City of Hope’s Alpha Clinic Plots ‘the Future of Nursing’

November 3, 2017 | by Wayne Lewis

A specialized City of Hope clinic for investigational stem cell-based treatments is setting the template for a new nursing role. The key is bringing together experienced hematology nurses and infusing them with research knowledge, according to a new paper in Stem Cells Translational Medicine.

The publication reports on the implementation of the City of Hope Alpha Clinic. Established in 2015 with a grant from the California Institute for Regenerative Medicine (CIRM), the clinic is one of five pilot programs constituting the Alpha Stem Cell Clinics Network. The goal is to accelerate progress in stem cell therapies for patients with intractable disease.
The authors identify the role of a nurse qualified in both patient care and research protocols, the so-called “hybrid nurse” — a homegrown City of Hope innovation — as an important component of their success in the development of the Alpha Clinic.

We are moving away from task-based practice to what we see as the global future of nursing,” said Mary Perrin, B.S.N., R.N. O.C.N., B.M.T.C.N, director of ambulatory services and co-primary author of the paper, which was published Oct. 30. “You’re familiar with the research study and all the implications. You’re familiar with the treatment and symptom management and the theory behind it. The science is as important as your ability to administer care.”

Early Success

The Alpha Clinic landed as a research entity within a very active nursing unit, the Day Hospital, not in the City of Hope Clinical Research Unit. The reason for this was to accelerate the stem cell trials into practice by testing therapies in an actual outpatient setting. The successful integration of this innovative research clinic into a modern outpatient, nursing unit is proven by its tremendous growth — from two clinical studies in April 2015 to 20 studies in October 2017. Key to this achievement is the clinic’s focus on the nursing element, highlighted in this publication. The other clinics in the CIRM network have taken notice.

“We share our nursing education materials with the network, and it is working to build nursing infrastructures based on a model similar to ours,” said corresponding author Rodica Stan, Ph.D., staff scientist in the Center for Gene Therapy and project manager of the Alpha Clinic.
The clinic has garnered high patient satisfaction in surveys by independent arbiter Press Ganey. With zero staff turnover so far, the nurses also remain satisfied.

Drafting a Blueprint

Hybrid nurses are trained in good clinical practice guidelines for research and must be certified in specialized nursing practices. The development of the position is credited in part to the paper’s co-primary author and patient care coordinator at the Alpha Clinic, Teresa Kim, B.S., B.S.N., R.N.
“Teresa knew the nurse’s perspective in terms of clinical care, and then built up the role to integrate research expertise and move toward coordination of care,” Perrin said. “Our nurses’ repertoire of skills has so expanded, and they’ve seen the impact on patients.”
As patient care coordinator, Kim creates a host of materials such as patient safety procedures, detailed information about research protocols tailored for nurses and educational materials for patients.
“It’s based on my personal experience, honestly,” she said. “When a new protocol comes in, it’s immediately, ‘How do I get this done? If I’m at the bedside, what do I need to do it safely?’”

The Right Stuff

At City of Hope, the Alpha Clinic grew out of the Day Hospital, an outpatient hub for therapeutic transplants of blood stem cells. Kim was there on day one of both endeavors, and she lauds her colleagues’ flexibility and dedication.
“Everybody’s willing to do whatever they need to for the patients,” she said, “and I feel lucky to receive so much support from everyone around me in the Alpha Clinic.”
The Alpha Clinic thrives on nurses’ stretching out of their comfort zones. Those previously steeped in care for hematological malignancies must watch over patients facing illnesses such as brain cancer, HIV/AIDS and hemophilia, and deliver first-in-human investigational treatments tested at City of Hope. 
Going with the flow is second nature for Kim. A former per diem nurse at City of Hope, at times she had to float from unit to unit. And then again, in the first months of the Day Hospital, while the new unit was being set up, she and her colleagues served as utility players.
“Sometimes it’s hard to wake up and not know where you’re going to work that day. But I enjoyed it. You just have to go in with a positive attitude,” Kim said.
Being a familiar face to co-workers around campus was another advantage for her, since collaboration is vital at the Alpha Clinic. In addition to working smoothly alongside the Day Hospital, the clinic’s staff closely coordinates with the studies’ principal investigators and those who manage clinical trials at City of Hope, among others.
According to colleague and “hybrid nurse” Christina Joseph, B.S.N., the chance to collaborate, learn and grow is a perk of the job.
Said Joseph: “For our patients, we’re not just nurses. We wear many hats. We’re advocates. We’re educators. The opportunity to call myself a researcher is another hat, and it’s an honor to wear it. Seeing what we’re doing with stem cell therapy is, quite frankly, phenomenal.”
Perrin looks at this type of activity as a sea change for nursing, at City of Hope and across the health care industry.
“This whole way of looking at nursing is because we’re going to need the strength of this discipline to manage care,” she said. “We see it in the care model in our clinics — maximizing your resources for efficiency and quality. In the Alpha Clinic, this small little unit, we had the right stuff come together. It was serendipitous, but it happened.”
Rodica Stan, Ph.D., is the corresponding author for this Stem Cells Translational Medicine publication. John A. Zaia, M.D., the Aaron D. Miller and Edith Miller Chair in Gene Therapy and program director of the Alpha Clinic, is senior author. Other authors were CIRM’s Geoffrey P. Lomax, Dr.P.H., and City of Hope’s Pamela Giesie, M.S.N., R.N., Jason Tabor, M.B.A., B.S.N., R.N., Virginia Le Verche, Ph.D., and Shirley Johnson, M.S., M.B.A., R.N. The work was funded by CIRM grant AC1-07659.

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