Setting the Standards of Nursing Care

Oncology nurses, like UC Irvine Health’s Debi Boyle, must be able to provide pain control and manage treatments, while also being nurturers with good communication skills.

With a master’s degree, more than 200 publications and four books to her name—and more than four decades of experience as a nurse—Debi Boyle wears many hats in her role as an oncology clinical nurse specialist at UC Irvine Health. She consults with nurses who need assistance. She teaches. She serves on committees. She conducts research.

But she also often finds herself at a patient’s bedside, tending to the needs of the patient or family members. “There’s no cancer care without nurses,” she says. “We’re the ones who are there 24/7.”

Boyle spends a lot of time these days thinking about, discussing and researching the demands of cancer care—on patients, their families and caregivers. She grew up in New England and earned her master’s degree in nursing from Yale University. Of her 44 years in nursing, 35 years have been spent in oncology.

She recalls a turning point early in her career that piqued her interest about cancer. She was a student nurse and was caring for a young woman, about her own age, with cancer. “She was having a hard time coping,” Boyle recalls of her patient.

“There’s no cancer care without nurses. We’re the ones who are there 24/7.”

The challenge of trying to help the young woman made Boyle realize that oncology nurses “have to be good at the physical side of nursing, such as providing pain control and managing treatments, but you also have to have good communication skills.”

She was recruited by UC Irvine Health four years ago and divides her time now overseeing quality issues, such as whether nursing practices meet national standards; educating nurses who are becoming certified in oncology; taking leadership roles on committees that set and revise hospital policies; and conducting research.

One of her current studies focuses on improving end-of-life care in hospitals. While many patients benefit from hospice care at home, high-quality hospice care can also be provided in the hospital, she says. Boyle and some of her colleagues are interviewing families who have recently had a relative die in the hospital to learn from their experiences.

Boyle is also part of a research project at five University of California hospitals to teach nurses improved communications skills in dealing with patients with a poor prognosis. “The nurses feel more empowered with these skills,” she says. “It’s about listening and soliciting patients’ viewpoints.”

Within UC Irvine Health, Boyle has found a rapidly growing and vibrant community with outstanding standards for nursing care. In 2003 UC Irvine Medical Center became the first Magnet hospital in Orange County. Magnet Recognition is the highest level of recognition a hospital can achieve for excellence in nursing.

“I think the academic setting is very stimulating,” she says. “There is new research going on. People are always asking the question: ‘Is there a better way to do this?’ There is this sense of clinical inquiry.”

There is no “typical” day in Boyle’s life as a nurse. On a recent warm fall day, she spent part of the morning helping with a challenging case. Boyle serves as the lead palliative care nurse within a group of five who provide support to nurses about palliative care. Every morning she or one of her colleagues participates in interdisciplinary palliative care rounds—the daily meeting in which the team discusses patients’ cases.

Caring for the Caretakers

Boyle was the palliative care duty nurse on that morning and she encountered a young patient with advanced cancer who was battling pain while undergoing complex radiation treatments. The patient’s mother was worried, too.

“We talked about whether the patient’s pain management was optimal, how the patient was sleeping,” she recalls. But Boyle wasn’t finished. Then she asked the patient’s mother how she was holding up. The entire family’s well-being is something Boyle has become increasingly interested in over the course of her career.

“Families of cancer patients are often the unknown soldiers in the battle,” she says. “We focus so much on the patient, and family members say that’s what they want. They won’t ask for help for themselves.”

But oftentimes, she notes, the “caretaker” family member may be elderly or ill or overwhelmed. Boyle draws on her own experience when she talks to family members. Her husband died of cancer.

“I have been on the other side of the bed,” she says. “I know families need support.”

Sometimes a family member cries when discussing a loved one with cancer. “Then they apologize to me for crying,” Boyle says. “I tell them, ‘You’re having a normal response to an abnormal situation.’”

She also teaches beginning oncology nurses to be kind to themselves. In her free time, Boyle enjoys writing and working on art projects to restore her spirit and energy. Oncology nurses must face the reality of compassion fatigue, she tells the nurses she supervises. “That one quality that makes us good at what we do—having compassion—may also be the same one that leaves us wounded by our work.” That means taking good care of oneself, Boyle says, “in order to take optimum care of others.”