The patient was critically unstable. The room was filled with people trying to initiate care. Suddenly, someone expressed a possible concern with the patient’s breathing tube. Immediately, one nurse stopped everybody and all activity to make sure that key piece of equipment was working properly. Turns out, it wasn’t. The nurse made sure no further action was taken until the problem was corrected.
The nurse was Casey Z. Thomas, B.S.N., R.N., CCRN, BMTCN, described by some as a “force of nature” when it comes to protecting her patients in City of Hope’s intensive care unit.
“And that wasn’t unusual,” explained friend and colleague Kristen Krayer-White, M.S.N., R.N., as she told the story. “Across the board, Casey makes sure her patients get the best possible care. She’s not concerned about speaking up. She does whatever it takes.”
Recognized for Her Nursing Commitment
At City of Hope since 2017, Thomas was recently honored by the Simms/Mann Family Foundation with its Off the Chart award for nursing excellence. It’s not her first award. In 2022, she was cited as an Exemplary Professional Practice Nurse Leader. Those who regularly see her in action say she’s been this way from the day she first walked in the door at age 22.
“She was a new grad in the unit,” recalled ICU Nurse Manager Alia May, M.S.N., CCRN, who noticed that Thomas was “very bright, very inquisitive. She asked great questions and always wanted to know more about the ins and outs of the situation.”
Speak to Thomas for a few minutes and the depth is unmistakable. Encyclopedic knowledge pours out, framed in a powerful, determined manner. Friends call her a natural leader. She says it comes from her upbringing in Beaverton, Oregon, and especially from her father.
“Dad was like embodied sunshine,” she recalled. “He’d light up the room. He was an independent businessman who created many companies. He gave my sister and me that ‘take charge’ mentality. He made sure we knew we were capable of great things, and he gave us the tools to do them.”
Education was a key tool, both formal and informal. “We did word games at the dinner table,” she said. “And I started touring colleges in eighth grade!”
Leadership and independence were stressed as well. Thomas took on a full load of student-led activities, and she also found a way to grow her bank account, working as a hip-hop dance instructor. (“I started dancing when I was 5,” she smiled).
Cancer Hits Home
Thomas did not gravitate to nursing right away (“My family is not very medical,” she said). She planned to become a sports physical therapist. Her plans changed when her mother, a hospital chaplain, was diagnosed with breast cancer.
“Mom had lots of outpatient treatments,” recalled Thomas, “and she came in contact with lots of nurses. She would talk about them all the time.”
It left an impression. From that point on, Thomas knew she would choose a college based on its nursing program.
“Because of Mom, I started thinking about oncology,” she said. Enrolling in Azusa Pacific University, she discovered she was “fascinated by oncology, especially leukemia. I was also fascinated by transplants and CAR T cell treatment, which was just beginning at the time.”
It made perfect sense, then, to consider City of Hope, where pioneering CAR T cell work was done, and where more than 19,000 bone marrow and stem cell transplants have been performed to date. An APU professor who worked at City of Hope encouraged Thomas to apply. “City of Hope had pieces of everything I loved,” said Thomas, “critical care, oncology, hematology and pediatrics.”
But why pediatrics? As if tending to adults with cancer who’ve landed in the ICU wasn’t stressful enough. Why children?
She beams.
“To see their resilience, the strengthening of someone’s soul and heart, to see kids who take those strong meds and don’t even flinch, to see how their small bodies are capable of so many things — sure, it can be heartbreaking, but it can also be beautiful, and to be chosen to be part of that is truly special.”
Seeing a patient make significant progress, she says, is the best part of the job.
“When you get to be the nurse on the day your patient makes a big move forward, like standing up for the first time [after surgery] or finally realizing where they are, after being ‘out of it’ for a long time. To see the joy and the hope of the family is a very wonderful thing to be a part of.”
The hardest part? “When the family distrusts the care team,” she said. It can happen if anyone in the family has had a negative medical experience. “I want to do all I can for the family, but if they don’t trust…” her voice trails off. “I try to make sure the patient gets the right care and the family gets answers.”
Sometimes, at the same time.
Going the Extra Mile
Krayer-White recalled another ICU patient who was uncomfortable with her breathing tube. Her husband, seated beside her, was anxious. It was a tense, difficult situation. “Casey stepped in — it wasn’t even her patient! — opened up the computer, found the original order, spoke with the physician about altering the patient’s meds, all while reassuring the patient and educating the family,” she said. “In just a couple of minutes, she calmed the whole thing down for everybody. She’s really good at that.”
Like many of her ICU colleagues, Thomas frequently serves as the charge nurse, responsible for all the nurses and patients in the unit. She is also part of the rapid response team, called upon to assist in an emergency.
She notices things. Subtle changes in a patient’s condition. Better ways to optimize care. For example, after a cardiac arrest, it’s important to maintain a low body temperature to preserve the brain. This requires special training and protocols that must be consistent from one shift to another. Thomas took the initiative. “We brought forward the guidelines from other hospitals,” she said. Thomas then wrote the policy, created a workbook and trained the nurses. The end result has been the full implementation of temperature management in the ICU.
She also found a unique way to help prevent hospital-acquired infections. Patients can get infected from the tubes placed inside them — a catheter, an IV, a breathing tube — or from being immobile too long. “It’s in the hands of the nurses,” she said. Thomas learned about best practices, then created a “CSI”-style program that proactively looks for “NSIs” — nursing-sensitive indicators. She practiced what she preached, spending nearly a year coming in for extra duty, checking on each patient herself.
In a cancer ICU unit, every nurse will sometimes experience loss and failure. “I have felt powerless,” she said. “But to be able to say we did absolutely everything for the patient — even if it didn’t work — there’s a sense of peace in that, a feeling of pride that you gave everything.”
At those times, she gets support from her own family. “I always talk to my husband in the car on my way home, to process things. Home is a safe space.” It’s also a busy space. Thomas and husband Aaron have a 10-month-old son, Niko.
Fellow mom and co-worker Krayer-White says her friend is tailor-made for the tough job she has.
“The ICU is a stressful place,” she said. “But Casey always has a good attitude. She can make the situation lighter. She’s an enjoyable person to work with. And she’s a fierce advocate for patients and their families.
“I think she’s a rock star!”