will be sent to an affiliated hospital, which will have one or more pediatric oncologists on staff. If this hospital is not a regional pediatric hospital, you can go elsewhere to get state-of-the-art care (see the “Choosing a hospital” section later in this chapter). However, make sure your insurance will cover care at the institution you want to use.

The nurses

An essential part of the hospital hierarchy is the nursing staff. The following explanations will help you understand which type of nurse is caring for your child.

An LPN is a licensed practical nurse. LPNs complete certificate training and must pass a licensing exam. In some medical facilities, LPNs are allowed to perform most nursing functions, except those involving administration of medications. Many pediatric oncology services limit the involvement of LPNs to personal care, such as patient hygiene and monitoring fluid input and output.

An RN is a registered nurse who obtained an associate’s degree or higher in nursing and then passed a licensing examination. RNs who have a bachelor’s degree in nursing are also referred to as BSNs. RNs supervise all other nursing and patient care staff (such as nurses aides or nursing assistants), give medicines, take vital signs (e.g., heart rate, breathing rate, blood pressure), monitor IV machines, change bandages, and care for patients in hospitals, clinics, and doctors’ offices. Many RNs in the pediatric oncology service have received specialized training in pediatric oncology nursing and have taken an examination to receive the credential of Certified Pediatric Hematology/Oncology Nurse (CPHON^®).

A nurse practitioner or clinical nurse specialist is a registered nurse who has completed an educational program (generally a master’s or doctoral degree) that teaches advanced skills. For example, in some hospitals and clinics, nurse practitioners perform procedures such as spinal taps. Nurse practitioners or clinical nurse specialists are often the liaison between the medical teams and patients and their families. They often coordinate a child’s care, answer parent calls, help parents keep all the different multidisciplinary team members straight, and interpret medical jargon.

The head or charge nurse is an RN who supervises all the nurses on the hospital floor for one shift. If you have any problems with a nurse in the inpatient unit, your first step in resolving the issue should be to talk to the nurse involved. If this does not resolve the problem, a discussion with the charge nurse is your next step.

The clinical nurse manager is the administrator for an entire unit, such as a surgical or medical floor or outpatient clinic. The clinical nurse manager is in charge of all nurses in the unit.